OTOX 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., 1960Botox: 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: 0-597-83770-8 1. Botox-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:
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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 Botox. 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 BOTOX ....................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Botox ............................................................................................. 4 The National Library of Medicine: PubMed .................................................................................. 6 CHAPTER 2. CLINICAL TRIALS AND BOTOX.................................................................................... 19 Overview...................................................................................................................................... 19 Recent Trials on Botox ................................................................................................................. 19 Keeping Current on Clinical Trials ............................................................................................. 19 CHAPTER 3. BOOKS ON BOTOX ....................................................................................................... 21 Overview...................................................................................................................................... 21 Book Summaries: Online Booksellers........................................................................................... 21 Chapters on Botox ........................................................................................................................ 22 Directories.................................................................................................................................... 23 CHAPTER 4. PERIODICALS AND NEWS ON BOTOX.......................................................................... 25 Overview...................................................................................................................................... 25 News Services and Press Releases................................................................................................ 25 Newsletter Articles ...................................................................................................................... 29 Academic Periodicals covering Botox .......................................................................................... 30 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 35 Overview...................................................................................................................................... 35 NIH Guidelines............................................................................................................................ 35 NIH Databases............................................................................................................................. 37 Other Commercial Databases....................................................................................................... 39 APPENDIX B. PATIENT RESOURCES ................................................................................................. 41 Overview...................................................................................................................................... 41 Patient Guideline Sources............................................................................................................ 41 Finding Associations.................................................................................................................... 46 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 49 Overview...................................................................................................................................... 49 Preparation................................................................................................................................... 49 Finding a Local Medical Library.................................................................................................. 49 Medical Libraries in the U.S. and Canada ................................................................................... 49 ONLINE GLOSSARIES.................................................................................................................. 55 Online Dictionary Directories ..................................................................................................... 55 BOTOX DICTIONARY................................................................................................................... 57 INDEX ................................................................................................................................................ 73
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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 Botox 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 Botox, 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 Botox, 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 Botox. 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 Botox, 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 Botox. 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 BOTOX Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Botox.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Botox, 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 “Botox” (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: •
Short-Term Impact of Botox Injections on Speech Disability in Adductor Spasmodic Dysphonia Source: Disability and Rehabilitation. 19(1): 20-25. 1997. Summary: This article reports on a study undertaken to investigate the impact of Botox (botulinum toxin) injections on speech disability in a group of patients with adductor spasmodic dysphonia. Patient-perceived disability was assessed on the Speech Disability Questionnaire. A factor analysis of speech disability yielded five factors. Four of these, social isolation, negative communication, public avoidance, and limited understanding, showed significant change from prior to and one week post injection. Speech and language therapists' assessments also showed changes in voice quality over the same period. The authors discuss their findings in terms of the relationship between
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voice quality, disability, and handicap in adductor spasmodic dysphonia. 1 figure. 3 tables. 31 references. (AA).
Federally Funded Research on Botox The U.S. Government supports a variety of research studies relating to Botox. 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 Botox. 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 Botox. The following is typical of the type of information found when searching the CRISP database for Botox: •
Project Title: BIOCOMBINATORIAL STRATEGIES AGAINST BOTULINUM TOXIN Principal Investigator & Institution: Janda, Kim D.; Ely R. Callaway Professor of Chemistry; Scripps Research Institute 10550 N Torrey Pines Rd La Jolla, Ca 920371000 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): The current warfare and terrorist activities around the world, in particular directed against the American people and infrastructure, necessitates a vastly enhanced defense against potential weapons of mass destruction. Among the most lethal and readily deployed means that must be considered are the various toxins of biological origin. In this regard, an often cited scenario is the use of botulinum toxin (BoTox), the causative agent of the clinical condition of botulism, which can have a high fatality rate by either oral consumption or inhalation. New and improved methods of rapidly and conveniently detecting small amounts of BoTox in its various forms are needed, as well as therapeutics for protection against its deadly effects. We propose "biocombinatorial strategies" developed in our laboratory, which refer to human antibodies and cyclic peptides derived from novel phage-display libraries using various selection techniques, against the threat of BoTox. Each of these biotechnological reagents could serve for diagnostic and medicinal purposes, in other words, for detection and/or protection. Specifically, we will use our proprietary antibody and peptide libraries for (1) selection of antibodies and cyclic peptides against BoTox by routine panning, (2) selection of antibodies and cyclic peptides against BoTox by BIAcore panning, (3) characterization of selected antibodies and cyclic peptides by ELISA, (4) characterization of selected antibodies and cyclic peptides using BIAcore, (5) detection of trace amounts of BoTox using antibodies/peptides and BIAcore, and (6) evaluation of selected antibodies and cyclic peptides using the PC12 cell line. The
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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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research described provides a foundation for highly sensitive detection and monitoring of BoTox in progenitor and toxic forms and for passive immunotherapy against the active toxin. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: COMBINED MODALITY TREATMENT OF ADSD Principal Investigator & Institution: Pearson, Erin J.; Communication Sci & Disorders; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2003; Project Start 08-AUG-2003; Project End 07-AUG-2005 Summary: (provided by applicant): This phase 1 clinical trial involves a prospective, randomized, and placebo-controlled repeated measures parallel arm design to examine the effect of phonatory retraining ("behavioral voice therapy") following botulinum toxin type A (Botox m) injections for adductor-type spasmodic dysphonia (ADSD). Subjects will include individuals undergoing first-time injections for ADSD. Following the collection of baseline measures, and after Botox injection, subjects will be randomized to 1 of 3 experimental groups: Botox only, Botox plus behavioral voice therapy, or Botox plus sham voice therapy. The Botox plus behavioral therapy group will incorporate current and well-recognized techniques for phonatory retraining that are widely practiced by voice therapists in the management of ADSD. A Botox plus sham voice therapy group is included in the design in order to better examine nonspecific treatment effects which may emerge as a result of close patient-therapist interaction during behavioral voice therapy for ADSD. Dependent variables to be examined include voice-related Quality of Life, duration of benefit, as well as acoustic source measures (obtained from both connected speech and sustained phonation) of phonation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NOVEL INTERVENTION STRATEGIES FOR NEUROGENIC BLADDER Principal Investigator & Institution: Chancellor, Michael B.; Professor; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 22-AUG-2001; Project End 30-JUN-2006 Description (provided by applicant): It is proposed to critically evaluate several promising neuro-urological treatment options for the neurogenic bladder. The first priority will be to study the effects of intravesical instillation of vanilloid receptor agonists, which cause functional C-fiber afferent lesion, in both the clinical setting and in rat models. An additional priority of Project 4 is to determine if RTX treatment during the spinal shock phase can prevent the severe complications of detrusor hyperreflexia, autonomic dysreflexia, and detrusor-sphincter dyssynergia from developing. The project will undertake the first ever study to evaluate urologic neuroprotective therapy based on logical rational and promising preliminary data. The potential clinical benefits for SCI patients may be enormous. Aim 1 of Project 4 proposes to identify and characterize the long-term clinical outcome and to establish the safety of repeated intravesical RTX therapy in traumatic SCI and MS patients with detrusor hyperreflexia. Aim 2 proposes to systematically study the effect of three vanilloids in an SCI rat model, including comparison of effective doses for functional and anatomical C-fiber lesion (Aim 2-a), the effect of short- versus long-term (repeated) intravesical administration at different doses (Aim 2-b), therapeutic versus prophylactic intravesical administration (Aim 2-c), and alternative non-toxic vehicles for instillation (Aim 2-d). Metabolic cage
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studies will be utilized to determine micturition frequency in awake animals and the effect on detrusor hyperreflexia, autonomic dysreflexia and detrusor-sphincter dyssynergia will be determined using a variety of physiological techniques. Aim 3 proposes to evaluate alternative treatment strategies, such as the use of intramural bladder injection of botulinum toxin (BoTox) for detrusor hyperreflexia (Aim 3-a), the use of pelvic floor injection of BoTox and Conopeptide Ml for long-and short-term treatment of detrusor-sphincter dyssynergia using the rat SCI model (Aim 3-b), and the use of gene therapy to treat detrusor hyperreflexia, autonomic dysreflexia, and detrusorsphincter dyssynergia in SCI rats and to develop a spinal cord intact model to study Cfiber hyperexcitability and detrusor hyperreflexia in the absence of detrusor-sphincter dyssynergia (Aim 3-c). Herpes simplex virus (HSV) transfected with nerve growth factor (NGF) and preproenkephalin (PPE) will be tested (HSV-NGF and HSV-PPE, respectively). Bladders and urine from the rat studies will be harvested for gross and immuno-histological examination, determination of tissue structure-function relationships (Project 2) and presence or absence of cancer markers (Project 3). Comparisons to the results of vanilloid experiments in the acute SCI cat model (Project 1) will also be made. This Project builds on the commitment of the participants to SCI research, and the synergistic and collaborative history of the laboratories. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PATHOPHYSIOLOGY OF CHRONIC ANORECTAL PAIN AND BOTOX TREATMENT Principal Investigator & Institution: Rao, Satish S.; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 30-NOV-2001 Summary: This study is investigating the pathophysiology of chronic idiopathic anorectal pain and assessing the therapeutic utility of intrasphincteric injection of botulinum toxin in subjects with proctalgia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with Botox, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “Botox” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for Botox (hyperlinks lead to article summaries): 3
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 complication with the aesthetic use of Botox: herniation of the orbital fat. Author(s): Paloma V, Samper A. Source: Plastic and Reconstructive Surgery. 2001 April 15; 107(5): 1315. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11379558&dopt=Abstract
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A double blind, randomised, parallel group study to investigate the dose equivalence of Dysport and Botox in the treatment of cervical dystonia. Author(s): Odergren T, Hjaltason H, Kaakkola S, Solders G, Hanko J, Fehling C, Marttila RJ, Lundh H, Gedin S, Westergren I, Richardson A, Dott C, Cohen H. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1998 January; 64(1): 6-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9436720&dopt=Abstract
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A prospective, randomized, parallel group study analyzing the effect of BTX-A (Botox) and nonanimal sourced hyaluronic acid (NASHA, Restylane) in combination compared with NASHA (Restylane) alone in severe glabellar rhytides in adult female subjects: treatment of severe glabellar rhytides with a hyaluronic acid derivative compared with the derivative and BTX-A. Author(s): Carruthers J, Carruthers A. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 August; 29(8): 802-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12859378&dopt=Abstract
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Acoustic variations in reading produced by speakers with spasmodic dysphonia prebotox injection and within early stages of post-botox injection. Author(s): Sapienza CM, Cannito MP, Murry T, Branski R, Woodson G. Source: Journal of Speech, Language, and Hearing Research : Jslhr. 2002 October; 45(5): 830-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381042&dopt=Abstract
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Adductor laryngeal dystonia (spastic dysphonia): treatment with local injections of botulinum toxin (Botox). Author(s): Brin MF, Blitzer A, Fahn S, Gould W, Lovelace RE. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 1989; 4(4): 287-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2811888&dopt=Abstract
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Alternating unilateral botulinum toxin type A (BOTOX) injections for spasmodic dysphonia. Author(s): Koriwchak MJ, Netterville JL, Snowden T, Courey M, Ossoff RH. Source: The Laryngoscope. 1996 December; 106(12 Pt 1): 1476-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8948606&dopt=Abstract
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An evaluation of the safety and efficacy of botulinum toxin type A (BOTOX) when used to produce a protective ptosis. Author(s): Ellis MF, Daniell M. Source: Clinical & Experimental Ophthalmology. 2001 December; 29(6): 394-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11778810&dopt=Abstract
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Are we underestimating the clinical efficacy of botulinum toxin (type A)? Quantifying changes in spasticity, strength and upper limb function after injections of Botox to the elbow flexors in a unilateral stroke population. Author(s): Pandyan AD, Vuadens P, van Wijck FM, Stark S, Johnson GR, Barnes MP. Source: Clinical Rehabilitation. 2002 September; 16(6): 654-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12392341&dopt=Abstract
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Beauty, biological weapons, and Botox. Author(s): Klein AW. Source: Science. 2002 April 19; 296(5567): 468-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11965674&dopt=Abstract
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Beyond Botox. Author(s): Kher U. Source: Time. 2003 May 19; 161(20): 58-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776449&dopt=Abstract
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Botox A and spasticity treatment. Author(s): Ward KA. Source: Archives of Physical Medicine and Rehabilitation. 1996 October; 77(10): 1095. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8929128&dopt=Abstract
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Botox alternatives. Author(s): Hoefflin SM. Source: Plastic and Reconstructive Surgery. 1998 March; 101(3): 865. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9500422&dopt=Abstract
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Botox and Dysport are distinct. Author(s): Madalinski M. Source: Endoscopy. 2000 June; 32(6): 502-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10863924&dopt=Abstract
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BOTOX and physical therapy in the treatment of piriformis syndrome. Author(s): Fishman LM, Anderson C, Rosner B. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 December; 81(12): 936-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12447093&dopt=Abstract
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Botox and the management of pectoral spasm after subpectoral implant insertion. Author(s): Senior MA, Fourie LR. Source: Plastic and Reconstructive Surgery. 2000 July; 106(1): 224-5. Erratum In: Plast Reconstr Surg 2000 November; 106(6): 1447. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10883646&dopt=Abstract
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Botox concerns. Author(s): Carruthers A, Carruthers J. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 1997 April; 23(4): 308-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9149801&dopt=Abstract
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Botox cosmetic: a look at looking good. Author(s): Lewis C. Source: Fda Consumer. 2002 July-August; 36(4): 11-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12184296&dopt=Abstract
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Botox for contraction of pectoral muscles. Author(s): Richards A, Ritz M, Donahoe S, Southwick G. Source: Plastic and Reconstructive Surgery. 2001 July; 108(1): 270-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11420550&dopt=Abstract
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Botox for hyperadduction of the false vocal folds: a case report. Author(s): Rosen CA, Murry T. Source: Journal of Voice : Official Journal of the Voice Foundation. 1999 June; 13(2): 2349. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10442753&dopt=Abstract
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Botox for rejuvenation of the periorbital region. Author(s): Frankel AS. Source: Facial Plastic Surgery : Fps. 1999; 15(3): 255-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11816088&dopt=Abstract
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Botox for the treatment of dynamic and hyperkinetic facial lines and furrows: adjunctive use in facial aesthetic surgery. Author(s): Fagien S. Source: Plastic and Reconstructive Surgery. 1999 February; 103(2): 701-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9950563&dopt=Abstract
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Botox in dermatology. Author(s): Khawaja HA, Hernandez-Perez E. Source: International Journal of Dermatology. 2001 May; 40(5): 311-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11554992&dopt=Abstract
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Botox injection for achalasia: a modified technique. Author(s): Goldstein JA, Barkin JS. Source: Gastrointestinal Endoscopy. 1999 February; 49(2): 272-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9925719&dopt=Abstract
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Botox party at Johns Hopkins comes under fire. Author(s): Charatan F. Source: Bmj (Clinical Research Ed.). 2002 July 20; 325(7356): 124. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12134850&dopt=Abstract
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Botox use in prevention of dry eyes. Author(s): Benvenuti D. Source: Plastic and Reconstructive Surgery. 1998 September; 102(3): 918. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9727468&dopt=Abstract
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BOTOX use in the mid and lower face and neck. Author(s): Carruthers J, Carruthers A. Source: Semin Cutan Med Surg. 2001 June; 20(2): 85-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11474748&dopt=Abstract
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BOTOX: a review. Author(s): Mendez-Eastman SK. Source: Plastic Surgical Nursing : Official Journal of the American Society of Plastic and Reconstructive Surgical Nurses. 2003 Summer; 23(2): 64-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533572&dopt=Abstract
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BOTOX: a review. Author(s): Mendez-Eastman SK. Source: Plastic Surgical Nursing : Official Journal of the American Society of Plastic and Reconstructive Surgical Nurses. 2000 Summer; 20(2): 60-5; Quiz 66-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12024621&dopt=Abstract
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Botox? Smooth out the risks. Author(s): Johnson LJ. Source: Med Econ. 2002 October 25; 79(20): 65. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12422382&dopt=Abstract
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Botox-induced prostatic involution. Author(s): Doggweiler R, Zermann DH, Ishigooka M, Schmidt RA. Source: The Prostate. 1998 September 15; 37(1): 44-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9721068&dopt=Abstract
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Botulinum A neurotoxin for axillary hyperhidrosis. No sweat Botox. Author(s): Glogau RG. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 1998 August; 24(8): 817-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9723044&dopt=Abstract
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Botulinum A toxin (BOTOX) in the lower eyelid: dose-finding study. Author(s): Flynn TC, Carruthers JA, Carruthers JA, Clark RE 2nd. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 September; 29(9): 943-50; Discussion 950-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930337&dopt=Abstract
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Botulinum toxin (botox) chemodenervation for facial rejuvenation. Author(s): Carruthers J, Carruthers A. Source: Facial Plast Surg Clin North Am. 2001 May; 9(2): 197-204, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11457686&dopt=Abstract
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Botulinum toxin (BOTOX) for the treatment of “spastic dysphonia” as part of a trial of toxin injections for the treatment of other cranial dystonias. Author(s): Blitzer A, Brin MF, Fahn S, Lange D, Lovelace RE. Source: The Laryngoscope. 1986 November; 96(11): 1300-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3773633&dopt=Abstract
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Botulinum toxin (botox) reduces pain after hemorrhoidectomy: results of a doubleblind, randomized study. Author(s): Davies J, Duffy D, Boyt N, Aghahoseini A, Alexander D, Leveson S. Source: Diseases of the Colon and Rectum. 2003 August; 46(8): 1097-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907905&dopt=Abstract
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Botulinum toxin type A (BOTOX) for treatment of migraine headaches: an open-label study. Author(s): Binder WJ, Brin MF, Blitzer A, Schoenrock LD, Pogoda JM. Source: Otolaryngology and Head and Neck Surgery. 2000 December; 123(6): 669-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11112955&dopt=Abstract
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Botulinum toxin type A (BOTOX) for treatment of migraine. Author(s): Binder WJ, Brin MF, Blitzer A, Pogoda JM. Source: Disease-A-Month : Dm. 2002 May; 48(5): 323-35. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195263&dopt=Abstract
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Botulinum toxin type A (BOTOX) for treatment of migraine. Author(s): Binder WJ, Brin MF, Blitzer A, Pogoda JM. Source: Semin Cutan Med Surg. 2001 June; 20(2): 93-100. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11474749&dopt=Abstract
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Botulinum toxin type A as a migraine preventive treatment. For the BOTOX Migraine Clinical Research Group. Author(s): Silberstein S, Mathew N, Saper J, Jenkins S. Source: Headache. 2000 June; 40(6): 445-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10849039&dopt=Abstract
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Botulinum toxin type A neuromuscular blockade in the treatment of lower extremity spasticity in cerebral palsy: a randomized, double-blind, placebo-controlled trial. BOTOX Study Group. Author(s): Koman LA, Mooney JF 3rd, Smith BP, Walker F, Leon JM. Source: Journal of Pediatric Orthopedics. 2000 January-February; 20(1): 108-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10641699&dopt=Abstract
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Botulinum toxin type B (MYOBLOC) versus botulinum toxin type A (BOTOX) frontalis study: rate of onset and radius of diffusion. Author(s): Flynn TC, Clark RE 2nd. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 May; 29(5): 519-22; Discussion 522. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752521&dopt=Abstract
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By the way doctor. I've been reading about the cosmetic benefits of Botox injections, but what are the risks? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 2002 November; 10(3): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12453770&dopt=Abstract
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Caution in using botox in patients with previous frontal surgery. Author(s): Prado AC, Andrades PR. Source: Plastic and Reconstructive Surgery. 2002 April 1; 109(4): 1472-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11965021&dopt=Abstract
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Colon and rectal surgeons are trying Botox treatment, too. Author(s): Mitka M. Source: Jama : the Journal of the American Medical Association. 2002 July 24-31; 288(4): 439-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132956&dopt=Abstract
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Comparing biological potencies of Botox and Dysport with a mouse diaphragm model may mislead. Author(s): Dressler D, Rothwell JC, Marsden CD. Source: Journal of Neurology. 1998 June-July; 245(6-7): 332. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9669486&dopt=Abstract
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Comparison of Botox with a Chinese type A botulinum toxin. Author(s): Tang X, Wan X. Source: Chinese Medical Journal. 2000 September; 113(9): 794-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11776072&dopt=Abstract
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DYSBOT: a single-blind, randomized parallel study to determine whether any differences can be detected in the efficacy and tolerability of two formulations of botulinum toxin type A--Dysport and Botox--assuming a ratio of 4:1. Author(s): Sampaio C, Ferreira JJ, Simoes F, Rosas MJ, Magalhaes M, Correia AP, BastosLima A, Martins R, Castro-Caldas A. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 1997 November; 12(6): 1013-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9399229&dopt=Abstract
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Dysport produces intrinsically more swallowing problems than Botox: unexpected results from a conversion factor study in cervical dystonia. Author(s): Dressler D. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002 November; 73(5): 604; Author Reply 604. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12397170&dopt=Abstract
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Electrically stimulated glottal opening combined with adductor muscle botox blockade restores both ventilation and voice in a patient with bilateral laryngeal paralysis. Author(s): Zealear DL, Billante CR, Courey MS, Sant'Anna GD, Netterville JL. Source: The Annals of Otology, Rhinology, and Laryngology. 2002 June; 111(6): 500-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12090705&dopt=Abstract
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Electroglottographic tracking of phonatory response to Botox. Author(s): Fisher KV, Scherer RC, Swank PR, Giddens C, Patten D. Source: Journal of Voice : Official Journal of the Voice Foundation. 1999 June; 13(2): 20318. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10442750&dopt=Abstract
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Further experience with Botox injection for tracheoesophageal speech failure. Author(s): Lewin JS, Bishop-Leone JK, Forman AD, Diaz EM Jr. Source: Head & Neck. 2001 June; 23(6): 456-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11360306&dopt=Abstract
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Introduction. Botox. Author(s): Klein AW. Source: Disease-A-Month : Dm. 2002 May; 48(5): 296-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195261&dopt=Abstract
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Modification of muscle activity after BOTOX injections in spasmodic torticollis. Author(s): Marin C, Marti MJ, Tolosa E, Alvarez R, Montserrat LL, Santamaria J. Source: Annals of Neurology. 1992 September; 32(3): 411-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1416815&dopt=Abstract
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Other noncosmetic uses of BOTOX. Author(s): Verheyden J, Blitzer A. Source: Disease-A-Month : Dm. 2002 May; 48(5): 357-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195265&dopt=Abstract
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Other noncosmetic uses of BOTOX. Author(s): Verheyden J, Blitzer A, Brin MF. Source: Semin Cutan Med Surg. 2001 June; 20(2): 121-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11474744&dopt=Abstract
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Painful injections with Botox. Author(s): Yavuzer R, Demirtas Y. Source: Plastic and Reconstructive Surgery. 2003 January; 111(1): 509. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12496647&dopt=Abstract
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Patient care after Botox injections. Author(s): Schuh FD. Source: Plastic Surgical Nursing : Official Journal of the American Society of Plastic and Reconstructive Surgical Nurses. 1999 Winter; 19(4): 218. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12024601&dopt=Abstract
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Practical cosmetic Botox techniques. Author(s): Carruthers J, Carruthers A. Source: Journal of Cutaneous Medicine and Surgery. 1999 December; 3 Suppl 4: S49-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11749899&dopt=Abstract
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Primary and adjunctive use of botulinum toxin type A (Botox) in facial aesthetic surgery: beyond the glabella. Author(s): Fagien S, Brandt FS. Source: Clin Plast Surg. 2001 January; 28(1): 127-48. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11248863&dopt=Abstract
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Re: “Botulinum toxin type A as a migraine preventive treatment” (Silberstein S, Mathew N, Saper J, Jenkins S, for the BOTOX Migraine Clinical Research Group. Headache. 2000;40:445-450). Author(s): Galvez-Jimenez N, Hanson MR. Source: Headache. 2001 June; 41(6): 607. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11437903&dopt=Abstract
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Re: “Botulinum toxin type A as a migraine preventive treatment” (Silberstein S, Mathew N, Saper J, Jenkins S, for the BOTOX Migraine Clinical Research Group. Headache. 2000;40:445-450). Author(s): Zlotnik G. Source: Headache. 2001 June; 41(6): 606. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11437902&dopt=Abstract
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Re: Botox for a lifetime or tumescent axillary liposuction and curettage: once. Author(s): Field LM. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 July; 29(7): 793-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828712&dopt=Abstract
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Respective potencies of Botox and Dysport: a double blind, randomised, crossover study in cervical dystonia. Author(s): Ranoux D, Gury C, Fondarai J, Mas JL, Zuber M. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002 April; 72(4): 459-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11909903&dopt=Abstract
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Respective potencies of Botox and Dysport: a double blind, randomised, crossover study in cervical dystonia. Author(s): Poewe W. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002 April; 72(4): 430. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11909897&dopt=Abstract
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Smile--you're on botox! Author(s): Corliss R. Source: Time. 2002 February 18; 159(7): 59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11881439&dopt=Abstract
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The botox boom. Author(s): Noonan D, Adler J. Source: Newsweek. 2002 May 13; 139(19): 50-6, 58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12037916&dopt=Abstract
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The effect of patient factors on response outcomes to Botox treatment of spasmodic dysphonia. Author(s): Lundy DS, Lu FL, Casiano RR, Xue JW. Source: Journal of Voice : Official Journal of the Voice Foundation. 1998 December; 12(4): 460-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9988033&dopt=Abstract
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The pros and cons of Botox. Author(s): Lemonick MD. Source: Time. 2002 April 29; 159(17): 77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11989320&dopt=Abstract
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The short-term impact of Botox injections on speech disability in adductor spasmodic dysphonia. Author(s): Epstein R, Stygall J, Newman S. Source: Disability and Rehabilitation. 1997 January; 19(1): 20-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9021281&dopt=Abstract
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The treatment of congenital nystagmus with Botox. Author(s): Carruthers J. Source: Journal of Pediatric Ophthalmology and Strabismus. 1995 September-October; 32(5): 306-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8531035&dopt=Abstract
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Therapeutic uses of botulinum toxin (Botox). Author(s): Epperson LW. Source: Ala Med. 1995 November-1996 January; 65(5-7): 49-50. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8607384&dopt=Abstract
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Treatment of wrinkles with Botox. Author(s): Klein AW. Source: Current Problems in Dermatology. 2002; 30: 188-217. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12471713&dopt=Abstract
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CHAPTER 2. CLINICAL TRIALS AND BOTOX Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning Botox.
Recent Trials on Botox The following is a list of recent trials dedicated to Botox.4 Further information on a trial is available at the Web site indicated. •
Botulinum Toxin (BOTOX) for Cerebral Palsy Condition(s): Cerebral Palsy; Muscle Spasticity Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: This study examines botulinum toxin (BOTOX, or BTX) for the treatment of muscle twitches and spasticity associated with cerebral palsy in children. Botulinum toxin is a naturally occurring bacterial toxin (botulinum toxin) that inactivates certain parts of muscles. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00060957
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. 4
These are listed at www.ClinicalTrials.gov.
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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 “Botox” (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 3. BOOKS ON BOTOX Overview This chapter provides bibliographic book references relating to Botox. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on Botox include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “Botox” at online booksellers’ Web sites, you may discover nonmedical books that use the generic term “Botox” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “Botox” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Age-Less: The Definitive Guide to Botox, Collagen, Lasers, Peels, and Other Solutions for Flawless Skin by Fredric, Md Brandt, et al; ISBN: 0060516259; http://www.amazon.com/exec/obidos/ASIN/0060516259/icongroupinterna
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Beautiful Skin: Consumer Guide to Cosmetic Botox by Joseph A., Jr. Mauriello, Jr. MD Mauriello (2002); ISBN: 0595254233; http://www.amazon.com/exec/obidos/ASIN/0595254233/icongroupinterna
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Botox by Ron M. Shelton M.D., Terry Malloy; ISBN: 0425189171; http://www.amazon.com/exec/obidos/ASIN/0425189171/icongroupinterna
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The Botox Book by Michael Kane (2002); ISBN: 031231048X; http://www.amazon.com/exec/obidos/ASIN/031231048X/icongroupinterna
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The Botox Book: What You Need to Know About America's Most Popular Cosmetic Treatment by Everett M. Lautin, et al (2002); ISBN: 1590770110; http://www.amazon.com/exec/obidos/ASIN/1590770110/icongroupinterna
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The Botox Diaries [ABRIDGED] by Lynn Schnurnberger (Author); ISBN: 0739312731; http://www.amazon.com/exec/obidos/ASIN/0739312731/icongroupinterna
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The Botox Miracle by Deborah Mitchell, Amanda Ayers (Editor) (2002); ISBN: 074346463X; http://www.amazon.com/exec/obidos/ASIN/074346463X/icongroupinterna
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The U.S. Baby Boomer Market: From The Beatles to Botox - 3rd Edition [DOWNLOAD: PDF] by Packaged Facts (Author); ISBN: B00007EIEA; http://www.amazon.com/exec/obidos/ASIN/B00007EIEA/icongroupinterna
Chapters on Botox In order to find chapters that specifically relate to Botox, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Botox 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 “Botox” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on Botox: •
Dysphagia Source: in Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 33-47. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgraw-hill.com. PRICE: $45.00;plus shipping and handling. ISBN: 0070220557. Summary: Dysphagia is defined as difficulty swallowing, most often described by patients as 'the food gets stuck.' Dysphagia generally is not painful (painful swallowing is termed odynophagia). Symptoms of dysphagia always require a diagnostic evaluation to determine the etiology. This chapter on dysphagia is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include definitions and background; principal diagnoses, which can include cerebrovascular accident (stroke), amyotrophic lateral sclerosis (ALS), myasthenia gravis, Parkinson disease, myopathy (muscle weakness), incomplete relaxation of the upper esophageal sphincter, esophageal cancer, peptic stricture, Schatzki ring, achalasia, diffuse esophageal spasm, and aperistalsis of the esophageal body; key points of the patient history; the physical examination; ancillary tests, including videofluoroscopy, barium swallow, endoscopy, and esophageal manometry; treatment options; patient education, including dietary modification and swallowing therapy; common errors in diagnosis and treatment; controversies, including the use of Botox for esophageal motility disorders; and emerging concepts. The chapter includes a chapter outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. 1 figure. 1 table. 15 references.
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Spasmodic Dysphonia Source: in Sataloff, R.T., ed. Professional Voice: The Science and Art of Clinical Care. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1997. p. 499-505. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. E-mail:
[email protected]. Website: www.singpub.com. PRICE: $325.00 plus shipping and handling. ISBN: 1565937287. Summary: This chapter on spasmodic dysphonia is from a book on the clinical care of the professional voice. Spasmodic dysphonia is a dystonia characterized by spasm during phonation. Many types of interruptions in vocal fluency are incorrectly diagnosed as spasmodic dysphonia. Spasmodic dysphonia is encountered only occasionally in professional voice users, but can be quite debilitating when it does occur. Generally considered a focal laryngeal dystonia, the severity of spasmodic dysphonia varies substantially among patients and over time. In many cases, the voice may be normal or more normal during laughing, coughing, crying, or other involuntary vocal activities or during singing. Topics include diagnostic strategies, treatment options including the use of botulinum toxin (Botox), and the problem of respiratory dystonia. Voice therapy reduces the effort of speaking and counterproductive compensation. 2 tables. 25 references.
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to Botox have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:5 •
Botox Treatment Centers for Spasmodic Dysphonia Source: National Spasmodic Dysphonia Association (NSDA). 1996. 5 p. Contact: Available from National Spasmodic Dysphonia Association (NSDA). P.O. Box 203, Atwood, CA 92601-0203. (800) 795-6732 or (714) 961-0945; Fax (714) 961-0945. PRICE: Single copy free. Summary: This directory lists treatment centers that offer Botox treatment for spasmodic dysphonia. Compiled by the National Spasmodic Dysphonia Association (NSDA), the list provides the name, address and telephone number of each treatment center by state. The list notes that the NSDA does not endorse any specific drug or
5
You will need to limit your search to “Directory” and “botox” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “botox” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.
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treatment and provides the directory only as a courtesy to its readers. The directory lists treatment centers in 34 states, as well as one center each in Canada and England.
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CHAPTER 4. PERIODICALS AND NEWS ON BOTOX Overview In this chapter, we suggest a number of news sources and present various periodicals that cover Botox.
News Services and Press Releases One of the simplest ways of tracking press releases on Botox 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 “Botox” (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 Botox. 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 “Botox” (or synonyms). The following was recently listed in this archive for Botox: •
Botox may remove frowns from migraine sufferers Source: Reuters Health eLine Date: September 16, 2003
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Botox relieves voiding dysfunction due to benign prostatic hypertrophy Source: Reuters Industry Breifing Date: August 26, 2003
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Botox can relieve urination difficulties for men Source: Reuters Health eLine Date: August 26, 2003
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Acupuncture points might guide Botox injections for migraine Source: Reuters Medical News Date: July 16, 2003
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Acupuncture and Botox, great for migraines Source: Reuters Health eLine Date: July 16, 2003
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Allergan gets FDA warning letter for Botox ads Source: Reuters Health eLine Date: June 24, 2003
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Survey suggests Botox, "tummy tucks" on rise Source: Reuters Health eLine Date: March 07, 2003
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Allergan's Botox gets French nod for frown lines Source: Reuters Industry Breifing Date: February 25, 2003
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Botox gets EU committee's backing for sweating indication Source: Reuters Industry Breifing Date: February 21, 2003
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Smelly armpits? Consider Botox shots - study Source: Reuters Health eLine Date: January 21, 2003
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Botox may relieve cluster headaches Source: Reuters Health eLine Date: November 28, 2002
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Experts study Botox as migraine remedy Source: Reuters Health eLine Date: September 26, 2002
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Allergan says it will work with FDA on Botox ads Source: Reuters Industry Breifing Date: September 13, 2002
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FDA calls for Botox ads to be pulled because information is misleading Source: Reuters Industry Breifing Date: September 10, 2002
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FDA calls Botox ads misleading, asks for fix Source: Reuters Health eLine Date: September 09, 2002
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Botox found effective for type of stroke disability Source: Reuters Health eLine Date: August 07, 2002
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Dysport more effective than Botox for cervical dystonia Source: Reuters Industry Breifing Date: April 29, 2002
Periodicals and News
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Botox wrinkle drug to get $40-$50 million ad campaign Source: Reuters Health eLine Date: April 17, 2002
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Botox approved for cosmetic use in US Source: Reuters Health eLine Date: April 15, 2002
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Allergan plans $50 million promotional push for new Botox indication Source: Reuters Industry Breifing Date: April 15, 2002
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Botox and lasers may reduce demand for facelifts Source: Reuters Health eLine Date: April 11, 2002
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Botox injections, acupressure might relieve stroke-related lower limb spasticity Source: Reuters Industry Breifing Date: August 17, 2001
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Botox before laser treatment smooths fine wrinkles Source: Reuters Health eLine Date: August 17, 2001
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Botox treatment for muscle spasms aids well-being Source: Reuters Health eLine Date: August 01, 2001
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Allergan's Botox cleared for sale in Japan Source: Reuters Industry Breifing Date: June 25, 2001
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Elan explores new uses for Myobloc, heating up battle with Allergan's Botox Source: Reuters Industry Breifing Date: May 09, 2001
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Allergan receives FDA approval of Botox for treatment of cervical dystonia Source: Reuters Industry Breifing Date: December 27, 2000
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Botox helps children with cerebral palsy Source: Reuters Health eLine Date: December 25, 2000
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Warning about dangers of Botox injections Source: Reuters Health eLine Date: November 21, 2000
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Botox may help urinary continence in spinal cord injuries Source: Reuters Health eLine Date: September 06, 2000
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Botox may be useful in preventing migraine headache Source: Reuters Medical News Date: July 03, 2000
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Botox injection relieves muscle disorder Source: Reuters Health eLine Date: October 26, 1999
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Botox injection effective for migraine prophylaxis Source: Reuters Medical News Date: September 28, 1999
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Botox shots may prevent chronic migraine symptoms Source: Reuters Health eLine Date: September 27, 1999
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Botox appears effective for acute and chronic migraine Source: Reuters Medical News Date: June 15, 1999
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AASH '99: Botox appears effective for acute and chronic migraine Source: Reuters Medical News Date: June 15, 1999
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Pericranial Botox injection promising for migraine prophylaxis Source: Reuters Medical News Date: April 23, 1999
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American Academy of Neurology: Pericranial Botox injection promising for migraine prophylaxis Source: Reuters Medical News Date: April 23, 1999
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Botox injections may ease tension headache Source: Reuters Health eLine Date: April 21, 1999
•
'Botox' may exacerbate paralytic illness Source: Reuters Health eLine Date: December 04, 1998 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
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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 “Botox” (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 “Botox” (or synonyms). If you know the name of a company that is relevant to Botox, 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 “Botox” (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 “Botox” (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 Botox: •
When BOTOX Doesn't Work Source: NSDA Newsletter. National Spasmodic Dysphonia Association Newsletter. 10(1): 10-11. January 2001. Contact: Available from National Spasmodic Dysphonia Association. 1 East Wacker Drive, Suite 2430, Chicago, IL 60601. (800) 795-6732. Fax (312) 803-0138. Summary: In this newsletter article, an otolaryngologist answers readers questions about the clinical use of BOTOX (botulinum toxin) for spasmodic dysphonia, focusing on strategies to undertake when botulinum therapy seems to fail. The author first encourages readers to clarify what they mean when they think the drug has 'failed' for them, noting the differences between no effects at all, and effects that are less than desirable or unacceptable. The author then describes the reasons that may explain each of these situations. In patients who experienced no effect at all from the injection, the author postulates three explanations: miss of the target muscle, immunity to BOTOX, and marked insensitivity to BOTOX. The author then describes patients who get some
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response, but cannot tolerate the side effects, which include initial breathiness, coughing on liquids, and shortness of breath. The author concludes that BOTOX therapy provides dramatic benefit to the majority of persons with spasmodic dysphonia and encourages patients to work closely with their health care team when difficulties are encountered. 1 reference. •
Your BOTOX Injection: What to Expect for Adductor Spasmodic Dysphonia Patients Source: NSDA Newsletter. National Spasmodic Dysphonia Association Newsletter. 9(1): 8-9. July 2000. Contact: Available from National Spasmodic Dysphonia Association. 1 East Wacker Drive, Suite 2430, Chicago, IL 60601. (800) 795-6732. Fax (312) 803-0138. Summary: Spasmodic dysphonia (SD) is a rare neurological voice disorder caused by involuntary spasms of the vocal cord muscles. With adductor (AD) spasmodic dysphonia, the vocal cords close too tightly when speaking and the voice may sound either strained, choked, interrupted, or a combination of these. This article helps patients with adductor spasmodic dysphonia know what to expect when they are treated with injections of botulinum toxin (BOTOX). The author reviews the benefits of BOTOX injections, the history of this therapy, what to expect before and during the injection, what to expect after the injection (the author notes that the length of time for the toxin to take effect can vary from 24 hours to several days), post injection side effects (breathiness, and slight difficulty in swallowing liquids), and the author's experiences with BOTOX injections. One section of the article offers another author's description of the use of BOTOX for abductor SD (in which the vocal cords pull apart, producing a whispered or breathy voice). The effects of most BOTOX injections last for four to six months.
•
Botox: Not Just for Faces Source: Harvard Women's Health Watch. 11(1): 6-7. September 2003. Contact: Available from Harvard Health Publications. P.O. Box 421073 Palm Coast, FL 06905-1073. PRICE: $5.00 for an issue. Summary: This newsletter article examines the use of botox to treat medical conditions. Botox works by preventing the release of the neurochemical acetylcholine which makes muscles contract. Botox is FDA approved for cosmetic purposes; eye problems; and pain in the face, neck, and shoulders. Doctors prescribe botox off-label for chronic headaches, rectal fissures, excessive sweating, spasms related to central nervous system disorders, jaw problems, laryngeal spasm and dysphonia, and pytalism (excessive saliva secretion). Botox injections wear off in a few months so repeated injections for these conditions are necessary. Doses are based on the person's weight, severity of pain, and the amount of muscle that needs to be injected. Insurance generally covers the injections if deemed medically necessary.
Academic Periodicals covering Botox Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to Botox. In addition to these sources, you can search for articles covering Botox that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to
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http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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APPENDICES
35
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 Institute6: •
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/
6
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
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.7 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:8 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
•
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
•
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
•
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
•
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
7
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). 8 See http://www.nlm.nih.gov/databases/databases.html.
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
•
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM Gateway9 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.10 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “Botox” (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 1367 18 152 0 0 1537
HSTAT11 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.12 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.13 Simply search by “Botox” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
9
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
10
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). 11 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 12 13
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 Biologists14 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.15 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.16 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/.
14 Adapted 15
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. 16 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 Botox 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 Botox. 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 Botox. 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 “Botox”:
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Guides on Botox Botox http://www.nlm.nih.gov/medlineplus/botox.html
•
Other guides Bell's Palsy http://www.nlm.nih.gov/medlineplus/bellspalsy.html Migraine http://www.nlm.nih.gov/medlineplus/migraine.html Plastic & Cosmetic Surgery http://www.nlm.nih.gov/medlineplus/plasticcosmeticsurgery.html Thyroid Diseases http://www.nlm.nih.gov/medlineplus/thyroiddiseases.html
Within the health topic page dedicated to Botox, the following was listed: •
General/Overviews Botox Cosmetic: A Look at Looking Good Source: Food and Drug Administration http://www.fda.gov/fdac/features/2002/402_botox.html Botulinum Toxin Source: American Academy of Dermatology http://www.aad.org/pamphlets/botox.html Tired of That Same “Old” Expression? Botulinum Toxin Erases Signs of Aging and Common Facial Expressions Source: American Academy of Dermatology http://www.aad.org/PressReleases/samexpress.html
•
Specific Conditions/Aspects Botox and Migraine Source: American Council for Headache Education http://www.achenet.org/articles/24.php Botox Effective in Treating Upper Eyelid Retraction Associated with Thyroid Disease Source: American Academy of Ophthalmology http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZM6LR552D& sub_cat=2 Botox Treatment Source: Children's Hemiplegia and Stroke Association http://www.hemikids.org/botox.htm Botox: Can It Treat Fibromyalgia? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00540
Patient Resources
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Botulinum Toxin Injections: A Treatment for Muscle Spasms Source: American Academy of Family Physicians http://familydoctor.org/handouts/017.html •
Organizations American Academy of Dermatology http://www.aad.org/ American Society of Plastic Surgeons http://www.plasticsurgery.org/ We Move http://www.wemove.org/
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 Botox. 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: •
Nerve Disease and Bladder Control Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 2003. 6 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301) 634-0716. E-mail:
[email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. NIH Publication number: 034560. Summary: For the urinary system to do its job, muscles and nerves must work together to hold urine in the bladder and then release it at the right time. A nerve problem might affect the bladder control if the nerves that are supposed to carry messages between the brain and the bladder do not work properly. This brochure describes the interplay between nerve disease and bladder control. Topics include bladder control problems related to nerve damage, including overactive bladder, poor control of sphincter muscles, urine retention; the causes of nerve damage and bladder control problems; how these problems are diagnosed; the treatments for overactive bladder, including bladder training, electrical stimulation, drug therapy, and surgery; the treatments for lack of coordination between the bladder and urethra, including drug therapy and
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Botox injection; the treatments for urine retention, including catheters, urethral stents, surgery, and urinary diversion; and current research in this area. One sidebar describes specific steps for performing Kegel exercises. The brochure concludes with the contact information for two resource organizations, and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2 figures. •
Catalog of Publications and Videos Source: Chicago, IL: National Spasmodic Dysphonia Association. 4 p. Contact: National Spasmodic Dysphonia Association. One East Wacker Drive, Suite 2430, Chicago, IL 60601-1905. 800-795-NSDA (6732). Fax: 312-803-0138. Web site: http://www.dysphonia.org/nsda/publications/publications.asp. PRICE: Single copy free. Summary: The National Spasmodic Dysphonia Association sells a variety of print and audiovisual resources about the symptoms and treatment of the neurological voice disorder spasmodic dysphonia. Interested persons can purchase brochures, books, or videotapes that describe the effects of the condition and expectations regarding Botox and other treatments. Physician referral lists and a public service announcement audiotape can be ordered at no cost. A newsletter also is available for patients, friends, and physicians who join the organization. The brochure provides a brief description of each item, as well as an order form.
•
Spasmodic Dystonia Source: Chicago, IL: Dystonia Medical Research Foundation. 1995. [2 p.]. Contact: Available from Dystonia Medical Research Foundation. One East Wacker Drive, Suite 2430, Chicago, IL 60601-1905. (312) 755-0198. Fax (312) 803-0138. E-mail:
[email protected]. Website: www.dystonia-foundation.org. PRICE: $0.20. Summary: This brochure describes spasmodic dysphonia, a neurological condition affecting the vocal muscles of the larynx. Written in a question-and-answer format, the brochure covers the symptoms of spasmodic dysphonia; the different types of spasmodic dysphonia (adductor type and abductor type); the causes of the condition; diagnostic tests used to confirm spasmodic dysphonia; the epidemiology of the condition; current forms of therapy, including physical therapy, speech therapy, and the use of local injections of botulinum toxin (Botox); and the possibility that spasmodic dysphonia is genetic. The brochure includes the address and telephone number of the Dystonia Medical Research Foundation.
•
Mature Skin Source: American Academy of Dermatology. 2000. 12 p. Contact: Available from American Academy of Dermatology. 930 N. Beacham Rd., P.O. Box 4014, Schaumberg, IL 60168-4014. (888) 462-DERM ext. 22. Website: www.aad.org. PRICE: Single copies free; bulk prices available. Summary: This brochure discusses common conditions of aging skin. As skin ages it loses elasticity, firmness, moisture, and it becomes wrinkled. The main cause of wrinkles is childhood sun damage. Precautions for avoiding overexposure to sunlight are listed.
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Botox, dermal fillers, and retinoic acid are some of the treatments that can eliminate wrinkles. Dry skin can be managed by using moisturizers, bathing less often, using soap substitutes, and using warm instead of hot water for bathing. Some of the more common growths in older people include age or liver spots, cherry angiomas, and seborrheic keratoses. Less common conditions of the skin include actinic keratoses, often a precursor of skin cancer, squamous cell carcinoma; basal cell carcinoma; and malignant melanoma. Skin cancer has a high cure rate if caught early. Skin diseases more common in older people include shingles, seborrheic dermatoitis, varicose veins, varicose ulcers, bruising, and itching. Tables of symptoms and signs are included. 6 figures and 2 tables. •
Hyperhidrosis, Excessive Sweating Source: Kirksville, MO: American Osteopathic College of Dermatology (AOCD). 2001. 2 p. Contact: Available online from American Osteopathic College of Dermatology. 1501 East Illinois Street, P.O. Box 7525, Kirksville, MO 63501. (800) 449-2623 or (660) 665-2184. Fax (660) 627-2623. E-mail:
[email protected]. Website: www.aocd.org/skin/dermatologic_diseases/ index.html. Summary: This fact sheet provides people who experience excessive sweating, or hyperhidrosis, with information on treating this problem. The armpits and palms are affected most often. Excessive sweating begins after puberty, and it is worse when a person is under stress. Most antiperspirants are not strong enough to control the problem, but a prescription product (Drysol) can help control the condition. Drysol should be applied at bedtime and washed off in the morning shower. A regular deodorant should not be used. The procedure should be repeated nightly until the sweating is under control. Alternatives to Drysol include botox injections, oral Robinul pills, or a Drionic electrophoretic machine. Endoscopic transthoracic sympathectomy can cure hyperhidrosis of the palms, and some liposuction surgeons know a special technique to scrape out the sweat glands in the armpits. 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 Botox. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDHealth: 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 Botox. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with Botox. 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 Botox. 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 “Botox” (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
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your search to “Organizations” and “Botox”. 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 “Botox” (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 “Botox” (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.17
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
17
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)18: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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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
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
18
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries
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•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
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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
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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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
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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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
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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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/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
55
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).
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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BOTOX DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abductor: A muscle that draws a part away from the median line. [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] Acoustic: Having to do with sound or hearing. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Agonists: Drugs that trigger an action from a cell or another drug. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] 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] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH]
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Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] 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] Anus: The opening of the rectum to the outside of the body. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Dysreflexia: That part of the nervous system concerned with the unconscious regulation of the living processes of the body. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]
Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial toxin: A toxic substance, made by bacteria, that can be modified to kill specific tumor cells without harming normal cells. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Barium swallow: A series of x-rays of the esophagus. The x-ray pictures are taken after the person drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. Also called an esophagram. [NIH] Basal cell carcinoma: A type of skin cancer that arises from the basal cells, small round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Basal cells: Small, round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] 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]
Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of
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fats in the duodenum. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [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] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]
Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] 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] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH]
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Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]
Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] 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] 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] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Consumption: Pulmonary tuberculosis. [NIH] Continence: The ability to hold in a bowel movement or urine. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [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 Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [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] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]
Curette: A spoon-shaped instrument with a sharp edge. [NIH] 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] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases,
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and treatment. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Duct: A tube through which body fluids pass. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysphonia: Difficulty or pain in speaking; impairment of the voice. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [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]
Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidermoid carcinoma: A type of cancer in which the cells are flat and look like fish scales. Also called squamous cell carcinoma. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Manometry: A test to measure muscle tone inthe esophagus. [NIH] Esophageal Motility Disorders: Disorders affecting the motor function of the upper or lower esophageal sphincters, the esophageal body, or a combination of these parts. The failure of the sphincters to maintain a tonic pressure may result in the impeding of the passage of food, regurgitation of food, or reflux of gastric acid into the esophagus. [NIH]
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Esophagram: A series of x-rays of the esophagus. The x-ray pictures are taken after the person drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. Also called a barium swallow. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Eye socket: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] 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] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Flexor: Muscles which flex a joint. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [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]
Genital: Pertaining to the genitalia. [EU] Glabella: The median elevation which connects the 2 superciliary arches on the frontal bone. [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] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the
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recipient. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Handicap: A handicap occurs as a result of disability, but disability does not always constitute a handicap. A handicap may be said to exist when a disability causes a substantial and continuing reduction in a person's capacity to function socially and vocationally. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoidectomy: An operation to remove hemorrhoids. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Host: Any animal that receives a transplanted graft. [NIH] Hyperhidrosis: Excessive sweating. In the localized type, the most frequent sites are the palms, soles, axillae, inguinal folds, and the perineal area. Its chief cause is thought to be emotional. Generalized hyperhidrosis may be induced by a hot, humid environment, by fever, or by vigorous exercise. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH]
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Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Instillation: . [EU] Intravesical: Within the bladder. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Involution: 1. A rolling or turning inward. 2. One of the movements involved in the gastrulation of many animals. 3. A retrograde change of the entire body or in a particular organ, as the retrograde changes in the female genital organs that result in normal size after delivery. 4. The progressive degeneration occurring naturally with advancing age, resulting in shrivelling of organs or tissues. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and
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strengthen joints. [EU] 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] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]
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]
Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] 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] Micturition: The passage of urine; urination. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH]
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Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopathy: Any disease of a muscle. [EU] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Blockade: The intentional interruption of transmission at the neuromuscular junction by external agents, usually neuromuscular blocking agents. It is distinguished from nerve block in which nerve conduction is interrupted rather than neuromuscular transmission. Neuromuscular blockade is commonly used to produce muscle relaxation as an adjunct to anesthesia during surgery and other medical procedures. It is also often used as an experimental manipulation in basic research. It is not strictly speaking anesthesia but is grouped here with anesthetic techniques. The failure of neuromuscular transmission as a result of pathological processes is not included here. [NIH] Neuromuscular Junction: The synapse between a neuron and a muscle. [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] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nystagmus: Rhythmical oscillation of the eyeballs, either pendular or jerky. [NIH] Odynophagia: A painful condition of the esophagus. [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]
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Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Overactive bladder: A condition in which the patient experiences two or all three of the following conditions: [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Pelvic: Pertaining to the pelvis. [EU] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perineal: Pertaining to the perineum. [EU] Periorbital: Situated around the orbit, or eye socket. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phonation: The process of producing vocal sounds by means of vocal cords vibrating in an expiratory blast of air. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]
Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [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]
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Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prophylaxis: An attempt to prevent disease. [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] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Ptosis: 1. Prolapse of an organ or part. 2. Drooping of the upper eyelid from paralysis of the third nerve or from sympathetic innervation. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Radius: The lateral bone of the forearm. [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] 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] 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] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH]
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Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] 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] 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] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skin graft: Skin that is moved from one part of the body to another. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Social Isolation: The separation of individuals or groups resulting in the lack of or minimizing of social contact and/or communication. This separation may be accomplished by physical separation, by social barriers and by psychological mechanisms. In the latter, there may be interaction but no real communication. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with
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heightened deep tendon reflexes. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cells: Flat cells that look like fish scales under a microscope. These cells cover internal and external surfaces of the body. [NIH] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [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] Strained: A stretched condition of a ligament. [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] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [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]
Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathectomy: The removal or interruption of some part of the sympathetic nervous system for therapeutic or research purposes. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to
Dictionary 71
the parasympathetic system. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thoracic: Having to do with the chest. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Torticollis: Wryneck; a contracted state of the cervical muscles, producing twisting of the neck and an unnatural position of the head. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [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] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [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] 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] 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] 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]
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Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]
Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] 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] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] 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] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vocal cord: The vocal folds of the larynx. [NIH] Voice Quality: Voice quality is that component of speech which gives the primary distinction to a given speaker's voice when pitch and loudness are excluded. It involves both phonatory and resonatory characteristics. Some of the descriptions of voice quality are harshness, breathiness and nasality. [NIH] Volition: Voluntary activity without external compulsion. [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]
Wounds, Gunshot: Disruption of structural continuity of the body as a result of the discharge of firearms. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]
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INDEX A Abdominal, 57, 61, 67 Abductor, 30, 44, 57 Acetylcholine, 30, 57 Acoustic, 5, 7, 57 Adverse Effect, 57, 69 Afferent, 5, 57 Agonists, 5, 57 Algorithms, 57, 59 Alkaline, 57, 58 Alternative medicine, 28, 57 Alveoli, 57, 72 Amino Acid Sequence, 57, 58 Amino Acids, 57, 67, 68, 71 Ammonia, 57, 70, 71 Anatomical, 5, 57, 64, 69 Anesthesia, 57, 66 Ankle, 57, 72 Anorectal, 6, 58 Antibodies, 4, 58, 68 Antibody, 4, 58 Antigen, 58 Anus, 58, 59, 68 Arteries, 58, 59, 60, 65 Autonomic, 5, 57, 58, 70 Autonomic Dysreflexia, 5, 58 Axillary, 11, 15, 58 B Bacteria, 58, 62, 72 Bacterial toxin, 19, 58 Barium, 22, 58, 62 Barium swallow, 22, 58, 62 Basal cell carcinoma, 45, 58 Basal cells, 58 Base, 58, 64 Benign, 25, 58, 63 Bilateral, 14, 58 Bile, 58, 62, 65 Biological Transport, 59, 61 Biotechnology, 6, 28, 37, 59 Bladder, 5, 43, 59, 64, 66, 71 Blood vessel, 59, 69, 70, 71 Bowel, 59, 60, 61 Bowel Movement, 59, 60, 61 Branch, 53, 59, 70, 71 C Carcinoma, 59 Case report, 9, 59
Catheters, 44, 59 Cell, 4, 57, 58, 59, 63, 66, 67, 68, 71, 72 Central Nervous System, 30, 57, 59, 62, 63 Central Nervous System Infections, 59, 63 Cerebral, 12, 19, 27, 59, 69 Cerebral Palsy, 12, 19, 27, 59, 69 Cerebrovascular, 22, 59 Cerebrum, 59 Cervical, 7, 13, 15, 16, 26, 27, 59, 71 Cervix, 59 Chronic, 6, 28, 30, 59 Clinical Medicine, 60, 68 Clinical trial, 4, 5, 19, 20, 37, 60, 68 Cloning, 59, 60 Computational Biology, 37, 60 Conduction, 60, 66 Constitutional, 60, 66 Consumption, 4, 60 Continence, 27, 60 Contraindications, ii, 60 Coordination, 43, 60 Coronary, 60, 65 Coronary Thrombosis, 60, 65 Cranial, 11, 60, 63 Craniocerebral Trauma, 60, 63 Curative, 60, 71 Curettage, 15, 60 Curette, 60 Cyclic, 4, 60 D Databases, Bibliographic, 37, 60 Dermal, 45, 60 Dermatology, 10, 17, 42, 43, 44, 45, 60 Diagnostic procedure, 29, 61 Diaphragm, 13, 61 Diffusion, 12, 59, 61 Digestion, 58, 59, 61, 65, 67, 70 Digestive system, 20, 61 Digestive tract, 61, 70 Direct, iii, 60, 61, 68 Duct, 61, 69, 70 Dysphagia, 22, 61 Dysphonia, 3, 5, 7, 11, 16, 23, 29, 30, 44, 61 Dystonia, 7, 13, 15, 16, 23, 26, 27, 44, 61 E Effector, 57, 61 Efficacy, 8, 13, 61 Elasticity, 44, 61
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Endoscopy, 8, 10, 22, 61 Environmental Health, 36, 38, 61 Epidermis, 58, 61 Epidermoid carcinoma, 61, 70 Esophageal, 22, 61 Esophageal Manometry, 22, 61 Esophageal Motility Disorders, 22, 61 Esophagram, 58, 62 Esophagus, 58, 61, 62, 65, 66, 68, 70 Expiratory, 62, 67 Extremity, 12, 62 Eye socket, 62, 67 F Facial, 9, 10, 11, 15, 42, 62 Family Planning, 37, 62 Fat, 7, 62 Fibrosis, 62, 69 Flexor, 8, 62 Forearm, 62, 68 G Gallbladder, 57, 61, 62 Ganglia, 57, 62, 66, 70 Gas, 57, 61, 62, 72 Gas exchange, 62, 72 Gastric, 61, 62, 67 Gastric Acid, 61, 62 Gastric Juices, 62, 67 Gene, 6, 59, 62 Genital, 62, 64 Glabella, 15, 62 Gland, 62, 65, 67, 69, 70 Governing Board, 62, 68 Graft, 62, 63, 64 Graft Rejection, 62, 64 Gravis, 22, 63 Growth, 63, 65, 66, 67 H Handicap, 4, 63 Headache, 12, 15, 27, 28, 42, 63 Headache Disorders, 63 Hemorrhage, 60, 63, 70 Hemorrhoidectomy, 11, 63 Hemorrhoids, 63 Heredity, 62, 63 Host, 63, 64 Hyperhidrosis, 11, 45, 63 Hypertension, 63 Hypertrophy, 25, 63 I Id, 42, 45, 52, 54, 63 Idiopathic, 6, 63 Immune response, 58, 62, 63, 64, 70, 72
Immune system, 63, 64, 72 Immunity, 29, 63 Immunization, 63, 64 Immunosuppressive, 64 Immunosuppressive therapy, 64 Immunotherapy, 5, 64 Impairment, 61, 64, 65 Indicative, 21, 64 Infarction, 60, 64, 65 Inguinal, 63, 64 Inhalation, 4, 64 Innervation, 64, 68 Instillation, 5, 64 Intravesical, 5, 64 Invasive, 63, 64 Involuntary, 23, 30, 64, 66, 69 Involution, 11, 64 J Joint, 62, 64 K Kb, 36, 64 L Large Intestine, 61, 64, 68 Laryngeal, 7, 14, 23, 30, 64 Larynx, 44, 64, 71, 72 Lesion, 5, 64, 71 Lethal, 4, 64 Library Services, 52, 64 Ligament, 64, 70 Liver, 45, 57, 58, 61, 62, 65, 71 Localized, 63, 65, 67, 71 Lower Esophageal Sphincter, 61, 65 Lymph, 58, 59, 65 Lymph node, 58, 59, 65 Lymphoid, 58, 65 M Malignant, 45, 65 MEDLINE, 37, 65 Melanocytes, 65 Melanoma, 45, 65 Membrane, 64, 65, 67 Meninges, 59, 60, 65 Mental Disorders, 20, 65, 68 MI, 55, 65 Micturition, 6, 65 Modification, 14, 22, 65 Molecular, 37, 39, 59, 60, 65 Molecule, 58, 61, 65, 68 Mucins, 65, 69 Muscle Relaxation, 65, 66 Myasthenia, 22, 66 Myocardium, 65, 66
Index 75
Myopathy, 22, 66 N NCI, 1, 20, 35, 66 Necrosis, 64, 65, 66 Need, 3, 21, 22, 23, 29, 46, 66 Nerve, 6, 43, 57, 64, 66, 68, 69, 71 Nerve Growth Factor, 6, 66 Nervous System, 57, 58, 59, 66, 70 Neural, 57, 66 Neurogenic, 5, 66 Neuromuscular, 12, 57, 66 Neuromuscular Blockade, 12, 66 Neuromuscular Junction, 57, 66 Neurons, 62, 66, 70 Neurotoxin, 11, 66 Nucleus, 60, 66 Nystagmus, 16, 66 O Odynophagia, 22, 66 Orbit, 62, 66, 67 Orbital, 7, 67 Otolaryngologist, 29, 67 Overactive bladder, 43, 67 P Palliative, 67, 71 Pancreas, 57, 61, 67 Paralysis, 14, 67, 68, 69 Pathophysiology, 6, 67 Patient Education, 22, 43, 50, 52, 55, 67 Pelvic, 6, 67 Pepsin, 67 Peptic, 22, 67 Peptide, 4, 67, 68 Perineal, 63, 67 Periorbital, 9, 67 Pharmacologic, 57, 67, 71 Phonation, 5, 23, 67 Phospholipids, 62, 67 Physical Examination, 22, 67 Physical Therapy, 9, 44, 67 Physiologic, 67, 68 Pigment, 65, 67 Pitch, 67, 72 Plants, 67, 71 Plasma, 58, 68 Plasma cells, 58, 68 Practice Guidelines, 38, 68 Precursor, 45, 61, 68 Progressive, 63, 64, 66, 68 Prophylaxis, 28, 68 Protein S, 59, 68 Proteins, 57, 58, 65, 67, 68, 71, 72
Psychiatry, 7, 13, 15, 16, 68, 72 Ptosis, 8, 68 Puberty, 45, 68 Public Policy, 37, 68 R Radius, 12, 68 Randomized, 5, 7, 11, 12, 13, 61, 68 Receptor, 5, 58, 68 Rectal, 13, 30, 68 Rectum, 11, 58, 59, 61, 62, 64, 68 Refer, 1, 4, 68 Reflux, 61, 68 Regimen, 61, 68 Regurgitation, 61, 68 Respiratory Physiology, 68, 72 Restoration, 67, 69 Retrograde, 64, 69 S Saliva, 30, 69 Salivary, 61, 69 Salivary glands, 61, 69 Sclerosis, 22, 69 Screening, 60, 69 Secretion, 30, 65, 69 Sex Characteristics, 68, 69 Shock, 5, 69 Side effect, 30, 57, 69, 71 Skeletal, 69 Skin graft, 69, 70 Smooth muscle, 69, 70 Social Isolation, 3, 69 Sodium, 69, 70 Spasm, 9, 22, 23, 30, 69 Spasmodic, 3, 5, 7, 14, 16, 23, 29, 30, 44, 69 Spastic, 7, 11, 69 Spasticity, 8, 12, 19, 27, 69 Specialist, 46, 70 Sphincter, 5, 22, 43, 64, 70 Spinal cord, 6, 27, 59, 65, 66, 70 Spinal Cord Injuries, 27, 70 Squamous, 45, 61, 70 Squamous cell carcinoma, 45, 61, 70 Squamous cells, 70 Stents, 44, 70 Stomach, 57, 61, 62, 65, 67, 68, 70 Strained, 30, 70 Stress, 45, 70 Stricture, 22, 70 Stroke, 8, 20, 22, 26, 27, 36, 42, 70 Subarachnoid, 63, 70 Substance P, 69, 70 Sweat, 11, 45, 70
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Sweat Glands, 45, 70 Sympathectomy, 45, 70 Sympathetic Nervous System, 70 Synergistic, 6, 71 T Therapeutics, 4, 71 Thoracic, 61, 71 Thrombosis, 68, 70, 71 Tissue, 6, 58, 60, 62, 63, 64, 65, 66, 67, 69, 70, 71 Tonic, 61, 71 Tonicity, 61, 71 Torticollis, 14, 71 Toxic, iv, 5, 58, 63, 71 Toxicology, 38, 71 Toxins, 4, 58, 71 Trachea, 64, 71 Transfection, 59, 71 Transmitter, 57, 71 Tuberculosis, 60, 71 U Ulcer, 71, 72 Unconscious, 58, 63, 71
Urea, 70, 71 Urethra, 43, 71 Urinary, 27, 43, 71 Urine, 6, 43, 59, 60, 65, 71 Uterus, 59, 71 V Vaccines, 72 Varicose, 45, 72 Varicose vein, 45, 72 VE, 12, 72 Vein, 72 Ventilation, 14, 72 Vertebrae, 70, 72 Veterinary Medicine, 37, 72 Virus, 6, 59, 72 Vocal cord, 30, 67, 72 Voice Quality, 3, 72 Volition, 64, 72 W White blood cell, 58, 65, 68, 72 Wounds, Gunshot, 70, 72 X X-ray, 58, 62, 72
Index 77
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Index 79
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