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

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

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

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1 Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Cesarean Section: 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: 0-597-84371-6 1. Cesarean Section-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on cesarean section. 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 CESAREAN SECTION ................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Cesarean Section ........................................................................... 8 E-Journals: PubMed Central ....................................................................................................... 27 The National Library of Medicine: PubMed ................................................................................ 28 CHAPTER 2. NUTRITION AND CESAREAN SECTION ....................................................................... 73 Overview...................................................................................................................................... 73 Finding Nutrition Studies on Cesarean Section .......................................................................... 73 Federal Resources on Nutrition ................................................................................................... 75 Additional Web Resources ........................................................................................................... 76 CHAPTER 3. ALTERNATIVE MEDICINE AND CESAREAN SECTION ................................................. 77 Overview...................................................................................................................................... 77 National Center for Complementary and Alternative Medicine.................................................. 77 Additional Web Resources ........................................................................................................... 81 General References ....................................................................................................................... 82 CHAPTER 4. DISSERTATIONS ON CESAREAN SECTION ................................................................... 83 Overview...................................................................................................................................... 83 Dissertations on Cesarean Section............................................................................................... 83 Keeping Current .......................................................................................................................... 84 CHAPTER 5. BOOKS ON CESAREAN SECTION ................................................................................. 85 Overview...................................................................................................................................... 85 Book Summaries: Federal Agencies.............................................................................................. 85 Book Summaries: Online Booksellers........................................................................................... 86 Chapters on Cesarean Section ...................................................................................................... 87 CHAPTER 6. PERIODICALS AND NEWS ON CESAREAN SECTION .................................................... 89 Overview...................................................................................................................................... 89 News Services and Press Releases................................................................................................ 89 Academic Periodicals covering Cesarean Section ........................................................................ 94 CHAPTER 7. RESEARCHING MEDICATIONS .................................................................................... 95 Overview...................................................................................................................................... 95 U.S. Pharmacopeia....................................................................................................................... 95 Commercial Databases ................................................................................................................. 96 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 99 Overview...................................................................................................................................... 99 NIH Guidelines............................................................................................................................ 99 NIH Databases........................................................................................................................... 101 Other Commercial Databases..................................................................................................... 103 APPENDIX B. PATIENT RESOURCES ............................................................................................... 105 Overview.................................................................................................................................... 105 Patient Guideline Sources.......................................................................................................... 105 Finding Associations.................................................................................................................. 109 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 111 Overview.................................................................................................................................... 111 Preparation................................................................................................................................. 111 Finding a Local Medical Library................................................................................................ 111 Medical Libraries in the U.S. and Canada ................................................................................. 111 ONLINE GLOSSARIES................................................................................................................ 117 Online Dictionary Directories ................................................................................................... 117

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CESAREAN SECTION DICTIONARY ..................................................................................... 119 INDEX .............................................................................................................................................. 173

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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 cesarean section is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about cesarean section, 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 cesarean section, 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 cesarean section. 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 cesarean section, 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 cesarean section. 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 CESAREAN SECTION Overview In this chapter, we will show you how to locate peer-reviewed references and studies on cesarean section.

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

Mother-to-Infant Transmission of Hepatitis C Virus Source: Hepatology. 34(2): 223-229. August 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: Hepatitis C virus (HCV) is acquired through transfusion of infected blood or blood products or through routes not related to transfusion, classified as community acquired disease. The rate of mother to infant HCV transmission is critical to predicting the burden of HCV infection in future generations (particularly after the implementation of blood product screening in 1991). The factors that determine whether or not an infant actually becomes infected need to be identified. This article reports on a review of published studies (n = 77, 1992 to 2000) of mother to infant transmission of HCV. The

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number of anti HCV positive mother-infant pairs ranged from 10 to 1,338 per study. The articles in this review reported a total of 363 cases of mother to infant transmission; the majority of studies originated from Italy and Japan. The prevalence of anti HCV positive women among all pregnant women varied widely across these studies, from 0.6 percent to 95.4 percent, reflecting the heterogeneity of the populations studied. For example, the 3 studies with highest prevalence were limited to intravenous drug users (IVDU). The reported rate of mother to infant HCV transmission ranged from 0 to 35 percent among children born to anti HCV positive women. HCV transmission patterns may differ among certain groups and, indeed, the definition of mother to infant transmission differed among studies. The rate of mother to infant HCV transmission appears increased among women coinfected with human immunodeficiency virus (HIV) compared with women without HIV infection. Between infants delivered vaginally versus by Cesarean section, overall rates of mother to infant transmission were similar. Overall rates of mother to infant transmission between breast fed and non breast fed infants were similar. Suggested viral factors such as genotype and viral titer were not consistently measured across studies; hence, their roles as significant risk factors in mother to infant transmission remain to be conclusively shown. Inconsistent follow up among studies resulted in only sporadic description of clinical outcome for infected infants. The authors conclude that, based on observational data from these 77 cohort studies, maternal risk factors for increased mother to infant transmission of HCV include coinfection with HIV, history of IVDU, and maternal viremia greater than 10 to the 6th power copies per milliliter. 2 tables. 102 references. •

Comparison of World Health Organization and National Diabetes Data Group Procedures to Detect Abnormalities of Glucose Tolerance During Pregnancy Source: Diabetes Care. 17(11): 1264-1268. November 1994. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: In this article, the authors report on their study that compared the one-step procedure proposed by the World Health Organization (WHO) with the two-step procedure proposed by the National Diabetes Data Group (NDDG) for the identification of abnormalities of glucose tolerance during pregnancy. The study group consisted of 127 nondiabetic pregnant Pima Indian women who had a 75-g 2-hour glucose tolerance test (WHO criteria). Those with an elevated 1-hour glucose concentration were referred for a 100-g, 3-hour glucose tolerance test (National Diabetes Data Group criteria). The effectiveness of the two test procedures was determined by comparing the frequency of macrosomia and cesarean section as outcomes of pregnancy. The authors conclude that the one-step WHO test for glucose tolerance during pregnancy was abnormal in a greater percentage of women with adverse outcomes than the more cumbersome two step NDDG test. The one-step test has the added advantage of being directly comparable to the standard glucose tolerance test used in nonpregnant women. 2 tables. 27 references. (AA-M).

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Maternal-Infant Transmission of Hepatitis C Virus Infection Source: Hepatology. 36(5 Supplemental 1): S106-S114. November 2002. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: Mother-to-infant transmission of hepatitis C virus (HCV) is comparatively uncommon. This article considers the role of mother to infant transmission of HCV

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infection, including issue relating to pregnancy itself. The prevalence of antibody to HCV (anti-HCV) in pregnancy women is 0.1 percent to 2.4 percent, although in some endemic areas it is much higher. The proportion of women with anti-HCV who have active infection with viremia (virus in the blood) is 60 to 70 percent. Transmission of HCV occurs only when HCV RNA is detectable and may be related to higher levels. The rate of mother-to-infant transmission is 4 to 7 percent per pregnancy in women with HCV viremia. Co-infection with HIV (human immunodeficiency virus) increases the rate of transmission 4 to 5 fold. The actual time and mode of transmission are not known. Elective Cesarean section is not recommended for women with chronic HCV infection alone. The role of treatment to prevent transmission is limited by the fetal toxicity of currently available medications for hepatitis C. Breast feeding poses no important risk of HCV transmission if nipples are not traumatized and maternal hepatitis C is quiescent. Pregnancy women at high risk for HCV infection should be screened for anti-HCV and HCV RNA testing should be performed if anti-HCV is positive. Infants of women with hepatitis C should be tested for HCV RNA on two occasions, between the ages of 2 and 6 months, and again at 18 to 24 months, along with serum anti-HCV. The natural history of mother-to-infant hepatitis C remains uncertain, especially the course in the first year of life when some infants appear to have spontaneous resolution. 3 tables. 71 references. •

Gestational and Pre-Gestational Diabetes: Comparison of Maternal and Fetal Characteristics and Outcome Source: International Journal of Gynecology and Obstetrics. 58(2): 203-209. August 1997. Contact: Available from Elsevier Science. P.O. Box 945, New York, NY 10159-0945. (888) 437-4636 or (212) 633-3730. Fax (212) 633-3680. E-mail: [email protected]. Summary: This article is based on a study designed to determine the incidence of maternal and fetal complications of gestational diabetes mellitus (GDM) and compare such pregnancies with pre-gestational diabetes mellitus (pre-GDM) and non-diabetic pregnancies. Researchers analyzed the prenatal and intrapartum complications of 972 women with GDM, 71 women with pre-GDM, 8,904 women in the control group, and the offspring of all participants. Maternal complications included higher incidences of cesarean section and perineal lacerations in GDM and pre-GDM patients than in the non-diabetic pregnancies. In addition, there were higher rates of macrosomia and hypoglycemic episodes in the offspring of GDM and pre-GDM offspring. The authors conclude that because GDM and pre-GDM have a similar incidence of maternal, fetal, and neonatal complications, they should be monitored and managed identically. 3 tables. 24 references. (AA-M).

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Gestational Diabetes Source: International Journal of Childbirth Education. 15(1): 20-30. November 1991. Summary: This article presents a literature review of gestational diabetes (GDM). After a section describing the history of GDM, the author covers topics including terminology; glucose intolerance of pregnancy; differences among women with GDM; problems with the oral glucose tolerance test (OGTT); the potential complications of GDM, including perinatal death, congenital anomalies, macrosomia, respiratory distress syndrome, neonatal hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia, maternal hypertension and cesarean section; the potential risks of diagnosing and treating GDM; and decision-making guidelines for the pregnant woman. Throughout the article, the author makes a case for caution in testing for and treating GDM. 105 references.

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Perinatal Lactation Protocol and Outcome in Mothers With and Without InsulinDependent Diabetes Mellitus Source: American Journal of Clinical Nutrition. 58(1): 43-48. July 1993. Summary: This article reports on a study that compared the course of lactation from postpartum days 2 to 84 in 33 women with IDDM, 33 control subjects, and 11 reference subjects. Women with gestational diabetes were not included. The control group of 33 lactating women who did not have diabetes was selected on the basis of gestational age of the infant at delivery, methods of delivery, and sex of the infant. Nutritionists visited the mothers on days 2, 3, 7, 14, 42, and 84 postpartum; obtained prenatal and perinatal medical information; and questioned the mothers on their breastfeeding experience. Results showed that women with IDDM were able to establish lactation despite postpartum separation from their infants, delays in the start of breastfeeding, reduced frequency of feeding, increased use of supplemental feedings, and the high rate of cesarean section. The authors emphasize that clinicians must recognize the need to provide appropriate counseling so that mothers with IDDM will not be discouraged by problems with breastfeeding. 2 figures. 2 tables. 25 references. (AA-M).

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Prenatal, Perinatal, and Neonatal Factors in Autism, Pervasive Developmental Disorder-Not Otherwise Specified, and the General Population Source: Pediatrics. 107(4): [6 p.]. April 2001. Contact: Available from American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (888) 227-1773. Fax (847) 434-8000. E-mail: [email protected]. Website: www.pediatrics.org. Full text of this article is available at www.pediatrics.org/cgi/content/full/107/4/e63. Summary: This article reports on a study undertaken to examine various prenatal, perinatal, and neonatal factors in children with autism and in children with pervasive developmental disorder not otherwise specified (PPD NOS); the study compared the incidence of each factor to that of the normal population. The 74 participants (66 males, 8 females) were diagnosed with autism between age 2.5 and 4 years. At age 5, all participants were reevaluated, resulting in 61 autistic and 13 PDD NOS diagnoses. The study examined 28 factors in these 2 groups, using medical records and parental interviews. Incidences were compared with those of the United States population as reported in the Report of Final Natality Statistics (1995). Factors included maternal age, parity (number of pregnancies), number of previous abortions or miscarriages, gestational age, bleeding in pregnancy, vaginal infections, fever, preeclampsia, gestational diabetes, rhesus (blood factor) incompatibility, smoking during pregnancy, use of contraception at conception, induced labor, Cesarean section, nonvertex presentation, forcep extraction, vacuum extraction, prolonged labor (longer than 20 hours), precipitous labor (less than 3 hours), multiple gestation, cord complication (prolapse, around the neck, knotted), trauma on delivery, low birth weight, low Apgar score, respiratory distress syndrome, oxygen treatment, hyperbilirubinemia, seizures, and birth defect. Although most of the factors showed comparable incidences between the index and control groups, several factors showed statistically significant differences. The autism group was found to have a significantly higher incidence of uterine bleeding, a lower incidence of maternal vaginal infection, and less maternal use of contraceptives during conception when compared with the general population. Similarly, the PDD NOS group showed a higher incidence of hyperbilirubinemia when compared with the general population. The results of this study support previous findings. However, the authors caution that interpretation of these results is difficult.

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Additional studies are needed to corroborate and strengthen these associations, as well as to determine the possibility of an underlying unifying pathological process. 5 tables. 25 references. •

Inflammatory Bowel Disease and Pregnancy Source: Gastroenterology Clinics of North America. 27(1): 213-224. March 1998. Contact: Available from W.B. Saunders. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This article reviews the interplay of inflammatory bowel disease (IBD) and pregnancy. The author begins by cautioning that many of the research studies are somewhat dated and often did not distinguish between the subtypes of IBD. However, general implications for practice can be ascertained. Topics include fertility, inheritance and IBD, the influence of ulcerative colitis (UC) on fetal outcome, the influence of Crohn's disease on fetal outcome, the influence of pregnancy on the course of UC and of Crohn's disease, episiotomy in IBD, the influence of drug therapy on the pregnant woman and the fetus, smoking, the effect of surgery for IBD on subsequent pregnancies, and the management of IBD during pregnancy. Drugs discussed include 5aminosalicylic acid agents (mesalamine, olsalazine), corticosteroids, immunosuppressives, cyclosporine, methotrexate, and antibiotics. Rates of healthy babies, congenital abnormalities, stillbirths, and spontaneous abortions are roughly the same in women with UC and Crohn's disease as in the normal population. The presence of UC did not influence the mode of delivery (vaginal versus cesarean section) or the incidence of preeclampsia during gestation. However, if a severe exacerbation requiring surgery occurs during pregnancy, the fetal mortality is high. 71 references.

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Childbearing, Curve Progression, and Sexual Function in Women 22 Years After Treatment for Adolescent Idiopathic Scoliosis: A Case Control Study Source: Spine. 26(13): 1449-1456. July 1, 2001. Summary: This journal article provides health professionals with information on a long term follow up evaluation of formerly treated with patients with adolescent idiopathic scoliosis to determine outcome with regard to sex life and childbearing. From an unbiased follow up evaluation of 283 consecutive patients with adolescent idiopathic scoliosis treated between 1968 and 1977, 145 surgically treated (ST) and 122 bracetreated (BT) women were included in the study. The Scoliosis Research Society/MODEM's questionnaire concerning childbearing and sexual life was completed by 136 ST and 111 BT patients. Of these, 129 ST and 105 BT women also underwent a radiographic examination. The Cobb method was used to measure curve size in present and earlier examinations. An age-matched control group of 90 women was randomly selected and subjected to the same examinations. The study found that the mean age for all the groups was 40 years. Of the ST and BT women, 85 percent were or had been married, as compared with 82 percent of the control women. In the total cohort, 628 pregnancies had occurred. No significant mean difference existed between the groups in the number of children born (1.8 for the ST, 1.9 for the BT, and 2 for the control women). The patients in the BT group had a significantly higher mean age at first pregnancy (28 years) than the control women (25.9 years), whereas the age for the ST (26.6 years) did not differ significantly from that for the BT women. There were no significant differences between the groups in rates for low back pain (35 percent for the ST women, 43 percent for the BT women, and 28 percent for the controls) or for cesarean section (19 percent for the ST group, 14 percent for the BT group, and 18 percent for the

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controls) during the first pregnancy. The rate of vacuum extractions was higher in the ST group (16 percent) than in the control group (5 percent) or the BT group ( 8 percent). Limitation of sexual function from the back was admitted by 33 percent of the ST, 28 percent of the BT, and 15 percent of the control women. These limitations were largely because of difficulties participating physically in activities or self-consciousness about appearance. Pain was a minor reason for limitation. There was no correlation between progression of the major or lumbar curve and number of pregnancies, or between curve progression and age at first pregnancy. The article concludes that patients treated for adolescent idiopathic scoliosis appeared to function well with regard to marital status and number of children. The scoliotic curve did not seem to increase as a result of childbearing. Minor problems occurred during pregnancy and delivery. Some patients, however, experienced a slight negative effect in their sexual life. 1 figure, 6 tables, and 36 references. (AA-M). •

Women and HIV/AIDS Source: HRSA Care Action December 1998; 1-12. Contact: US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Office of Communications, 5600 Fishers Ln Rm 746, Rockville, MD, 20857, (301) 443-6652, http://www.hrsa.gov/hab. Summary: This newsletter discusses the clinical care of women with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). It provides statistics on HIV in women and factors that determine need in this population. These factors include parenthood, lack of awareness of risk and serostatus, discrimination, poverty, and psychological distress, violence, and substance abuse. Other topics include the delivery of quality care to HIV-positive women, conditions necessary for receiving care, and conditions for retaining women in care. The newsletter also discusses findings from studies on perinatal transmission of HIV and AZT, antiretroviral therapy and pregnancy, Cesarean section and vertical transmission, other risk factors for vertical transmission, gender and viral load, genital tract HIV, and the human papilloma virus and cervical dysplasia. It also provides four perspectives from female professionals (i.e., an executive director of a family planning council, a director of a county health department, and two researchers) involved in the delivery of services to women with HIV and information on a recommendation for routine HIV tests for pregnant women made by the Institute of Medicine (IOM) of the National Academy of Sciences.

Federally Funded Research on Cesarean Section The U.S. Government supports a variety of research studies relating to cesarean section. 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.

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

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

Project Title: A RHESUS MONKEY MODEL OF MALARIA IN PREGNANCY Principal Investigator & Institution: Davison, Billie B.; None; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2002; Project Start 01-FEB-2000; Project End 31-JAN-2005 Summary: Malaria in pregnant women has devastating effects on the fetus and infant, resulting in abortions, premature deliveries, intrauterine growth retardation, failure to thrive, infant mortality and congenital infection. The long term objective of this proposal is to clarify the pathogenesis of malaria in pregnancy so that effective interventions that prevent these complications can be devised. The specific aims are to determine the effects of parity and prior exposure to Plasmodium on the course, severity, and outcome of clinical malaria in the mother, fetus, and newborn and to test the hypothesis that macrophage-induced cytokine imbalance causes morphologic and physiologic placental lesions that result in fetal damage, post-natal failure to thrive, and congenital infection. We have developed an animal model utilizing pregnant rhesus monkeys infected with Plasmodium coatneyi with which to study this problem. Using this model, four groups of eight rhesus monkeys will be studied. These will be nulliparous primagravida, secundigravida or multigravida animals. The monkeys will be time-bred and inoculated with Plasmodium coatneyi during the first trimester of pregnancy. After delivery, the mothers will be treated for malaria. In the second and third years, these same animals will be bred again and reinoculated with Plasmodium, with each animal and group serving as its own control. Animals will be non- immune, or have one or two previous exposures to Plasmodium. This design will allow us to examine the effects of parity and prior exposure to Plasmodium on fetal/infant outcome. Infants will be delivered by cesarean section so that placental tissues can be collected from all animals. The placentas will be examined by RT- PCR, immunohistochemistry, and in situ hybridization for cell types, cytokines, and growth factors that are important and likely to interact in placental development and malaria. The results of these studies will be correlated with histopathology of placental sections the clinical course in the mother, and the outcome of the newborn. This design will test the hypothesis that macrophages and the cytokines they produce are the likely causes of fetal injury. The information derived from these studies will allow effective interventions to be designed which will prevent the devastating effects of malaria in pregnant women and their children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ACTH INFUSION INTO RHESUS MONKEY FETUS LEADS TO PREMATURE LABOR & DELIVERY Principal Investigator & Institution: Haluska, George J.; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002

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Summary: The activation of the hypothalamic-pituitary-adrenal axis in fetal sheep is the primary initiator of parturition; however, this same mechanism has not been proven to be important in primate parturition. To determine if adrenocorticotropic hormone (ACTH) can induce premature parturition in primates, we infused ACTH (0.1 U in 30 min, every 2 hrs; n=7) beginning on day 135 of pregnancy (term=167 days) until delivery occurred. A control group of animals (n=3) received saline vehicle infusions. All animals were surgically instrumented with fetal and maternal vascular and amniotic fluid catheters, fetal ECG and myometrial EMG electrodes. Uterine activity (UA) and fetal ECG were recorded continuously. The results of ACTH and vehicle infusion are listed in the following table (values are mean + SEM) * = P<0.05 (t-test) ACTH vs Vehicle Begin Infusion (day of preg) Onset Nocturnal UA (days) Days to Delivery Delivery (Day of Pregnancy) ACTH (n=6) 135.3 + 0.6 6.3 + 0.8 15.2 + 1.3 149.7 + 1.3 Vehicle (n=3) 135.7 + 1.8 24.7 + 2.7* 27.6 + 3.2* 163.3 + 1.5* One ACTH-treated animal was delivered by cesarean section at 165 days of pregnancy after prolonged labor and dystocia and was excluded from the data set. Mean (+ SEM) maternal and fetal steroid changes in ACTHtreated animals *=P<0.005 (Rank Sum Test) (n=6) Fetal Cortisol (ng/ml) Fetal DHEASulfate (?g/ml) Fetal Androstene-dione (ng/ml) Fetal Estrone (pg/ml) Maternal Estradiol (pg/ml) Baseline 79 + 11 0.4 +.08 0.8 + 0.2 97 + 27 360 + 45 Labor 276 + 48* 6.6 + 3.1* 7.4 + 1.7* 519 + 170* 877 + 187* We conclude that infusion of ACTH into the fetal circulation activates fetal adrenal steroid biosynthesis causing increased secretion of glucocorticoids and androgens leading to increased estrogen and cortisol production and pre-term delivery in rhesus monkeys. FUNDING NIH HD06159, HD18185 PUBLICATIONS None Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BNOS-NO ON NEONATAL ARTERIAL PRESURE REGULATION IN NTS Principal Investigator & Institution: Ma, Sheng-Xing X.; Harbor-Ucla Research & Educ Inst 1124 W Carson St Torrance, Ca 90502 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 31-JUL-2004 Summary: (provided by applicant): Despite the dramatic rise in circulating norepinephrine (NE) concentrations during transition from fetal to newborn life, arterial blood pressure does not substantively change. However, altered regulation of arterial blood pressure at birth, perhaps due to prematurity or depleted NE following fetal stress, may result in neonatal hypotension or hypertension. The nucleus tractus solitarius (NTS) is the principal sensory nucleus for central control of the circulation. Nitric oxide (NO) in the NTS plays an important role in the central inhibition of sympathetic tone and thus decreases blood pressure. We have recently shown that ovine brain NO synthase (bNOS) expression in the NTS is markedly enhanced in neonates at 4 hours following birth, as compared to the term fetus. Consistent with the postulated role of NO, fetal arterial blood pressure is decreased by fourth ventricle administration of a NO donor and increased by a NO synthesis inhibitor. Furthermore, our preliminary results demonstrate that fourth ventricle administration of a NE uptake inhibitor increases ovine fetal bNOS protein and y-aminobutyric acid (GABA) expression in the NTS and rostral ventral medulla (RVM). We hypothesize that during fetal and neonatal life (1) elevated circulating NE induces up-regulation of bNOS in the NTS during birth transition, and (2) the bNOS-NO-GABA system regulates neonatal arterial blood pressure in the NTS-RVM central sympathetic pathways. In view of the critical importance of fetal/neonatal arterial blood pressure regulation, our major aims are: 1) If exogenous fetal NE mimics up-regulation of bNOS-NO in the NTS and the RVM? 2) If

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arterial blood pressure increases and NTS bNOS-GABA expression decreases in newborn lambs by fourth ventricle administration of nNOS antisense oligonucleotides before birth? and 3) If the enhanced bNOS and GABA expression in the NTS and RVM regions at birth are promoted by an inhibitor of NE uptake? These studies will examine bNOS expression in the NTS and RVM neurons in the ovine fetus and neonate. Quantification of arterial blood pressure, plasma NE concentrations, bNOS and GABA expressions in brain regions will be incorporated with neuropharmacological manipulations to test our hypotheses. These results will advance our understanding of the sites and mechanisms for bNOS-NO-GABA effects on arterial blood pressure regulation during the transition from fetal to newborn life and will yield new insights regarding noradrenergic mechanisms for bNOS regulation and central neurocardiovascular control at birth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF PHYTOESTROGENS ON PRIMATE MATERNAL FETOPLACENTAL UNIT Principal Investigator & Institution: Harrison, Richard M.; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2002 Summary: Ten female rhesus monkeys, in early stages of pregnancy, were studied to determine the effects of a dietary supplement of genistein, a phytoestrogen found in soy, on the steroidogenesis in the maternal-fetoplacental unit. The monkeys were placed in two equal groups. The experimental group received 8mg/kg body weight of genistein each Monday through Friday. Dosing continued until day 155 of gestation, at which time a Cesarean section was performed to collect the fetus and placenta. Blood was collected from the maternal peripheral circulation twice weekly during the study period. At delivery blood was collected from the maternal peripheral circulation, the uterine veins, the ovarian veins, and the fetal heart. Placental tissues were collected and frozen until assayed. Sera from the blood sample were frozen until assayed for steroid hormones. Estradiol levels in the genistein-treated monkeys were higher than in the control monkeys during gestation and at delivery all maternal and fetal blood levels from the genistein-treated monkeys were significantly higher. The estrone levels in the genistein-treated monkeys trended to be higher than the control but were not significant (p=0.057). There were no significant differences between the two groups in weight gained during pregnancy, fetal weights, or placental weights. There were trends but no significant differences in blood levels of DHEA-S, or progesterone. The placental assays found no significant differences in placental LDL and HDL levels. These data suggest that the elevated levels of estradiol in the maternal blood may be due to deconjugation of estrone in the gut and conversion to estradiol. The higher levels in the fetal blood indicate that the genistein crossed the placental barrier and stimulated the production of estradiol, since estradiol produced by the placenta is preferentially directed to the maternal circulation, as a protective measure to the fetus. This finding is significant when the use of soy-based food products used by the mother during pregnancy and soy-based infant formulas is increasing. Reports in the literature suggest that soy-based formulas may be associated with an increased incidence of goiter and thyroid disease. FUNDING Chancellor?s Grant, Tulane University School of Medicine Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Cesarean Section

Project Title: EPIDURAL ANESTHESIA EFFECT ON FETAL POSITION Principal Investigator & Institution: Lieberman, Ellice; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-APR-1998; Project End 30-SEP-2003 Summary: (Adapted from Investigator's Abstract) The nearly one million cesarean deliveries performed in this country each year are associated with increased maternal morbidity, mortality, and health care costs. The long-term goal of the proposed project is to understand the factors contributing to the high c-section rate, with special emphasis on identification of potentially modifiable risk factors. It has been suggested that epidural anesthesia may increase c-sections by increasing the prevalence of fetal occiput posterior (OP) position at delivery. This fetal malposition, which is associated with a high risk of c-section, is present at delivery more frequently among women with epidural anesthesia. This suggests that either epidural anesthesia directly contributes to persistence of OP position or that women with OP fetuses receive epidural anesthesia more frequently. The proposed study is intended to distinguish between these alternative explanations and to quantify the contribution of epidural anesthesia to the persistence of OP position and c-section. Three-thousand low risk, nulliparous women, in spontaneous labor will be screened. Fetal position will be determined by ultrasonography at admission, at the time of administration of epidural anesthesia, if used, and at the time of full dilation. The position of the infant at delivery will be noted by the practitioner. Crude rate ratios and 95% confidence intervals will be calculated. Multiple logistic regression analysis will be used to adjust for confounding. The investigators state that this project is designed to determine whether epidural anesthesia is responsible for an increased persistence of OP fetal position at delivery. If epidural anesthesia does increase the prevalence of OP position at delivery, then its use could be associated with over 19,000 excess c-sections in women with OP fetuses; this could account for an additional $50 million in health care costs annually. The investigators further state that demonstration of this association would provide the first documentation of a mechanism by which epidural anesthesia affects the course of labor. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ESTABLISHMENT OF RHESUS BONE MARROW CHIMERAS Principal Investigator & Institution: Rosenzweig, m; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002 Summary: In vivo evaluation of candidate stem cell populations has traditionally utilized either lethal irradiation experiments or SCID/NOD-mice To explore alternatives in a model that could examine both human and monkey cells, we have developed a fetal chimera model First trimester, immune incompetent rhesus fetuses have been transplanted with human CD34+ cells by ultrasound guided intraperitoneal injection On evaluation at birth and during the first 12 months of life, we have demonstrated persistent chimerism of human hematopoietic cells Chimerism is highest in the bone marrow (5-10% of CD34+ cells are of human phenotype) Chimerism in the peripheral blood varies between mononuclear fractions from 0 1-4% However, the majority of human CD34+ cells in the bone marrow are apoptotic This may explain the discordant level of engraftment in the bone marrow as compared to the peripheral blood We have identified a putative CD34- hematopoietic stem cell population in macaques Although in vitro experiments suggest that these cells have the expected in vitro characteristics of HSC (multipotency, highly enriched for LTC-IC), demonstration that rhesus CD34- SP

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cells contain HSC requires in vivo experiments showing long-term multilineage hematopoiesis Other investigators utilizing rhesus macaques to characterize HSC have typically examined hematopoietic reconstitution of lethally irradiated macaques In order to assess the engraftment capacity of the SP cells in an alternative model, we created male-female hematopoietic chimeras 10,000 rhesus SP cells were FACS purified from an SPF donor male animal and transplanted into a female recipient at 70 days of gestation At approximately 60 - 75 days of gestation, the SP cells were injected into the fetal peritoneal cavity The SP cells were resuspended in 1x106 irradiated (10,000 Rads) maternal red blood cells in 100 ml of seru m free PBS Maternal red cells were used as a means to increase the density of tranplanted cells as the number of SP cells was very small A source of cells that could not contribute to engraftment was selected so as not to confuse the results Ultrasound-guided intraperitoneal injections were carried out by Dr Tom Shipp, an obstetrician/gynecologist at Massachusetts General Hospital This was accomplished using ultrasound guidance to insert a 22 gauge spinal needle through the maternal abdominal wall, uterus and fetal abdominal wall We allowed the mother to carry the pregnancy until just prior to term, at which point the baby was delivered by cesarean section The evaluation of chimerism was performed using a PCR reaction specific for Y chromosome We have been able to achieve 1-10% chimerism in a rhesusrhesus macaque model using this approach To demonstrate the feasibility of establishing mixed hematopoietic chimerism using a fetal transplant model, we performed mixed lym phocyte reactions against donor and an unrelated third party PBMCs Four of the animals who demonstrated engraftment using Y chromosome PCR, exhibit in vitro tolerance to donor PBMCs This demonstrates clearly that mixed chimerism has been achieved and set the precedence for using this model for the passive transfer of autologous CTL Furthermore, this data is consistent with what has been demonstrated in the murine model in showing that only a low level (0 01%) of hematopoietic chimerism is required in order to induce tolerance to donor PBMCs These studies continue in an attempt to optimise the model and determine the in vivo engraftment characteristics of various hematopoietic progenitor subsets Establishment of this model should prove useful in characterizing novel populations of human hematopoietic stem cells Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EXPERIMENTAL MODEL PREMATURITY

FOR CHORIOAMNIONITIS

AND

Principal Investigator & Institution: Gravett, Michael G.; Chief; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 01-SEP-1997; Project End 31-MAY-2006 Summary: Prematurity is the leading cause of neonatal morbidity and mortality in the United States. Intrauterine infections are an important, and potentially treatable cause of prematurity, and are associated with increased risk of neonatal white matter lesions of the brain and cerebral palsy. However, the mechanisms by which infection leads to prematurity and/or cerebral palsy remain speculative and treatment strategies untested largely because humans cannot be longitudinally studied following infection. We propose to use chronically instrumented pregnant rhesus monkeys at 120-130 day gestation with experimental intrauterine infection, as previously described (Gravett et al, Am J Obstet and Gynecol; 171:1660-1667,1994) to study the temporal and quantitative relationships among infection, cytokines, prostaglandins, steroid hormones, cytokine antagonists, preterm labor, and neonatal white matter lesions of the brain in order to develop effective interventional strategies. After postoperative stabilization in a tether,

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we will; (1) inoculate Group B Streptococci (GBS) into the amniotic fluid to establish intrauterine infection and preterm labor. Uterine contractility will be continuously monitored and periodic samples of amniotic fluid and maternal and fetal blood (1-4 cc) will be obtained for assays of eicosanoids, steroid hormones, cytokines, matrix metalloproteinases and for microbial studies; (2) utilize antibiotics with and without potent inhibitors of proinflammatory cytokine production (dexamethasone,IL-10) o prostaglandin production (indomethacin) to ascertain the most effective intervention to down-regulate the cytokine/prostaglandin cascade and associated uterine activity; (3) infuse proinflammatory cytokine IL-1beta into the amniotic cavity through indwelling catheters in the absence of infection. Prior to infusion of IL-1beta in the absence of infection, specific novel proinflammatory cytokine inhibitors (IL-1ra and sTNF-R1 PEG) will be used to identify other potentially useful immunomodulators. Samples of the decidua, fetal membranes, tissues, and brain will be obtained at cesarean section for microbiologic, histopathologic studies, immunohistochemistry for cytokines, localization and quantitation of mRNA for cytokines and PGHS-2. Fetal brain will be examined for increased apoptosis associated with white matter lesions. Leukocytes in amniotic fluid and tracheal aspirates will be assessed by flow cytometry Postpartum, the mother will be treated with appropriate antibiotics to eradicate the GBS from the genital tract and returned to the colony. These studies will clarify the pathophysiology of infection-associated preterm labor and will suggest effective interventional strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FACTORS RESPONSIBLE FOR THE CONTROL OF HUMAN LABOR Principal Investigator & Institution: Young, Roger C.; Professor; Obstetrics and Gynecology; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2002; Project Start 01-JAN-1999; Project End 30-JUN-2002 Summary: This proposal will elucidate how the human pregnant uterus coordinates myometrial cell function with uterine contractility. Knowledge gained from this work will define the factors responsible for the coordination, initiation, and maintenance of labor. These issues are intimately associated with preterm labor, postdates pregnancy, and dysfunctional labor, which correlate directly with prematurity, fetal distress, and cesarean section rates. Improved understanding of uterine contractility will potentially allow treatments of an abnormality of labor to be directed towards the underlying physiological abnormality. We have recently developed the initial form of a hypothesis that specifies how the uterine cells communicate in human labor. This model incorporates global (throughout the entire uterus) with local mechanisms. The essence of this model is that organ-level communication is by action potential propagation, but the signal responsible for initiating contraction of each cell is carried by intercellular calcium waves. This hypothesis is therefore called the action potential - calcium wave hypothesis (AP-wave hypothesis). The purpose of this research is to test the foundation and formulation of the AP-wave hypothesis and to modify it when shortcomings are identified. The evolving form of this hypothesis will hopefully allow clinicians to trace specific clinical parameters of labor (such as strength and frequency of uterine contractions) back to cellular mechanisms. As a result, specific abnormalities of labor (poor spacing of contractions, abnormal response to oxytocin, elevated baseline pressure, and many others) would then be able to be correlated with specific cellular functions. This knowledge would provide the scientific basis for the selection of a particular therapy for a particular abnormality of labor. We propose a combination of techniques (structural studies of tissue, confocal microscopy, electrophysiology and calcium dye imaging) with a goal of understanding calcium metabolism and signal

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transmission through tissue. At the conclusion of this project we will have an improved understanding of the functional unit of the human pregnant uterus, which will provide the basis for education, research, and application of basic science knowledge to clinical medicine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTIONAL HETEROGENEITY OF PULMONARY ARTERIES AND VEINS Principal Investigator & Institution: Raj, Usha; Professor of Pediatrics; Harbor-Ucla Research & Educ Inst 1124 W Carson St Torrance, Ca 90502 Timing: Fiscal Year 2003; Project Start 22-SEP-2003; Project End 31-JUL-2007 Summary: (provided by applicant): In the pulmonary circulation, arteries and veins demonstrate structural and functional heterogeneity, at the tissue, cellular and molecular level. We have reported that in the perinatal period (during fetal life and in the immediate newborn period) both pulmonary arteries and veins are very vasoactive and that veins contribute significantly to total pulmonary vascular resistance. In utero, the entire vascular tree is exposed to the low oxygen tension of fetal blood. However, immediately after birth, veins are exposed to oxygenated blood whereas the arteries continue to be exposed to de-oxygenated blood. We therefore hypothesize that the observed heterogeneity in functional behavior of pulmonary arteries and veins in the postnatal period may in part be explained by differential effects induced by oxygen exposure in pulmonary arteries and veins. Our specific aims are based on our preliminary data which demonstrate that exposure to oxygen augments cGMPdependent protein kinase (PKG)-mediated vasodilation in pulmonary veins but NOT in arteries. Based on this observation, our main hypothesis is that the amount and type(s) of reactive species that are generated in pulmonary arterial versus venous SMC in response to changes in oxygen tension are different, resulting in different cell signaling events and responses in arteries and veins. We believe that the mechanisms behind our observation that there is heterogeneity in oxygen effects on cGMP-mediated relaxation in pulmonary arteries and veins might provide a common explanation for heterogeneous responses in pulmonary arteries and veins. In this proposal, we will determine the role of reactive oxygen species in the heterogeneous behavior of pulmonary arteries and veins. We will determine the type(s), amount and site(s) of production of reactive oxygen and nitrogen species in pulmonary artery and vein smooth muscle and determine the effect of these reactive species on PKG protein amount, activity and PKG-dependent relaxation responses in pulmonary arteries and veins. We will also determine the role of reactive oxygen species on PKG gene expression in pulmonary artery and vein smooth muscle. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INDICATIONS AND OUTCOME OF REPEAT C SECTION AT HARBOR-UCLA, 1987-1990 Principal Investigator & Institution: Nelson, Anita; Harbor-Ucla Research & Educ Inst 1124 W Carson St Torrance, Ca 90502 Timing: Fiscal Year 2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MATERNAL ANESTHESIA AND FETAL CEREBRAL OXYGENATION Principal Investigator & Institution: Reynolds, James D.; Anesthesiology; Duke University Durham, Nc 27706 Timing: Fiscal Year 2002; Project Start 15-DEC-2001; Project End 30-NOV-2003 Summary: The goal of this exploratory/developmental grant is to use novel technology to determine and differentiate the effects of maternal general anesthesia to those of regional anesthesia on fetal cerebral oxygenation. Maintaining an adequate supply of oxygen and nutrients to the fetal brain is of primary importance during manipulations of the gravid female. Prevailing medical practice encourages the use of general anesthesia for such procedures as non-obstetric related surgery and emergent cesarean section. However, relatively little is known about the effects of inhalational agents (e.g. isoflurane) upon fetal cerebral oxygen status. By extension, one could propose that regional techniques (e.g. epidermal anesthesia) might have reduced fetal effects because of the localization of anesthetic to the maternal CNS. However, this benefit could be counter-acted by the maternal hypotension and with respect to fetal effects, is the impracticability of measuring oxygen levels. To that end, we are developing a means (near infrared spectroscopy; NIRS) of continually measuring in utero fetal cerebral oxygenation in pregnant sheep. An NIRS device was designed specifically for in utero animal experimentation. Currently, we have validated our NIRS methodology by measuring changes in fetal sheep cerebral oxygenation in response to systemic decreases in oxygen levels produced by umbilical cord occlusion. With the present proposal, we plan to further optimize our technology by applying it to answer a clinically-relevant question: Does maternal anesthesia alter fetal cerebral oxygenation? Completion of this study will yield new information regarding the effects of maternal anesthesia on fetal cerebral oxygenation and well-being. In addition, this research will produce clinically relevant data that will be of significant interest to anesthesiologists, obstetricians, and general surgeons who are presented parturients with fetal or abdominal distress. It is expected that the results of these studies will be used to further develop and refine standards of care for anesthetic use during pregnancy. These results will also validate our NIRS methodology, and will allow us to refine-optimize the technology and to develop the appropriate analysis tools to quantitatively evaluate the resultant NIRS data. Finally, the results will serve as the basis for a long-term outcome study designed to identify the optimal anesthetic parameters to be used during an episode of fetal distress, maternal surgery, and eventually fetal surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MATERNAL HYPOTENSION & EPIDURAL ANESTHESIA FOR CSECTION Principal Investigator & Institution: Fiedler, Michael A.; None; University of Tennessee Health Sci Ctr Memphis, Tn 38163 Timing: Fiscal Year 2002; Project Start 01-APR-2002 Summary: Data on central hemodynamics of pregnant women during regional anesthesia is lacking. The purpose of this study is to determine the 1) influence of heart rate (HR), stroke volume (SV), systemic vascular resistance (SVR) and IV fluid administration on maternal hypotension after epidural anesthesia and 2) the pattern of these variables throughout C-section. Despite preventative measures, hypotension during regional anesthesia for cesarean section is common. Maternal hypotension poses a risk to fetal oxygenation, causes maternal nausea and vomiting, and poses maternal danger when extreme. Intravenous fluid is most often used to prevent hypotension, but

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an optimal volume of fluid has not been found and the incidence of hypotension varies widely. Fluid alone at best reduces the incidence of hypotension at 38%. An underlying practice assumption is that regional anesthesia, which results in a chemical sympathectomy, causes hypotension by reducing venous return and does not significantly reduce widely. Fluid alone at best reduces the incidence of hypotension at 38%. An underlying practice assumption is that regional anesthesia, which results in a chemical sympathectomy, causes hypotension by reducing venous return and does not significantly reduce SVR. This view is based on an average 15% (range up to 40%) reduction in SVR in non-pregnant persons. But there is evidence that SVR is reduced more in pregnant than non-pregnant women during regional anesthesia. If SVR is reduced sufficiently, fluid alone will not increase cardiac output enough to prevent hypotension. In this case, addressing SVR should result in superior prevention of hypotension. Determining which variables have a significant influence on the pattern of hypotension over time is necessary to direct future interventional studies. Elimination of maternal hypotension will reduce the risk of fetal hypoxemia, maternal discomfort, and maternal morbidity while improving maternal enjoyment of the birth experience. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MENTORED PATIENT ORIENTED CAREER DEVELOPMENT AWARD Principal Investigator & Institution: Nicholson, James; Family Practice and Cmty Med; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 17-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): This application for a Mentored Patient-Oriented Research Career Development Award (K23 Award) seeks support to develop a program of research related to an alternative method of care for the treatment of pregnancy at term [l]. Called AMOR-IPAT: the Active Management of Risk in PreEnancy at Term, this method of care is focused on improving obstetrical outcomes by: 1) identifying risk factors for untoward obstetrical outcomes; 2) preventing the development of clinical disease by insuring, through induction if necessary, that labor and delivery occur at a calculateable optimum time for mother and fetus, and; 3) using prostaglandin products in all inductions complicated by an unfavorable cervix. This application proposes a prospective randomized controlled trial, adequately powered to identify an eight percentage point drop in cesarean section rates, to measure the impact of AMOR-IPAT on population cesarean section rates. Secondary outcomes will include rates of neonatal intensive care unit admission, low one-minute APGAR score and major maternal perineal trauma, as well as patient satisfaction and cost-effectiveness. It is anticipated, based on previous retrospective research, that, in this project, AMOR-IPAT exposure will be associated with a significant reduction in cesarean section rate, and either no change, or improvement, in other important birth outcomes. The educational component of this application, culminating in a Ph.D. in Clinical Epidemiology, will raise the candidate s capacity to design, implement, evaluate and disseminate interventions in the field of primary care obstetrics to the level of an expert. This program will integrate, through both the Prospective AMOR-IPAT Research Trial and the development of the candidate himself, the principles of preventive medicine, family practice, and clinical epidemiology with the modem obstetrical management of pregnancy at term. As such, this Mentored Patient-Oriented Research Career Development Award application provides a unique opportunity to both assist the candidate in becoming an expert independent interventional researcher and promote a new promising area of obstetrical research.

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

Project Title: MOLECULAR INCONTINENCE

MECHANISM

FEMALE

STRESS

URINARY

Principal Investigator & Institution: Lue, Tom F.; Professor of Urology; Urology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 01-DEC-1996; Project End 30-NOV-2002 Summary: (Adapted from the Applicant's Abstract): In the past 1 and 1/2 years, supported by grant 1 R55DK51374, we have modified and tested the feasibility of developing a reproducible rat model to study female stress urinary incontinence. We have studied the effect of pregnancy and delivery on the ultrastructure and function of the continence mechanism. We also modified our model by using pregnant rats and placed a intravaginal balloon under traction to direct the force to the levators and perineum to simulate the human situation. The information we have gained strongly support our opinion that the continence mechanism in the rats is similar to that of humans. We therefore propose to study the molecular mechanism involved in the pathogenesis of female stress urinary incontinence. We hypothesize that birth trauma, hormonal deficiency (menopause) and old age affect the gene and protein expression of several growth factors (IGF system, FGF, NGF, TGF, PDGF) and receptors (adrenergic, muscarinic and estrogen) which in turn change the structure and function of the continence mechanism. The hypothesis will be tested by completing the following specific aims: 1. To study and compare the functional, ultrastructural, cellular and molecular changes of the continence mechanism a). during pregnancy and after spontaneous delivery, b) after oxytocin-induced delivery and c) after delivery by cesarean section. 2. To examine the functional, ultrastructural, cellular and molecular changes of the continence mechanism after repeated birth trauma. 3. To examine the functional, ultrastructural, cellular and molecular changes of the continence mechanism after simulated birth trauma and bilateral ovariectomy. 4. To determine the functional, ultrastructural, cellular and molecular changes of the continence mechanism after combined simulated birth trauma, ovariectomy and aging. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MULTICENTER TRIAL OF FETAL MYELOMENINGOCELE REPAIR Principal Investigator & Institution: Adzick, N. Scott.; Surgeon-In-Chief; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 15-MAR-2002; Project End 28-FEB-2007 Summary: (provided by applicant): Since 1997, 180 fetuses have had in utero closure of myelomeningocele (MMC) by open fetal surgery. Preliminary clinical evidence suggests that this procedure reduces the incidence of shunt-dependent hydrocephalus and restores the cerebellum and brainstem to more normal configuration. However, clinical results of fetal surgery for MMC are based on comparisons with historical controls and examine only efficacy and not safety. The Myelomeningocele Repair Randomized Trial is a multi-center unblinded randomized clinical trial of 200 patients that will be conducted at three Fetal Surgery Units (FSUs), the University of California-San Francisco, Children s Hospital of Philadelphia, and Vanderbilt University Medical Center, along with an independent Data and Study Coordinating Center (DSCC), the George Washington University Biostatistics Center. The primary objective of the trial is to determine if intrauterine repair of fetal myelomeningocele at 18 to 25 weeks gestation improves outcome, as measured by (1) death or the need for ventricular decompressive

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shunting by one year of life and (2) death or Bayley Mental Development Index, as compared to standard postnatal repair. Consenting patients who satisfy eligibility criteria will be centrally randomized to either intrauterine or standard postnatal repair of the MMC. Patients assigned to the fetal surgery group will be discharged to nearby accommodation following surgery, unless unfeasible, in which case they will return to their assigned FSU at 32 weeks gestation for delivery at 37 weeks gestation by cesarean section. Patients assigned to the postnatal surgery group will return home and at 37 weeks, return to their assigned FSU for delivery by cesarean section. Magnetic resonance imaging will be conducted at enrollment, discharge or term gestation, and one year of age to determine if intrauterine repair improves the degree of the Chiari II malformation. Neonatal morbidity will be recorded as will the number of surgical procedures for conditions related to the MMC, muscle strength, ambulation status and urinary and fecal continence. Infants will make follow-up visits at twelve and thirty months corrected age for detailed neuromotor function analysis, cognitive testing and evaluation of neurodevelopmental status. In addition, the long term psychosocial and reproductive consequences in mothers will be evaluated. In summary, the proposed trial is expected to demonstrate whether fetal intervention offers improved outcome with a reasonable quality of life for spina bifida children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: POPULATION STUDY OF PREGNANCY AND PELVIC FLOOR DISORDERS Principal Investigator & Institution: Luber, Karl M.; Director, Section of Urogynecology; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 946123433 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2005 Summary: The prevalence, natural history and risk factors for female pelvic floor disorders (PFD) are poorly understood. These disorders, which include urinary incontinence, anal incontinence and pelvic organ prolapse, have a profound effect upon women's lives and impact a large percentage of the adult female population in the United States. Despite years of research, the fundamental question of the effects of pregnancy versus parity versus aging alone on the development of these disorders remains unanswered. The primary aims of this study are to (1) to determine whether the effects of pregnancy, vaginal delivery or aging act as independent risk factors for the development of PFD, (2) to establish the prevalence of individual PFDs across a full age spectrum of a multi-ethnic population, and, (3) to validate and implement a multifaceted questionnaire for large population screening that includes information related to urinary incontinence (stress and urge), anal incontinence, and prolapse symptomatology. In order to control for potential confounders, race/ethnicity, socioeconomic status, physical activities, smoking, menopause, hormone use, and comorbid medical conditions will be measured and their relative contributions to PFD will be evaluated. The association between prolapse symptoms and incontinence symptoms will also be examined. Validation of a questionnaire to evaluate PFD will be done with female patients recruited from the Gynecology and Female Pelvic Medicine clinics in Kaiser Permanente's San Diego Service Area. The subjects for the population-based study will be drawn from approximately one million female members of Kaiser Foundation Health Plan that reside in the Southern California region who are between the ages of 25 and 84 years. For the population-based study, women will be invited to complete a self-administered, mailed questionnaire after receiving an introductory letter in the mail explaining the study. Responses from the questionnaire will be analyzed to ascertain the impact of age, pregnancy, and vaginal birth on PFD. It remains unknown

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whether vaginal delivery increases the risk of PFD independent of other risk factors, specifically pregnancy and aging. To answer these questions, large population based studies on the prevalence of these disorders among women of all ages and various reproductive histories, specifically nulliparas, those delivered by elective cesarean section alone and those with a history of vaginal delivery, are needed. The answer to these questions will direct future research in both treatment and prevention of PFDs, and enable physicians to counsel their patients on the risk of vaginal delivery as it relates to PFD particularly for women with a history of cesarean section delivery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRE-CLINICAL TRIALS FOR FEMALE FERTILITY PRESERVATION Principal Investigator & Institution: Tilly, Jonathan L.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114

Associate

Professor;

Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2008 Summary: (provided by applicant): Early ovarian failure and infertility are well-known side effects of anti-cancer treatments. While the need for tumor eradication is clear, the long-term consequences of these treatments on non-target tissues, such as the ovaries, are substantial. Unfortunately, attempts to preserve fertility and ovarian function in female cancer patients have met with little success. In studies with mice, we have shown that sphingosine-1- phosphate (S1P), a metabolite of the pro-apoptotic stress sensor ceramide, completely protects the ovaries from radiation-induced damage in vivo. Long-term in vivo mating trials have further shown that S1P preserves a normal level of fertility in irradiated female mice, and that offspring conceived with oocytes protected from radiation by S1P in vivo show no evidence of transgenerational genomic damage. With the use of a human ovarian-mouse xenograft model, we have also shown that injecting S1P directly into ovarian tissue can prevent radiation-induced loss of human primordial and primary follicles in vivo. Although these findings support that S1Pbased strategies could be developed to combat infertility and ovarian failure, two major points still need to be addressed. The first is to establish the safety and efficacy of S1P for preserving ovarian function and fertility in non-human primates exposed to anticancer treatments. The second is to validate technologies to deliver S1P only to the ovaries, thereby preventing systemic availability of S1P that could benefit the tumor cells targeted for destruction. To accomplish these goals, the following Specific Aims are proposed: (1) to determine if S1P can be administered directly into the rhesus monkey ovary as a means to protect the gonads from radiotherapy-induced damage in vivo; (2) to evaluate the competency of the oocytes protected from radiotherapy by S1P in the non-human primate ovary for fertilization and embryogenesis; and (3) to assess if offspring conceived from non-human primate oocytes protected from radiotherapy by S1P in vivo show evidence of propagated genomic damage. The goal of our work is to develop safe and effective strategies for protecting human ovaries in vivo from the sideeffect damage caused by anti-cancer therapies. We believe that the published and preliminary data discussed herein strongly support the need for now evaluating the efficacy of, as well as the delivery mechanisms for, S1P in this regard using the nonhuman primate as a model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREDICTING LABOR OUTCOMES IN WOMEN ATTEMPTING VBAC Principal Investigator & Institution: Macones, George A.; Associate Professor; Obstetrics and Gynecology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104

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Timing: Fiscal Year 2002; Project Start 03-JUL-2001; Project End 31-MAR-2005 Summary: Hypothesis: It is well established that rates of major maternal morbidity are highest among women who undergo an attempt at a vaginal birth after a prior c-section (i.e., VBAC, but "fail" that attempt and are delivered by cesarean. Because of this, several investigators have developed scoring systems to predict the labor outcome of women who are attempting a VBAC. Because of both inadequate test characteristics as well as clinical issues with these scoring systems, they have not gained acceptance in the general obstetrical community. A novel test, the fetal-pelvic index (i.e., FPI which combines ultrasound measures of the fetus with x-ray measurements of the maternal pelvis), has been tested in small studies in various groups of women at high-risk for cesarean (including those attempting a VBAC), and appears to have both high sensitivity and specificity. Specific Aims: This proposal has 2 specific aims: 1) To assess the sensitivity and specificity of the fetal-pelvic index (which combines x-ray measures of the pelvis with ultrasound measurements of the fetus) for the success/failure of a trial of labor among those attempting VBAC, and 2) To develop a clinical predictive index to define groups of patients at high risk for a failed trial of labor among women attempting a VBAC. This predictive index could include radiological studies (i.e., the fetal-pelvic index), clinical factors, and historical factors. This clinical predictive index will help clinicians decide whether or not to offer a patient with a prior cesarean section an attempt at a vaginal delivery, based on the risk of a failed attempt at a vaginal delivery to that patient. Validation of the prediction rule will be done internally, using a bootstrapping approach. Methods: We propose a 4-year prospective study to meet the aims of this study. We will enroll pregnant women who have had a prior cesarean and a re planning on a VBAC attempt between 36 and 42 weeks gestation. Patients will be enrolled as outpatients at 2 hospitals-the Hospital of the University of Pennsylvania and Pennsylvania Hospital. Procedures at the time of enrollment will include an in-person interview, review of the prenatal record from the current pregnancy, review of the medical records from all previous deliveries, as well as an ultrasound examination to obtain measurements for the calculation of the FPI. The patient will have the remainder of her care at the discretion of her physicians. Enrolled subjects will have x-ray pelvimetry performed after delivery, but while in the hospital, and these measures will be combined with the ultrasound-based fetal measurements to calculate the FPI. We have chosen to perform the x-ray pelvimetry after delivery (and calculate the FPI posthoc) because of safety concerns with direct pelvic radiation during pregnancy. Our analysis will consist of descriptive and bivariate analysis, as well as the development of a multivariable clinical predictive index. This index will predict the likelihood of cesarean for any indication in those attempting a VBAC, and could include historical or clinical predictors, as well as the FPI. If the predictive index has high sensitivity and specificity, its implementation could increase the number of women attempting VBAC, reduce the number of failed VBAC attempts, and reduce the total cesarean section rate in this group of women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREGNANCY OUTCOME AFTER TREATMENT OF CERVICAL DYSPLASIA Principal Investigator & Institution: Sadler, Lynn C.; University of Auckland Private Bag 92019 Auckland, Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: (Adapted from the Investigator's Abstract) The proposed research will investigate pregnancy outcome after treatment of cervical dysplasia. Cervical dysplasia

22

Cesarean Section

is a precancerous condition that can be effectively treated to prevent cancer of the uterine cervix. Incidence of cervical dysplasia peaks in women ages 25-35. Those with low-grade lesions are often not treated. The most common conservative treatment procedures are large-loop excision of the transformation zone (LLETZ), carbon dioxide laser conization, and carbon dioxide laser vaporization. There is presently insufficient evidence concerning the potential effect of these procedures on subsequent pregnancy outcome. The proposed research will investigate whether: 1) treatment of cervical dysplasia is associated with increased risk of preterm delivery in subsequent pregnancies; 2) whether treatment of cervical dysplasia is associated with specific subcategories of preterm delivery; 3) whether treatment of cervical dysplasia is associated with infertility, low birthweight, prelabor rupture of membranes at term, duration of labor and cesarean section rate; and 4) whether severity of dysplasia, length of cone, number of cervical treatments and interval between treatment and birth among treated women are related to adverse pregnancy outcome. The proposed research study has a retrospective cohort design. The cohort will consist of all women less than 45 years of age seen at the Colposcopy Clinic of Greenlane Hospital in Auckland, New Zealand, from 1989 through June 1998 who subsequently carried a singleton pregnancy beyond 20 weeks gestation. The cohort will be identified by linkage of the colposcopy and obstetric databases by means of a unique patient identification number. Outcome of the first >/= 20 week pregnancy following diagnosis will be compared for 535 treated women and 535 women not requiring treatment, using multiple logistic and linear regression models to control for confounding. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREVENTION OF HSV MORBIDITY IN PREGANCY & NEWBORN Principal Investigator & Institution: Wald, Anna; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008 Summary: New data indicate HSV seronegative women have the high estrisk of HSV transmission to the neonate and viral shedding at delivery has a (R.R. >300) for HSV transmission suggesting that interventions should be directed at: 1) the pregnant woman who acquires genital HSV near term and 2) the HSV-2 sero positive woman who reactivates HSV at the time of delivery,who while less likely to transmit, may have morbidity associated with abdominal delivery. SpecificAim 1 evaluates the acceptance of type specific HSV serologic testing in pregnancy and its effect on sexual behavior at the end of pregnancy. Two clinical trials are proposed: a randomized clinical trial of antenatal versus post-partum testing for HSV type-specific antibodies and a trial to evaluate the effect of HSV serologic testing of pregnant women alone vs. pregnant women and their partnerson sexual behavior in 3rd trimester of pregnancy. Hypothesis: women identified as susceptible Ito HSV-1 or HSV-2 will have reduced unprotected coital and unprotected oral-genital activity; knowledge of partners status will lead to further decrease in risky sexual activity. Specific Aim 2 will define the efficacy of short course acyclovir therapy in prevention of viral shedding at delivery among HSV-2 seropositive women. Specific Aim 3 is aimed at development, testing and field implementation of a rapid PCR assay to detect Igenital HSV shedding in women at delivery. Hypothesis:Testing for HSV DNA in genital secretions in labor is an accurate method for identifying women at risk for transmission of herpes to the neonate. Specific Aim 4 will use the results of the proposed studies to perform a decision, cost effectiveness, and utility analyses of various approaches to prevention of neonatal herpes. The strategies for evaluation will include serologici testing, cesarean deliveries,

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23

acyclovir treatment and rapid HSV DNA PCR; outcomes will include neonatal herpes, maternal morbidity from cesarean section, and women's preferences. The results from these studies will allow for development of recommendations to decrease the incidence of neonatal herpes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREVENTION OF HSV MORBIDITY IN PREGNANCY AND NEWBORN Principal Investigator & Institution: Brown, Zane A.; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2002 Summary: The rising seroprevalence of HSV-2 infection in the United States combined with the shift in the age of acquisition of HSV-1 from childhood to early adulthood has resulted in a continuing increase in neonatal HSV infections. Despite a remarkable increase in the rate of cesarean sections among mothers with recurrent genital herpes, neonatal herpes occurs in 1 in early 2,000 live births at our institution. Much of this dichotomy appears due to the fact that the vast majority of cases of neonatal herpes are associated with the acquisition of HSV at or near the time of delivery. HSV seroconversion which is completed by the time of labor does not appear to be associated with an increase in adverse pregnancy outcome nor does exposure of the infants to HSV-2 from an HSV-2 seropositive mother. This delineation of the morbidity of HSV to the late pairs of pregnancy allows one to develop strategies to 1) reduce the acquisition of HSV among susceptible women, and 2) reduce the morbidity of excess cesarean sections among women who are HSV-2 seropositive. The specific aims of this project are to 1) define the virological and obstetrical factors associated with perinatal maternalfetal transmission of HSV, 2) to initiate phase I/II studies among serologically discordant couples to reduce the frequency of acquiring HSV during the third trimester of pregnancy. 3) to define strategies to reduce the frequency of caesarean section among women with symptomatic recurrent genital herpes at the time of labor. Studies to further define the association between viral load is measured by quantitative PCR and role of type specific (HSV-2) versus heterologous (HSV-1) antibodies in decreasing the transmission of HSV-2 to the neonate will be conducted. To reduce seroconversion in the late third trimester, a randomized controlled trial to compare counseling, versus counseling plus treatment of the male HSV-2 seropositive acyclovir administered from 36 weeks to the onset of labor among women with a history of symptomatic recurrent genital herpes to reduce the frequency of cesarean section and to assess the role suppressive acyclovir has on reducing subclinical reactivation of HSV as detected by PCR. These studies are directed at initiating attempts to reduce the transmission of neonatal herpes and reduce the morbidity of standard medical obstetrical care worldwide. The program involves a collaboration between the University of Washington, the University of British Columbia and Madigan Army Hospital. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: REGULAR PREECLAMPSIA

EXERCISE

AMONG

WOMEN

AT

RISK

FOR

Principal Investigator & Institution: Yeo, Seonae; None; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 30-APR-2006

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Cesarean Section

Summary: (Applicant's abstract): Preeclampsia, the sudden onset of high blood pressure along with proteinuria during pregnancy, is a serious complication affecting nearly one in every 20 pregnancies. It is the main cause of maternal death worldwide, and affects women of all races and socioeconomic groups. Unfortunately, no definitive preventive treatment is currently available for this ominous disease. Scientists now believe that preeclampsia is a disease of the endothelium, due in part to oxidative stress. As such, regular exercise has emerged as a potential preventive measure. This contrasts to daily low dose aspirin or calcium supplement which have failed to demonstrate a significant effect and may have adverse effects. The purpose of this study is to determine if moderate intensity exercise during pregnancy will reduce the incidence of preeclampsia and to assess the process (involving oxidative stress and antioxidant process) hypothesized to explain the effect of exercise on preeclampsia. This is a randomized clinical trial with a total of 250 pregnant subjects at risk for preeclampsia. Eligible subjects will enter a run-in period (i.e., qualifying period) at 14 to 18 weeks gestation. Baseline data to be obtained include demographic information, health history, daily physical activities, cardiovascular fitness level, blood pressure, blood sample for serum iron, transferrin, low density lipoprotein, malondialdehyde, superoxide dismutase. At 18 weeks, compliant subjects will be randomly assigned to either the exercise (40 min., 70 percent VO2max, 5x/week) or sham exercise (control group; 10 min. stretch exercise, 5x/week) condition. For both groups, all baseline measurements will be repeated at 28 weeks (Outcome I). Subjects will continue the exercise regimen after 28 weeks up to her term and as long as it is safe and comfortable. A blood sample will be collected again during labor (Outcome II). Subjects who undergo cesarean section for obstetrical reasons will provide a small amount of subcutaneous tissue at the time of incision to measure endothelial superoxide dismutase. Medical records will be reviewed for additional outcome data (pregnancy/birth outcomes and diagnosis of preeclampsia). Chi-square tests of association and logistic regression analysis will be applied to address the effect of exercise, prediction of preeclampsia, and other pregnancy outcomes. Repeated Measures ANOVA will be applied to assess the effect of exercise on various biological markers. ANCOVA will be applied to control confounding factors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATORY ROLE OF CALCITONIN GENE RELATED PEPTIDE Principal Investigator & Institution: Chan, Kenneth K.; Harbor-Ucla Research & Educ Inst 1124 W Carson St Torrance, Ca 90502 Timing: Fiscal Year 2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: SPIRAL ELECTRODE SENSOR FOR INTRAPARTUM FETAL OXIMETRY Principal Investigator & Institution: Pologe, Jonas A.; Kestrel Labs, Inc. 515 Hartford Dr Boulder, Co 80305 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 30-JUN-2004 Summary: (provided by applicant): Fetal heart rate monitoring is intended to detect signs of fetal distress due to oxygen starvation of the fetus. Unfortunately these methods of fetal monitoring are subject to a high incidence of false positives, resulting in more than 200,000 unnecessary cesarean section deliveries in the U.S. each year with an associated cost of over $1 billion per year. Clinicians have long recognized that direct

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measurement of fetal oxygen status would provide a more definitive indication of fetal well being. Other methods of fetal surveillance only provide secondary indications of fetal hypoxia. Direct and continuous measurement of fetal oxygen saturation during labor requires the use of pulse oximetry, the continuous, noninvasive measurement of oxygen saturation in arterial blood. Intrapartum fetal pulse oximetry has only recently been made available as a commercial product, but with severely limited success. In particular, the "Indications for Use" of the only available commercial product state that it "is intended as an adjunct to fetal heart rate monitoring in fetuses with a non-reassuring fetal heart rate pattern. It must be used in conjunction with clinical signs and symptoms." Further, the American Cotlege of Obstetricians and Gynecologists (ACOG) has recently issued a Committee Opinion stating that it cannot endorse the adoption of this new technology in clinical practice and is recommending further clinical trials. Kestrel Labs, Inc. proposes to develop a fetal pulse oximetry sensor for continuous measurement of fetal oxygen status and heart rate from a single, easily-accessible monitoring site located on the fetal scalp. Unlike current sensor technology, which uses a "blind" insertion method, has no means for securing the sensor to the fetus, and requires repositioning nearly 4 times an hour, the Kestrel Labs fetal oximetry sensor will be easy to insert, securely attach to the fetal scalp, and will require no maintenance once placed. This SBIR Phase I effort focuses on determining the optimum optomechanical configuration of this new fetal oximetry sensor. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UTERINE CONTRACTILITY AND CERVICAL RIPENING IN PREGNANCY Principal Investigator & Institution: Garfield, Robert E.; Professor; Obstetrics and Gynecology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2002; Project Start 01-FEB-1999; Project End 31-JAN-2004 Summary: The problems associated with labor during pregnancy are among the most important health issues facing physicians. Understanding the role of the uterus and cervix in labor and developing methods to control their function is essential to solving problems relating to labor. At the moment, only crude, inaccurate and subjective methods are used to assess changes in the uterus and cervix that occur in preparation for or during labor. In the past several years, the applicant and his colleagues have developed noninvasive methods to quantitatively evaluate the uterus and cervix based respectively on recording of uterine electrical signals from the abdominal surface (uterine EMG) and measurement of light- induced cervical collagen fluorescence (LIF) with an optical device (Collascope). The methods are rapid and allow assessment of uterine contractility and cervical ripening. Preliminary studies in rats and humans indicate that uterine and cervical function can be successfully monitored during pregnancy using these approaches and that these techniques might be used in a variety of conditions associated with labor to better define management. This application is for funds to extend the initial studies. Four studies are proposed using abdominal EMB recordings and cervical LIF. A competent team of investigators and staff has been assembled to fulfill the needs and goals of this proposal. The specific hypotheses are that LIF and abdominal EMG recordings can be used to: 1) differentiate between true and false labor; 2) predict the onset of labor; 3) monitor patients during tocolysis or induction of labor. The specific aims are to use EMG activity and LIF to determine if they are helpful to: 1) assess patients in true versus false labor; 2) monitor antepartum patients longitudinally; 3) examine the effectiveness of tocolytics or induction. The

26

Cesarean Section

potential benefits of the proposed instrumentation and methods include reducing the rate of preterm delivery, improving maternal and perinatal outcome, monitoring treatment, decreasing cesarean section rate and improving research methods to understand uterine and cervical function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UTERINE RELAXING FACTORS: MOLECULAR ASPECTS OF ACTION Principal Investigator & Institution: Sanborn, Barbara M.; Professor; Vet Biomedical Sciences; Colorado State University Fort Collins, Co 80523 Timing: Fiscal Year 2003; Project Start 01-MAY-1979; Project End 31-JUL-2008 Summary: (provided by applicant): The long-term objective of this work is to understand the molecular mechanisms by which hormones influence uterine smooth muscle contraction and relaxation. This proposal focuses on defining cellular and subcellular mechanisms involved in crosstalk between major contractant and relaxant signaling pathways in the myometrium, in particular the role of scaffolding proteins and compartmentalization of signaling units in these mechanisms. Aim 1 will determine the mechanism responsible for the decline in myometrial plasma membrane-associated PKA prior to delivery in the pregnant rat and the relationship of this decline to the regulation of uterine contractile activity by cAMP. We will use a combination of muscle strip, cell culture and whole animal models to study basic mechanism and relate biochemical changes to effects on uterine contractile activity. Aim 2 will determine if similar changes in myometrial plasma membrane PKA occur in primate pregnancy in relation to labor. We will examine changes in tissue from both fundus and lower uterine segment in pregnant baboons at different stages in the transition from contractures to contractions and in myometrial tissues from women obtained at the time of cesarean section before or after the onset of labor. Mechanisms of regulation will be explored in vivo and in a pregnant human myometrial cell line. Aim 3 will determine the importance of the association of PKA and PP2B with AKAP79/150 in the control of myometrial PLCbeta3 phosphorylation. We will determine the phosphorylation status of PLCbeta3 in response to PKA activation in cells and tissue under conditions where we know Galpha(q) coupling is affected and will explore mechanisms by which PKA can influence activity and membrane association of itself, PP2B subunits and AKAP79/150 in cell culture and pregnant rat myometrial strip models. Aim 4 will determine how the constituents of OTR and cAMP regulatory pathways and K(Ca) channels are distributed between plasma membrane microdomains and assess whether distribution is affected by contractant or relaxant signals to influence signaling crosstalk. For these studies we will immunoblot, confocal microscopic immunolocalization and patch clamp methodology. Understanding the mechanisms for the changes in the influence of the cAMP pathway and signaling crosstalk balance will enhance understanding of myometrial activity during pregnancy and labor and may lead to design of improved methods for management of uterine contractile activity and the prevention of premature labor. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VBAC: LINKING HOSPITAL AND CLINICAL FACTORS TO OUTCOME Principal Investigator & Institution: Gregory, Kimberly D.; Cedars-Sinai Medical Center Box 48750, 8700 Beverly Blvd Los Angeles, Ca 900481804 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-AUG-2005

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Summary: (provided by applicant): VBAC as a Hospital Quality Indicator: Linking Hospital Organizational and Clinical Factors on L&D to Delivery Outcome. VBAC is a common indicator used to monitor maternal health care quality and hospital performance. There is marked variation in VBAC rates, yet little is known about the specific hospital organizational factors and L&D clinical factors that contribute to this variation. Given recent concern about the relative safety of VBAC it is important to characterize the specific factors associated with safe VBAC rates for both mothers and babies. This project has 4 study aims: 1) To validate and administer a survey instrument designed to identify hospital specific organizational factors and L&D clinical policies associated with utilization of VBAC; 2) To describe the existing variation in hospital specific organizational factors, clinical policies, and case mix; 3) To assess the relationship of hospital specific organizational factors and L&D clinical policies with utilization of VBAC (primary study outcomes: repeat cesarean, attempted VBAC and successful VBAC); 4) To assess the relationship of hospital specific organizational factors and L&D clinical policies with maternal and neonatal outcomes (secondary study outcomes) stratifying by type of delivery for women with a history of prior cesarean delivering in California hospitals during the proposed study year (2003). This is a 2-part study. Primary survey data obtained from structured interviews with L&D nurse managers will elicit information about hospital organizational factors and L&D clinical factors believed to be associated with VBAC outcome. The survey responses will be merged with population based administrative data that includes linked maternal and neonatal hospital discharge data and vital statistics data. Rates for the primary and selected secondary outcomes will be calculated. It is hypothesized that hospital specific organizational and clinical factors vary among hospitals in California, and that these factors are related to VBAC outcomes. These factors will be used to develop models that predict which hospital organizational factors and clinical polices are associated with safe VBAC utilization. By linking hospital organizational factors and clinical polices to patient outcomes, this information could serve as the basis for the development of evidenced-based policy recommendations regarding "best practices" to promote safe VBAC utilization in different hospital settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

3 4

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

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

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Cesarean section versus forceps-assisted vaginal birth: It's time to include pelvic injury in the risk --benefit equation. by Farrell SA.; 2002 Feb 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=99315

•

Choice of antibiotic in nonelective cesarean section. by Hager WD, Rapp RP, Billeter M, Bradley BB.; 1991 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245268

•

Comparison of moxalactam and cefazolin as prophylactic antibiotics during cesarean section. by Rayburn W, Varner M, Galask R, Petzold CR, Piehl E.; 1985 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=176272

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Prospective cost analysis of moxalactam versus clindamycin plus gentamicin for endomyometritis after cesarean section. by Knodel LC, Goldspiel BR, Gibbs RS.; 1988 Jun; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=172295

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

A 40-week-gestational-age, 2.5-kg girl with a prenatally diagnosed giant omphalocele was delivered by elective cesarean section. Author(s): Horwitz JR, Lally KP. Source: Journal of Pediatric Surgery. 1994 December; 29(12): 1636-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7877061&dopt=Abstract

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

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A critical appraisal of cesarean section rates at teaching hospitals in India. Author(s): Kambo I, Bedi N, Dhillon BS, Saxena NC. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 November; 79(2): 151-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12427402&dopt=Abstract

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A randomized controlled study of peritoneal closure at cesarean section. Author(s): Galaal KA, Krolikowski A. Source: Saudi Med J. 2000 August; 21(8): 759-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11423890&dopt=Abstract

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A randomized, controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage. Author(s): Lowder JL, Shackelford DP, Holbert D, Beste TM. Source: American Journal of Obstetrics and Gynecology. 2003 December; 189(6): 1559-62; Discussion 1562. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14710063&dopt=Abstract

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Abdominal circumference: a single measurement versus growth rate in the prediction of intrapartum Cesarean section for fetal distress. Author(s): Williams KP, Nwebube N. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2001 June; 17(6): 493-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11422969&dopt=Abstract

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Abdominal wall endometrioma after cesarean section: a preventable complication. Author(s): Wasfie T, Gomez E, Seon S, Zado B. Source: Int Surg. 2002 July-September; 87(3): 175-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12403094&dopt=Abstract

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Accidental vaginal incision during cesarean section. A report of four cases. Author(s): Gortzak-Uzan L, Walfisch A, Gortzak Y, Katz M, Mazor M, Hallak M. Source: J Reprod Med. 2001 November; 46(11): 1017-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11762146&dopt=Abstract

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Acoustic neuroma in pregnancy: emergency cesarean section and definitive neurosurgery. Author(s): Sharma JB, Pundir P, Sharma A. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2003 March; 80(3): 321-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12628539&dopt=Abstract

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Acute epidural hematoma related to cesarean section in a neonate with Chiari II malformation. Author(s): Akiyama Y, Moritake K, Maruyama N, Takamura M, Yamasaki T. Source: Child's Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery. 2001 April; 17(4-5): 290-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11398952&dopt=Abstract

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Airway ion transport on the first postnatal day in infants delivered vaginally or by elective cesarean section. Author(s): Gaillard EA, Shaw NJ, Wallace HL, Subhedar NV, Southern KW. Source: Pediatric Research. 2003 July; 54(1): 58-63. Epub 2003 April 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12700365&dopt=Abstract

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Ampicillin/sulbactam versus ampicillin alone for cesarean section prophylaxis: a randomized double-blind trial. Author(s): Rijhsinghani A, Savopoulos SE, Walters JK, Huggins G, Hibbs JR. Source: American Journal of Perinatology. 1995 September; 12(5): 322-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8540932&dopt=Abstract

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An ectopic pregnancy embedded in the myometrium of a previous cesarean section scar. Author(s): Lai YM, Lee JD, Lee CL, Chen TC, Soong YK. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1995 August; 74(7): 573-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7618461&dopt=Abstract

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Anal sphincter injury during vaginal delivery--an argument for cesarean section on request? Author(s): Faridi A, Willis S, Schelzig P, Siggelkow W, Schumpelick V, Rath W. Source: Journal of Perinatal Medicine. 2002; 30(5): 379-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442601&dopt=Abstract

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Anesthetic management of a parturient undergoing cesarean section with a tracheal tumor and hemoptysis. Author(s): Ng YT, Lau WM, Yu CC, Hsieh JR, Chung PC. Source: Chang Gung Med J. 2003 January; 26(1): 70-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12656313&dopt=Abstract

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Anesthetic management of emergency cesarean section and reoperative mitral valve replacement in a 32-week parturient. Author(s): Tempe DK, Virmani S, Tempe A, Sharma JB, Datt V, Nigam M. Source: Journal of Cardiothoracic and Vascular Anesthesia. 2003 April; 17(2): 281-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698421&dopt=Abstract

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Antibiotic prophylaxis for cesarean section. Author(s): Smaill F, Hofmeyr GJ. Source: Cochrane Database Syst Rev. 2002; (3): Cd000933. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12137614&dopt=Abstract

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Appendectomy at the time of cesarean section. Author(s): Kraus SF, Abell RD, Schipul AH Jr. Source: J Okla State Med Assoc. 2003 September; 96(9): 431-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520930&dopt=Abstract

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Aspiration cytodiagnosis of endometriosis in an abdominal scar after cesarean section. Author(s): Gupta RK, Naran S. Source: Acta Cytol. 1995 May-June; 39(3): 603-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7762362&dopt=Abstract

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Assessment of a newer technique for cesarean section. Author(s): Lurie S, Feinstein M, Mamet Y. Source: Archives of Gynecology and Obstetrics. 2002 August; 266(4): 195-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12192477&dopt=Abstract

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Awake fiberoptic intubation for cesarean section in a parturient with odontoid fracture and atlantoaxial subluxation. Author(s): Wong SY, Wong KM, Chao AS, Liang CC, Hsu JC. Source: Chang Gung Med J. 2003 May; 26(5): 352-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934852&dopt=Abstract

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Baby friendly hospital practices: cesarean section is a persistent barrier to early initiation of breastfeeding. Author(s): Rowe-Murray HJ, Fisher JR. Source: Birth (Berkeley, Calif.). 2002 June; 29(2): 124-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12000413&dopt=Abstract

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Bacteroides fragilis arthritis following cesarean section. Author(s): Failla DM, Dalovisio JR. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1995 November; 21(5): 1341-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8589176&dopt=Abstract

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Benefits of cesarean section stapling device understated? Author(s): Martens M. Source: American Journal of Obstetrics and Gynecology. 1992 January; 166(1 Pt 1): 266-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1571049&dopt=Abstract

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Benign pulmonary metastasizing leiomyomatosis in pregnancy: a rare complication after cesarean section. Author(s): Nardo LG, Iyer L, Reginald PW. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 August; 82(8): 770-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12848652&dopt=Abstract

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Beyond the simple economics of cesarean section birthing: women's resistance to social inequality. Author(s): Behague DP. Source: Culture, Medicine and Psychiatry. 2002 December; 26(4): 473-507. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12572770&dopt=Abstract

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Birth weight-specific fetal deaths and neonatal mortality and the rising cesarean section rate. Author(s): Sepkowitz S. Source: J Okla State Med Assoc. 1992 May; 85(5): 236-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1512646&dopt=Abstract

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Bladder stone in a woman after cesarean section: a case report. Author(s): Su CM, Lin HY, Li CC, Chou YH, Huang CH. Source: Kaohsiung J Med Sci. 2003 January; 19(1): 42-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12693726&dopt=Abstract

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Blood loss at time of cesarean section by method of placental removal and exteriorization versus in situ repair of the uterine incision. Author(s): Magann EF, Dodson MK, Allbert JR, McCurdy CM Jr, Martin RW, Morrison JC. Source: Surg Gynecol Obstet. 1993 October; 177(4): 389-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8211584&dopt=Abstract

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Blunt versus sharp expansion of the uterine incision in low-segment transverse cesarean section. Author(s): Rodriguez AI, Porter KB, O'Brien WF. Source: American Journal of Obstetrics and Gynecology. 1994 October; 171(4): 1022-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7943065&dopt=Abstract

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B-Lynch Brace Suturing in primary post-partum hemorrhage during cesarean section. Author(s): Pal M, Biswas AK, Bhattacharya SM. Source: The Journal of Obstetrics and Gynaecology Research. 2003 October; 29(5): 31720. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14641702&dopt=Abstract

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Bolus metoclopramide does not enhance morphine analgesia after cesarean section. Author(s): Driver RP Jr, D'Angelo R, Eisenach JC. Source: Anesthesia and Analgesia. 1996 May; 82(5): 1033-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8610862&dopt=Abstract

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Brachial plexus palsy associated with cesarean section: an in utero injury? Author(s): Gherman RB, Goodwin TM, Ouzounian JG, Miller DA, Paul RH. Source: American Journal of Obstetrics and Gynecology. 1997 November; 177(5): 1162-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9396913&dopt=Abstract

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Breast feeding practices amongst mothers having undergone cesarean section. Author(s): Kapil U, Kaul S, Vohra G, Chaturvedi S. Source: Indian Pediatrics. 1992 February; 29(2): 222-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1592504&dopt=Abstract

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Breast reconstruction using the extended vertical unilateral rectus abdominis myocutaneous flap in a patient who had undergone cesarean section. Author(s): Sakai S. Source: Plastic and Reconstructive Surgery. 1993 August; 92(2): 369-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8337295&dopt=Abstract

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Breastfeeding in babies delivered by cesarean section. Author(s): Mathur GP, Pandey PK, Mathur S, Sharma S, Agnihotri M, Bhalla M, Bhalla JN. Source: Indian Pediatrics. 1993 November; 30(11): 1285-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8039852&dopt=Abstract

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Breech extraction of low-birth-weight second twins: can cesarean section be justified? Author(s): Davison L, Easterling TR, Jackson JC, Benedetti TJ. Source: American Journal of Obstetrics and Gynecology. 1992 February; 166(2): 497-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1536218&dopt=Abstract

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Breech extraction--an alternative method of delivering a deeply engaged head at cesarean section. Author(s): Fong YF, Arulkumaran S. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1997 February; 56(2): 183-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9061396&dopt=Abstract

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Breech presentation and cesarean section in term nulliparous women. Author(s): Leiberman JR, Fraser D, Mazor M, Chaim W, Karplus M, Katz M, Glezerman M. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1995 August; 61(2): 111-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7556830&dopt=Abstract

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Brief history of vaginal birth after cesarean section. Author(s): Cohen B, Atkins M. Source: Clinical Obstetrics and Gynecology. 2001 September; 44(3): 604-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11685884&dopt=Abstract

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Bupivacaine 0.01% and/or epinephrine 0.5 microg/ml improve epidural fentanyl analgesia after cesarean section. Author(s): Cohen S, Lowenwirt I, Pantuck CB, Amar D, Pantuck EJ. Source: Anesthesiology. 1998 December; 89(6): 1354-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9856709&dopt=Abstract

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Cecal dilatation and perforation after cesarean section. Author(s): Noory N, Abbaszadeh E. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2003 April; 81(1): 47-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12676393&dopt=Abstract

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Cefazolin versus cefazolin plus metronidazole for antibiotic prophylaxis at cesarean section. Author(s): Meyer NL, Hosier KV, Scott K, Lipscomb GH. Source: Southern Medical Journal. 2003 October; 96(10): 992-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570343&dopt=Abstract

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Cerebral hemorrhage following spinal anesthesia for cesarean section: a case report. Author(s): Swei SC, Chiu WH, Liang HC, Wu GJ, Huang FY, Lin HY. Source: Acta Anaesthesiol Sin. 1994 December; 32(4): 279-81. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7894927&dopt=Abstract

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Cesarean section by transfundal approach for placenta previa percreta attached to anterior uterine wall in a woman with a previous repeat cesarean section: case report. Author(s): Ogawa M, Sato A, Yasuda K, Shimizu D, Hosoya N, Tanaka T. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2004 January; 83(1): 115-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14678097&dopt=Abstract

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Cesarean section competence, maternity care training, and community need. Author(s): Williamson HA Jr. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1995 March-April; 8(2): 163-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7778485&dopt=Abstract

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Cesarean section for non-medical reasons. Author(s): Penna L, Arulkumaran S. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2003 September; 82(3): 399-409. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14499986&dopt=Abstract

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Cesarean section in a pregnant patient with an anterior mediastinal mass and failed supradiaphragmatic irradiation. Author(s): Martin WJ. Source: Journal of Clinical Anesthesia. 1995 June; 7(4): 312-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7546758&dopt=Abstract

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Cesarean section in a wedged head. Author(s): Khosla AH, Dahiya K, Sangwan K. Source: Indian Journal of Medical Sciences. 2003 May; 57(5): 187-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14514249&dopt=Abstract

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Cesarean section on demand. Author(s): Morrison J, MacKenzie IZ. Source: Semin Perinatol. 2003 February; 27(1): 20-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641300&dopt=Abstract

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Cesarean section rates and perinatal outcomes in resident and midwife attended low risk deliveries. Author(s): Turan C, Kutlay B. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1995 September; 62(1): 3-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7493704&dopt=Abstract

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Changes in the provision of anesthesia for the parturient undergoing cesarean section. Author(s): Gaiser RR. Source: Clinical Obstetrics and Gynecology. 2003 September; 46(3): 646-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972746&dopt=Abstract

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Choosing route of delivery for the macrosomic infant of a diabetic mother: Cesarean section versus vaginal delivery. Author(s): Conway DL. Source: J Matern Fetal Neonatal Med. 2002 December;12(6):442-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12683659&dopt=Abstract

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Classic metaphyseal lesion following external cephalic version and cesarean section. Author(s): Lysack JT, Soboleski D. Source: Pediatric Radiology. 2003 June; 33(6): 422-4. Epub 2003 April 23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709748&dopt=Abstract

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Clear cell carcinoma arising in a cesarean section scar. Report of a case with fine needle aspiration cytology. Author(s): Ishida GM, Motoyama T, Watanabe T, Emura I. Source: Acta Cytol. 2003 November-December; 47(6): 1095-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14674088&dopt=Abstract

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Clinical conference: aprotinin use during deep hypothermic circulatory arrest for type A aortic dissection and cesarean section in a woman with preeclampsia. Author(s): Murphy BA, Zvara DA, Nelson LH, Kon ND, Shore-Lesserson L, Milas BL. Source: Journal of Cardiothoracic and Vascular Anesthesia. 2003 April; 17(2): 252-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698412&dopt=Abstract

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Clinical effects and maternal and fetal plasma concentrations of epidural ropivacaine versus bupivacaine for cesarean section. Author(s): Datta S, Camann W, Bader A, VanderBurgh L. Source: Anesthesiology. 1995 June; 82(6): 1346-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7793647&dopt=Abstract

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Combination of transarterial embolization of uterine arteries and conservative surgical treatment for pregnancy in a cesarean section scar. A report of 3 cases. Author(s): Yang MJ, Jeng MH. Source: J Reprod Med. 2003 March; 48(3): 213-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698784&dopt=Abstract

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Comparison of case-finding methodologies for endometritis after cesarean section. Author(s): Baker C, Luce J, Chenoweth C, Friedman C. Source: American Journal of Infection Control. 1995 February; 23(1): 27-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7762871&dopt=Abstract

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Comparison of neonatal effects of epidural and general anesthesia for cesarean section. Author(s): Sener EB, Guldogus F, Karakaya D, Baris S, Kocamanoglu S, Tur A. Source: Gynecologic and Obstetric Investigation. 2003; 55(1): 41-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12624551&dopt=Abstract

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Continuous vs interrupted sutures for single-layer closure of uterine incision at cesarean section. Author(s): Hohlagschwandtner M, Chalubinski K, Nather A, Husslein P, Joura EA. Source: Archives of Gynecology and Obstetrics. 2003 April; 268(1): 26-8. Epub 2002 May 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12673471&dopt=Abstract

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Declining cesarean section rates: a continuing trend? Author(s): Millar WJ, Nair C, Wadhera S. Source: Health Reports / Statistics Canada, Canadian Centre for Health Information = Rapports Sur La Sante / Statistique Canada, Centre Canadien D'information Sur La Sante. 1996 Summer; 8(1): 17-24 (Eng); 17-24 (Fre). English, French. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8844177&dopt=Abstract

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Decrease in perinatal mortality and increase in cesarean section rates. Author(s): Shehata AI, Hashim TJ. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1995 March; 48(3): 261-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7781867&dopt=Abstract

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Decreasing the cesarean section rate in a private hospital: success without mandated clinical changes. Author(s): Lagrew DC Jr, Morgan MA. Source: American Journal of Obstetrics and Gynecology. 1996 January; 174(1 Pt 1): 18491. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8572004&dopt=Abstract

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Definition and adjustment of Cesarean section rates and assessments of hospital performance. Author(s): Kritchevsky SB, Braun BI, Gross PA, Newcomb CS, Kelleher CA, Simmons BP. Source: International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care / Isqua. 1999 August; 11(4): 283-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10501598&dopt=Abstract

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Delivery after one previous cesarean section. Author(s): Turner MJ. Source: American Journal of Obstetrics and Gynecology. 1997 April; 176(4): 741-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9125596&dopt=Abstract

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Delivery of the macrosomic infant: cesarean section versus vaginal delivery. Author(s): Conway DL. Source: Semin Perinatol. 2002 June; 26(3): 225-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12099313&dopt=Abstract

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Desflurane: a new volatile anesthetic for cesarean section. Maternal and neonatal effects. Author(s): Abboud TK, Zhu J, Richardson M, Peres da Silva E, Donovan M. Source: Acta Anaesthesiologica Scandinavica. 1995 August; 39(6): 723-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7484023&dopt=Abstract

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Desmoid tumor arising in a cesarean section scar during pregnancy: monitoring and management. Author(s): De Cian F, Delay E, Rudigoz RC, Ranchere D, Rivoire M. Source: Gynecologic Oncology. 1999 October; 75(1): 145-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10502442&dopt=Abstract

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Development of jaundice in Korean neonates after cesarean section. Author(s): Lee CS, Vreman HJ, Choi JH, Yun CK, Stevenson DK. Source: Acta Paediatr Jpn. 1997 June; 39(3): 309-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9241890&dopt=Abstract

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Differences in umbilical cord blood units collected during cesarean section, before or after the delivery of the placenta. Author(s): Pafumi C, Farina M, Bandiera S, Cavallaro A, Pernicone G, Russo A, Iemmola A, Chiarenza M, Leonardi I, Calogero AE, Calcagno A, Cianci A. Source: Gynecologic and Obstetric Investigation. 2002; 54(2): 73-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566747&dopt=Abstract

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Differential analgesic effect of tenoxicam on the wound pain and uterine cramping pain after cesarean section. Author(s): Hsu HW, Cheng YJ, Chen LK, Wang YP, Lin CJ, Lee CN, Sun WZ. Source: The Clinical Journal of Pain. 2003 January-February; 19(1): 55-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12514457&dopt=Abstract

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Disappearance of human chorionic gonadotropin after cesarean section with regard to fetal sex. Author(s): Steier JA, Bergsjo PB, Myking OL. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 May; 81(5): 403-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12027812&dopt=Abstract

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Do prophylactic prostaglandins reduce the transfusion rate at cesarean section in high-order multiple pregnancies? Author(s): Bayoumeu F, Baka NE, Fresson J, Monnier-Barbarino P. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003 November 10; 111(1): 38-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14557009&dopt=Abstract

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Does cesarean section decrease the incidence of major birth trauma? Author(s): Puza S, Roth N, Macones GA, Mennuti MT, Morgan MA. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1998 January-February; 18(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9527937&dopt=Abstract

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Does manual removal of the placenta affect operative blood loss during cesarean section? Author(s): Gol M, Baloglu A, Aydin C, Ova L, Yensel U, Karci L. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2004 January 15; 112(1): 57-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14687740&dopt=Abstract

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Dose of prophylactic intravenous ephedrine during spinal anesthesia for cesarean section. Author(s): Simon L, Provenchere S, de Saint Blanquat L, Boulay G, Hamza J. Source: Journal of Clinical Anesthesia. 2001 August; 13(5): 366-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11498318&dopt=Abstract

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Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section. Author(s): Dansereau J, Joshi AK, Helewa ME, Doran TA, Lange IR, Luther ER, Farine D, Schulz ML, Horbay GL, Griffin P, Wassenaar W. Source: American Journal of Obstetrics and Gynecology. 1999 March; 180(3 Pt 1): 670-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10076146&dopt=Abstract

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Double-blind, randomized comparison of the effect of carbetocin and oxytocin on intraoperative blood loss and uterine tone of patients undergoing cesarean section. Author(s): Boucher M, Horbay GL, Griffin P, Deschamps Y, Desjardins C, Schulz M, Wassenaar W. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1998 May-June; 18(3): 202-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9659650&dopt=Abstract

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Droperidol and the side effects of epidural morphine after cesarean section. Author(s): Sanansilp V, Areewatana S, Tonsukchai N. Source: Anesthesia and Analgesia. 1998 March; 86(3): 532-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9495408&dopt=Abstract

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Dysuria due to bladder distortion after repeat cesarean section. Author(s): Jozwik M, Jozwik M, Lotocki W, Mironczuk J. Source: Gynecologic and Obstetric Investigation. 1998; 45(4): 279-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9623798&dopt=Abstract

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Early medical termination pregnancy with methotrexate and misoprostol in lower segment cesarean section cases. Author(s): Gautam R, Agrawal V. Source: The Journal of Obstetrics and Gynaecology Research. 2003 August; 29(4): 251-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959148&dopt=Abstract

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Early oral hydration: a novel regimen for management after elective cesarean section. Author(s): Abd Rabbo S. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 1995 December; 21(6): 563-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8640466&dopt=Abstract

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Effect of early pregnancy on a previous lower segment cesarean section scar. Author(s): Weimin W, Wenqing L. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 June; 77(3): 201-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12065130&dopt=Abstract

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Effect of epidural analgesia on the primary cesarean section and forceps delivery rates. Author(s): Echt M, Begneaud W, Montgomery D. Source: J Reprod Med. 2000 July; 45(7): 557-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10948466&dopt=Abstract

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Effect of labor induction on cesarean section rates in diabetic pregnancies. Author(s): Levy AL, Gonzalez JL, Rappaport VJ, Curet LB, Rayburn WF. Source: J Reprod Med. 2002 November; 47(11): 931-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12497683&dopt=Abstract

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Effects of methylergometrine and oxytocin on thoracic epidural pressure during cesarean section. Author(s): Kikutani T, Shimada Y. Source: The Journal of Obstetrics and Gynaecology Research. 2003 June; 29(3): 180-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841703&dopt=Abstract

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Efficacy and safety of repeated postoperative administration of intramuscular diclofenac sodium in the treatment of post-cesarean section pain: a double-blind study. Author(s): Al-Waili NS. Source: Archives of Medical Research. 2001 March-April; 32(2): 148-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11343813&dopt=Abstract

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Efficacy of intrathecal morphine for analgesia following elective cesarean section: comparison with previous delivery. Author(s): Terajima K, Onodera H, Kobayashi M, Yamanaka H, Ohno T, Konuma S, Ogawa R. Source: Journal of Nippon Medical School = Nihon Ika Daigaku Zasshi. 2003 August; 70(4): 327-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928713&dopt=Abstract

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Elective Cesarean section for breech presentation: a reminder about true lies. Author(s): Parekh C, Patole SK. Source: J Matern Fetal Neonatal Med. 2002 July;12(1):67. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12422913&dopt=Abstract

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Elective cesarean section vs. spontaneous delivery: a comparative study of birth experience. Author(s): Schindl M, Birner P, Reingrabner M, Joura E, Husslein P, Langer M. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 September; 82(9): 834-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911445&dopt=Abstract

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Elective induction of labor in multiparous women. Does it increase the risk of cesarean section? Author(s): Heinberg EM, Wood RA, Chambers RB. Source: J Reprod Med. 2002 May; 47(5): 399-403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12063879&dopt=Abstract

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Endometrioma in a cesarean section scar--a case report. Author(s): Lai CS, Lin TM, Tsai CC, Lin SD, Su JH. Source: Kaohsiung J Med Sci. 2001 June; 17(7): 381-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11593966&dopt=Abstract

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Eosinophil degranulation during pregnancy and after delivery by cesarean section. Author(s): Matsumoto K, Ogasawara T, Kato A, Homma T, Iida M, Akasawa A, Wakiguchi H, Saito H. Source: International Archives of Allergy and Immunology. 2003 June; 131 Suppl 1: 34-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771547&dopt=Abstract

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Epidemic of cesarean section at the general, private and university hospitals in Thailand. Author(s): Chanrachakul B, Herabutya Y, Udomsubpayakul U. Source: The Journal of Obstetrics and Gynaecology Research. 2000 October; 26(5): 35761. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11147723&dopt=Abstract

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Epidemiologic predictors of cesarean section in nulliparous patients at low risk. RADIUS Study Group. Routine Antenatal Diagnostic Imaging with Ultrasound Study. Author(s): Harlow BL, Frigoletto FD, Cramer DW, Evans JK, Bain RP, Ewigman B, McNellis D. Source: American Journal of Obstetrics and Gynecology. 1995 January; 172(1 Pt 1): 15662. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7847528&dopt=Abstract

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Epidural anesthesia for cesarean section in a patient with Romano-Ward syndrome. Author(s): Ganta R, Roberts C, Elwood RJ, Maddineni VR. Source: Anesthesia and Analgesia. 1995 August; 81(2): 425-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7542433&dopt=Abstract

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Etiology and incidence of endotracheal intubation following spinal anesthesia for cesarean section. Author(s): Hagberg C, Ezri T, Abouleish E. Source: Isr Med Assoc J. 2001 September; 3(9): 653-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11574980&dopt=Abstract

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Evaluation of breast stimulation for induction of labor in women with a prior cesarean section and in grandmultiparas. Author(s): Segal S, Gemer O, Zohav E, Siani M, Sassoon E. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1995 January; 74(1): 40-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7856430&dopt=Abstract

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Evaluation of combinations of procedures in cesarean section. Author(s): Stark M, Chavkin Y, Kupfersztain C, Guedj P, Finkel AR. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1995 March; 48(3): 273-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7781869&dopt=Abstract

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Extra-strong graduated compression stocking reduces usage of vasopressor agents during spinal anesthesia for cesarean section. Author(s): Iwama H, Furuta S, Tanigawa S, Ohmizo H, Ohmori S, Kaneko T. Source: Archives of Gynecology and Obstetrics. 2001 May; 265(2): 60-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11409475&dopt=Abstract

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Factors associated with unjustified Cesarean section in four hospitals in Cali, Colombia. Author(s): Gomez OL, Carrasquilla G. Source: International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care / Isqua. 1999 October; 11(5): 385-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10561029&dopt=Abstract

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Factors in intraoperative blood transfusion in cesarean section at Ramathibodi Hospital. Author(s): Suchartwatnachai C, O-Prasertsawat P, Chaturachinda K. Source: J Med Assoc Thai. 1990 February; 73 Suppl 1: 61-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2351916&dopt=Abstract

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Factors influencing the practice of vaginal birth after cesarean section. Author(s): Goldman G, Pineault R, Potvin L, Blais R, Bilodeau H. Source: American Journal of Public Health. 1993 August; 83(8): 1104-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8342717&dopt=Abstract

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Failed vaginal birth after a cesarean section: how risky is it? I. Maternal morbidity. Author(s): Hibbard JU, Ismail MA, Wang Y, Te C, Karrison T, Ismail MA. Source: American Journal of Obstetrics and Gynecology. 2001 June; 184(7): 1365-71; Discussion 1371-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11408854&dopt=Abstract

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Family planning and desire for additional children after cesarean section. Author(s): Maier K, Wacker J, Bastert G. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1993 April; 41(1): 81-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8098300&dopt=Abstract

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Fatal trophoblastic embolism during cesarean section. Author(s): Tews G, Yaman C, Ebner T. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 February; 76(2): 179-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11818116&dopt=Abstract

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Fear of childbirth during pregnancy may increase the risk of emergency cesarean section. Author(s): Ryding EL, Wijma B, Wijma K, Rydhstrom H. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1998 May; 77(5): 542-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9654177&dopt=Abstract

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Feasibility of a randomized controlled trial of planned cesarean section versus planned vaginal delivery for breech presentation at term. Author(s): Hannah ME, Hannah WJ. Source: American Journal of Obstetrics and Gynecology. 1996 April; 174(4): 1393-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8623877&dopt=Abstract

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Fertility in anovulatory patients after primary cesarean section. Author(s): Bider D, Blankstein J, Tur-Kaspa I. Source: J Reprod Med. 1998 October; 43(10): 869-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9800669&dopt=Abstract

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Fetal blood sampling in patients undergoing elective cesarean section: a correlation with cord blood gas values obtained at delivery. Author(s): Khoury AD, Moretti ML, Barton JR, Shaver DC, Sibai BM. Source: American Journal of Obstetrics and Gynecology. 1991 October; 165(4 Pt 1): 10269. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1951507&dopt=Abstract

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Fetal cardiotocography and acid-base status during cesarean section. Author(s): Matorras R, Tacuri C, Nieto A, Pijoan JI, Cortes J. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2000 April; 89(2): 217. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10836853&dopt=Abstract

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Fetal cardiotocography and acid-base status during cesarean section. Author(s): Matorras R, Tacuri C, Nieto A, Pijoan JI, Cortes J. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1998 October; 80(2): 161-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9846661&dopt=Abstract

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Fetal cardiotocography during cesarean section. Author(s): Bernardes J. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2000 December; 93(2): 221-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11203435&dopt=Abstract

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Fetal effects of prophylactic ephedrine and maternal hypotension during regional anesthesia for cesarean section. Author(s): Shearer VE, Ramin SM, Wallace DH, Dax JS, Gilstrap LC 3rd. Source: The Journal of Maternal-Fetal Medicine. 1996 March-April; 5(2): 79-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8796773&dopt=Abstract

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Fetal heart rate monitoring during cesarean section. Author(s): Dunn LK. Source: American Journal of Obstetrics and Gynecology. 1990 July; 163(1 Pt 1): 253. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2375359&dopt=Abstract

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Fetal sex and cesarean section. Author(s): Jakobovits AA. Source: American Journal of Obstetrics and Gynecology. 1997 November; 177(5): 1270-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9396929&dopt=Abstract

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Field perimortem cesarean section. Author(s): Bowers W, Wagner C. Source: Air Medical Journal. 2001 July-August; 20(4): 10-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11438803&dopt=Abstract

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First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Author(s): Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2003 March; 21(3): 220-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666214&dopt=Abstract

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Formal education does not improve the acceptance of cesarean section among pregnant Nigerian women. Author(s): Onah HE. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 March; 76(3): 321-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880141&dopt=Abstract

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Frequency of, indications for and clinical epidemiological characteristics of first time cesarean section, compared with repeated cesarean section. Author(s): Trujillo-Hernandez B, Rios-Silva M, Huerta M, Trujillo X, Vasquez C, MillanGuerrero R. Source: Archives of Gynecology and Obstetrics. 2002 November; 267(1): 27-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12410370&dopt=Abstract

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Ga-67 uptake post cesarean section. Author(s): Lopez OL, Maisano ER. Source: Clinical Nuclear Medicine. 1984 February; 9(2): 103-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6585280&dopt=Abstract

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General anesthesia for cesarean section in a parturient with a single ventricle and pulmonary atresia. Author(s): Zavisca FG, Johnson MD, Holubec JT, Kao YJ, Racz GB. Source: Journal of Clinical Anesthesia. 1993 July-August; 5(4): 315-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8373611&dopt=Abstract

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General anesthesia in cesarean section: effect on mother and neonate. Author(s): Zagorzycki MT. Source: Obstetrical & Gynecological Survey. 1984 March; 39(3): 134-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6371624&dopt=Abstract

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General anesthesia with remifentanil for Cesarean section in a parturient with an acoustic neuroma. Author(s): Bedard JM, Richardson MG, Wissler RN. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1999 June; 46(6): 576-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10391607&dopt=Abstract

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Genital herpes simplex at term necessitating cesarean section. Author(s): Kikuchi I. Source: The Journal of Dermatology. 1986 June; 13(3): 228-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3023467&dopt=Abstract

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Gestational diabetes alters the male bias for cesarean section. Author(s): Knights S, Lucas E, Moses R. Source: Diabetes Care. 2000 March; 23(3): 425-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10868882&dopt=Abstract

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Gestational diabetes: is a higher cesarean section rate inevitable? Author(s): Moses RG, Knights SJ, Lucas EM, Moses M, Russell KG, Coleman KJ, Davis WS. Source: Diabetes Care. 2000 January; 23(1): 15-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10857961&dopt=Abstract

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Goal oriented general anesthesia for Cesarean section in a parturient with a large intracranial epidermoid cyst. Author(s): Imarengiaye C, Littleford J, Davies S, Thapar K, Kingdom J. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2001 October; 48(9): 884-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11606346&dopt=Abstract

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Gonococcal endocarditis during pregnancy: simultaneous cesarean section and aortic valve surgery. Author(s): Burstein H, Sampson MB, Kohler JP, Levitsky S. Source: Obstetrics and Gynecology. 1985 September; 66(3 Suppl): 48S-51S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3895084&dopt=Abstract

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Granisetron/dexamethasone combination for reducing nausea and vomiting during and after spinal anesthesia for cesarean section. Author(s): Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Source: Anesthesia and Analgesia. 1999 June; 88(6): 1346-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10357343&dopt=Abstract

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Gravid uterine rupture following cesarean section and intervening vaginal delivery. Author(s): Udo-Inyang A, Lee C, Evans E. Source: Henry Ford Hosp Med J. 1986; 34(3): 215-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3804778&dopt=Abstract

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Halothane for supplementation of general anesthesia during cesarean section. Author(s): Baraka A, Siddik S, Assaf B. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1999 January; 46(1): 95-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10078415&dopt=Abstract

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Hand-assisted laparoscopic cholecystectomy at cesarean section. Author(s): Pelosi MA, Pelosi MA 3rd, Villalona E. Source: The Journal of the American Association of Gynecologic Laparoscopists. 1999 November; 6(4): 491-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10548711&dopt=Abstract

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Health maintenance organizations, independent practice associations, and cesarean section rates. Author(s): Tussing AD, Wojtowycz MA. Source: Health Services Research. 1994 April; 29(1): 75-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8163381&dopt=Abstract

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Heart rate variability changes in association with ST segment depression during cesarean section under regional anesthesia. Author(s): Hogue CW Jr, Stein PK. Source: Anesthesia and Analgesia. 1994 October; 79(4): 812-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7943806&dopt=Abstract

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Hematometra of the rudimentary horn of a unicornuate uterus resulting from cesarean section. Author(s): Chang CY, Chang SY, Changchien CC, Lui CC, Huang HW. Source: American Journal of Obstetrics and Gynecology. 2001 November; 185(5): 1263-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11717669&dopt=Abstract

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Hemodynamic adaptations at birth and neonates delivered vaginally and by Cesarean section. Author(s): Agata Y, Hiraishi S, Misawa H, Han JH, Oguchi K, Horiguchi Y, Fujino N, Takeda N, Padbury JF. Source: Biology of the Neonate. 1995; 68(6): 404-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8721884&dopt=Abstract

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Hemodynamic deterioration after cardiopulmonary bypass during pregnancy: resuscitation by postoperative emergency Cesarean section. Author(s): Baraka A, Kawkabani N, Haroun-Bizri S. Source: Journal of Cardiothoracic and Vascular Anesthesia. 2000 June; 14(3): 314-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10890489&dopt=Abstract

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Hemostatic technique for myomectomy during cesarean section. Author(s): Cobellis L, Pecori E, Cobellis G. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 December; 79(3): 261-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12445997&dopt=Abstract

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Heparin-induced thrombocytopenia type II with pulmonary embolism after cesarean section. Author(s): Meyberg R, Ertan AK, Axt R, Villena-Heinsen C, Schmidt W, Friedrich M. Source: Clin Exp Obstet Gynecol. 2000; 27(1): 33-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10758796&dopt=Abstract

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Herpes labialis in parturients receiving epidural morphine following cesarean section. Author(s): Crone LA, Conly JM, Storgard C, Zbitnew A, Cronk SL, Rea LM, Greer K, Berenbaum E, Tan LK, To T. Source: Anesthesiology. 1990 August; 73(2): 208-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2166452&dopt=Abstract

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High cesarean section rates for pregnant medical practitioners in South Africa. Author(s): Lawrie TA, de Jager M, Hofmeyr GJ. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 January; 72(1): 71-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11146080&dopt=Abstract

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High frequency of cesarean section, antepartum hemorrhage, placenta previa, and preterm delivery in in-vitro fertilization twin pregnancies. Author(s): Smithers PR, Halliday J, Hale L, Talbot JM, Breheny S, Healy D. Source: Fertility and Sterility. 2003 September; 80(3): 666-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12969724&dopt=Abstract

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High incidence of emergency cesarean section among fetuses with unrecognized chromosomal abnormalities. Author(s): de la Vega A, Verdiales M. Source: P R Health Sci J. 2001 December; 20(4): 347-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11845666&dopt=Abstract

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High risk of cesarean section among ethnic Filipinos: an effect of the paternal contribution to birthweight? Author(s): Vangen S, Stray-Pedersen B, Skrondal A, Magnus P, Stoltenberg C. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 February; 82(2): 192-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648185&dopt=Abstract

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Higher white blood cell counts and band forms in newborns delivered vaginally compared with those delivered by cesarean section. Author(s): Hasan R, Inoue S, Banerjee A. Source: American Journal of Clinical Pathology. 1993 August; 100(2): 116-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8356942&dopt=Abstract

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Hospital practice more than specialty influences the choice of regional or general anesthesia for Cesarean section. Author(s): Johnson D, Truman C. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 November; 49(9): 954-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12419724&dopt=Abstract

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Hydroxyethylstarch 10% is superior to Ringer's solution for preloading before spinal anesthesia for Cesarean section. Author(s): Siddik SM, Aouad MT, Kai GE, Sfeir MM, Baraka AS. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2000 July; 47(7): 616-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10930199&dopt=Abstract

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Hypermagnesemia-induced cardiopulmonary arrest before induction of anesthesia for emergency cesarean section. Author(s): Morisaki H, Yamamoto S, Morita Y, Kotake Y, Ochiai R, Takeda J. Source: Journal of Clinical Anesthesia. 2000 May; 12(3): 224-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10869923&dopt=Abstract

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Hyperreactio luteinalis: intraoperative finding during a cesarean section in a twin pregnancy. Author(s): Quereda F, Acien P, Hernandez A. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1996 May; 66(1): 71-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8735763&dopt=Abstract

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Hypotension in spinal anesthesia for cesarean section: a comparison of 0.5% hyperbaric bupivacaine and 5% hyperbaric lidocaine. Author(s): Kyokong O, Charuluxananan S, Pothimamaka S, Leerapun R. Source: J Med Assoc Thai. 2001 June; 84 Suppl 1: S256-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11529341&dopt=Abstract

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Impact of antibiotic prophylaxis on wound infection after cesarean section in a situation of expected higher risk. Author(s): Mah MW, Pyper AM, Oni GA, Memish ZA. Source: American Journal of Infection Control. 2001 April; 29(2): 85-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11287874&dopt=Abstract

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Implantation despite an extensive endometrial defect after hysteroscopic resection of symptom-free residual trophoblastic tissue 15 months after cesarean section. Author(s): Foth D, Nawroth F, Isachenko E, Valter M, Mallmann P, Schmidt T. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 November; 9(4): 545-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12386371&dopt=Abstract

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Implantation of a gestational sac in a cesarean section scar. Author(s): Shufaro Y, Nadjari M. Source: Fertility and Sterility. 2001 June; 75(6): 1217. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11384652&dopt=Abstract

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Incidental carcinoid of appendix in cesarean section. Author(s): Gokaslan H, Sismanoglu A, Kaya H, Durmusoglu F. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 August 5; 104(1): 76-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12128269&dopt=Abstract

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Increased cesarean section rates in Turkey. Author(s): Koc I. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 2003 March; 8(1): 1-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725669&dopt=Abstract

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Induction of general anesthesia using propofol for cesarean section of a woman with cerebral palsy. Author(s): Kariya N, Toyoyama H, Furuichi K, Kubota H, Toyoda Y. Source: Journal of Clinical Anesthesia. 1999 December; 11(8): 672-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10680111&dopt=Abstract

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Induction of labor in grand multiparous women and previous cesarean section: is it safe? Author(s): Abu-Heija AT, Ali AM. Source: Gynecologic and Obstetric Investigation. 2002; 53(2): 121-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11961388&dopt=Abstract

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Induction of labor in women with previous cesarean section using the double balloon device. Author(s): Khotaba S, Volfson M, Tarazova L, Odeh M, Barenboym R, Fait V, Ophir E, Oettinger M. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 November; 80(11): 1041-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11703204&dopt=Abstract

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Induction of labor with prostaglandin E2 vaginal tablets in parous and grandmultiparous patients with previous cesarean section. Author(s): Sobande AA, Albar H. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 July; 78(1): 19-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113966&dopt=Abstract

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Infertility treatment is an independent risk factor for cesarean section among nulliparous women aged 40 and above. Author(s): Sheiner E, Shoham-Vardi I, Hershkovitz R, Katz M, Mazor M. Source: American Journal of Obstetrics and Gynecology. 2001 October; 185(4): 888-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11641672&dopt=Abstract

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Inhalation induction of anesthesia with sevoflurane for emergency Cesarean section in an amphetamine-intoxicated parturient without an intravenous access. Author(s): Kuczkowski KM. Source: Acta Anaesthesiologica Scandinavica. 2003 October; 47(9): 1181-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14518499&dopt=Abstract

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Initiation of breastfeeding in cesarean section mothers: antenatal advise versus postnatal assistance. Author(s): Banapurmath CR, Selvamuthukumarasamy A. Source: Indian Pediatrics. 1995 August; 32(8): 902-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8635835&dopt=Abstract

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Intraoperative surgical complication during cesarean section: an observational study of the incidence and risk factors. Author(s): Bergholt T, Stenderup JK, Vedsted-Jakobsen A, Helm P, Lenstrup C. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 March; 82(3): 251-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694122&dopt=Abstract

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Intrapartum management of vaginal birth after cesarean section. Author(s): Kobelin CG. Source: Clinical Obstetrics and Gynecology. 2001 September; 44(3): 588-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11685882&dopt=Abstract

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Intrathecal fentanyl/meperidine combined with low-dose epidural bupivacaine for Cesarean section in a patient with advanced Krukenberg tumors. Author(s): Okutomi T, Hoshino Y, Amano K, Okamoto H, Hoka S. Source: Acta Anaesthesiologica Scandinavica. 2002 November; 46(10): 1272-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12421201&dopt=Abstract

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Intravenous omeprazole before emergency cesarean section. Author(s): Gin T. Source: Anesthesia and Analgesia. 1995 April; 80(4): 848-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7893050&dopt=Abstract

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Inversion of uterus during cesarean section. Author(s): Banerjee N, Deka D, Roy KK, Takkar D. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2000 July; 91(1): 75-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10817883&dopt=Abstract

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Is delivery by cesarean section a risk factor for food allergy? Author(s): Eggesbo M, Botten G, Stigum H, Nafstad P, Magnus P. Source: The Journal of Allergy and Clinical Immunology. 2003 August; 112(2): 420-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897751&dopt=Abstract

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Is high-dose misoprostol able to lower the incidence of cesarean section? A randomized controlled trial. Author(s): de la Torre S, Gilson GJ, Flores S, Curet LB, Qualls CE, Rayburn WF. Source: The Journal of Maternal-Fetal Medicine. 2001 April; 10(2): 85-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11392598&dopt=Abstract

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Is the chance to cut a chance to cure? The cesarean section controversy revisited. Author(s): Anderson JR. Source: Hopkins Hiv Rep. 2001 January; 13(1): 6-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12184256&dopt=Abstract

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Ketamine induction for cesarean section in a patient with acute intermittent porphyria and achondroplastic dwarfism. Author(s): Bancroft GH, Lauria JI. Source: Anesthesiology. 1983 August; 59(2): 143-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6869873&dopt=Abstract

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Labor after prior cesarean section. Author(s): Pridjian G. Source: Clinical Obstetrics and Gynecology. 1992 September; 35(3): 445-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1521374&dopt=Abstract

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Labor epidural analgesia and dystocia-related cesarean section. Author(s): Downing JW, Herman N, Husain F, Knape KG. Source: American Journal of Obstetrics and Gynecology. 1990 September; 163(3): 1096-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2403141&dopt=Abstract

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Labor epidurals improve outcomes for babies of mothers at high risk for unscheduled cesarean section. Author(s): Stuart KA, Krakauer H, Schone E, Lin M, Cheng E, Meyer GS. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2001 April-May; 21(3): 178-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11503105&dopt=Abstract

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Labor induction in patients with previous cesarean section. Author(s): Adair CD, Sanchez-Ramos L, Gaudier FL, Kaunitz AM, McDyer DC, Briones D. Source: American Journal of Perinatology. 1995 November; 12(6): 450-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8579661&dopt=Abstract

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Labor pain before elective cesarean section reduces neonatal respiratory distress. Author(s): Yang JY, Fang LJ, Tsou Yau KI. Source: Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1997 January-February; 38(1): 38-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9066188&dopt=Abstract

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Laceration injury at cesarean section. Author(s): Haas DM, Ayres AW. Source: J Matern Fetal Neonatal Med. 2002 March;11(3):196-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380677&dopt=Abstract

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Laparoscopic cholecystectomy at cesarean section. A new surgical option. Author(s): Pelosi MA 3rd, Pelosi MA, Villalona E. Source: Surgical Laparoscopy & Endoscopy. 1997 October; 7(5): 369-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9348614&dopt=Abstract

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Large uterine defect found at cesarean section. A case report. Author(s): Reed WC. Source: J Reprod Med. 2003 January; 48(1): 60-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611099&dopt=Abstract

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Late second stage rupture of the uterus and bladder with vaginal birth after cesarean section: a case report and review of the literature. Author(s): Webb JC, Gilson G, Gordon L. Source: The Journal of Maternal-Fetal Medicine. 2000 November-December; 9(6): 362-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11243296&dopt=Abstract

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Lateral position and epidural anesthesia for cesarean section. Author(s): Norris MC, Leighton BL, DeSimone CA, Larijani GE. Source: Anesthesia and Analgesia. 1988 August; 67(8): 788-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3394969&dopt=Abstract

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Legal issues in transfusing a Jehovah's Witness patient following cesarean section. Author(s): Liang BA, Ostheimer GW. Source: Journal of Clinical Anesthesia. 1995 September; 7(6): 522-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8534473&dopt=Abstract

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Lidocaine hydrocarbonate and lidocaine hydrochloride for cesarean section: transplacental passage and neonatal effects. Author(s): Guay J, Gaudreault P, Boulanger A, Tang A, Lortie L, Dupuis C. Source: Acta Anaesthesiologica Scandinavica. 1992 October; 36(7): 722-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1441877&dopt=Abstract

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Long-term implications of cesarean section. Author(s): Greene R, Gardeit F, Turner MJ. Source: American Journal of Obstetrics and Gynecology. 1997 January; 176(1 Pt 1): 254-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9024123&dopt=Abstract

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Low complication rate associated with cesarean section under spinal anesthesia for HIV-1-infected women on antiretroviral therapy. Author(s): Avidan MS, Groves P, Blott M, Welch J, Leung T, Pozniak A, Davies E, Ball C, Zuckerman M. Source: Anesthesiology. 2002 August; 97(2): 320-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12151919&dopt=Abstract

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Low dose of intrathecal hyperbaric bupivacaine combined with epidural lidocaine for cesarean section--a balance block technique. Author(s): Fan SZ, Susetio L, Wang YP, Cheng YJ, Liu CC. Source: Anesthesia and Analgesia. 1994 March; 78(3): 474-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8109762&dopt=Abstract

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Low risk of post-cesarean section infection in insulin-requiring diabetic women. Author(s): Riley LE, Tuomala RE, Heeren T, Greene MF. Source: Diabetes Care. 1996 June; 19(6): 597-600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8725858&dopt=Abstract

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Low segment cesarean section: a supracervical hysterotomy. Author(s): Reamy KJ. Source: American Journal of Obstetrics and Gynecology. 1990 March; 162(3): 866. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2316598&dopt=Abstract

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Lowering the cesarean section rate in a private hospital: comparison of individual physicians' rates, risk factors, and outcomes. Author(s): Lagrew DC Jr, Adashek JA. Source: American Journal of Obstetrics and Gynecology. 1998 June; 178(6): 1207-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9662303&dopt=Abstract

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Low-risk cesarean section prophylaxis issue still unsettled. Author(s): Pearlman M, Faro S, Hammill H, Maccato M. Source: American Journal of Obstetrics and Gynecology. 1991 January; 164(1 Pt 1): 232-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1898839&dopt=Abstract

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Lumbar lordosis and the spread of subarachnoid hyperbaric 0.5% bupivacaine at cesarean section. Author(s): van Bogaert LJ. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2000 October; 71(1): 65-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11044545&dopt=Abstract

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Managed care market share and cesarean section rates in the United States: is there a link? Author(s): Hueston WJ, Sutton A. Source: Am J Manag Care. 2000 November; 6(11): 1202-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11185845&dopt=Abstract

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Management of autonomic hyperreflexia during cesarean section in a woman with spinal cord injury: a case report. Author(s): Li S, Tang X, Bai C, Han S. Source: Chinese Medical Journal. 2002 August; 115(8): 1257-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12515277&dopt=Abstract

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Management of previous cesarean section. Author(s): Biswas A. Source: Current Opinion in Obstetrics & Gynecology. 2003 April; 15(2): 123-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12634604&dopt=Abstract

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Massive deep vein thrombosis after cesarean section treated with a temporary inferior vena cava filter: a case report. Author(s): Nakajima O, Arishiro K, Kani K, Moriguchi T, Tamoto S, Akioka H, Higashiura W, Sakaguchi H, Ohue S. Source: J Cardiol. 2000 November; 36(5): 337-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11107556&dopt=Abstract

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Maternal and fetal colloid osmotic pressure following fluid expansion during cesarean section. Author(s): Hauch MA, Gaiser RR, Hartwell BL, Datta S. Source: Critical Care Medicine. 1995 March; 23(3): 510-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7874903&dopt=Abstract

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Maternal and perinatal mortality/morbidity associated with cesarean section in Indonesia. Author(s): Wirakusumah FF. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 1995 October; 21(5): 475-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8542472&dopt=Abstract

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Maternal complications associated with cesarean section. Author(s): Loverro G, Greco P, Vimercati A, Nicolardi V, Varcaccio-Garofalo G, Selvaggi L. Source: Journal of Perinatal Medicine. 2001; 29(4): 322-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11565201&dopt=Abstract

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Maternal deaths associated with cesarean section in Enugu, Nigeria. Author(s): Ozumba BC, Anya SE. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 March; 76(3): 307-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880136&dopt=Abstract

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Maternal Herpes simplex virus type 2 encephalitis following Cesarean section. Author(s): Godet C, Beby-Defaux A, Agius G, Pourrat O, Robert R. Source: The Journal of Infection. 2003 August; 47(2): 174-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860155&dopt=Abstract

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Measurement of bladder volume following cesarean section using bladderscan. Author(s): Barrington JW, Edwards G, Ashcroft M, Adekanmi O. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(6): 373-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11795639&dopt=Abstract

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Measurement of cerebral oxygenation in neonates after vaginal delivery and cesarean section using full-spectrum near infrared spectroscopy. Author(s): Isobe K, Kusaka T, Fujikawa Y, Okubo K, Nagano K, Yasuda S, Kondo M, Itoh S, Hirao K, Onishi S. Source: Comparative Biochemistry and Physiology. Part A, Molecular & Integrative Physiology. 2002 May; 132(1): 133-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12062201&dopt=Abstract

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Mechanisms and management of an incomplete epidural block for cesarean section. Author(s): Portnoy D, Vadhera RB. Source: Anesthesiology Clinics of North America. 2003 March; 21(1): 39-57. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698831&dopt=Abstract

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Misoprostol for second trimester termination of pregnancies with prior low transverse cesarean section. Author(s): Pongsatha S, Tongsong T. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2003 January; 80(1): 61-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12527463&dopt=Abstract

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Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section. Author(s): Chauhan SP, Magann EF, Carroll CS, Barrilleaux PS, Scardo JA, Martin JN Jr. Source: American Journal of Obstetrics and Gynecology. 2001 August; 185(2): 349-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11518890&dopt=Abstract

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Modifications to the Misgav Ladach technique for cesarean section. Author(s): Ayres-de-Campos D, Patricio B. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2000 April; 79(4): 326-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10746852&dopt=Abstract

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Multiple-dose methotrexate for pregnancy in a cesarean section scar. A case report. Author(s): Lam PM, Lo KW. Source: J Reprod Med. 2002 April; 47(4): 332-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12012889&dopt=Abstract

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Myomectomy during cesarean section. Author(s): Kwawukume EY. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 February; 76(2): 183-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11818118&dopt=Abstract

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Myomectomy during cesarean section. Author(s): Ehigiegba AE, Ande AB, Ojobo SI. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 October; 75(1): 21-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11597615&dopt=Abstract

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Necrotizing fasciitis of abdominal wall after cesarean section. Author(s): Krowlikowski A, Gowri V, Radha K. Source: Saudi Med J. 2000 April; 21(4): 399-400. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11533831&dopt=Abstract

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Neonatal clinical outcome after elective cesarean section before the onset of labor at the 37th and 38th week of gestation. Author(s): Yamazaki H, Torigoe K, Numata O, Nagai S, Haniu H, Uchiyama A, Ogawa Y, Imamura M, Hasegawa S. Source: Pediatrics International : Official Journal of the Japan Pediatric Society. 2003 August; 45(4): 379-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911470&dopt=Abstract

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Neonatal morbidity after elective repeat cesarean section and trial of labor. Author(s): Hook B, Kiwi R, Amini SB, Fanaroff A, Hack M. Source: Pediatrics. 1997 September; 100(3 Pt 1): 348-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9282704&dopt=Abstract

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Neonatal outcome after trial of labor compared with elective repeat cesarean section. Author(s): Fisler RE, Cohen A, Ringer SA, Lieberman E. Source: Birth (Berkeley, Calif.). 2003 June; 30(2): 83-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752164&dopt=Abstract

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Neonatal rectovaginal tear during cesarean section. Author(s): Lickstein DA, Moriarty KP, Feins NR. Source: Journal of Pediatric Surgery. 1998 August; 33(8): 1315-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9722014&dopt=Abstract

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Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective cesarean section. Author(s): Lavery S, Harvey D. Source: British Journal of Obstetrics and Gynaecology. 1995 October; 102(10): 843. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7547750&dopt=Abstract

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Neonatal thyroid function is unaffected by maternal topical iodine disinfection for cesarean section or vaginal delivery. Author(s): Jeng MJ, Lin CY, Soong WJ, Hsiao KJ, Hwang B, Chiang SH. Source: Clinical Pediatrics. 1997 February; 36(2): 109-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9118588&dopt=Abstract

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Newborn kidnapping by cesarean section. Author(s): Burgess AW, Baker T, Nahirny C, Rabun JB Jr. Source: J Forensic Sci. 2002 July; 47(4): 827-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12136992&dopt=Abstract

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Newborn resuscitation and anesthesia responsibility post-cesarean section. Author(s): Gaiser RR. Source: Journal of Clinical Anesthesia. 1999 February; 11(1): 69-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10396722&dopt=Abstract

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Non-closure of peritoneum and adhesions: the repeat cesarean section. Author(s): Joura EA, Nather A, Husslein P. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 March; 80(3): 286. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11207502&dopt=Abstract

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Observation of cesarean section scar by transvaginal ultrasonography. Author(s): Chen HY, Chen SJ, Hsieh FJ. Source: Ultrasound in Medicine & Biology. 1990; 16(5): 443-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2238250&dopt=Abstract

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Obstetric and perinatal outcome of women para > or = 5 including one lower segment cesarean section. Author(s): Ali AM, Abu-Heija AT. Source: The Journal of Obstetrics and Gynaecology Research. 2002 June; 28(3): 163-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12214833&dopt=Abstract

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Obstetric referral in family practice. Factors Affecting Cesarean Section (FACS) Study Group. Author(s): Hueston WJ. Source: The Journal of Family Practice. 1994 April; 38(4): 368-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8163961&dopt=Abstract

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Occurrence of Bifidobacterium in the feces of newborns delivered by cesarean section. Author(s): Bezirtzoglou E, Romond C. Source: Biology of the Neonate. 1990; 58(5): 247-51. Erratum In: Biol Neonate 1991; 60(5): 340. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2076442&dopt=Abstract

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Offering a woman sterilization during an emergency cesarean section may sometimes be appropriate. Author(s): Remez L. Source: International Family Planning Perspectives. 2003 March; 29(1): 52. Erratum In: Int Fam Plan Perspect. 2003 June; 29(2): 100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12731485&dopt=Abstract

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Once a Cesarean section, always a Cesarean section: back to the future? Author(s): Rozenberg P, Ville Y. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2003 February; 21(2): 103-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12601827&dopt=Abstract

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Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section. Author(s): Lomas J, Enkin M, Anderson GM, Hannah WJ, Vayda E, Singer J. Source: Jama : the Journal of the American Medical Association. 1991 May 1; 265(17): 2202-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2013952&dopt=Abstract

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Out-of-hospital perimortem cesarean section. Author(s): Kupas DF, Harter SC, Vosk A. Source: Prehosp Emerg Care. 1998 July-September; 2(3): 206-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9672696&dopt=Abstract

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Ovarian vein thrombosis during cesarean section. A report of two cases. Author(s): Catanzarite VA, Low RN, Wong DY. Source: J Reprod Med. 1997 May; 42(5): 315-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9172126&dopt=Abstract

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Oxytocin, prolactin, milk production and their relationship with personality traits in women after vaginal delivery or Cesarean section. Author(s): Nissen E, Gustavsson P, Widstrom AM, Uvnas-Moberg K. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 1998 March; 19(1): 49-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9575469&dopt=Abstract

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Patients' versus nurses' assessments of pain and sedation after cesarean section. Author(s): Olden AJ, Jordan ET, Sakima NT, Grass JA. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1995 February; 24(2): 137-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7745487&dopt=Abstract

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Perimortem cesarean section: case reports and recommendations. Author(s): Lanoix R, Akkapeddi V, Goldfeder B. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 1995 December; 2(12): 1063-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8597917&dopt=Abstract

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Placenta previa and previous cesarean section. Author(s): To WW, Leung WC. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1995 October; 51(1): 25-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8582514&dopt=Abstract

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Post cesarean section death. Author(s): Avery JK. Source: J Ark Med Soc. 1995 July; 92(2): 79-80. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7642478&dopt=Abstract

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Post-cesarean section splenic rupture. Author(s): Kaluarachchi A, Krishnamurthy S. Source: American Journal of Obstetrics and Gynecology. 1995 July; 173(1): 230-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7631690&dopt=Abstract

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Posterior wall cesarean section following chronic uterine torsion. Author(s): Aviram R, Shtreitzent O, Fejgin M. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1995 October; 51(1): 59-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8582521&dopt=Abstract

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Preinduction prostaglandin E2 gel prior to induction of labor in women with a previous cesarean section. Author(s): Williams MA, Luthy DA, Zingheim RW, Hickok DE. Source: Gynecologic and Obstetric Investigation. 1995; 40(2): 89-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8575698&dopt=Abstract

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Prevention of hypotension after spinal anesthesia for cesarean section: six percent hetastarch versus lactated Ringer's solution. Author(s): Riley ET, Cohen SE, Rubenstein AJ, Flanagan B. Source: Anesthesia and Analgesia. 1995 October; 81(4): 838-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7574020&dopt=Abstract

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Progressive respiratory insufficiency after cesarean section. Author(s): Chanatry BJ, Gettinger A. Source: Critical Care Medicine. 1995 January; 23(1): 204-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8001373&dopt=Abstract

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Pulmonary edema after long-term beta-adrenergic therapy and cesarean section. Author(s): Tatara T, Morisaki H, Shimada M, Ochiai R, Takeda J, Fukushima K. Source: Anesthesia and Analgesia. 1995 August; 81(2): 417-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7618740&dopt=Abstract

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Randomized trial of cefotiam prophylaxis in the prevention of postoperative infectious morbidity after elective cesarean section. Author(s): Kolben M, Mandoki E, Ulm K, Freitag K. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2001 January; 20(1): 40-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11245321&dopt=Abstract

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Reducing infections among women undergoing cesarean section in Colombia by means of continuous quality improvement methods. Author(s): Weinberg M, Fuentes JM, Ruiz AI, Lozano FW, Angel E, Gaitan H, Goethe B, Parra S, Hellerstein S, Ross-Degnan D, Goldmann DA, Huskins WC. Source: Archives of Internal Medicine. 2001 October 22; 161(19): 2357-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11606152&dopt=Abstract

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Reflections on hypotension during Cesarean section under spinal anesthesia: do we need to use colloid? Author(s): Weeks S. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2000 July; 47(7): 607-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10930197&dopt=Abstract

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Repeat cesarean section in a morbidly obese parturient: a new anesthetic option. Author(s): Kuczkowski KM, Benumof JL. Source: Acta Anaesthesiologica Scandinavica. 2002 July; 46(6): 753-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12059905&dopt=Abstract

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Reply to P. Vargas letter to the editor: Comparative evaluation of the Misgav Ladach cesarean section with two traditional techniques. The first four years' experience (published in volume 80, 1). Author(s): Ayres-de-Campos D. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 March; 80(3): 285. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11207501&dopt=Abstract

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Risk factors for cesarean section of primiparous women aged over 35 years. Author(s): Kozinszky Z, Orvos H, Zoboki T, Katona M, Wayda K, Pal A, Kovacs L. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 April; 81(4): 313-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11952460&dopt=Abstract

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Risk factors for complicating infections after cesarean section. Author(s): Litta P, Vita P, Konishi de Toffoli J, Onnis GL. Source: Clin Exp Obstet Gynecol. 1995; 22(1): 71-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7736646&dopt=Abstract

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Risk factors for surgical-site infections following cesarean section. Author(s): Killian CA, Graffunder EM, Vinciguerra TJ, Venezia RA. Source: Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America. 2001 October; 22(10): 613-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11776346&dopt=Abstract

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Risk of cesarean section in singleton pregnancies after assisted reproductive techniques. Author(s): Kozinszky Z, Zadori J, Orvos H, Katona M, Pal A, Kovacs L. Source: J Reprod Med. 2003 March; 48(3): 160-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698772&dopt=Abstract

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Routine hemoglobin testing following an elective Cesarean section: is it necessary? Author(s): Horowitz E, Yogev Y, Ben-Haroush A, Rabinerson D, Feldberg D, Kaplan B. Source: J Matern Fetal Neonatal Med. 2003 October;14(4):223-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14738165&dopt=Abstract

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Safety and efficacy of early postoperative solid food consumption after cesarean section. Author(s): Burrows WR, Gingo AJ Jr, Rose SM, Zwick SI, Kosty DL, Dierker LJ Jr, Mann LI. Source: J Reprod Med. 1995 June; 40(6): 463-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7650662&dopt=Abstract

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Serum levels of macrophage colony-stimulating factor after cesarean section, vaginal delivery, or laparotomy in normal pregnant women and gynecologic patients. Author(s): Hayashi M, Shibazaki M, Sohma R, Ohkura T, Inaba N. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 July; 82(7): 597-602. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12790839&dopt=Abstract

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Site-to-site variation in the factors affecting cesarean section rates. Author(s): Hueston WJ. Source: Archives of Family Medicine. 1995 April; 4(4): 346-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7711922&dopt=Abstract

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Soaring cesarean section rates: a cause for alarm. Author(s): Williams DR, Shah MA. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2003 May-June; 32(3): 283-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12774867&dopt=Abstract

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Spinal and epidural versus general anesthesia for elective cesarean section at term: effect on the acid-base status of the mother and newborn. Author(s): Petropoulos G, Siristatidis C, Salamalekis E, Creatsas G. Source: J Matern Fetal Neonatal Med. 2003 April;13(4):260-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854928&dopt=Abstract

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Spinal anesthesia hypotension in elective cesarean section in parturients wearing extra-strong compression stockings. Author(s): Iwama H, Ohmizo H, Furuta S, Ohmori S, Watanabe K, Kaneko T. Source: Archives of Gynecology and Obstetrics. 2002 December; 267(2): 85-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439553&dopt=Abstract

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Spinal anesthesia is the preferred technique for cesarean section in severe preeclampsia: proponent position. Author(s): Hood DD. Source: Acta Anaesthesiol Belg. 2002; 53(4): 305-10. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12503355&dopt=Abstract

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Spinal anesthesia with two different dosages of 0.75% glucose-free ropivacaine: a comparison of efficacy and safety in Chinese parturients undergoing cesarean section. Author(s): Wong JO, Tan TD, Leung PO, Tseng KF, Cheu NW. Source: Acta Anaesthesiol Sin. 2003 September; 41(3): 131-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14601199&dopt=Abstract

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Spinal versus epidural anesthesia for cesarean section. Author(s): Colclough GW. Source: Anesthesia and Analgesia. 1995 December; 81(6): 1318-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7486139&dopt=Abstract

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Spinal versus epidural anesthesia for cesarean section: a comparison of time efficiency, costs, charges, and complications. Author(s): Riley ET, Cohen SE, Macario A, Desai JB, Ratner EF. Source: Anesthesia and Analgesia. 1995 April; 80(4): 709-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7893022&dopt=Abstract

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The control of blood loss at cesarean section with intramyometrial prostaglandin F2 alpha analog versus intravenous synthetic oxytocin. Author(s): Ezeh UO, Pearson M. Source: American Journal of Obstetrics and Gynecology. 1995 July; 173(1): 353-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7631722&dopt=Abstract

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The effect of delivery on umbilical arterial cord blood gases and lipid peroxides: comparison of vaginal delivery and cesarean section. Author(s): Pence S, Kocoglu H, Balat O, Balat A. Source: Clin Exp Obstet Gynecol. 2002; 29(3): 212-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519045&dopt=Abstract

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The effect of intrathecal bupivacaine with combined fentanyl in cesarean section. Author(s): Chu CC, Shu SS, Lin SM, Chu NW, Leu YK, Tsai SK, Lee TY. Source: Acta Anaesthesiol Sin. 1995 September; 33(3): 149-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7493145&dopt=Abstract

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The effect of physician factors on the cesarean section decision. Author(s): Burns LR, Geller SE, Wholey DR. Source: Medical Care. 1995 April; 33(4): 365-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7731278&dopt=Abstract

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The effects of epidural ropivacaine and bupivacaine for cesarean section on uteroplacental and fetal circulation. Author(s): Alahuhta S, Rasanen J, Jouppila P, Kangas-Saarela T, Jouppila R, Westerling P, Hollmen AI. Source: Anesthesiology. 1995 July; 83(1): 23-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7605013&dopt=Abstract

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The partograph in the management of labor following cesarean section. Author(s): Khan KS, Rizvi A. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1995 August; 50(2): 151-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7589750&dopt=Abstract

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The preemptive effect of regional anesthesia on post-cesarean section pain. Author(s): Wang JJ, Ho ST, Liu HS, Tzeng JI, Tze TS, Liaw WJ. Source: Acta Anaesthesiol Sin. 1995 December; 33(4): 211-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8705153&dopt=Abstract

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Thrombin-antithrombin complex and alpha2-plasmin inhibitor-plasmin complex levels after cesarean section in normal pregnancies and pre-eclampsia. Author(s): Hayashi M, Hamada Y, Ohkura T. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2003 August; 82(2): 213-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873784&dopt=Abstract

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Thromboembolism prophylaxis and cesarean section. Author(s): Block WA Jr. Source: Southern Medical Journal. 2003 February; 96(2): 121. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12630632&dopt=Abstract

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Thromboembolism prophylaxis and cesarean section: a survey of general obstetricians. Author(s): Connolly T. Source: Southern Medical Journal. 2003 February; 96(2): 146-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12630638&dopt=Abstract

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Ultrasound diagnosis of a pregnancy in a Cesarean section scar. Author(s): Seow KM, Hwang JL, Tsai YL. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2001 November; 18(5): 547-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11844184&dopt=Abstract

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Umbilical cord blood collection in Cesarean section: a comparison before and after placental delivery. Author(s): Pafumi C, Milone G, Maggi I, Mancari R, Farina M, Russo A, Pernicone G, Bandiera S, Giardina P, Franceschini A, Calogero AE, Cianci A. Source: Archives of Gynecology and Obstetrics. 2002 August; 266(4): 193-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12192476&dopt=Abstract

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Ureterouterine and vesicoureterovaginal fistulas as a complication of cesarean section. Author(s): Billmeyer BR, Nygaard IE, Kreder KJ. Source: The Journal of Urology. 2001 April; 165(4): 1212-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11257679&dopt=Abstract

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Urinary incontinence after vaginal delivery or cesarean section. Author(s): Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S; Norwegian EPINCONT Study. Source: The New England Journal of Medicine. 2003 March 6; 348(10): 900-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621134&dopt=Abstract

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Urogynecologists are not encouraging a higher cesarean section rate. Author(s): Davila GW. Source: American Journal of Obstetrics and Gynecology. 2003 June; 188(6): 1660. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12825009&dopt=Abstract

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Use of fetal-pelvic index in the prediction of vaginal birth following previous cesarean section. Author(s): Wong KS, Wong AY, Tse LH, Tang LC. Source: The Journal of Obstetrics and Gynaecology Research. 2003 April; 29(2): 104-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755531&dopt=Abstract

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Use of inhaled nitric oxide for emergency Cesarean section in a woman with unexpected primary pulmonary hypertension. Author(s): Decoene C, Bourzoufi K, Moreau D, Narducci F, Crepin F, Krivosic-Horber R. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2001 June; 48(6): 584-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11444454&dopt=Abstract

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Use of methergine for the prevention of postoperative endometritis in non-elective cesarean section patients. Author(s): Dweck MF, Lynch CM, Spellacy WN. Source: Infectious Diseases in Obstetrics and Gynecology. 2000; 8(3-4): 151-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10968597&dopt=Abstract

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Uterine incisional necrosis complicating cesarean section. Author(s): Rivlin ME, Carroll CS Sr, Morrison JC. Source: J Reprod Med. 2003 September; 48(9): 687-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14562632&dopt=Abstract

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Uterine rupture associated with vaginal birth after cesarean section: a complication of intravaginal misoprostol? Author(s): Gherman RB, McBrayer S, Browning J. Source: Gynecologic and Obstetric Investigation. 2000; 50(3): 212-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11014958&dopt=Abstract

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Vaginal birth after cesarean section in a rural African setting. Author(s): Thistle PJ, Chamberlain JA. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 April; 77(1): 31-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11929653&dopt=Abstract

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Vaginal birth after cesarean section versus elective repeat cesarean delivery: Weightbased outcomes. Author(s): Carroll CS Sr, Magann EF, Chauhan SP, Klauser CK, Morrison JC. Source: American Journal of Obstetrics and Gynecology. 2003 June; 188(6): 1516-20; Discussion 1520-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12824987&dopt=Abstract

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Vaginal birth after cesarean section: trial of labor or repeat cesarean section? A decision analysis. Author(s): Mankuta DD, Leshno MM, Menasche MM, Brezis MM. Source: American Journal of Obstetrics and Gynecology. 2003 September; 189(3): 714-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14526300&dopt=Abstract

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Vaginal birth after primary cesarean section: the fetal size factor. Author(s): Nwokoro CA, Njokanma OF, Orebamjo T, Okeke GC. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 July; 23(4): 392-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881079&dopt=Abstract

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Vaginal delivery after cesarean section: is the risk acceptable? Author(s): Waldman R, Mielcarski E. Source: Journal of Midwifery & Women's Health. 2001 September-October; 46(5): 272-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11725897&dopt=Abstract

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Vaginal hysterectomy following previous cesarean section. Author(s): Sheth SS, Malpani AN. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1995 August; 50(2): 165-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7589752&dopt=Abstract

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Value of subcutaneous drainage system in obese females undergoing cesarean section using pfannenstiel incision. Author(s): Al-Inany H, Youssef G, Abd ElMaguid A, Abdel Hamid M, Naguib A. Source: Gynecologic and Obstetric Investigation. 2002; 53(2): 75-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11961377&dopt=Abstract

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Vernix caseosa peritonitis. An infrequent complication of cesarean section with distinctive histopathologic features. Author(s): George E, Leyser S, Zimmer HL, Simonowitz DA, Agress RL, Nordin DD. Source: American Journal of Clinical Pathology. 1995 June; 103(6): 681-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7785650&dopt=Abstract

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Vesicouterine fistula after cesarean section. A case report. Author(s): Vu KK, Brittain PC, Fontenot JP, Harlass FE, Hawley-Bowland CG, Diaz-Ball F. Source: J Reprod Med. 1995 March; 40(3): 221-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7776308&dopt=Abstract

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Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature. Author(s): Porcaro AB, Zicari M, Zecchini Antoniolli S, Pianon R, Monaco C, Migliorini F, Longo M, Comunale L. Source: International Urology and Nephrology. 2002; 34(3): 335-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899224&dopt=Abstract

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Wakefulness during cesarean section after anesthetic induction with ketamine, thiopental, or ketamine and thiopental combined. Author(s): Schultetus RR, Hill CR, Dharamraj CM, Banner TE, Berman LS. Source: Anesthesia and Analgesia. 1986 July; 65(7): 723-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3717612&dopt=Abstract

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Wakefulness during cesarean section. Author(s): Crawford JS. Source: Anesthesia and Analgesia. 1987 August; 66(8): 802-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3605706&dopt=Abstract

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Weight at birth of singleton live births between the 23rd and 27th week of gestation delivered vaginally or by cesarean section. Author(s): Parazzini F, Cortinovis I, Bortolus R, Soliani A, Fedele L. Source: Acta Paediatrica (Oslo, Norway : 1992). 1994 November; 83(11): 1206-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7841738&dopt=Abstract

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What every midwife should know about ACOG and VBAC. Critique of ACOG Practice Bulletin #5, July 1999, “Vaginal birth after previous cesarean section”. Author(s): Wagner M. Source: Midwifery Today Int Midwife. 2001 Fall; (59): 41-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12152554&dopt=Abstract

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When pregnant women and their physicians disagree on the need for cesarean section: no simple solution. Author(s): Catlin AJ. Source: Adv Pract Nurs Q. 1998 Fall; 4(2): 23-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9874946&dopt=Abstract

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Which induction drug for cesarean section? A comparison of thiopental sodium, propofol, and midazolam. Author(s): Celleno D, Capogna G, Emanuelli M, Varrassi G, Muratori F, Costantino P, Sebastiani M. Source: Journal of Clinical Anesthesia. 1993 July-August; 5(4): 284-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8373604&dopt=Abstract

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Women's preference for a cesarean section: incidence and associated factors. Author(s): Gamble JA, Creedy DK. Source: Birth (Berkeley, Calif.). 2001 June; 28(2): 101-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11380381&dopt=Abstract

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Women's request for a cesarean section: a critique of the literature. Author(s): Gamble JA, Creedy DK. Source: Birth (Berkeley, Calif.). 2000 December; 27(4): 256-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11251511&dopt=Abstract

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Wound infection after cesarean section. Author(s): Pelle H, Jepsen OB, Larsen SO, Bo J, Christensen F, Dreisler A, Jorgensen PJ, Kirstein A, Kjoller M, Lange A, et al. Source: Infect Control. 1986 September; 7(9): 456-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3639069&dopt=Abstract

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Wound infections after cesarean section with Mycoplasma hominis and Ureaplasma urealyticum. A report of three cases. Author(s): Maccato M, Faro S, Summers KL. Source: Diagnostic Microbiology and Infectious Disease. 1990 September-October; 13(5): 363-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2282776&dopt=Abstract

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CHAPTER 2. NUTRITION AND CESAREAN SECTION Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and cesarean section.

Finding Nutrition Studies on Cesarean Section The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “cesarean section” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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

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

Alkalinization of epidural 0.5% bupivacaine for cesarean section. Author(s): Department of Anesthesiology, Universite Paris-Sud, Hopital Beclere, Clamart, France. Source: Benhamou, D Labaille, T Bonhomme, L Perrachon, N Reg-Anesth. 1989 SepOctober; 14(5): 240-3 0146-521X

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Cesarean section in a mother with uncorrected congenital coronary to pulmonary artery fistula. Author(s): Department of Anesthesia & Surgical Intensive Care, Singapore General Hospital, Singapore. [email protected] Source: Tay, S M Ong, B C Tan, S A Can-J-Anaesth. 1999 April; 46(4): 368-71 0832-610X

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Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section. Author(s): Department of Anesthesia, Foothills Hospital, The University of Calgary, Alberta, Canada. [email protected] Source: Yang, T Breen, T W Archer, D Fick, G Can-J-Anaesth. 1999 September; 46(9): 856-60 0832-610X

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Dystocias, cesarean section, and puerperium. Author(s): Women's Hospital, Ann Arbor, Michigan. Source: Hayashi, R H Curr-Opin-Obstet-Gynecol. 1989 December; 1(2): 172-6 1040-872X

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Epidemiology of cesarean sections: prolonged pregnancy. Author(s): Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy. Source: Scollo, P Clin-Exp-Obstet-Gynecol. 1999; 26(1): 22-6 0390-6663

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Mini-dose intrathecal morphine for post-cesarean section analgesia. Author(s): Department of Anesthesiology, National Taiwan University Hospital, Taipei, R.O.C. Source: Jiang, C J Liu, C C Wu, T J Sun, W Z Lin, S Y Huang, F Y Chao, C C Ma-Zui-XueZa-Zhi. 1991 December; 29(4): 683-9 0254-1319

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Nalbuphine pretreatment in cesarean section patients receiving epidural morphine. Author(s): Department of Anaesthesia, Mount Sinai Hospital, University of Toronto, Ontario, Canada. Source: Morgan, P J Mehta, S Kapala, D M Reg-Anesth. 1991 Mar-April; 16(2): 84-8 0146521X

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Preoperative dextrose does not affect spinal-induced hypotension in elective Cesarean section. Author(s): Department of Anaesthesia, BC Women's Hospital and Health Centre, Vancouver, Canada. Source: Wilson, D Douglas, J Heid, R Rurak, D Can-J-Anaesth. 1999 November; 46(11): 1024-9 0832-610X

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Splenectomy combined with cesarean section in a patient with severe immunological thrombocytopenic purpura refractory to medical therapy. Author(s): Department of Obstetrics and Gynecology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey. Source: Sendag, F Kazandi, M Terek, M C J-Obstet-Gynaecol-Res. 2001 April; 27(2): 85-8 1341-8076

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The effect of volume of epidural morphine on postoperative analgesia in patients undergoing cesarean section. Author(s): Department of Anesthesia, Cathay General Hospital, Taiwan, R.O.C. Source: Sun, S L Cheng, K W Chien, C C Che, C J Chang, C F Ma-Zui-Xue-Za-Zhi. 1990 December; 28(4): 433-7 0254-1319

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The effects of rocking, diet modifications, and antiflatulent medication on postcesarean section gas pain. Source: Thomas, L Ptak, H Giddings, L S Moore, L Oppermann, C J-Perinat-NeonatalNurs. 1990 December; 4(3): 12-24 0893-2190

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The impact of nalmefene on side effects due to intrathecal morphine at cesarean section. Author(s): Naval Medical Center, Portsmouth, Va., USA. Source: Pellegrini, J E Bailey, S L Graves, J Paice, J A Shott, S Faut Callahan, M AANA-J. 2001 June; 69(3): 199-205 0094-6354

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Use of methergine for the prevention of postoperative endometritis in non-elective cesarean section patients. Author(s): Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa 33606, USA. Source: Dweck, M F Lynch, C M Spellacy, W N Infect-Dis-Obstet-Gynecol. 2000; 8(3-4): 151-4 1064-7449

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Vaginal birth after cesarean section. A safe option in carefully selected patients. Author(s): Medical Center, Beaver, PA 15009. Source: McKenna, J P Guerdan, B R Wright, J C Postgrad-Med. 1988 November 1; 84(6): 211-5 0032-5481

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to cesarean section and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “cesarean section” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to cesarean section: •

“I'd do it again!”. Author(s): Marzluf MJ. Source: Nurs Care. 1975 December; 8(12): 8-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1042744&dopt=Abstract

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Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Author(s): Stein DJ, Birnbach DJ, Danzer BI, Kuroda MM, Grunebaum A, Thys DM. Source: Anesthesia and Analgesia. 1997 February; 84(2): 342-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9024025&dopt=Abstract

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Acupuncture analgesia and cesarean section. Author(s): Vallette C, Niboyet JE, Imbert-Martelet M, Roux JF.

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Source: J Reprod Med. 1980 September; 25(3): 108-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7431353&dopt=Abstract •

Anesthesia case of the month. Dystocia, cesarean section and acupuncture resuscitation of newborn kittens. Author(s): Skarda RT. Source: J Am Vet Med Assoc. 1999 January 1; 214(1): 37-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9887937&dopt=Abstract

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Blood glucose concentration and the levels of cortisol, growth hormone and insulin in women at labour and their healthy neonates born by vaginal delivery and cesarean section. Author(s): Lauterbach R, Szafran H, Szafran Z. Source: Endokrynol Pol. 1988; 39(4): 169-79. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3073953&dopt=Abstract

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Blood serum gastrin level in women at labour and in their healthy neonates born by vaginal delivery and cesarean section. Author(s): Szafran H, Lauterbach R, Szafran Z. Source: Endokrynol Pol. 1988; 39(4): 181-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3248585&dopt=Abstract

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Care of the neonate after cesarean section. Author(s): Bacon KK, Louch GK. Source: Aorn Journal. 1981 November; 34(5): 860-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7030202&dopt=Abstract

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Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. Author(s): Thurmond AS, Harvey WJ, Smith SA. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 1999 January; 18(1): 13-6; Quiz 17-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9952074&dopt=Abstract

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Complication of cesarean section: pregnancy on the cicatrix of a previous cesarean section. Author(s): Wang W, Long W, Yu Q. Source: Chinese Medical Journal. 2002 February; 115(2): 242-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11940341&dopt=Abstract

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Court-ordered cesarean sections. A judicial standard for resolving the conflict between fetal interests and maternal rights. Author(s): Noble-Allgire AM.

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Source: The Journal of Legal Medicine. 1989 March; 10(1): 211-49. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2651546&dopt=Abstract •

Early oral hydration: a novel regimen for management after elective cesarean section. Author(s): Abd Rabbo S. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 1995 December; 21(6): 563-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8640466&dopt=Abstract

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Effect of early pregnancy on a previous lower segment cesarean section scar. Author(s): Weimin W, Wenqing L. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 June; 77(3): 201-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12065130&dopt=Abstract

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Effect of P-6 acupressure on prevention of nausea and vomiting after epidural morphine for post-cesarean section pain relief. Author(s): Ho CM, Hseu SS, Tsai SK, Lee TY. Source: Acta Anaesthesiologica Scandinavica. 1996 March; 40(3): 372-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8721471&dopt=Abstract

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Every birth is sacred: helping each other through the pain of cesarean section. Author(s): Howe M. Source: The Birth Gazette. 1999 Summer; 15(3): 9-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10474336&dopt=Abstract

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External cephalic version as an alternative to breech delivery and cesarean section. Author(s): Jordan B. Source: Social Science & Medicine (1982). 1984; 18(8): 637-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6374911&dopt=Abstract

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Fulminating pre-eclampsia with cesarean section performed under hypnosis; a case report. Author(s): WINKELSTEIN LB, LEVINSON J. Source: American Journal of Obstetrics and Gynecology. 1959 August; 78(2): 420-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13670218&dopt=Abstract

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'High touch' approach lowers C-section rates. Author(s): Simmons J. Source: The Quality Letter for Healthcare Leaders. 1998 July; 10(7): 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10182814&dopt=Abstract

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Hypnoanesthesia for cesarean section and hysterectomy. Author(s): DELEE ST, KROGER WS. Source: J Am Med Assoc. 1957 February 9; 163(6): 442-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13398289&dopt=Abstract

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Mode of delivery in the low birth weight fetus. Delivery by cesarean section independent of fetal lie versus vaginal delivery in vertex presentation. A study with long-term follow-up. Author(s): Westgren M, Dolfin T, Halperin M, Milligan J, Shennan A, Svenningsen NW, Ingemarsson I. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1985; 64(1): 51-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3976377&dopt=Abstract

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Present status of cesarean section under acupuncture anesthesia in China. Author(s): Wang DW, Jin YH. Source: Fukushima J Med Sci. 1989 December; 35(2): 45-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2487311&dopt=Abstract

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Temperament and neonatal risk in full-term and preterm combined vaginal/cesarean section twin pairs. Author(s): Riese ML. Source: Acta Genet Med Gemellol (Roma). 1988; 37(3-4): 239-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3254016&dopt=Abstract

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Transcutaneous electrical nerve stimulation for reducing narcotic use after cesarean section. Author(s): Reynolds RA, Gladstone N, Ansari AH. Source: J Reprod Med. 1987 November; 32(11): 843-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2892930&dopt=Abstract

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Vaginal birth 2, cesarean section 0. Author(s): Dederscheck S. Source: Midwifery Today Childbirth Educ. 1997 Spring; (41): 21-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9136409&dopt=Abstract

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Vaginal birth after cesarean section. Author(s): Chez RA. Source: American Journal of Obstetrics and Gynecology. 1989 May; 160(5 Pt 1): 1251. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2729403&dopt=Abstract

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Vaginal birth following unmonitored labor in patients with prior cesarean section. Author(s): Zorlu CG, Danisman N, Caglar T, Turan C, Isik AZ, Kaleli B, Gokmen O.

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Source: Gynecologic and Obstetric Investigation. 1996; 42(4): 222-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8979091&dopt=Abstract •

Vaginal delivery following cesarean section. Author(s): Donnelly JP, Franzoni KT. Source: Obstetrics and Gynecology. 1967 June; 29(6): 871-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6025039&dopt=Abstract

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

General Overview Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com Gestational Hypertension Source: Healthnotes, Inc.; www.healthnotes.com

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Preeclampsia Source: Healthnotes, Inc.; www.healthnotes.com Preeclampsia Source: Integrative Medicine Communications; www.drkoop.com

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

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CHAPTER 4. DISSERTATIONS ON CESAREAN SECTION Overview In this chapter, we will give you a bibliography on recent dissertations relating to cesarean section. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “cesarean section” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on cesarean section, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Cesarean Section ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to cesarean section. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A Decision Analysis of Utility and Cost Effectiveness of Vaginal Delivery Versus Cesarean Section for Women with Previous 3rd or 4th Degree of Anal Laceration in Their First Delivery by Habib, Farida Mahmoud, MSPH from University of Louisville, 2003, 84 pages http://wwwlib.umi.com/dissertations/fullcit/1415206

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Association of Temporal Variations and Hospital Ownership with Cesarean Sections by Gemmel, David James, PhD from Kent State University, 2002, 231 pages http://wwwlib.umi.com/dissertations/fullcit/3068675

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Court-Ordered Cesarean Sections: A Case Study in Medical Ethics and Moral Theology by Poundstone, Thomas Jude; PhD from University of Notre Dame, 1999, 447 pages http://wwwlib.umi.com/dissertations/fullcit/9969797

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•

Nosocomial Infections amongst Patients Delivered by Cesarean Section by Henderson, Elizabeth Ann; PhD from University of Calgary (Canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL54240

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Under the Knife: Cesarean Section and Female Sterilization in Brazil by Hopkins, Kristine Leilani, PhD from The University of Texas at Austin, 1998, 234 pages http://wwwlib.umi.com/dissertations/fullcit/9837988

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. BOOKS ON CESAREAN SECTION Overview This chapter provides bibliographic book references relating to cesarean section. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on cesarean section include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “cesarean section” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on cesarean section: •

Roundtable Discussion; AIDS in the Developing World (Prevention & Control). III International Conference on Acquired Immunodeficiency Syndrome (AIDS); Washington, D.C., June 1-5, 1987 Contact: InfoMedix, 12800 Garden Grove Blvd, Ste F, Garden Grove, CA, 92643, (714) 530-3454. Summary: This sound recording of proceedings from the III International Conference on AIDS, held June 1-5, 1987, in Washington, D.C., is a roundtable discussion of the prevention and control of the Human immunodeficiency virus (HIV) in developing nations. The discussion begins by defining Acquired immunodeficiency syndrome (AIDS) and HIV infection. The need for seroprevalence surveys in Africa is discussed. Fighting AIDS with education and preventive measures is presently the only means of control, and one speaker suggests applying marketing and advertising principles to contraceptives and condom use to gain wider acceptance of their use. The need to find

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an economical, effective means to screen blood supplies in African countries is described. Problems of administering routine childhood immunizations where needles, syringes, and sterilization equipment remain in short supply are examined. Ways to eliminate the need to sterilize equipment are being developed. Perinatal transmission and the high seropositive levels among young African women are analyzed. The need to provide contraceptives, tubal ligations, vasectomies, or abortions is discussed. The possible role of the Cesarean section in minimizing transmission risks to the infant is explained. The role of condoms and spermicides as infection-control measures is explored. The final speaker presents his concerns as a physician in a developing country. This sound recording continues the roundtable discussion on the prevention and control of the Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS) in developing nations. In this portion, the effects of, and the need for, childhood immunizations for children with AIDS are discussed. The role of the World Health Organization (WHO) in the control of HIV is described. Heterosexual transmission of HIV in Africa is also analyzed. •

What We Told Our Kids About Sex Contact: Harcourt Brace Jovanovich, 111 5th Ave, New York, NY, 10003, (212) 614-3000. Summary: Written for parents, this monograph explains both bodily sexual changes at puberty and sexual intercourse. It also discusses pregnancy and childbirth, (including natural childbirth, Cesarean section, and breech birth), sex outside of marriage, and prostitution. Coverage of Sexually transmitted diseases (STD's) includes herpes, gonorrhea, syphilis, and Acquired immunodeficiency syndrome (AIDS). Contraceptives are reviewed and other forms of sexuality, such as homosexuality, are introduced. Sexrelated crimes are also covered. The monograph closes with a glossary of terms. The material is presented from a morally neutral standpoint and emphasizes the need to provide children with sex information at an early age.

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

Cesarean Section and Birth Factors by Sherry A. Walker; ISBN: 0881646091; http://www.amazon.com/exec/obidos/ASIN/0881646091/icongroupinterna

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Cesarean Section: Guidelines for Appropriate Utilization by Bruce L. Flamm (Editor), Edward J. Quilligan (Editor); ISBN: 0387942386; http://www.amazon.com/exec/obidos/ASIN/0387942386/icongroupinterna

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Cesarean Section: Understanding and Celebrating Your Baby's Birth by Caroline De Costa, Michele, Md. Moore; ISBN: 0801873371; http://www.amazon.com/exec/obidos/ASIN/0801873371/icongroupinterna

Books

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Conditions for Cesarean Section Chart by Anatomical Chart; ISBN: 1587792230; http://www.amazon.com/exec/obidos/ASIN/1587792230/icongroupinterna

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How to Avoid a Cesarean Section by Christopher Norwood; ISBN: 0671469169; http://www.amazon.com/exec/obidos/ASIN/0671469169/icongroupinterna

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Just Take It Out! : The Ethics and Economics of Cesarean Section and Hysterectomy by D. Campbell Walters, Edward Quillinan; ISBN: 0966716205; http://www.amazon.com/exec/obidos/ASIN/0966716205/icongroupinterna

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Recovering from a Cesarean Section by Manuel, M.D. Alvarez, Karyn L. Feiden (Contributor); ISBN: 0061042447; http://www.amazon.com/exec/obidos/ASIN/0061042447/icongroupinterna

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Reducing Cesarean Section Rates While Maintaining Materal and by Donald Berwick, et al; ISBN: 1890070017; http://www.amazon.com/exec/obidos/ASIN/1890070017/icongroupinterna

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Responsible Childbirth: How to Give Birth Normally-And Avoid a Cesarean Section by Linda Meyer, Cynthia L. Duffy; ISBN: 0882477137; http://www.amazon.com/exec/obidos/ASIN/0882477137/icongroupinterna

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The Essential C-Section Guide : Pain Control, Healing at Home, Getting Your Body Back, and Everything Else YouNeed to Know About a Cesarean Birth by Maureen Connolly (Author), Dana Sullivan (Author); ISBN: 0767916077; http://www.amazon.com/exec/obidos/ASIN/0767916077/icongroupinterna

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The Expectant Parent's Guide to Preventing a Cesarean Section by Carl Jones (Author); ISBN: 0897892232; http://www.amazon.com/exec/obidos/ASIN/0897892232/icongroupinterna

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Unnecessary Cesarean Sections Curing a National Epidemic State Report for Illinois by Mary Gabay, Sidney M. M.D. Wolfe; ISBN: 0937188557; http://www.amazon.com/exec/obidos/ASIN/0937188557/icongroupinterna

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Unnecessary Cesarean Sections: How to Cure a National Epidemic: Cesarean Section Rates for the United States, 41 States and 2,388 Hospitals in 30 st by Lynn Silver; ISBN: 9991796282; http://www.amazon.com/exec/obidos/ASIN/9991796282/icongroupinterna

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Variations in the Use of Cesarean Sections: Literature Synthesis by Joanna Z. Heilbrunn, et al; ISBN: 0833023063; http://www.amazon.com/exec/obidos/ASIN/0833023063/icongroupinterna

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Women's Health Alert: What Most Doctors Won't Tell You About Birth Control, CSections, Weight Control Products, Hormone Replacement Therapy, Osteop by Sidney M. Wolfe, et al; ISBN: 0201550415; http://www.amazon.com/exec/obidos/ASIN/0201550415/icongroupinterna

Chapters on Cesarean Section In order to find chapters that specifically relate to cesarean section, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and cesarean section 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

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the dates and language you prefer, and the format option “Book Chapter.” Type “cesarean section” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on cesarean section: •

Obstetric Complications Source: in Reece, E.A. and Coustan, D.R., eds. Diabetes Mellitus in Pregnancy. 2nd ed. New York, NY: Churchill Livingstone. 1995. p. 287-302. Contact: Available from Churchill Livingstone. 300 Lighting Way, Secaucus, NJ 07094. (800) 553-5426. PRICE: $92.00. ISBN: 0443089795. Summary: In this chapter, from a text on diabetes mellitus in pregnancy, the author reports on two literature searches designed to review obstetric complications, specifically maternal morbidity, among pregnancies complicated by diabetes. The first search review the English language literature from 1965 to 1985; the second from 1986 to 1993. The complications reported in both series, and discussed in this article, include pre-eclampsia, pregnancy-induced hypertension, chronic hypertension, hypertension (total), diabetic ketoacidosis (DKA), hydramnios, preterm labor, primary cesarean section, repeat cesarean section, pyelonephritis, and maternal mortality. In the 1986 to 1993, spontaneous preterm delivery, total preterm delivery, predelivery hospitalization days, and postcesarean infectious rates are also compared between categories of diabetes. 4 tables. 69 references.

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Childbirth and Incontinence Source: in Parker, W.H., et al. Incontinence Solution: Answers for Women of All Ages. New York, NY: Simon and Schuster. 2002. p.67-88. Contact: Available from Fireside, Rockefeller Center. 1230 Avenue of the Americans, New York, NY 10020. (800) 456-6798. PRICE: $13.00; plus shipping and handling. ISBN: 0743215877. Summary: Urinary incontinence is the uncontrollable loss of enough urine to cause social or sanitary difficulties. This chapter discusses childbirth and urinary incontinence. The chapters is from a book that offers women up to date medical explanations for incontinence and its treatment. The authors first review how childbirth can cause incontinence, noting that there are many factors that can lead to incontinence: the strength of the pelvic supporting structures the woman is born with, the forces these structures have resisted over the years (including childbirth, heavy lifting and straining during bowel movements), the ability to heal if these tissues are injured, and the effect of the aging process on the collagen that gives strength to these structures. Other topics include the impact of long labor on incontinence, vaginal delivery and its consequences, forceps delivery and incontinence, nonmedical reasons to avoid cesarean section deliveries, how childbirth can weaken the bladder, the use of Kegel exercises during and after pregnancy, childbirth as a cause of anal incontinence, complications of episiotomy, and strategies to prevent the incontinence associated with childbirth. The chapter includes the stories of two women who had complications of incontinence after pregnancy. Chapter references are located at the end of the book. 1 figure. 9 references.

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CHAPTER 6. PERIODICALS AND NEWS ON CESAREAN SECTION Overview In this chapter, we suggest a number of news sources and present various periodicals that cover cesarean section.

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

Cesarean section can prevent anal incontinence Source: Reuters Health eLine Date: December 26, 2003

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C-section may increase risk for food allergy Source: Reuters Health eLine Date: September 03, 2003

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C-sections on rise among Flemish women: study Source: Reuters Health eLine Date: June 27, 2003

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C-section birth may be associated with increased asthma risk later Source: Reuters Medical News Date: February 11, 2003

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C-section protects against neonatal transmission of HSV Source: Reuters Medical News Date: January 09, 2003

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C-section lowers herpes risk for newborns Source: Reuters Health eLine Date: January 07, 2003

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Fewer women giving birth vaginally after C-section Source: Reuters Health eLine Date: November 07, 2002

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Fewer women give birth vaginally after C-section Source: Reuters Medical News Date: November 07, 2002

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C-section may be safer option for twins: report Source: Reuters Health eLine Date: November 01, 2002

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High or low C-section rates predict infant outcomes Source: Reuters Health eLine Date: October 29, 2002

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Classic C-section linked with higher morbidity rates than newer procedures Source: Reuters Medical News Date: October 04, 2002

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First baby breech doesn't require repeat C-section Source: Reuters Health eLine Date: August 06, 2002

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Trial of labor found riskier than repeat C-section Source: Reuters Health eLine Date: May 21, 2002

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Less maternal incontinence seen after planned c-section for breech presentation Source: Reuters Medical News Date: April 10, 2002

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Rise in cesarean sections may not translate into better perinatal outcome in India Source: Reuters Medical News Date: January 30, 2002

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Low dose propofol during cesarean section an effective anti-emetic Source: Reuters Industry Breifing Date: December 31, 2001

Periodicals and News

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New hospital systems help cut C-section infection Source: Reuters Health eLine Date: November 23, 2001

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Infertility treatment ups chance of C-section Source: Reuters Health eLine Date: November 23, 2001

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Most women would not choose C-section: study Source: Reuters Health eLine Date: November 16, 2001

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Epidural does not raise C-section risk Source: Reuters Medical News Date: August 13, 2001

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Epidural does not raise C-section odds: study Source: Reuters Health eLine Date: August 13, 2001

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Appropriate use of c-section cannot prevent all cases of shoulder dystocia Source: Reuters Medical News Date: July 23, 2001

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Prostaglandin-induced labor linked to high risk of uterine rupture after C-section Source: Reuters Medical News Date: July 04, 2001

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Induced labor after C-section has risks: study Source: Reuters Health eLine Date: July 04, 2001

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Eating soon after C-section cuts hospital stay Source: Reuters Health eLine Date: July 02, 2001

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Induced labor may lead to repeat C-section Source: Reuters Health eLine Date: June 13, 2001

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Induced labor does not always lead to C-section Source: Reuters Health eLine Date: June 05, 2001

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Risk of adult asthma increased in individuals born by cesarean section Source: Reuters Medical News Date: May 07, 2001

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C-section birth may increase risk of adult asthma Source: Reuters Health eLine Date: May 07, 2001

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Antibiotic prophylaxis unnecessary for elective cesarean section Source: Reuters Industry Breifing Date: March 15, 2001

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High rate of persistent pulmonary hypertension seen in babies born by C-section Source: Reuters Medical News Date: March 01, 2001

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Getting pregnant too soon after C-section risky Source: Reuters Health eLine Date: January 31, 2001

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Study says Chilean docs perform C-sections for profit Source: Reuters Health eLine Date: January 01, 2001

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Obesity linked to increased cesarean section risk Source: Reuters Health eLine Date: January 01, 2001

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C-sections tied to asthma in childhood Source: Reuters Health eLine Date: December 26, 2000

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C-section? You're still at risk for incontinence Source: Reuters Health eLine Date: December 01, 2000

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Male doctors perform more cesarean sections Source: Reuters Health eLine Date: November 02, 2000

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Cesarean section best for breech babies Source: Reuters Health eLine Date: October 20, 2000

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Planned cesarean section for breech presentation at term can save lives Source: Reuters Medical News Date: October 19, 2000

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C-sections may prevent liver infection in infants Source: Reuters Health eLine Date: October 02, 2000

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Hemostatic cesarean section reduces vertical HIV transmission Source: Reuters Medical News Date: September 15, 2000

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Cesarean section seems capable of preventing vertical transmission of HCV Source: Reuters Medical News Date: September 11, 2000

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C-section technique cuts HIV transmission risk Source: Reuters Health eLine Date: September 11, 2000

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Epidural analgesia not associated with increase in C-sections Source: Reuters Medical News Date: August 21, 2000

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C-section best for women with cervical cancer Source: Reuters Health eLine Date: June 13, 2000

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Obstetricians urges physicians to offer C-sections to more women Source: Reuters Medical News Date: May 24, 2000

Periodicals and News

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Heavy women more likely to need 2nd C-section Source: Reuters Health eLine Date: May 24, 2000

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OK to eat sooner after C-section Source: Reuters Health eLine Date: May 23, 2000

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Do we need more--not fewer--C-sections? Source: Reuters Health eLine Date: May 22, 2000

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Rare but there: endometriosis after C-section Source: Reuters Health eLine Date: April 13, 2000

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “cesarean section” (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 “cesarean section” (or synonyms). If you know the name of a company that is relevant to cesarean section, you can go to any stock trading Web site (such as http://www.etrade.com/)

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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 “cesarean section” (or synonyms).

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

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CHAPTER 7. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for cesarean section. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with cesarean section. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to cesarean section: Penicillins and Beta-Lactamase Inhibitors •

Systemic - U.S. Brands: Augmentin; Timentin; Unasyn; Zosyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202705.html

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

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

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APPENDICES

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

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute8: •

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/

8

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.9 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:10 •

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

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

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

9

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). 10 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 Gateway11 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.12 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “cesarean section” (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 29292 599 87 233 124 30335

HSTAT13 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.14 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.15 Simply search by “cesarean section” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

11

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

12

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

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 Biologists16 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.17 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.18 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/.

16 Adapted 17

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. 18 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 cesarean section 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 cesarean section. 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 cesarean section. 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 “cesarean section”:

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Other guides Anemia http://www.nlm.nih.gov/medlineplus/anemia.html Birth Defects http://www.nlm.nih.gov/medlineplus/birthdefects.html Health Occupations http://www.nlm.nih.gov/medlineplus/healthoccupations.html High Risk Pregnancy http://www.nlm.nih.gov/medlineplus/highriskpregnancy.html Infant and Toddler Health http://www.nlm.nih.gov/medlineplus/infantandtoddlerhealth.html Preeclampsia http://www.nlm.nih.gov/medlineplus/preeclampsia.html Prenatal Care http://www.nlm.nih.gov/medlineplus/prenatalcare.html Sexually Transmitted Diseases http://www.nlm.nih.gov/medlineplus/sexuallytransmitteddiseases.html

Within the health topic page dedicated to cesarean section, the following was listed: •

General/Overviews Cesarean Childbirth http://www.facs.org/public_info/operation/cesarean.pdf C-Section: A Safe Birthing Option Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=PR00078 What You Need to Know about Cesarean Section Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/pnhec/240_1031.asp

•

Specific Conditions/Aspects Cesarean Section--A Brief History Source: National Library of Medicine http://www.nlm.nih.gov/exhibition/cesarean/cesarean_1.html Vaginal Birth after Cesarean Delivery Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ10PRJ97C&s ub_cat=4

•

Organizations American College of Obstetricians and Gynecologists http://www.acog.org/

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Research Epidural Pain Relief During Labor Does Not Increase Chance of C-Section Source: National Institute of Child Health and Human Development http://www.nih.gov/news/pr/aug2001/nichd-09.htm Labor Induction at 41 Weeks Lowers Cesarean Rate Source: American College of Obstetricians and Gynecologists http://www.acog.org/from_home/publications/press_releases/nr05-31-03-4.cfm Risk of Uterine Rupture During Labor Higher for Women with a Prior Cesarean Delivery Source: National Institute of Nursing Research http://www.nih.gov/news/pr/jul2001/ninr-04.htm Weighing the Pros and Cons of Cesarean Delivery Source: American College of Obstetricians and Gynecologists http://www.acog.org/from_home/publications/press_releases/nr07-31-03-3.cfm

•

Statistics FASTATS: Births--Method of Delivery Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/delivery.htm New CDC Report Tracks Trends in Cesarean Births and VBACs During the 1990s Source: National Center for Health Statistics http://www.cdc.gov/nchs/releases/01facts/cesarean.htm U.S. Birth Rate Reaches Record Low: Births to Teens Continue 12-Year Decline; Cesarean Deliveries Reach All-Time High Source: National Center for Health Statistics http://www.cdc.gov/nchs/releases/03news/lowbirth.htm

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 cesarean section. 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: •

Women HIV and AIDS Contact: AVERT, 4 Brighton Rd, Horsham, http://www.avert.org.

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Summary: This brochure discusses women and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). HIV is a virus that attacks the immune system and eventually develops into HIV/AIDS. Women are often infected through unprotected sex with an HIV-positive man, a risk factor that can be reduced through safer sex and protected oral sex. HIV/AIDS is often treated by a number of antiretroviral drugs used in combination to help to curb the effects of the virus on the immune system. People who practice high-risk behaviors should be tested as some strains of the virus act much quicker than others and early treatment can help to protect an infected person. Testing is also available for pregnant women, who if infected can pass HIV on to their infants. HIV-positive pregnant women can protect their infants with AZT-centered drug treatment, childbirth via cesarean section, and avoidance of breastfeeding. HIV-positive women must consider issues such as how to learn more about their condition, who to tell about their seropositive status, whether or not to conduct sexual relationships, whether or not to have children, and the type of treatment to undergo and when it should start. The brochure presents personal anecdotes of women with HIV discussing how the virus and related issues have changed their lives. •

Reducing costs and improving outcomes: An introduction to the Breakthrough Series Source: Boston, MA: Institute for Healthcare Reform. 1997. 4 pp. Contact: Available from Institute for Healthcare Reform, 135 Francis Street, Boston, MA 02215. Telephone: (617) 754-4800 / fax: (617) 754- 4848. Available at no charge. Summary: This brochure presents information about the Breakthrough Series of special training for health care organizations. The training consists of collaboratives of 20-40 health care organizations working together for 12 months to to bring about breakthrough improvement in a key clinical or operational area. The training is specific to particular areas where improvements could reduces costs with no deleterious changes in outcomes. Topics include: reducing Cesarean section rates while improving maternal and infant outcomes, improving asthma care in children and adults, improving care for chronic diseases and reducing delays and waiting times, reducing delays and waiting times, and other topics.

•

Hepatitis C: How Do You Diagnose It? Source: Kennilworth, NJ: Schering Corporation. 2000. [2 p.]. Contact: Available from Schering Corporation. 2000 Galloping Hill Road, Kenilworth, NJ 07033. (800) 446-8766 or (908) 298-4000. Fax (908) 298-4490. Website: www.scheringplough.com. PRICE: Single copy free for patients; available to health professionals through local sales representatives. Summary: This two-sided cardstock document reviews the diagnosis of hepatitis C. One side of the document lists the risk factors for hepatitis C: blood transfusions before 1992, including blood received during a Cesarean section; hemodialysis; ear or body piercing (using improperly sterilized equipment); exposure to blood as a health care worker or member of the military; tattoos (due to potentially contaminated needles or ink); IV (intravenous) drug use, even just once; snorting cocaine or other drugs (due to blood on shared straw or bill); and sharing a razor, toothbrush, or any item that could carry infected blood. The reverse side of the document offers a diagnosis algorithm (flow chart for decision making) for hepatitis C, based on whether or not the patient has or does not have risk factors for the disease. Diagnostic tests incorporated into the algorithm include ALT (alanine aminotransferase), EIA (ELISA, or enzyme linked immunoadsorbent assay), PCR (polymerase chain reaction), and RIBA (recombinant

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immunoblot assay). The disclaimer on the bottom of the factsheet reminds readers that all decisions on the diagnosis and management of hepatitis C rest in the hands of the individual physician, and should not be based solely on the material contained on this sheet. 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 cesarean section. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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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 “cesarean section” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “cesarean section”. 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 “cesarean section” (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 “cesarean section” (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.19

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

19

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)20: •

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

•

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

•

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

•

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

•

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

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

20

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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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CESAREAN SECTION DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] 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] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Acupuncture Anesthesia: Insertion of acupuncture needles at specific points in the body to block the afferent nerve impulses from reaching the brain, thus producing the loss of sensation of pain. The technique is used in performing surgery. [NIH] Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] 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] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element,

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organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allantois: An embryonic diverticulum of the hindgut of reptiles, birds, and mammals; in man its blood vessels give rise to those of the umbilical cord. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility. [NIH]

Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] 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]

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Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH] Amnion: The extraembryonic membrane which contains the embryo and amniotic fluid. [NIH]

Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broadspectrum antibiotic. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

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Anomalies: Birth defects; abnormalities. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Valve: The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH]

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Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriosus: Circle composed of anastomosing arteries derived from two long posterior ciliary and seven anterior ciliary arteries, located in the ciliary body about the root of the iris. [NIH]

Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Atony: Lack of normal tone or strength. [EU] ATP: ATP an abbreviation for adenosine triphosphate, a compound which serves as a carrier of energy for cells. [NIH] Atresia: Lack of a normal opening from the esophagus, intestines, or anus. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Autacoids: A chemically diverse group of substances produced by various tissues in the body that cause slow contraction of smooth muscle; they have other intense but varied pharmacologic activities. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH]

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Autonomic: Self-controlling; functionally independent. [EU] 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] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [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]

Beta-Lactamases: Enzymes found in many bacteria which catalyze the hydrolysis of the amide bond in the beta-lactam ring. Well known antibiotics destroyed by these enzymes are penicillins and cephalosporins. EC 3.5.2.6. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological Markers: Measurable and quantifiable biological parameters (e.g., specific enzyme concentration, specific hormone concentration, specific gene phenotype distribution in a population, presence of biological substances) which serve as indices for health- and physiology-related assessments, such as disease risk, psychiatric disorders, environmental exposure and its effects, disease diagnosis, metabolic processes, substance abuse, pregnancy, cell line development, epidemiologic studies, etc. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH]

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Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] 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] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradycardia: Excessive slowness in the action of the heart, usually with a heart rate below 60 beats per minute. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Neoplasms: Neoplasms of the intracranial components of the central nervous system, including the cerebral hemispheres, basal ganglia, hypothalamus, thalamus, brain stem, and cerebellum. Brain neoplasms are subdivided into primary (originating from brain tissue) and secondary (i.e., metastatic) forms. Primary neoplasms are subdivided into benign and malignant forms. In general, brain tumors may also be classified by age of onset, histologic type, or presenting location in the brain. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal

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cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Caesarean section: A surgical incision through the abdominal and uterine walls in order to deliver a baby. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoid: A type of tumor usually found in the gastrointestinal system (most often in the appendix), and sometimes in the lungs or other sites. Carcinoid tumors are usually benign. [NIH]

Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiotocography: Monitoring of fetal heart frequency before birth in order to assess impending prematurity in relation to the pattern or intensity of antepartum uterine contraction. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH]

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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] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cefazolin: Semisynthetic cephalosporin analog with broad-spectrum antibiotic action due to inhibition of bacterial cell wall synthesis. It attains high serum levels and is excreted quickly via the urine. [NIH] Cefotiam: A cephalosporin antibiotic that has a broad spectrum of activity against both gram-positive and gram-negative microorganisms. It is the drug of choice for biliary tract infections and is a safe drug for perinatal infections. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Size: The physical dimensions of a cell. It refers mainly to changes in dimensions correlated with physiological or pathological changes in cells. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] 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] Cephalosporins: A group of broad-spectrum antibiotics first isolated from the Mediterranean fungus Acremonium (Cephalosporium acremonium). They contain the betalactam moiety thia-azabicyclo-octenecarboxylic acid also called 7-aminocephalosporanic acid. [NIH] Ceramide: A type of fat produced in the body. It may cause some types of cells to die, and is being studied in cancer treatment. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH]

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Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Aqueduct: Narrow channel in the mesencephalon that connects the third and fourth ventricles. [NIH] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] 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] Cervical Ripening: A change in the cervix with respect to its readiness to relax. The cervix becomes softer, more flexible, more distensible, and shorter in the final weeks of pregnancy. Though naturally occurring during normal pregnancy, it can also be induced for certain cases of prolonged or high-risk pregnancy by administration of hormones. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Cesarean Section, Repeat: Extraction of the fetus by abdominal hysterotomy anytime following a previous cesarean. [NIH] Chimera: An individual that contains cell populations derived from different zygotes. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chorion: The outermost extraembryonic membrane. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH]

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Cicatrix: The formation of new tissue in the process of wound healing. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clot Retraction: Retraction of a clot resulting from contraction of platelet pseudopods attached to fibrin strands that is dependent on the contractile protein thrombosthenin. Used as a measure of platelet function. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colposcopy: The examination, therapy or surgery of the cervix and vagina by means of a specially designed endoscope introduced vaginally. [NIH] Competency: The capacity of the bacterium to take up DNA from its surroundings. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin

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system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confidence Intervals: A range of values for a variable of interest, e.g., a rate, constructed so that this range has a specified probability of including the true value of the variable. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Conization: The excision of a cone of tissue, especially of the cervix uteri. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH]

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Continence: The ability to hold in a bowel movement or urine. [NIH] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Conus: A large, circular, white patch around the optic disk due to the exposing of the sclera as a result of degenerative change or congenital abnormality in the choroid and retina. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] 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] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH]

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Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] 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] 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] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH]

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Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Ketoacidosis: Complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration. The metabolic acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids. Glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis). [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt, diclofenac sodium. [NIH] Diclofenac Sodium: The sodium form of diclofenac. It is used for its analgesic and antiinflammatory properties. [NIH] 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] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfection: Rendering pathogens harmless through the use of heat, antiseptics, antibacterial agents, etc. [NIH] Dissection: Cutting up of an organism for study. [NIH] DNA Topoisomerase: An enzyme catalyzing ATP-independent breakage of single-stranded DNA, followed by passage and rejoining of another single-stranded DNA. This enzyme

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class brings about the conversion of one topological isomer of DNA into another, e.g., the relaxation of superhelical turns in DNA, the interconversion of simple and knotted rings of single-stranded DNA, and the intertwisting of single-stranded rings of complementary sequences. (From Enzyme Nomenclature, 1992) EC 5.99.1.2. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Dwarfism: The condition of being undersized as a result of premature arrest of skeletal growth. It may be caused by insufficient secretion of growth hormone (pituitary dwarfism). [NIH]

Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dystocia: Difficult childbirth or labor. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]

Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus. [NIH]

Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] 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] Eicosanoids: A class of oxygenated, endogenous, unsaturated fatty acids derived from arachidonic acid. They include prostaglandins, leukotrienes, thromboxanes, and hydroxyeicosatetraenoic acid compounds (HETE). They are hormone-like substances that act near the site of synthesis without altering functions throughout the body. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus

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becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Embryogenesis: The process of embryo or embryoid formation, whether by sexual (zygotic) or asexual means. In asexual embryogenesis embryoids arise directly from the explant or on intermediary callus tissue. In some cases they arise from individual cells (somatic cell embryoge). [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Emetic: An agent that causes vomiting. [EU] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalitis, Viral: Inflammation of brain parenchymal tissue as a result of viral infection. Encephalitis may occur as primary or secondary manifestation of Togaviridae infections; Herpesviridae infections; Adenoviridae infections; Flaviviridae infections; Bunyaviridae infections; Picornaviridae infections; Paramyxoviridae infections; Orthomyxoviridae infections; Retroviridae infections; and Arenaviridae infections. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and

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stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotracheal intubation: Insertion of an airtube into the windpipe. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophilia: Abnormal increase in eosinophils in the blood, tissues or organs. [NIH] Ephedrine: An alpha- and beta-adrenergic agonist that may also enhance release of norepinephrine. It has been used in the treatment of several disorders including asthma, heart failure, rhinitis, and urinary incontinence, and for its central nervous system stimulatory effects in the treatment of narcolepsy and depression. It has become less extensively used with the advent of more selective agonists. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH]

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Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epidural block: An injection of an anesthetic drug into the space between the wall of the spinal canal and the covering of the spinal cord. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Episiotomy: An incision of the posterior vaginal wall and a portion of the pudenda which enlarges the vaginal introitus to facilitate delivery and prevent lacerations. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrone: 3-Hydroxyestra-1,3,5(10)-trien-17-one. A metabolite of estradiol but possessing less biological activity. It is found in the urine of pregnant women and mares, in the human placenta, and in the urine of bulls and stallions. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985), estrone may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and

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laminin). [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [NIH] Fallopian Tubes: Two long muscular tubes that transport ova from the ovaries to the uterus. They extend from the horn of the uterus to the ovaries and consist of an ampulla, an infundibulum, an isthmus, two ostia, and a pars uterina. The walls of the tubes are composed of three layers: mucosal, muscular, and serosal. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Fasciitis: Inflammation of the fascia. There are three major types: 1) Eosinophilic fasciitis, an inflammatory reaction with eosinophilia, producing hard thickened skin with an orangepeel configuration suggestive of scleroderma and considered by some a variant of scleroderma; 2) Necrotizing fasciitis, a serious fulminating infection (usually by a beta hemolytic Streptococcus) causing extensive necrosis of superficial fascia; 3) Nodular/Pseudosarcomatous/Proliferative fasciitis, characterized by a rapid growth of fibroblasts with mononuclear inflammatory cells and proliferating capillaries in soft tissue, often the forearm; it is not malignant but is sometimes mistaken for fibrosarcoma. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetal Blood: Blood of the fetus. Exchange of nutrients and waste between the fetal and maternal blood occurs via the placenta. The cord blood is blood contained in the umbilical vessels at the time of delivery. [NIH] Fetal Death: Death of the young developing in utero. [NIH] Fetal Distress: Adverse or threatening condition of the fetus identified by fetal bradycardia or tachycardia and passage of meconium in vertex presentation. [NIH] Fetal Heart: The heart of the fetus of any viviparous animal. It refers to the heart in the postembryonic period and is differentiated from the embryonic heart (heart/embryology) only on the basis of time. [NIH] Fetal Membranes: Thin layers of tissue which surround the embryo or fetus and provide for its nutrition, respiration, excretion and protection; they are the yolk sac, allantois, amnion, and chorion. [NIH] Fetal Monitoring: Physiologic or biochemical monitoring of the fetus. It is usually done during labor and may be performed in conjunction with the monitoring of uterine activity. It

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may also be performed prenatally as when the mother is undergoing surgery. [NIH] Fetal Weight: The weight of the fetus in utero, which is usually estimated by various formulas based on measurements made during prenatal ultrasonography. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosarcoma: A type of soft tissue sarcoma that begins in fibrous tissue, which holds bones, muscles, and other organs in place. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorescent Dyes: Dyes that emit light when exposed to light. The wave length of the emitted light is usually longer than that of the incident light. Fluorochromes are substances that cause fluorescence in other substances, i.e., dyes used to mark or label other compounds with fluorescent tags. They are used as markers in biochemistry and immunology. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Follicles: Shafts through which hair grows. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fourth Ventricle: An irregularly shaped cavity in the rhombencephalon, between the medulla oblongata, the pons, and the isthmus in front, and the cerebellum behind. It is continuous with the central canal of the cord below and with the cerebral aqueduct above, and through its lateral and median apertures it communicates with the subarachnoid space. [NIH]

Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of

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shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] 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] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genistein: An isoflavonoid derived from soy products. It inhibits protein-tyrosine kinase and topoisomerase-ii (dna topoisomerase (atp-hydrolysing)) activity and is used as an antineoplastic and antitumor agent. Experimentally, it has been shown to induce G2 phase arrest in human and murine cell lines. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomeruli: Plural of glomerulus. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen

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frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Goiter: Enlargement of the thyroid gland. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Gonads: The gamete-producing glands, ovary or testis. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] 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

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other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hematopoiesis: The development and formation of various types of blood cells. [NIH] Hematopoietic Stem Cells: Progenitor cells from which all blood cells derive. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemoptysis: Bronchial hemorrhage manifested with spitting of blood. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes

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simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Hetastarch: A derivative of starch used as a plasma substitute in the treatment of hemorrhage. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Homosexuality: Sexual attraction or relationship between members of the same sex. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydration: Combining with water. [NIH] Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH]

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Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypotension: Abnormally low blood pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxemia: Deficient oxygenation of the blood; hypoxia. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hysterectomy: Excision of the uterus. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] 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] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU]

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In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incisional: The removal of a sample of tissue for examination under a microscope. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indomethacin: A non-steroidal anti-inflammatory agent (NSAID) that inhibits the enzyme cyclooxygenase necessary for the formation of prostaglandins and other autacoids. It also inhibits the motility of polymorphonuclear leukocytes. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant Mortality: Perinatal, neonatal, and infant deaths in a given population. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inferior vena cava: A large vein that empties into the heart. It carries blood from the legs and feet, and from organs in the abdomen and pelvis. [NIH] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Infuse: To pour (a liquid) into something. [EU] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH]

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Initiator: A chemically reactive substance which may cause cell changes if ingested, inhaled or absorbed into the body; the substance may thus initiate a carcinogenic process. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intracranial Hemorrhages: Bleeding within the intracranial cavity, including hemorrhages in the brain and within the cranial epidural, subdural, and subarachnoid spaces. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [NIH] Intrathecal: Describes the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. Drugs can be injected into the fluid or a sample of the fluid can be removed for testing. [NIH] Intravenous: IV. Into a vein. [NIH] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] 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]

Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential

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element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ion Transport: The movement of ions across energy-transducing cell membranes. Transport can be active or passive. Passive ion transport (facilitated diffusion) derives its energy from the concentration gradient of the ion itself and allows the transport of a single solute in one direction (uniport). Active ion transport is usually coupled to an energy-yielding chemical or photochemical reaction such as ATP hydrolysis. This form of primary active transport is called an ion pump. Secondary active transport utilizes the voltage and ion gradients produced by the primary transport to drive the cotransport of other ions or molecules. These may be transported in the same (symport) or opposite (antiport) direction. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Isoflurane: A stable, non-explosive inhalation anesthetic, relatively free from significant side effects. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [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] Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (receptors, NMethyl-D-Aspartate) and may interact with sigma receptors. [NIH] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketorolac: A drug that belongs to a family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in cancer prevention. [NIH] Ketorolac Tromethamine: A pyrrolizine carboxylic acid derivative structurally related to indomethacin. It is a non-steroidal anti-inflammatory agent used for analgesia for postoperative pain and inhibits cyclooxygenase activity. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Lacerations: Torn, ragged, mangled wounds. [NIH]

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Lactation: The period of the secretion of milk. [EU] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Lincomycin: (2S-trans)-Methyl 6,8-dideoxy-6-(((1-methyl-4-propyl-2pyrrolidinyl)carbonyl)amino)-1-thio-D-erythro-alpha-D-galacto-octopyranoside. An antibiotic produced by Streptomyces lincolnensis var. lincolnensis. It has been used in the treatment of staphylococcal, streptococcal, and Bacteroides fragilis infections. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an

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electron acceptor. [NIH] Lipid Peroxides: Peroxides produced in the presence of a free radical by the oxidation of unsaturated fatty acids in the cell in the presence of molecular oxygen. The formation of lipid peroxides results in the destruction of the original lipid leading to the loss of integrity of the membranes. They therefore cause a variety of toxic effects in vivo and their formation is considered a pathological process in biological systems. Their formation can be inhibited by antioxidants, such as vitamin E, structural separation or low oxygen tension. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lordosis: The anterior concavity in the curvature of the lumbar and cervical spine as viewed from the side. The term usually refers to abnormally increased curvature (hollow back, saddle back, swayback). It does not include lordosis as normal mating posture in certain animals ( = posture + sex behavior, animal). [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lutein Cells: The cells of the corpus luteum which are derived from the granulosa cells and the theca cells of the Graafian follicle. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH]

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Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Macrophage Colony-Stimulating Factor: A mononuclear phagocyte colony-stimulating factor synthesized by mesenchymal cells. The compound stimulates the survival, proliferation, and differentiation of hematopoietic cells of the monocyte-macrophage series. M-CSF is a disulfide-bonded glycoprotein dimer with a MW of 70 kDa. It binds to a specific high affinity receptor (receptor, macrophage colony-stimulating factor). [NIH] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malondialdehyde: The dialdehyde of malonic acid. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Marital Status: A demographic parameter indicating a person's status with respect to marriage, divorce, widowhood, singleness, etc. [NIH] Maternal Mortality: Maternal deaths resulting from complications of pregnancy and childbirth in a given population. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Meconium: The thick green-to-black mucilaginous material found in the intestines of a fullterm fetus. It consists of secretions of the intestinal glands, bile pigments, fatty acids, amniotic fluid, and intrauterine debris. It constitutes the first stools passed by a newborn. [NIH]

Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH]

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Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Microdomains: Detergent-insoluble cell membrane components. They are enriched in sphingolipids and cholesterol and clustered with glycosyl-phosphatidylinositol (GPI)-anchored proteins. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Meperidine: 1-Methyl-4-phenyl-4-piperidinecarboxylic acid ethyl ester. A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is

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used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and cardiac patients. [NIH]

Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitral Valve: The valve between the left atrium and left ventricle of the heart. [NIH] Mode of Transmission: Hepatitis A [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocyte: A type of white blood cell. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Moxalactam: Broad- spectrum beta-lactam antibiotic similar in structure to the cephalosporins except for the substitution of an oxaazabicyclo moiety for the thiaazabicyclo moiety of certain cephalosporins. It has been proposed especially for the meningitides because it passes the blood-brain barrier and for anaerobic infections. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multiparous: 1. Having had two or more pregnancies which resulted in viable fetuses. 2. Producing several ova or offspring at one time. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU]

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Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myometrium: The smooth muscle coat of the uterus, which forms the main mass of the organ. [NIH] Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Natural Childbirth: Psychophysical relaxation techniques that are used to facilitate childbirth. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] 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] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasm: A new growth of benign or malignant tissue. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuroma: A tumor that arises in nerve cells. [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] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nipples: The conic organs which usually give outlet to milk from the mammary glands. [NIH]

Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of

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aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Oocytes: Female germ cells in stages between the prophase of the first maturation division and the completion of the second maturation division. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The

Dictionary 155

ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oximetry: The determination of oxygen-hemoglobin saturation of blood either by withdrawing a sample and passing it through a classical photoelectric oximeter or by electrodes attached to some translucent part of the body like finger, earlobe, or skin fold. It includes non-invasive oxygen monitoring by pulse oximetry. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papilloma: A benign epithelial neoplasm which may arise from the skin, mucous membranes or glandular ducts. [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of

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tissues and organs. [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]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvimetry: Measurement of the dimensions and capacity of the pelvis. It includes cephalopelvimetry (measurement of fetal head size in relation to maternal pelvic capacity), a prognostic guide to the management of labor associated with disproportion. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering

Dictionary 157

the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Phagocyte: An immune system cell that can surround and kill microorganisms and remove dead cells. Phagocytes include macrophages. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Placental tissue: The tissue intervening between fetal blood and maternal blood in the placenta; it acts as a selective membrane regulating the passage of substances from the maternal to the fetal blood. [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] 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] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight

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of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Porphyrins: A group of compounds containing the porphin structure, four pyrrole rings connected by methine bridges in a cyclic configuration to which a variety of side chains are attached. The nature of the side chain is indicated by a prefix, as uroporphyrin, hematoporphyrin, etc. The porphyrins, in combination with iron, form the heme component

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in biologically significant compounds such as hemoglobin and myoglobin. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [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] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Pre-Eclampsia: Development of hypertension with proteinuria, edema, or both, due to pregnancy or the influence of a recent pregnancy. It occurs after the 20th week of gestation, but it may develop before this time in the presence of trophoblastic disease. [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Preventive Medicine: A medical specialty primarily concerned with prevention of disease and the promotion and preservation of health in the individual. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from

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lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propofol: A widely used anesthetic. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostitution: The practice of indulging in promiscuous sexual relations for money. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protein-Tyrosine Kinase: An enzyme that catalyzes the phosphorylation of tyrosine

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residues in proteins with ATP or other nucleotides as phosphate donors. EC 2.7.1.112. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychotomimetic: Psychosis miming. [NIH] 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] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Circulation: The circulation of blood through the lungs. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulmonary Veins: The veins that return the oxygenated blood from the lungs to the left atrium of the heart. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quiescent: Marked by a state of inactivity or repose. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not

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sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reactivation: The restoration of activity to something that has been inactivated. [EU] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [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] Recombinant: A cell or an individual with a new combination of genes not found together

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in either parent; usually applied to linked genes. [EU] Reconstitution: 1. A type of regeneration in which a new organ forms by the rearrangement of tissues rather than from new formation at an injured surface. 2. The restoration to original form of a substance previously altered for preservation and storage, as the restoration to a liquid state of blood serum or plasma that has been dried and stored. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Relaxation Techniques: The use of muscular relaxation techniques in treatment. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory distress syndrome: A lung disease that occurs primarily in premature infants; the newborn must struggle for each breath and blueing of its skin reflects the baby's inability to get enough oxygen. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the

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retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Rhombencephalon: That part of the brain stem constituting the medulla oblongata (myelencephalon) and pons (metencephalon). [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Saline: A solution of salt and water. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Scoliosis: A lateral curvature of the spine. [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] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Seroconversion: The change of a serologic test from negative to positive, indicating the development of antibodies in response to infection or immunization. [EU] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH]

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Sex Behavior: Sexual activities of humans. [NIH] Sex Behavior, Animal: Sexual activities of animals. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [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]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH]

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Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spirochete: Lyme disease. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Stabilization: The creation of a stable state. [EU] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic

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hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] 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] Stroke Volume: The amount of blood pumped out of the heart per beat not to be confused with cardiac output (volume/time). [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Sulbactam: A beta-lactamase inhibitor with very weak antibacterial action. The compound prevents antibiotic destruction of beta-lactam antibiotics by inhibiting beta-lactamases, thus extending their spectrum activity. Combinations of sulbactam with beta-lactam antibiotics have been used successfully for the therapy of infections caused by organisms resistant to the antibiotic alone. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH]

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Superoxide Dismutase: An oxidoreductase that catalyzes the reaction between superoxide anions and hydrogen to yield molecular oxygen and hydrogen peroxide. The enzyme protects the cell against dangerous levels of superoxide. EC 1.15.1.1. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] 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 the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH]

Dictionary 169

Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tocolysis: Any drug treatment modality designed to inhibit uterine contractions in pregnant women at risk for preterm labor. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxaemia: 1. The condition resulting from the spread of bacterial products (toxins) by the bloodstream. 2. A condition resulting from metabolic disturbances, e.g. toxaemia of pregnancy. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Tractus: A part of some structure, usually that part along which something passes. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH]

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Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Umbilical Arteries: Either of a pair of arteries originating from the internal iliac artery and passing through the umbilical cord to carry blood from the fetus to the placenta. [NIH] Umbilical Cord: The flexible structure, giving passage to the umbilical arteries and vein, which connects the embryo or fetus to the placenta. [NIH] Umbilical cord blood: Blood from the placenta (afterbirth) that contains high concentrations of stem cells needed to produce new blood cells. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterine Rupture: A tearing of uterine tissue; it may be traumatic or spontaneous due to multiple pregnancy, large fetus, previous scarring, or obstruction. [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] 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]

Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginal Birth after Cesarean: Delivery of an infant through the vagina in a female who has had a prior cesarean section. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH]

Dictionary 171

Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilators: Any nerve or agent which induces dilatation of the blood vessels. [NIH] Vasopressor: 1. Stimulating contraction of the muscular tissue of the capillaries and arteries. 2. An agent that stimulates contraction of the muscular tissue of the capillaries and arteries. [EU]

Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Vena: A vessel conducting blood from the capillary bed to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] Viremia: The presence of viruses in the blood. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vital Statistics: Used for general articles concerning statistics of births, deaths, marriages, etc. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH]

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Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Yolk Sac: An embryonic membrane formed from endoderm and mesoderm. In reptiles and birds it incorporates the yolk into the digestive tract for nourishing the embryo. In placental mammals its nutritional function is vestigial; however, it is the source of most of the intestinal mucosa and the site of formation of the germ cells. It is sometimes called the vitelline sac, which should not be confused with the vitelline membrane of the egg. [NIH] Zygote: The fertilized ovum. [NIH]

173

INDEX A Abdomen, 119, 125, 144, 145, 146, 148, 149, 156, 167, 168 Abdominal, 13, 16, 22, 25, 29, 31, 59, 119, 126, 128, 146, 151, 155, 156, 157, 170 Abdominal Pain, 119, 157, 170 Accommodation, 19, 119 Acetylcholine, 119, 153 Acidosis, 119, 133 Acoustic, 29, 46, 119 Acupuncture Anesthesia, 80, 119 Acyclovir, 22, 23, 119 Adhesions, 60, 119 Adjustment, 38, 119 Adolescence, 119, 156 Adrenal Cortex, 119, 132, 137, 159 Adrenal Medulla, 119, 137, 154 Adrenergic, 18, 63, 119, 134, 136, 137, 168 Adverse Effect, 24, 119, 165 Afferent, 119 Affinity, 119, 120, 150, 165 Agonist, 120, 134, 136 Alanine, 108, 120 Algorithms, 120, 124 Alkaline, 119, 120, 126 Alkaloid, 120, 129, 152 Allantois, 120, 138 Alpha Particles, 120, 162 Alternative medicine, 93, 120 Ambulatory Care, 120 Amebiasis, 120, 151 Amino Acid Sequence, 120, 122 Amino Acids, 120, 156, 158, 160 Amnestic, 121, 151 Amnion, 121, 138 Amniotic Fluid, 10, 14, 121, 140, 150 Amphetamine, 52, 121, 133 Ampicillin, 30, 121 Anaerobic, 121, 152 Anaesthesia, 46, 47, 50, 63, 68, 74, 121, 145 Anal, 19, 30, 83, 88, 89, 121, 136 Analgesic, 39, 121, 133, 151, 152, 154 Analog, 66, 119, 121, 127, 129 Androgens, 10, 119, 121 Anemia, 106, 121, 150 Anesthetics, 121, 137 Aneurysm, 121, 171 Angiogenesis, 121, 150

Animal model, 9, 26, 121 Anions, 121, 147, 168 Annealing, 121, 158 Anomalies, 5, 122 Antibacterial, 122, 129, 133, 166, 167 Antibiotic, 28, 31, 34, 50, 91, 121, 122, 126, 127, 148, 152, 156, 166, 167 Antibiotic Prophylaxis, 34, 50, 122 Antibodies, 22, 23, 122, 144, 157, 162, 164 Antibody, 5, 120, 122, 129, 144, 145, 147, 152, 162, 166, 172 Antiemetic, 122, 151 Antigen, 120, 122, 130, 144, 145 Anti-infective, 122, 143, 147 Anti-inflammatory, 122, 123, 133, 140, 145, 147 Anti-Inflammatory Agents, 122, 123, 147 Antimetabolite, 119, 122 Antineoplastic, 122, 140 Antioxidant, 24, 122, 155 Antipyretic, 122, 133 Antiviral, 119, 122 Anus, 121, 122, 123, 125, 156 Anxiolytic, 122, 151 Aorta, 122, 126, 171 Aortic Valve, 47, 122 Apolipoproteins, 122, 149 Apoptosis, 14, 123 Aqueous, 123, 124, 132, 143, 148 Arachidonic Acid, 123, 134, 148, 160 Arginine, 123, 153 Arterial, 10, 15, 25, 66, 123, 128, 131, 144, 160, 168 Arteries, 15, 36, 122, 123, 125, 131, 149, 151, 161, 169, 170, 171 Arterioles, 123, 125, 170 Arteriosus, 123, 161 Aspiration, 31, 36, 123 Aspirin, 24, 123 Assay, 22, 108, 123 Ataxia, 123, 143 Atmospheric Pressure, 123, 143 Atony, 40, 123 ATP, 123, 133, 140, 147, 157, 161 Atresia, 46, 123, 131 Atrium, 123, 126, 131, 152, 161, 171 Autacoids, 123, 145 Autologous, 13, 123

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Autonomic, 56, 119, 124, 154, 156, 168 B Bacteria, 122, 124, 135, 138, 141, 151, 162, 165, 166, 170 Bacterium, 124, 129, 142 Base, 44, 45, 65, 124, 132, 147, 168 Benign, 32, 124, 125, 126, 141, 153, 155, 162 Beta-Lactamases, 124, 167 Bifida, 124 Bilateral, 18, 124 Bile, 124, 139, 147, 149, 150, 166 Bile Pigments, 124, 147, 150 Biliary, 124, 127 Biliary Tract, 124, 127 Bilirubin, 124, 143 Biochemical, 26, 122, 124, 138, 139 Biological Markers, 24, 124 Biological therapy, 124, 141 Biosynthesis, 10, 123, 124 Biotechnology, 27, 28, 93, 101, 124 Bladder, 32, 40, 54, 57, 88, 125, 139, 145, 167, 170 Blastocyst, 125, 130, 135, 157 Blood Coagulation, 125, 126 Blood Glucose, 125, 142, 144, 146 Blood Platelets, 125, 168 Blood pressure, 10, 24, 125, 144, 152, 161, 165 Blood transfusion, 43, 108, 125 Blood-Brain Barrier, 125, 152 Body Fluids, 125, 165 Bone Marrow, 12, 125, 132, 144, 149, 167 Bowel, 7, 88, 121, 125, 131, 145, 146, 157, 167, 170 Bowel Movement, 88, 125, 131, 167 Brachytherapy, 125, 146, 147, 162, 172 Bradycardia, 125, 138 Bradykinin, 125, 153 Brain Neoplasms, 125, 143 Brain Stem, 125, 127, 164 Branch, 115, 126, 155, 165, 168 Breakdown, 126, 133, 140 Broad-spectrum, 121, 126, 127 Bronchi, 126, 137, 169 Bupivacaine, 34, 36, 50, 52, 55, 56, 66, 74, 126, 148 C Calcium, 14, 24, 126, 129, 150 Callus, 126, 135 Carbohydrate, 126, 140, 141 Carbon Dioxide, 22, 126, 157, 163 Carcinogen, 126, 137, 151

Carcinogenic, 126, 145, 146, 166 Carcinoid, 51, 126 Carcinoma, 36, 126 Cardiac, 17, 126, 131, 135, 137, 148, 152, 153, 163, 166, 167 Cardiac Output, 17, 126, 167 Cardiopulmonary, 48, 50, 126 Cardiopulmonary Bypass, 48, 126 Cardiorespiratory, 126, 152 Cardiotocography, 44, 45, 126 Cardiovascular, 24, 121, 126, 148 Case report, 32, 34, 35, 42, 54, 56, 58, 62, 70, 79, 127 Catheterization, 127, 146 Catheters, 10, 14, 127, 144, 146 Caudal, 127, 144, 159 Cefazolin, 28, 34, 127 Cefotiam, 63, 127 Cell, 9, 12, 14, 15, 26, 36, 120, 123, 124, 125, 127, 128, 130, 132, 135, 137, 139, 140, 141, 144, 145, 146, 147, 149, 150, 151, 152, 153, 155, 157, 158, 160, 162, 163, 167, 168, 169, 172 Cell Death, 123, 127, 153 Cell Division, 124, 127, 141, 152, 157, 160 Cell membrane, 127, 147, 151, 157 Cell Size, 127, 139 Cell Survival, 127, 141 Central Nervous System, 119, 120, 121, 125, 127, 129, 133, 136, 141, 143, 148, 152, 158 Central Nervous System Infections, 127, 141, 143 Cephalosporins, 124, 127, 152 Ceramide, 20, 127 Cerebellum, 18, 125, 127, 139, 158 Cerebral, 13, 16, 34, 51, 57, 123, 125, 128, 131, 137, 139, 143, 150 Cerebral Aqueduct, 128, 139 Cerebral Infarction, 128, 143 Cerebral Palsy, 13, 51, 128 Cerebrospinal, 128, 143, 165 Cerebrospinal fluid, 128, 143, 165 Cerebrum, 128 Cervical, 8, 21, 25, 92, 128, 149 Cervical Ripening, 25, 128 Cervix, 17, 22, 25, 128, 129, 130 Cesarean Section, Repeat, 128 Chimera, 12, 128 Cholecystectomy, 48, 54, 128 Cholesterol, 124, 128, 149, 151, 166 Cholesterol Esters, 128, 149

Index 175

Chorion, 128, 138 Chromatin, 123, 128 Chromosomal, 49, 128 Chromosome, 13, 128, 148 Chronic, 5, 62, 88, 108, 120, 128, 133, 145, 149, 164, 167, 170 Chronic Disease, 108, 128 Chylomicrons, 128, 149 Cicatrix, 78, 129 Clamp, 26, 129 Clindamycin, 28, 129 Clinical Medicine, 15, 129 Clinical trial, 9, 22, 25, 101, 129, 131, 132, 162 Cloning, 124, 129 Clot Retraction, 129, 158 Coca, 129 Cocaine, 108, 129 Cohort Studies, 4, 129, 136 Colitis, 129 Collagen, 25, 88, 129, 137, 139, 150, 158, 160 Colposcopy, 22, 129 Competency, 20, 129 Complement, 129, 130 Complementary and alternative medicine, 77, 82, 130 Complementary medicine, 77, 130 Computational Biology, 101, 130 Conception, 6, 130, 131, 139, 159, 166 Condoms, 86, 130 Cone, 22, 130 Confidence Intervals, 12, 130 Confounding, 12, 22, 24, 130 Conization, 22, 130 Connective Tissue, 125, 129, 130, 149, 151 Consciousness, 8, 121, 130, 163 Constipation, 130, 157 Consumption, 64, 130, 163 Continence, 18, 19, 131 Contraception, 6, 51, 131 Contractility, 14, 25, 131 Contraindications, ii, 131 Control group, 5, 6, 7, 10, 24, 131 Controlled study, 29, 131 Conus, 131, 161 Convulsions, 131, 134, 159 Coordination, 14, 127, 131 Cor, 131 Coronary, 74, 131, 151 Coronary Thrombosis, 131, 151 Corpus, 131, 149, 156, 159

Corpus Luteum, 131, 149, 159 Cortex, 123, 131 Cortical, 131, 164 Corticosteroids, 7, 131, 140 Cortisol, 10, 78, 132 Cortisone, 132, 133 Cranial, 127, 132, 141, 146, 156 Craniocerebral Trauma, 132, 141, 143 Curative, 132, 168 Cyclic, 132, 141, 154, 158, 160 Cyclosporine, 7, 132 Cyst, 47, 132 Cytokine, 9, 13, 132 Cytoplasm, 123, 127, 132, 141 Cytotoxic, 132, 162 D Databases, Bibliographic, 101, 132 Decidua, 14, 132, 157 Decision Making, 108, 132 Degenerative, 131, 132, 142 Deletion, 123, 132 Delivery of Health Care, 132, 142 Denaturation, 132, 158 Dendrites, 132, 153 Density, 13, 24, 132, 139, 149, 154 Dexamethasone, 14, 47, 133 Dextroamphetamine, 121, 133 Diabetes Mellitus, 5, 6, 81, 88, 133, 141, 142 Diabetic Ketoacidosis, 88, 133 Diagnostic procedure, 93, 133 Dialyzer, 133, 142 Diastolic, 133, 144 Diclofenac, 41, 133 Diclofenac Sodium, 41, 133 Diffusion, 133, 147 Digestion, 124, 125, 133, 146, 149, 167 Dilatation, 34, 121, 133, 171 Dilatation, Pathologic, 133, 171 Dilation, 12, 125, 133, 143, 171 Direct, iii, 17, 18, 20, 21, 24, 95, 129, 133, 134, 140, 163 Discrimination, 8, 133 Disease Progression, 133, 171 Disinfection, 59, 133 Dissection, 36, 133 DNA Topoisomerase, 133, 140 Dopamine, 121, 129, 133, 134, 151, 152 Dorsal, 134, 159 Drive, ii, vi, 3, 4, 7, 73, 134, 147, 148 Drug Interactions, 96, 134 Drug Tolerance, 134, 169

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Dwarfism, 53, 134 Dysplasia, 8, 21, 134 Dystocia, 10, 53, 78, 91, 134 E Eclampsia, 134, 159 Ectopic, 30, 134 Ectopic Pregnancy, 30, 134 Edema, 63, 134, 146, 159 Efficacy, 18, 20, 22, 41, 64, 65, 134 Eicosanoids, 14, 134 Elastin, 129, 134, 137 Elective, 5, 20, 28, 30, 40, 41, 42, 44, 54, 59, 63, 64, 65, 68, 69, 74, 75, 79, 91, 134 Electrolyte, 134, 165 Electrons, 122, 124, 135, 147, 155, 162 Emboli, 36, 135 Embolism, 44, 135, 161 Embolization, 36, 135 Embryo, 121, 125, 135, 138, 145, 159, 166, 170, 172 Embryo Transfer, 135, 159 Embryogenesis, 20, 135 Embryology, 135, 138 Emetic, 90, 135 Encephalitis, 57, 135 Encephalitis, Viral, 135 Endemic, 5, 135, 150, 166 Endocarditis, 47, 135 Endocardium, 135 Endometrial, 51, 135 Endometriosis, 31, 93, 135 Endometrium, 132, 135, 136, 151 Endoscope, 129, 136 Endoscopic, 136, 152 Endothelium, 24, 136, 153, 158 Endothelium, Lymphatic, 136 Endothelium, Vascular, 136 Endothelium-derived, 136, 153 Endotracheal intubation, 42, 136 Environmental Exposure, 124, 136 Environmental Health, 100, 102, 136 Enzymatic, 126, 130, 136, 158, 163 Enzyme, 108, 124, 133, 136, 141, 145, 152, 158, 160, 161, 168, 171 Eosinophilia, 136, 138 Ephedrine, 39, 45, 136 Epidemic, 42, 87, 136, 166 Epidemiologic Studies, 124, 136 Epidemiological, 46, 136 Epidermal, 16, 136 Epidermis, 136, 161 Epidural block, 58, 137

Epinephrine, 34, 119, 134, 137, 154 Episiotomy, 7, 88, 137 Epithelial, 132, 137, 142, 155 Epithelium, 136, 137 Erythrocytes, 121, 125, 137, 163 Esophagus, 123, 137, 167 Estradiol, 10, 11, 137 Estrogen, 10, 18, 137, 159 Estrone, 10, 11, 137 Eukaryotic Cells, 137, 145 Excitation, 137, 139 Exhaustion, 137, 150 Exogenous, 10, 137 External-beam radiation, 137, 147, 162, 172 Extracellular, 130, 137, 139, 150, 165 Extracellular Matrix, 130, 137, 139, 150 Extracellular Matrix Proteins, 137, 150 Extraction, 6, 33, 34, 128, 138 Extravasation, 138, 142 F Failure to Thrive, 9, 138 Fallopian Tubes, 138, 170 Family Planning, 8, 61, 101, 138 Family Practice, 17, 35, 60, 138 Fasciitis, 59, 138 Fat, 123, 125, 127, 131, 135, 138, 147, 148, 165 Fatty acids, 133, 134, 138, 149, 150, 160, 169 Feces, 60, 130, 138, 167 Femoral, 126, 138 Femoral Artery, 126, 138 Fentanyl, 34, 52, 66, 138 Fertilization in Vitro, 138, 159 Fetal Blood, 11, 14, 15, 138, 157 Fetal Death, 32, 138 Fetal Distress, 14, 16, 24, 29, 138 Fetal Heart, 11, 25, 126, 138 Fetal Membranes, 14, 138 Fetal Monitoring, 24, 138 Fetal Weight, 11, 139 Fetus, 7, 9, 10, 11, 17, 21, 24, 80, 128, 138, 139, 150, 157, 159, 166, 167, 170 Fibrin, 125, 129, 139, 157, 158 Fibroblasts, 138, 139 Fibrosarcoma, 138, 139 Fistula, 70, 74, 139 Flatus, 139, 140 Flow Cytometry, 14, 139 Fluorescence, 25, 139 Fluorescent Dyes, 139

Index 177

Fold, 5, 139, 155 Follicles, 20, 139 Foramen, 139, 156 Forearm, 125, 138, 139 Fossa, 127, 139 Fourth Ventricle, 10, 128, 139 Fundus, 26, 139 G Gallbladder, 119, 124, 128, 139 Gamma Rays, 139, 162 Gas, 44, 75, 126, 133, 139, 140, 143, 153, 154 Gastrin, 78, 140, 143 Gastrointestinal, 125, 126, 137, 140, 148, 150, 167 Gene, 15, 18, 124, 140 Gene Expression, 15, 140 Genetic testing, 140, 158 Genistein, 11, 140 Genital, 8, 14, 22, 23, 46, 140, 170 Genotype, 4, 140, 157 Germ Cells, 140, 154, 155, 168, 172 Gestation, 6, 7, 11, 13, 18, 21, 22, 24, 59, 70, 140, 156, 157, 159, 166 Gestational, 5, 6, 28, 47, 51, 81, 140 Gestational Age, 6, 140 Giardiasis, 140, 151 Gland, 119, 132, 140, 149, 155, 164, 167, 169 Glomeruli, 140, 161 Glucocorticoid, 133, 140 Gluconeogenesis, 140 Glucose, 4, 5, 65, 78, 125, 133, 140, 141, 142, 146, 164 Glucose Intolerance, 5, 133, 140 Glucose tolerance, 4, 5, 140, 141 Glucose Tolerance Test, 4, 5, 140, 141 Glycogen, 141 Glycoprotein, 141, 150 Goiter, 11, 141 Gonadal, 141, 166 Gonadotropin, 39, 141 Gonads, 20, 141 Gonorrhea, 86, 141 Governing Board, 141, 159 Grade, 22, 141 Gram-negative, 127, 141 Gram-positive, 127, 141 Granulocytes, 141, 172 Gravidity, 141, 155 Growth, 9, 18, 29, 78, 119, 121, 122, 123, 127, 134, 138, 141, 150, 153, 157, 169, 170 Growth factors, 9, 18, 141

Guanylate Cyclase, 141, 154 H Headache, 141, 143 Health Care Costs, 12, 142 Health Expenditures, 142 Heart failure, 136, 142 Hematoma, 30, 142 Hematopoiesis, 13, 142 Hematopoietic Stem Cells, 13, 142 Heme, 124, 142, 158 Hemodialysis, 108, 133, 142 Hemodynamics, 16, 142 Hemoglobin, 64, 121, 137, 142, 155, 159 Hemolytic, 138, 142 Hemoptysis, 30, 142 Hemorrhage, 33, 34, 49, 132, 141, 142, 143, 161, 167 Hepatic, 141, 142, 158 Hepatitis, 3, 4, 108, 142, 152 Hepatocytes, 142 Heredity, 140, 142 Herpes, 22, 23, 46, 49, 57, 86, 90, 119, 142, 143 Herpes Zoster, 143 Hetastarch, 62, 143 Heterogeneity, 4, 15, 120, 143 Homosexuality, 86, 143 Hormonal, 18, 143 Hormone, 10, 19, 78, 87, 124, 131, 132, 134, 137, 140, 143, 146, 147, 155, 159, 169 Hydration, 40, 79, 143 Hydrocephalus, 18, 143, 146 Hydrogen, 119, 124, 126, 132, 137, 143, 148, 152, 153, 155, 161, 168 Hydrogen Peroxide, 143, 148, 168 Hydrolysis, 124, 143, 147, 158, 161 Hydrophobic, 143, 149 Hydroxylysine, 129, 143 Hydroxyproline, 129, 143 Hyperbaric, 50, 55, 56, 143 Hyperbaric oxygen, 143 Hyperbilirubinemia, 5, 6, 143, 147 Hypertension, 5, 10, 81, 88, 144, 146, 159 Hypnotic, 144, 151 Hypoglycemia, 5, 144 Hypoglycemic, 5, 144 Hypotension, 10, 16, 45, 50, 62, 63, 65, 74, 131, 144 Hypothalamic, 10, 144 Hypothalamus, 125, 144 Hypoxemia, 17, 144 Hypoxia, 25, 144

178

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Hysterectomy, 69, 80, 87, 144 Hysterotomy, 55, 128, 144 I Id, 76, 81, 106, 109, 114, 116, 144 Idiopathic, 7, 144 Immune response, 122, 132, 144, 167, 171 Immune system, 108, 124, 144, 148, 150, 157, 172 Immunity, 120, 144 Immunization, 144, 164 Immunodeficiency, 4, 5, 8, 85, 86, 108, 144 Immunodeficiency syndrome, 85, 86, 144 Immunohistochemistry, 9, 14, 144 Immunologic, 140, 144, 162 Implant radiation, 144, 146, 147, 162, 172 Implantation, 51, 130, 144 In situ, 9, 32, 144 In Situ Hybridization, 9, 145 In vitro, 12, 135, 145, 158 In vivo, 12, 20, 26, 145, 149, 169 Incision, 24, 29, 32, 37, 69, 126, 137, 144, 145, 146, 148 Incisional, 68, 145 Incontinence, 18, 19, 68, 88, 89, 90, 92, 136, 143, 145, 167 Indicative, 86, 145, 155, 170 Indomethacin, 14, 145, 147 Induction, 17, 25, 41, 42, 43, 50, 51, 52, 53, 54, 62, 70, 71, 107, 121, 145, 147, 159 Infant Mortality, 9, 145 Infarction, 128, 131, 145, 151 Inferior vena cava, 56, 145 Infertility, 20, 22, 52, 91, 145 Inflammation, 122, 123, 129, 135, 138, 142, 143, 145, 148, 157, 161, 164, 170 Inflammatory bowel disease, 7, 145 Infuse, 14, 145 Infusion, 10, 14, 145, 169 Ingestion, 141, 145, 158 Inhalation, 52, 145, 147, 158 Initiation, 14, 31, 52, 145 Initiator, 10, 146 Insulin, 6, 55, 78, 133, 141, 146, 147 Insulin-dependent diabetes mellitus, 146 Intensive Care, 17, 74, 146 Intermittent, 53, 146 Internal radiation, 146, 147, 162, 172 Interstitial, 125, 146, 147, 172 Intervertebral, 146, 149 Intervertebral Disk Displacement, 146, 149 Intestinal, 141, 146, 150, 172

Intestine, 125, 146, 163, 165 Intracellular, 145, 146, 154, 160 Intracranial Hemorrhages, 143, 146 Intracranial Hypertension, 141, 143, 146 Intramuscular, 41, 146 Intraperitoneal, 12, 146 Intrathecal, 41, 52, 55, 66, 74, 75, 146 Intravenous, 4, 16, 39, 52, 53, 66, 77, 108, 145, 146 Intubation, 31, 127, 146 Invasive, 144, 146, 155 Iodine, 59, 146 Ion Transport, 30, 147 Ionizing, 120, 136, 147, 162 Ions, 124, 134, 143, 147 Irradiation, 12, 35, 147, 172 Isoflurane, 16, 147 J Jaundice, 38, 143, 147 K Kb, 100, 147 Ketamine, 53, 70, 147 Ketone Bodies, 133, 147 Ketorolac, 29, 147 Ketorolac Tromethamine, 29, 147 Ketosis, 133, 147 L Lacerations, 5, 137, 147 Lactation, 6, 148, 155, 159 Laparotomy, 64, 148 Least-Squares Analysis, 148, 163 Lens, 148, 163 Lesion, 36, 148, 149, 165 Lethal, 12, 148 Lethargy, 143, 148 Leukocytes, 14, 125, 141, 145, 148 Leukotrienes, 123, 134, 148 Libido, 121, 148 Library Services, 114, 148 Lidocaine, 50, 55, 148 Ligaments, 131, 148 Ligation, 148 Likelihood Functions, 148, 163 Lincomycin, 129, 148 Linear Models, 148, 163 Linkage, 22, 148 Lipid, 66, 122, 146, 148, 149, 151, 155 Lipid Peroxidation, 148, 155 Lipid Peroxides, 66, 149 Lipoprotein, 24, 141, 149 Liver, 92, 119, 123, 124, 138, 139, 141, 142, 149

Index 179

Localization, 14, 16, 144, 149 Localized, 142, 145, 149, 157, 164 Logistic Models, 149, 163 Loop, 22, 149 Lordosis, 56, 149 Low Back Pain, 7, 149 Low-density lipoprotein, 149 Lumbar, 8, 56, 146, 149 Lutein Cells, 149, 160 Lymph, 128, 136, 149 Lymph node, 128, 149 Lymphatic, 136, 145, 149, 151, 158 Lymphoid, 122, 131, 150 Lytic, 150, 164 M Macrophage, 9, 64, 150 Macrophage Colony-Stimulating Factor, 64, 150 Malaria, 9, 150 Malaria, Falciparum, 150 Malaria, Vivax, 150 Malformation, 19, 30, 150 Malignant, 122, 125, 138, 150, 153, 162 Malondialdehyde, 24, 150 Mammary, 150, 153 Marital Status, 8, 150 Maternal Mortality, 88, 150 Matrix metalloproteinase, 14, 150 Meconium, 138, 150 Medical Records, 6, 21, 150 MEDLINE, 101, 150 Membrane, 26, 121, 127, 128, 130, 133, 135, 137, 141, 151, 152, 154, 157, 164, 172 Membrane Microdomains, 26, 151 Menopause, 18, 19, 151 Menstrual Cycle, 151, 159 Menstruation, 132, 151 Meperidine, 52, 151 Mercury, 139, 151 Mesenchymal, 150, 151 Mesentery, 151, 157 Metabolite, 20, 137, 151 Metastasis, 150, 151 Metoclopramide, 33, 77, 151 Metronidazole, 34, 151 MI, 6, 117, 151 Microbe, 151, 169 Microorganism, 151, 171 Microscopy, 14, 151 Midazolam, 71, 151 Milliliter, 4, 152 Mitochondrial Swelling, 152, 153

Mitosis, 123, 152 Mitral Valve, 30, 152 Mode of Transmission, 5, 152 Modification, 152, 161 Molecular, 15, 18, 26, 57, 101, 103, 121, 124, 130, 149, 152, 157, 158, 159, 167, 168 Molecule, 122, 124, 130, 136, 137, 143, 152, 155, 162 Monitor, 25, 27, 152, 154 Monoamine, 121, 133, 152 Monoclonal, 147, 152, 162, 172 Monocyte, 150, 152 Mononuclear, 12, 138, 150, 152 Morphine, 33, 40, 41, 49, 74, 75, 79, 151, 152, 153, 154 Motility, 145, 152 Motion Sickness, 152, 153 Moxalactam, 28, 152 Mucosa, 152, 160, 172 Mucus, 152, 170 Multiparous, 42, 51, 152 Mydriatic, 133, 152 Myocardium, 151, 153 Myometrium, 26, 30, 153 N Narcolepsy, 133, 136, 153 Narcosis, 153 Narcotic, 29, 80, 138, 151, 152, 153 Natural Childbirth, 86, 153 Nausea, 16, 47, 77, 79, 122, 147, 153 Necrosis, 68, 123, 128, 138, 145, 151, 153 Need, 3, 6, 8, 18, 20, 35, 63, 71, 85, 86, 87, 93, 106, 110, 141, 150, 153, 169 Neoplasm, 153, 155 Nerve, 80, 119, 121, 123, 132, 153, 159, 167, 169, 171 Nervous System, 30, 119, 121, 127, 153, 156, 168 Neurologic, 143, 153 Neuroma, 29, 46, 153 Neurons, 11, 129, 132, 153, 168 Neurosurgery, 29, 30, 153 Neutrons, 120, 147, 153, 162 Nipples, 5, 153 Nitric Oxide, 68, 153 Nitrogen, 15, 120, 121, 137, 154, 170 Norepinephrine, 10, 119, 134, 136, 154 Nuclear, 46, 135, 137, 140, 153, 154 Nucleic acid, 145, 154 Nucleus, 10, 123, 128, 132, 137, 140, 146, 152, 153, 154, 160, 161, 167 Nulliparous, 9, 12, 34, 42, 52, 154

180

Cesarean Section

O Observational study, 52, 154 Oocytes, 20, 154 Opacity, 132, 154 Opium, 152, 154 Osmosis, 154 Osmotic, 57, 152, 154 Outpatient, 154 Ovariectomy, 18, 154 Ovaries, 20, 138, 154, 165, 170 Ovary, 20, 131, 137, 141, 155 Ovum, 131, 132, 140, 155, 159, 160, 172 Oxidation, 122, 133, 148, 149, 155 Oxidative Stress, 24, 155 Oximetry, 25, 155 Oxygenation, 16, 57, 144, 155 Oxygenator, 126, 155 Oxytocin, 14, 18, 40, 41, 61, 66, 155 P Palliative, 155, 168 Palsy, 13, 33, 155 Pancreas, 119, 146, 155 Papilloma, 8, 155 Parietal, 155, 156 Parity, 6, 9, 19, 155 Parturition, 10, 154, 155, 159 Patch, 26, 131, 155 Pathogenesis, 9, 18, 155 Pathologic, 119, 123, 131, 143, 155, 163, 171 Pathologic Processes, 123, 155 Pathophysiology, 14, 156 Patient Education, 107, 112, 114, 117, 156 Patient Satisfaction, 17, 156 Pediatrics, 6, 15, 33, 52, 59, 156 Pelvic, 19, 21, 28, 57, 68, 88, 136, 156 Pelvimetry, 21, 156 Penicillin, 121, 156 Penis, 130, 156 Peptide, 156, 158, 160, 161 Perception, 130, 156 Perforation, 34, 139, 156 Perfusion, 144, 156 Perinatal, 5, 6, 8, 15, 23, 26, 30, 35, 37, 39, 40, 54, 57, 60, 86, 90, 127, 145, 156 Perineal, 5, 17, 156 Perineum, 18, 156 Peripheral blood, 12, 156 Peripheral Nervous System, 155, 156, 167 Peritoneal, 13, 29, 146, 156 Peritoneal Cavity, 13, 146, 156 Peritoneum, 60, 151, 156, 157 Peritonitis, 70, 157

Phagocyte, 150, 157 Pharmacologic, 121, 123, 157, 169 Phenotype, 12, 124, 157 Phenyl, 151, 157 Phospholipids, 138, 149, 157 Phosphorus, 126, 157 Phosphorylation, 26, 157, 160 Physical Examination, 140, 157 Physiologic, 9, 120, 124, 138, 151, 157, 160, 162, 163 Physiology, 57, 124, 157 Placenta, 11, 35, 38, 39, 49, 62, 137, 138, 157, 159, 161, 170 Placental tissue, 9, 11, 157 Plants, 120, 126, 129, 140, 154, 157, 164, 169 Plasma, 11, 26, 36, 120, 122, 127, 128, 136, 140, 141, 142, 143, 157, 158, 163, 171 Plasma cells, 122, 157 Plasmin, 67, 157, 158 Plasminogen, 157, 158 Plasminogen Activators, 157, 158 Platelet Aggregation, 153, 158, 169 Platelets, 154, 158 Platinum, 149, 158 Plexus, 33, 158 Poisoning, 151, 153, 158 Polymerase, 108, 158 Polymerase Chain Reaction, 108, 158 Polypeptide, 120, 129, 157, 158, 159 Pons, 126, 139, 158, 164 Porphyria, 53, 158 Porphyrins, 158 Posterior, 12, 62, 121, 123, 127, 134, 137, 155, 159 Postnatal, 15, 19, 30, 52, 159, 166 Postoperative, 13, 41, 48, 63, 64, 68, 75, 147, 151, 159 Practice Guidelines, 61, 102, 159 Precancerous, 22, 159 Preeclampsia, 6, 7, 24, 36, 65, 82, 106, 159 Pre-Eclampsia, 67, 79, 88, 159 Pregnancy Outcome, 21, 23, 24, 159 Pregnancy Tests, 140, 159 Premalignant, 159 Prenatal, 5, 6, 21, 106, 135, 139, 159 Prevalence, 4, 5, 12, 19, 159 Preventive Medicine, 17, 113, 159 Procaine, 148, 159 Progesterone, 11, 159, 166 Progression, 7, 8, 121, 159 Progressive, 63, 134, 141, 153, 159

Index 181

Projection, 154, 159 Prolactin, 61, 159 Prolapse, 6, 19, 160 Proline, 129, 143, 160 Prophase, 154, 160 Prophylaxis, 30, 31, 56, 63, 67, 91, 160 Propofol, 51, 71, 90, 160 Prospective study, 21, 160 Prostaglandin, 14, 17, 52, 62, 66, 91, 160, 169 Prostaglandins A, 145, 160 Prostitution, 86, 160 Protein C, 120, 122, 149, 160 Protein S, 124, 160 Protein-Tyrosine Kinase, 140, 160 Proteinuria, 24, 159, 161 Proteolytic, 130, 158, 161 Protons, 120, 143, 147, 161, 162 Psychiatric, 124, 161 Psychic, 148, 161, 164 Psychotomimetic, 121, 133, 161 Puberty, 86, 161 Public Policy, 101, 161 Publishing, 27, 161 Puerperium, 74, 154, 161 Pulmonary, 15, 32, 46, 49, 63, 68, 74, 91, 125, 130, 131, 148, 161, 171 Pulmonary Artery, 15, 74, 125, 161, 171 Pulmonary Circulation, 15, 161 Pulmonary Embolism, 49, 161 Pulmonary hypertension, 68, 91, 131, 161 Pulmonary Veins, 15, 161 Pulse, 25, 152, 155, 161 Pupil, 133, 152, 161 Purpura, 74, 161 Pyelonephritis, 88, 161 Q Quality of Life, 19, 161 Quiescent, 5, 161 R Race, 19, 161 Radiation, 20, 21, 136, 137, 139, 143, 146, 147, 151, 162, 172 Radiation therapy, 137, 143, 146, 147, 162, 172 Radioactive, 143, 144, 146, 147, 154, 162, 172 Radiography, 140, 162 Radioimmunotherapy, 162 Radiolabeled, 147, 162, 172 Radiological, 21, 162 Radiology, 36, 162

Radiotherapy, 20, 125, 147, 162, 172 Randomized, 17, 18, 22, 23, 24, 29, 30, 40, 44, 53, 63, 134, 162 Randomized clinical trial, 18, 22, 24, 162 Reactivation, 23, 162 Reactive Oxygen Species, 15, 162 Receptor, 122, 130, 134, 150, 162 Recombinant, 108, 162 Reconstitution, 13, 163 Rectum, 122, 125, 139, 140, 145, 163 Red blood cells, 13, 137, 142, 163, 164 Refer, 1, 129, 142, 149, 153, 162, 163 Refraction, 163, 166 Refractory, 74, 163 Regeneration, 163 Regimen, 24, 40, 79, 134, 163 Regression Analysis, 12, 24, 163 Relaxant, 26, 163 Relaxation Techniques, 153, 163 Reproduction Techniques, 159, 163 Resection, 51, 163 Resolving, 78, 163 Resorption, 143, 163 Respiration, 126, 138, 152, 163 Respiratory distress syndrome, 5, 6, 163 Restoration, 162, 163, 164, 172 Resuscitation, 48, 60, 78, 163 Retinal, 130, 163 Retrospective, 17, 22, 164 Rhinitis, 136, 164 Rhombencephalon, 139, 164 Risk factor, 4, 8, 12, 17, 19, 52, 53, 56, 64, 108, 136, 149, 160, 164 Rod, 124, 129, 164 S Saline, 10, 164 Sanitary, 88, 164 Saponins, 164, 166 Scleroderma, 138, 164 Scoliosis, 7, 164 Screening, 3, 19, 129, 164 Secretion, 10, 134, 146, 148, 152, 164 Sedative, 151, 164 Seizures, 6, 164 Semisynthetic, 127, 129, 164 Sensor, 20, 25, 164 Sequencing, 158, 164 Seroconversion, 23, 164 Serologic, 22, 164 Serous, 136, 164 Serum, 5, 24, 64, 78, 127, 129, 141, 149, 157, 163, 164

182

Cesarean Section

Sex Behavior, 149, 165 Sex Behavior, Animal, 149, 165 Sex Characteristics, 119, 121, 161, 165 Shedding, 22, 165 Shock, 165, 169 Shunt, 18, 165 Side effect, 20, 40, 75, 95, 119, 124, 147, 165, 169 Signs and Symptoms, 25, 165 Skeletal, 121, 129, 134, 165 Skeleton, 160, 165 Skull, 132, 165, 168 Small intestine, 128, 140, 143, 146, 165, 171 Smooth muscle, 15, 26, 123, 152, 153, 165, 167 Sneezing, 165, 167 Social Environment, 161, 165 Sodium, 71, 133, 165 Soft tissue, 125, 138, 139, 165 Solvent, 154, 165 Somatic, 119, 135, 152, 156, 165 Specialist, 109, 133, 165 Species, 15, 137, 150, 152, 161, 162, 166, 167, 170, 171, 172 Specificity, 21, 120, 166 Spectrum, 19, 57, 127, 152, 166, 167 Sperm, 86, 121, 128, 166 Sphincter, 30, 166, 167 Spina bifida, 19, 166 Spinal cord, 56, 126, 127, 128, 137, 146, 153, 156, 166, 168 Spirochete, 166, 168 Spontaneous Abortion, 7, 159, 166 Sporadic, 4, 166 Sprains and Strains, 149, 166 Stabilization, 13, 166 Statistically significant, 6, 166 Steel, 129, 166 Stem Cells, 166, 170 Sterility, 49, 51, 145, 166 Sterilization, 61, 84, 86, 166 Steroid, 10, 11, 13, 132, 164, 166 Stillbirth, 159, 167 Stimulant, 121, 133, 167 Stimulus, 131, 134, 137, 167, 168 Stomach, 119, 137, 139, 140, 141, 143, 147, 153, 156, 165, 167 Stool, 145, 167 Strand, 158, 167 Stress, 10, 18, 19, 20, 24, 132, 153, 155, 167 Stress urinary, 18, 167 Stroke, 16, 100, 126, 167

Stroke Volume, 16, 126, 167 Stromal, 136, 167 Stupor, 148, 153, 167 Subacute, 145, 167 Subarachnoid, 56, 139, 141, 146, 167 Subclinical, 23, 145, 164, 167 Subcutaneous, 24, 69, 134, 167 Subspecies, 166, 167 Substance P, 151, 163, 164, 167 Sulbactam, 30, 167 Superoxide, 24, 167, 168 Superoxide Dismutase, 24, 168 Supplementation, 47, 168 Suppression, 168 Suppressive, 23, 168 Sympathectomy, 17, 168 Sympathetic Nervous System, 153, 168 Sympathomimetic, 121, 133, 134, 137, 154, 168 Symptomatic, 23, 168 Symptomatology, 19, 168 Synergistic, 159, 168 Syphilis, 86, 168 Systemic, 16, 20, 96, 122, 125, 137, 142, 145, 146, 147, 162, 164, 168, 170, 172 Systolic, 144, 168 T Tachycardia, 138, 168 Temporal, 13, 83, 168 Testis, 137, 141, 168 Therapeutics, 96, 168 Thermal, 153, 158, 168 Thoracic, 41, 168, 172 Thorax, 119, 149, 168 Threshold, 144, 168 Thrombocytopenia, 49, 168 Thrombosis, 56, 61, 160, 167, 168 Thromboxanes, 123, 134, 169 Thyroid, 11, 59, 141, 147, 169 Thyroid Gland, 141, 169 Tissue, 14, 15, 20, 24, 26, 51, 120, 121, 122, 124, 125, 129, 130, 134, 135, 136, 137, 138, 139, 141, 142, 144, 145, 146, 148, 149, 150, 151, 153, 156, 157, 163, 165, 167, 169, 170, 171, 172 Tocolysis, 25, 169 Tolerance, 4, 13, 141, 169 Topical, 59, 143, 169 Torsion, 62, 145, 169 Toxaemia, 159, 169 Toxic, iv, 136, 144, 149, 169 Toxicity, 5, 134, 151, 169

Index 183

Toxicology, 102, 169 Toxins, 122, 135, 145, 162, 169 Trachea, 126, 169 Traction, 18, 129, 169 Tractus, 10, 169 Transfection, 124, 169 Transfusion, 3, 39, 169 Transmitter, 119, 134, 154, 169 Trauma, 6, 17, 18, 39, 153, 169, 172 Trichomoniasis, 151, 169 Tryptophan, 129, 170 Tubal ligation, 86, 170 Tuberculosis, 130, 170 U Ulcerative colitis, 7, 145, 170 Ultrasonography, 12, 60, 139, 140, 170 Umbilical Arteries, 170 Umbilical Cord, 16, 38, 120, 170 Umbilical cord blood, 38, 67, 170 Unconscious, 121, 144, 170 Urethra, 156, 170 Urinary, 18, 19, 68, 88, 136, 143, 145, 167, 170 Urine, 88, 125, 127, 131, 137, 145, 147, 161, 167, 170 Urogenital, 141, 170 Uterine Contraction, 14, 126, 155, 169, 170 Uterine Rupture, 47, 91, 107, 170 V Vaccines, 170, 171 Vagina, 128, 129, 144, 151, 170 Vaginal, 6, 7, 19, 21, 28, 29, 30, 34, 36, 38, 43, 44, 47, 52, 54, 57, 58, 59, 61, 64, 66, 68, 69, 70, 75, 78, 80, 81, 83, 88, 106, 137, 170 Vaginal Birth after Cesarean, 34, 43, 52, 54, 68, 106, 170 Vascular, 10, 15, 16, 30, 36, 48, 136, 145, 153, 157, 158, 169, 170 Vascular Resistance, 15, 16, 170 Vasoactive, 15, 171 Vasoconstriction, 137, 171

Vasodilation, 15, 171 Vasodilators, 153, 171 Vasopressor, 43, 171 Vein, 15, 56, 61, 121, 145, 146, 154, 170, 171 Vena, 171 Venereal, 168, 171 Venous, 15, 17, 128, 160, 171 Ventral, 10, 144, 158, 171 Ventricle, 10, 46, 122, 131, 144, 152, 161, 168, 171 Ventricular, 18, 131, 143, 171 Vertebrae, 146, 166, 171 Vertebral, 124, 166, 171 Veterinary Medicine, 101, 171 Villi, 143, 171 Viral, 4, 8, 22, 23, 135, 171 Viral Load, 8, 23, 171 Viremia, 4, 5, 171 Virulence, 169, 171 Virus, 3, 4, 8, 57, 85, 108, 127, 171 Visceral, 157, 171 Vital Statistics, 27, 171 Vitro, 12, 49, 171 Vivo, 13, 20, 171 W Weight Gain, 11, 138, 172 White blood cell, 49, 122, 148, 150, 152, 157, 172 Windpipe, 136, 169, 172 Withdrawal, 151, 172 Womb, 170, 172 Wound Healing, 129, 150, 172 Wound Infection, 50, 172 X Xenograft, 20, 121, 172 X-ray, 21, 139, 140, 147, 154, 162, 172 X-ray therapy, 147, 172 Y Yeasts, 157, 172 Yolk Sac, 138, 172 Z Zygote, 130, 172

184

Cesarean Section