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

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

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CLAUDICATION 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., 1960Claudication: 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: 0-497-00263-9 1. Claudication-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 claudication. 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 CLAUDICATION ........................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Claudication.................................................................................. 4 The National Library of Medicine: PubMed ................................................................................ 15 CHAPTER 2. NUTRITION AND CLAUDICATION............................................................................... 61 Overview...................................................................................................................................... 61 Finding Nutrition Studies on Claudication................................................................................. 61 Federal Resources on Nutrition ................................................................................................... 63 Additional Web Resources ........................................................................................................... 63 CHAPTER 3. ALTERNATIVE MEDICINE AND CLAUDICATION ........................................................ 65 Overview...................................................................................................................................... 65 National Center for Complementary and Alternative Medicine.................................................. 65 Additional Web Resources ........................................................................................................... 70 General References ....................................................................................................................... 72 CHAPTER 4. PATENTS ON CLAUDICATION ..................................................................................... 73 Overview...................................................................................................................................... 73 Patents on Claudication............................................................................................................... 73 Patent Applications on Claudication ........................................................................................... 76 Keeping Current .......................................................................................................................... 79 CHAPTER 5. BOOKS ON CLAUDICATION ......................................................................................... 81 Overview...................................................................................................................................... 81 Book Summaries: Federal Agencies.............................................................................................. 81 Chapters on Claudication............................................................................................................. 82 CHAPTER 6. PERIODICALS AND NEWS ON CLAUDICATION ........................................................... 85 Overview...................................................................................................................................... 85 News Services and Press Releases................................................................................................ 85 Academic Periodicals covering Claudication ............................................................................... 87 CHAPTER 7. RESEARCHING MEDICATIONS .................................................................................... 89 Overview...................................................................................................................................... 89 U.S. Pharmacopeia....................................................................................................................... 89 Commercial Databases ................................................................................................................. 90 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 95 Overview...................................................................................................................................... 95 NIH Guidelines............................................................................................................................ 95 NIH Databases............................................................................................................................. 97 Other Commercial Databases....................................................................................................... 99 APPENDIX B. PATIENT RESOURCES ............................................................................................... 101 Overview.................................................................................................................................... 101 Patient Guideline Sources.......................................................................................................... 101 Finding Associations.................................................................................................................. 104 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 107 Overview.................................................................................................................................... 107 Preparation................................................................................................................................. 107 Finding a Local Medical Library................................................................................................ 107 Medical Libraries in the U.S. and Canada ................................................................................. 107 ONLINE GLOSSARIES................................................................................................................ 113 Online Dictionary Directories ................................................................................................... 115

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CLAUDICATION DICTIONARY .............................................................................................. 117 INDEX .............................................................................................................................................. 157

1

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 claudication 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 claudication, 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 claudication, 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 claudication. 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 claudication, 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 claudication. The Editors

1

From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON CLAUDICATION Overview In this chapter, we will show you how to locate peer-reviewed references and studies on claudication.

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

Jaw Claudication: A Sign of Giant Cell Arteritis Source: JADA. Journal of American Dental Association. 126(7): 1028-1029. July 1995. Summary: Giant cell arteritis (GCA) is a polysymptomatic disease with manifestations that include headaches, joint pains, scalp tenderness, fever, malaise, and weight loss. This article presents a case report that describes a patient with jaw claudication as the initial sign of giant cell arteritis. Visual loss, usually due to ischemic optic neuropathy, is the major complication of this disorder, and early diagnosis and treatment are critical. The author stresses that dentists should consider jaw claudication when making the differential diagnosis of jaw pain, especially in the elderly patient. 5 references. (AA-M).

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

Project Title: ANGIOGENESIS AND MECHANISMS OF EXERCISE TRAINING IN PAD Principal Investigator & Institution: Annex, Brian H.; Associate Professor of Medicine; Medicine; Duke University Durham, Nc 27710 Timing: Fiscal Year 2003; Project Start 25-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Peripheral arterial disease (PAD) impairs arterial blood flow to the legs & is a major indicator of systemic atherosclerosis. PAD affects 5% of the US population over 50. Approx 1/3 of patients with PAD have typical claudication, defined as pain in one or both legs on walking that is relieved by rest. Patients with claudication have a marked impairment in exercise performance similar to patients with NYHA class III heart failure. Goals of treatment for PAD patients include risk-factor modification & antiplatelet drug therapy to address increased cardiovascular mortality risk. Supervised exercise training is the most efficacious treatment to improve walking capacity, demonstrated in many (small) randomized trials. Neither the pathophysiology of claudication nor the mechanism(s) by which exercise training improves walking times in persons with IC are completely understood. It is unknown how long-term exercise training affects skeletal muscle or to what extent skeletal muscle abnormalities in PAD are reversible. Women have been largely underrepresented in mechanistic studies of IC and exercise training. There is an urgent need for clinical research directed towards defining the basis of the exercise training changes induced in PAD patients in order to: 1) provide insights into the general pathophysiology of the exercise impairment in PAD; 2) permit scientifically plausible & testable modifications to currently prescribed exercise regimens to better employ this critical therapeutic modality &, 3) identify novel targets from pharmacotherapy that are capable of inducing the repertoire of molecular responses induced by exercise training. In this RFA (HL-03003) (AMNESTI in PAD), men & women (n=160), over 40 years, with IC & an ankle/brachial systolic blood pressure ratio (ABI) <0.8 at rest, will be recruited from Duke University Medical Center and the University of Colorado Health Science Center. Patients will be randomized to a supervised or home-based exercise program.

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).

Studies

5

Evaluations will be at baseline, 3-weeks (supervised exercise) and 3-months. Age-gender matched healthy controls (n=66) will be tested at base line. The central hypothesis is that the beneficial effects of exercise training are primarily mediated through an angiogenic effect. Sp Aim 1 will establish the baseline vascular abnormalities present in patients. Sp Aim 2 will establish the ability of the selected vascular abnormalities in Sp Aim I to predict peak oxygen consumption in PAD using a prediction model. Sp Aim 3 will establish the ability of exercise training to modify the vascular abnormalities in PAD. Sp Aim 4 will examine the gender specificity of the results obtained in Sp Aim 1-3. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ARTERIAL BAROREFLEX CONTROL OF BLOOD PRESSURE-EXERCISE Principal Investigator & Institution: Raven, Peter B.; Professor and Chairman; Integrative Physiology; University of North Texas Hlth Sci Ctr Fort Worth, Tx 761072699 Timing: Fiscal Year 2002; Project Start 01-JUL-1994; Project End 30-JUN-2003 Summary: (Applicant's abstract): Previously, we have demonstrated that the carotid baroreflex control of blood pressure during dynamic exercise is classically reset to the prevailing blood pressure of the dynamic exercise. Aortic baroreflex control of heart rate was also reset to the prevailing blood pressure without a change in maximal gain. Additionally, our findings suggest that at rest the arterial baroreflex function is modulated by aerobic fitness, cardiopulmonary baroreceptor load and increases in the intramuscular pressure. However, the mechanisms by which 1) the arterial baroreflexes are reset during exercise, 2) the interaction between increases in muscle pressure and the arterial baroreflex function, and 3) the effect of aerobic fitness on arterial and cardiopulmonary baroreflex function remain to the defined. We hypothesize that the feed forward mechanism of central command resets the baroreflexes in parallel with the induction of motor activity and continuous modulation of this resetting is provided by activation of intramuscular mechanoreceptors within the active tissue. We further hypothesize that increases in aerobic fitness results in an increased blood volume and a resetting of the aortic and cardiopulmonary baroreflex. In order to test these hypotheses we will use a historically unique experimental paradigm in which muscle tendon vibration will be used to selectively increase or decrease central command. During steady state exercise (a constant exercise pressor reflex input) with and without muscle tendon vibration, carotid arterial baroreflex function will be determined using procedures developed in our laboratory. Using a similar experimental paradigm and increasing intramuscular pressure by using lower body positive pressure, the interactions between central command and intramuscular pressure will be examined. Additionally, using techniques developed in our laboratory and measures of MSNA, NE spill-over and leg vascular conductance we will selectively model the aortic and cardiopulmonary baroreflexes of high and low fit endurance exercise trained subjects. A unique aspect of this investigation is that the data obtained is immediately relevant to the healthy human and will provide significant fundamental information for the investigation of blood pressure regulation during physical activity of patients with heart failure, hypertension and intermittent claudication. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: CHLAMYDIA SIGNIFICANCE

PNEUMONIAE

ANTIGENS

OF

BIOLOGICAL

Principal Investigator & Institution: Campbell, Lee Ann.; Professor; Pathobiology; University of Washington Grant & Contract Services Seattle, Wa 98105

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Timing: Fiscal Year 2002; Project Start 01-APR-1998; Project End 31-MAR-2007 Summary: (provided by the applicant): Chlamydia pneumoniae is a human respiratory pathogen that causes 5 percent to 10 percent of pneumonia, bronchitis, and sinusitis. Virtually everyone is infected in his or her lifetime and reinfection is common. Infection is difficult to treat even with sensitive antibiotics. Chronic infection is common and has been associated with asthma, reactive airway disease, Reiter's syndrome, erythema nodosum, and sarcoidosis. The potential public health impact of infection with this pathogen is underscored by the association of C. pneumoniae with atherosclerosis and related clinical manifestations such as coronary heart disease, carotid artery stenosis, aortic aneurysm, claudication, and stroke. If C. pneumoniae infection plays a role in atherogenesis, there will be an urgent need to facilitate diagnosis and develop strategies for intervention and prevention. The overall goal of this proposal is two fold. First, C. pneumoniae specific antigens that are recognized during human infection will be exploited to facilitate serodiagnosis and identify putative vaccine candidates. The second goal is to define chlamydial/host cell interactions that lead to entry and survival of C. pneumoniae in host cells relevant to atherosclerosis. The specific focus will be on the interaction of the chlamydial glycan moiety with carbohydrate binding receptors on the host cell. Importantly, infection of epithelial cells can be inhibited with N-linked high mannose type oligosaccharide, the major component of the glycan. The novel hypothesis to be tested is that C. pneumoniae enters through the mannose-6 phosphate receptor by binding to the site involved in transport of phosphomannosylated residues to the lysosome and this differs from C. trachomatis, which utilizes the mannose receptor. The ultimate goals of these studies are to identify C. pneumoniae specific antigens to facilitate laboratory diagnosis and virulence factors playing a role in pathogenesis to guide vaccine development or develop anti-adhesive strategies for prevention of infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL MORPHOLOGY

IMPLICATIONS

OF

PERIPHERAL

PLAQUE

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

Studies

7

completion of three separate but concurrent studies: (1) Histologic sections of fresh arterial segments from cadaver limbs and amputation specimens will be correlated with IVUS-derived radiofrequency data to quantify arterial plaque burden and composition (calcium, collagen, fibro-lipidic and necrotic components). (2) Patients undergoing standard lower extremity angiography for PAD will be studied with IVUS at the same sitting. IVUS findings will be correlated with demographic factors (age, gender, race) and symptom severity (claudication, rest pain, tissue loss). Patients will be followed for up to five years, and the occurrence of ischemic events (worsening of leg ischemia, need for intervention and re-intervention, and distant complications such as Mi and stroke) will be reconciled with the arterial wall content at the baseline examination. (3) A randomized, blinded clinical trial of high-dose atorvastatin vs. placebo will be performed in patients with intermittent claudication, based on our hypothesis that statin therapy will result in stabilization or regression of femoral artery plaque, differences best assessed with high resolution imaging studies. IVUS data will be collected at baseline and at 24 months. The primary endpoint will be the change in femoral arterial plaque volume; baseline arterial wall parameters will be assessed in the subgroup of stain responders vs. non-responders. The completion of these three investigations should yield a validated, high resolution, real time imaging study with which to assess risk and base treatment decisions in patients with PAD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECT OF LIPID MODIFICATION ON PAD Principal Investigator & Institution: Lumsden, Alan B.; Associate Proffesor; Surgery; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2003; Project Start 22-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): The benefit of aggressive lipid modification on the prevention of progression of atherosclerosis and restenosis in the lower extremity is unknown. This field is severely hampered by the lack of quantitative measurement of vascular lesion pathology. Complete natural history of restenosis following surgical intervention is not clear. We will combine our expertise and resources at Baylor College of Medicine in a multidisciplinary approach to address these important questions. We hypothesize that an aggressive regimen of serum lipid modification will inhibit the progression of atherosclerosis in femoral arteries and reduce the incidence of restenosis of femoral arteries following endovascular stenting by decreasing thrombosis and inflammation. We will recruit a total of 120 patients with symptomatic femoral artery occlusive disease in one leg. These patients will be treated with endovascular stenting, and randomized into two groups: 1) standard medical care and 2) aggressive lipid modification therapy which increases HDL (>40mg/dl) and decreases LDL (<80 mg/dl) and TG (cl50 mg/dl). We will follow these patients for 2 years. Our Specific Aims are to: 1) Determine the effect of aggressive lipid modification on progression of atherosclerosis and restenosis of femoral arteries. Recently, we have adapted high resolution magnetic resonance imaging (MRI) to study extremity vascular pathology including lesion size, composition, and morphology. This technology will be used to examine both the stented femoral artery for in-stent restenosis and the contralateral femoral artery for atherosclerosis progression or regression. 2) Determine the effects of an aggressive regimen of serum lipid modification on the clinically applicable hemodynamic measurements following femoral artery angioplasty and/or stenting and on the reduction of systemic major cardiovascular events. Large clinical volume and excellent endovascular therapy expertise at Baylor will enable us to evaluate the clinical outcomes, including ankle brachial index (ABI), walking distance, absolute claudication,

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and duplex ultrasound in a population with significant PAD. 3). Investigate effects of aggressive triple-drug therapy on lipoproteins, inflammation, and relationship to PAD progression, restenosis, and clinical events. Assays of LDL, HDL, TG, Lp(a), particle size and number, hsCRP, TNFalpha, IL-8, MCP-1, sP-selectin, s-ICAM-1, s-VCAM-1, and sCD40L will permit mechanistic insights into PAD progression and clinical events. 4). Investigate the effects of aggressive triple-drug therapy on thrombosis, and relationship to PAD progression, restenosis and clinical events. Association of these studies with clinical outcomes and quantitative femoral MR images will permit mechanistic insights into PAD progression and clinical events. This study will provide a novel strategy to retarding or preventing progression of atherosclerosis and restenosis following arterial revascularization procedures. Importantly, our MRI studies will, for the first time, provide quantitative data on the vascular lesions. Finally, these studies will advance our understanding of the molecular mechanisms of inflammation and thrombosis associated with aggressive lipid modification. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EXERCISE FOR ELDERLY PERIPHERAL REVASCULARIZED PATIENTS Principal Investigator & Institution: Gardner, Andrew W.; Health and Sport Sciences; University of Oklahoma Norman Office of Research Services Norman, Ok 73019 Timing: Fiscal Year 2002; Project Start 01-JUL-2000; Project End 30-JUN-2005 Summary: (adapted from Investigator's abstract): Peripheral arterial occlusive disease (PAOD) patients with critical limb-threatening ischemia have improved peripheral circulation following infrainguinal revascularization. Despite this hemodynamic benefit, little change in functional tatus occurs, and many patients have residual ambulatory dysfunction. The lack of functional improvement in revascularized patients may be due to muscle wasting, myopathy, and extreme physical deconditioning secondary to their pre-existing critical limb-threatening ischemia. Therefore, the investigators hypothesize that a program of aerobic exercise training is necessary to optimize ambulation, freeliving daily physical activity, and health-related quality of life through the mechanisms of improved muscle structure and function, walking economy, cardiopulmonary function, and further gains in peripheral circulation. This randomized controlled clinical trial comparing an exercise group undergoing a program of graded treadmill walking, and a delayed entry non-exercise control group will address the following two aims: (1) to determine whether a 6-month exercise rehabilitation program will improve claudication distances, free-living daily physical activity, and health-related quality of life of older, revascularized patients with PAOD, and (2) to determine whether the primary mechanisms by which exercise rehabilitation affects the above functional outcomes are through alterations in muscle structure and function, walking economy, peripheral circulation, and cardiopulmonary function. Eighty PAOD patients will be randomized into either the exercise group (n=40) or the delayed entry non-exercise control group (n=40) three to six months following successful lower extremity arterial bypass. The 6-month exercise program will consist of graded treadmill walking 3 times per week with progressive increments in exercise duration from 15 to 40 minutes, and progressive increments in exercise intensity from 50 to 80 percent of exercise capacity. The overall intent is that this study will demonstrate that exercise rehabilitation is an important adjuvant to revascularization surgery to achieve clinically meaningful gains in ambulation, free-living daily physical activity, and quality of life in PAOD patients with critical limb-threatening ischemia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies

•

Project Title: EXERCISE INSUFFICIENCY

TRAINING

AND

PERIPHERAL

9

ARTERIAL

Principal Investigator & Institution: Terjung, Ronald L.; Professor; Veterinary Biomedical Sciences; University of Missouri Columbia 310 Jesse Hall Columbia, Mo 65211 Timing: Fiscal Year 2002; Project Start 01-DEC-1986; Project End 31-MAY-2005 Summary: (Applicant's abstract): Physical activity represents one of the most potent physiological stimuli for angiogenesis (capillary proliferation) in muscle and arteriogenesis (enlargement of existing vessels) of collateral arteries that can benefit patients with peripheral arterial insufficiency. Our previous work, using a claudicate rat model produced by femoral artery occlusion, has shown that these adaptations improve muscle performance and increase collateral-dependent blood flow, the latter due to structural enlargement of collateral vessels. We now propose experiments to determine the mechanisms involved in collateral vessel expansion and microvascular proliferation, and the modulation of these processes by exercise and angiogenic growth factors. Unique approaches will evaluate: a) collateral vessel function and vasoreactivity in vitro, b) vascular signals contributing to collateral vessel arteriogenesis, and c) mechanisms controlling collateral blood flow increases in vivo. We will determine how vascular occlusion modifies affected collateral vessels to promote receptivity to arteriogenic stimuli, and how the dysfunction of collateral vessels is improved with exercise training and exogenous VEGF delivery. Adult rats are exercised by treadmill running. We will assess the means by which endothelial signaling of NO, alters regulation of VEGF and its receptors (VEGFR-1 and VEGFR-2), and the angiopoietins (Ang1 and Ang2, and their receptor Tie2) is modified to stimulate arteriogenesis in collateral vessels in vivo, using real-time rtPCR. NO, VEGF, Ang1, Ang2, and collateral flow demands will be experimentally managed to establish their interactions in controlling arteriogenesis and collateral blood flow increases following femoral artery occlusion. Collateral blood flow is determined during treadmill running in vivo. Further, we will evaluate the control of capillary proliferation induced by exercise and the functional impact of its absence in otherwise trained muscle. The outcome of these novel, physiologically relevant studies will enhance our understanding of vascular remodeling induced by physical activity and its applicability to managing patients with peripheral arterial insufficiency. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HOMOCYSTEINE AND PROGRESSION OF ATHEROSCLEROSIS Principal Investigator & Institution: Taylor, Lloyd M.; Professor; Surgery; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 01-AUG-1991; Project End 31-AUG-2004 Summary: Every year in the United States at least 300,000 persons have strokes, 50,000 persons have leg amputations for ischemia, 100,000 persons have interventional procedures to treat leg ischemia, and as many as 5 percent of the population over age 60 have claudication, all caused by atherosclerotic peripheral arterial disease (PAD). Few studies of progression of PAD have been performed and none have used objective methods to evaluate disease progression in a large number of symptomatic subjects. Elevation of plasma homocysteine (HC) has been shown in multiple studies to be an independent risk factor for atherosclerotic vascular disease. The Homocysteine and Progression of Atherosclerosis Study (HPAS) is a long term prospective blinded mulitfactoral clinical study which began in 1991 to study the relationship between

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elevated plasma HC as well as other risk factors and PAD progression. Progression of disease in HPAS is evaluated by primary endpoints of death from vascular disease, and ankle brachial pressure index and carotid artery stenosis, both determined in the noninvasive vascular laboratory, and by secondary endpoints including stroke, myocardial infarction, need for vascular surgery, amputation, and other clinical events. The study is divided into two phases, conducted sequentially upon 400 patients with symptomatic lower extremity (LED) and cerebrovascular disease (CVD). The first phase was a three year natural history study in which progression of PAD has been shown to be significantly more likely in patients with elevated plasma HC. This phase currently has 344 patients and is nearing completion. This proposal requests support to continue the second phase of HPAS, a blinded prospective randomized placebo controlled trial of folic acid treatment in the same patient population. Folic acid treatment has been demonstrated to result in lowering of elevated plasma HC. The treatment trial addresses the clincial question: Do patients with symptomatic PAD treated with folate have less frequent/rapid progression of PAD than patients with symptomatic PAD treated with placebo? Completion of this study is of obvious major clinical importance. Elevated plasma HC is well established as an independent risk factor for both presence of and progression of atherosclerosis. If folate treatment results in less frequent/rapid progression of PAD, then it will be confirmed as the first effective treatment for atherosclerosis which is without toxic side effects and does not involve major changes in life/dietary habits. The HPAS study already underway is the only currently extant clinical research trial with sufficient power and adequate multifactoral design to objectively determine the role of treatment of elevated plasma HC on PAD progression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVING FUNCTIONING IN PERIPHERAL ARTERIAL DISEASE Principal Investigator & Institution: Mcdermott, Mary M.; Medicine; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2003; Project Start 22-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Our previous work demonstrates that functional limitations associated with peripheral arterial disease (PAD) are diverse and include slower walking speed, poorer walking endurance, and impaired balance as compared to persons without PAD. Although treadmill-walking exercise improves treadmill performance in patients with intermittent claudication (IC), treadmill performance does not correlate well with community walking ability in older men and women. In older patient populations without PAD, resistance training improves functioning and walking endurance, but this mode of exercise has not been sufficiently studied in PAD. Furthermore, although 65% to 70% of men and women with PAD are either asymptomatic or have exertional leg symptoms other than IC, to our knowledge no prior studies have assessed the effects of exercise interventions in PAD patients who do not have IC. The primary aim of this study is to determine whether a six-month supervised treadmill exercise program and a supervised lower extremity progressive resistance training program, respectively, improve lower extremity functioning compared to a nutrition control group among 150 PAD patients with and without IC. We hypothesize that participants in the treadmill walking exercise program and participants in the progressive resistance training program, respectively, will experience greater improvement in functional outcomes than participants in the nutrition control group. Our primary functional outcome measures in descending order of importance are six-minute walk distance and the summary performance score. The summary performance score is a composite measure of lower extremity functioning (usual

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walking speed, standing balance, and time required for five repeated chair rises) measured on a 0-12 scale that predicts future risk of nursing home placement, mobility loss, and mortality. In our secondary specific aims we will identify mechanisms by which the exercise interventions improve functioning in PAD. Mechanisms we will study include changes in blood viscosity, peak oxygen consumption (VO2), calf blood flow, brachial artery endothelial reactivity, and inflammatory cytokine levels. By identifying the optimal exercise program for improving functioning in PAD patients with and without IC, our findings will have substantial clinical and public health implications for millions of patients with PAD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INFLAMMATION AND INSULIN RESISTANCE IN PAD Principal Investigator & Institution: Creager, Mark A.; Associate Professor of Medicine; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 22-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Patients with peripheral arterial disease (PAD) frequently have functional limitations and symptoms of claudication that impact adversely on their quality of life. Many progress to critical limb ischemia requiring revascularization. Vascular inflammation and insulin resistance are two important and interdependent conditions that are associated with atherosclerosis. Moreover, both inflammation and insulin resistance cause abnormalities in vascular function and insulin resistance interferes with skeletal muscle metabolism. As such, inflammation and insulin resistance provide attractive targets for therapy that could potentially ameliorate the development of symptomatic PAD or improve the function and clinical outcomes of patients with PAD. Accordingly, the applicants propose three specific aims to determine whether inflammation and insulin resistance contribute to the functional and clinical consequences of PAD. First, a prospective, nested, case-control evaluation will be performed to test the hypothesis that baseline plasma levels of inflammatory cytokines (e.g. interleukin (IL)-4, IL-6, IL-18, macrophage inhibiting cytokine-1, CD 40 ligand) among healthy men are associated with the development of future symptomatic PAD. Second, to test the hypothesis that inflammation and insulin resistance contribute to reduced walking distance in patients with intermittent claudication by impairing vascular reactivity and skeletal muscle metabolic function, plasma markers of inflammation and insulin resistance, endothelium-dependent and independent vasodilation (by vascular ultrasonography) and skeletal muscle glucose utilization (by [18F] FDG positron emission tomography) will be measured before and after 12 weeks of treatment with rosiglitazone, atorvastatin or placebo in a 2x2 factorial design protocol. Third, to test the hypothesis that inflammation and insulin resistance are associated with the incidence and progression of vein graft disease in patients undergoing lower extremity vein bypass, functional and morphologic changes in vein grafts (measured by ultrasound and magnetic resonance imaging) will be assessed and related to inflammation and insulin resistance and to a composite clinical outcome of graft occlusion, re-intervention or major amputation. It is anticipated that the findings from this investigation will uncover novel pathophysiologic mechanisms and foster a new paradigm for the treatment of PAD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LIPOSOMAL L-CARNITINE Principal Investigator & Institution: Hofland, Hans E.; Optime Therapeutics, Inc. 1333 N Mc Dowell Blvd Petaluma, Ca 94954

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Timing: Fiscal Year 2002; Project Start 02-SEP-2002; Project End 01-MAR-2004 Summary: (provided by applicant): The goal of this proposal is to develop a new topical formulation for the treatment of intermittent claudication. Intermittent claudication is the primary symptom of peripheral arterial disease, and it affects over 4 million individuals in the United States. Given orally, L-carnitine has shown great promise in clinical trials, however, its bloavailability is poor. Current treatments involve high doses over a prolonged period of time. A more efficient and faster treatment could be provided when the drug is applied topically, thus allowing direct transport into the underlying muscle tissue. To enhance transdermal delivery, L-carnitine will be formulated in a liposomal delivery system, which has already been proven to be successful for the topical delivery of other drugs. First, the carbon chain length of alkylL-carnitine will be optimized with respect to encapsulation efficiency and physicochemical stability of the formulation. Second, the formulation will be optimized with respect to L-carnitine transport through skin in vitro. Finally, in vivo proof of concept will be obtained of L-carnitine delivery into muscle tissue. The best formulation will be identified and developed for further clinical testing. PROPOSED COMMERCIAL APPLICATION: Currently, there is no topical drug treatment for intermittent claudication (IC). Last year a new oral drug (Pletal) was launched. This was the first drug for the treatment of intermittent claudication to reach the market in 15 years. Despite its poor bioavailability and questionable efficacy, this drug grossed 90 million US dollars. This is a striking example of the clinical need for such a drug. A topical formulation should provide a fast and efficient relief from this debilitating disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MRI CORRELATES OF LIMB ISCHEMIA IN PVD Principal Investigator & Institution: Floyd, Thomas F.; Anesthesia; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 22-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Peripheral vascular disease (PVD) caused by smoking, diabetes mellitus, and hypertension, results in limb ischemia in approximately 10% of the population over age 65 years. PVD results in claudication, tissue ischemia, gangrene, and amputation when not treated aggressively. Ninety thousand amputations are performed each year as a result of PVD. Diagnostic methods available at present include invasive techniques such as radiographic angiography, which, because of contrast dye toxicity, can result in serious complications such as renal failure. The diagnostic armamentarium is burgeoning however. Noninvasive techniques such as duplex Doppler and MRI angiography are today allowing surgery to be completed without radiographic angiography and with a high degree of success in selected populations. Patients with Chronic Critical Limb Ischemia (CCLI) are at the highest levels of risk for limb loss and perioperative morbidity and mortality when revascularization or amputation is performed. Evidence indicates that current diagnostic methods, again directed primarily at identifying macro-vascular flow impediments, do not adequately assist the surgeon in assessing potential for revascularization in patients with CCLI. As a result, grafting success is much poorer in this population, leading to repeated procedures, often delayed amputation, prolonged rehabilitation, and excessive morbidity and mortality. Astoundingly, when surgeons predicted that amputation stump wounds would not heal, they were wrong 50% of the time, leading one to wonder if their estimation of appropriate level for amputation doesn't tend to be a bit too aggressive. We propose the application of a noninvasive MRI method, Arterial Spin Labeling Perfusion MRI to this problem. Arterial spin-labeling sequences have been

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developed to study micro-vascular blood flow in the calf and foot. We intend to further the development and application of this technique at high field MRI where improved signal and resolution are likely. We also propose to develop flow indices for the foot, calf, and forearm and compare them with recognized diagnostic standards. Finally, we will apply them prospectively to predict graft patency and wound healing after amputation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PARASPINAL MUSCLE DENERVATION AND SYMPTOMS IN LUMBAR SS Principal Investigator & Institution: Haig, Andrew J.; Phys Med and Rehabilitation; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Objectives: The clinical syndrome of spinal stenosis is a significant problem for older Americans. Although stenosis causes neurogenic claudication, spinal canal size does not accurately predict the severity of symptoms. A pilot study shows that paraspinal muscle denervation relates to spinal canal size in symptomatic persons. It is possible that paraspinal denervation is a more accurate marker for the clinical syndrome than anatomical imaging. Other research shows that paraspinal denervation in a particular distribution also occurs in younger asymptomatic persons, and denervation increases with age. It is possible that paraspinal denervation causes subtle hypermobility and contributes to Kirkaldy-Willis's degenerative cascade of facet hypertrophy and canal stenosis. Specific Aims: 1. To assess whether paraspinal EMG scores or MRI measurements of stenosis relate best with the clinical syndrome in older persons. 2. To assess whether paraspinal EMG scores predict future symptoms of stenosis and future symptom severity in older persons with and without spinal stenosis. 3. To assess whether change in clinical status relates better to change in paraspinal EMG scores or change in MRI measurement of stenosis. 4. To assess the rate of denervation of the paraspinal muscles in older persons with and without back symptoms. Research Design: Blinded longitudinal study. Methods: Five groups of 30 subjects older than 55 years old, including: asymptomatic persons (healthy persons without low back pain) from the community, persons with lock back pain (LBP) but no stenosis on MRI, persons with stenosis symptoms with mild, moderate, and severe radiographic findings. An experienced neuroradiologist will measure spinal canal size and assign subjects to appropriate categories. A patient questionnaire, physical examination, a walking tolerance test with long latency nerve conduction studies (F- and H- waves) before and after walking, a 7-day pedometer test, and a measure of the flexion-relaxation phenomenon will be administered to the subjects. An unblinded examiner will perform one aspect of the MiniPM paraspinal EMG technique to acclimatize the patient, then a blinded examiner will perform the entire MiniPM, one extremity EMG, sensory and motor nerve conduction studies. Subjects will repeat the test battery (MRI, EMG, and clinical evaluation) approximately 18 months later. Appropriate statistics will test each of the four hypotheses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SENSORY NEURONS WITH MODALITIES IDENTIFIED IN CULTURE Principal Investigator & Institution: Mc Cleskey, Edwin W.; Senior Scientist/Professor; None; Oregon Health & Science University Portland, or 972393098

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Timing: Fiscal Year 2003; Project Start 01-JAN-1999; Project End 28-FEB-2007 Summary: (provided by applicant): This proposal will investigate properties of a class of molecules that transduce pain caused by ischemia (insufficient delivery of oxygen to an organ) and that might contribute to neuronal damage during stroke and seizure. The molecules are called acid-sensing ion channels (ASICs). They selectively pass sodium ions and calcium ions into cells when they are opened by a drop in extracellular pH. Such pH changes occur during ischemia when lactic acid is produced and they occur when there is hyperactivity in the CNS or when CNS blood vessels get occluded. The long-term objective is to determine whether ASlCs are appropriate pharmaceutical targets for: a) diminishing ischemic pain, and b) neuroprotection after stroke and seizure. Ischemia is the primary source of cardiac pain, sickle cell anemia pain, and the muscle pain of intermittent claudication; it may also contribute to other forms of muscle, bone, and visceral pain. The immediate goal is to describe the properties of ASlCs that seem critical to these pathological conditions. The specific aims arise from our preliminary results that demonstrate that ASlCs open through an unexpected mechanism. ASICs were thought to open because protons (lowered pH) trigger a conformation change in the protein. Instead, we find that protons open ASlC3 because they catalyze the release of a bound calcium ion that blocks the pore. This mechanism is important in disease because pH and calcium drop simultaneously in both peripheral and cerebral ischemia, providing two stimuli acting in concert to open ASlCs. The specific aims are: 1) to define the amino acids in ASlC3 that form the calcium/proton binding site that controls channel opening; 2) to define how ASlC1a, the dominant ASlC in the CNS, behaves under ionic conditions that occur during stroke and seizure; 3) to understand the basis of persistent currents through ASlC3 that occur around pH 7.0, the crucial range for ischemic muscle pain. Experiments utilize patch clamp electrophysiology and molecular mutagenesis of cloned ion channels Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STUDY OF CHRONIC ADMINISTRATION OF CILOSTAZOL Principal Investigator & Institution: Crouse, John R.; Professor; Wake Forest University 1834 Wake Forest Road Winston-Salem, Nc 27106 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: UCB DERIVED VASCULAR ENDOTHELIAL PRECURSOR CELLS Principal Investigator & Institution: Pompili, Vincent J.; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2005 Summary: (provided by applicant): Strategies for cellular therapy in vascular medicine are being developed to treat refractory claudication, but are limited by the resident population of vascular endothelial cells in adults that is competent to I respond to an available level of angiogenic growth factors. Umbilical cord blood derived endothelial precursor cells (UCB derived EPCs) have advantages of greater lifespan and reparative proliferation, relative to existing models of therapeutic angiogenesis derived from patient peripheral blood or bone marrow, and do not incur the ethical controversy of use of embryonic stem cells. This application outlines a highly interactive group of investigators focused on EPCs with laboratory studies directed to a further understanding of EPC differentiation and to optimize ex vivo expansion conditions.

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Since little is known of the cytokine and gene regulation in EPC ontogeny, our studies in a SCID.NOD murine study model of hind-limb ischemia will be conducted with concomitant in vitro cellular and gene array analyses in order to gain further understanding of EPC development from early AC133+ stem cells, as well as gene regulation of EPC differentiation. We propose to isolate and expand unselected and AC133 selected human UCB into EPCs. Optimum media and growth factor combinations will be determined and expanded cells will be transplanted into a murine model of hindlimb ischemia to determine the effects of cell infusion on angiogenesis. Blood flow will be measured with laser Doppler perfusion imaging, and capillary density in the affected and control limb compared. HLA analysis will be conducted to identify and compare 3referential grafting by specific cellular subsets. Current studies incorporating infusion of culture expanded EPC point to cells derived from immature hemangioblasts as well as mature endothelial cells derived from vascular intima as injury response. It is unclear the relative contributions of these cell populations to home and effect angiogenesis. Since the number and function of EPC decline with advancing age, UCB may be considered as a robust source of rapidly proliferating EPCs for therapeutic angiogenesis in the treatment of ischemic vascular disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

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A comparison of cilostazol and pentoxifylline for treating intermittent claudication. Author(s): Dawson DL, Cutler BS, Hiatt WR, Hobson RW 2nd, Martin JD, Bortey EB, Forbes WP, Strandness DE Jr. Source: The American Journal of Medicine. 2000 November; 109(7): 523-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11063952

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 comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication. Author(s): Yukawa Y, Lenke LG, Tenhula J, Bridwell KH, Riew KD, Blanke K. Source: The Journal of Bone and Joint Surgery. American Volume. 2002 November; 84A(11): 1954-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12429755

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A long-term study of policosanol in the treatment of intermittent claudication. Author(s): Castano G, Mas Ferreiro R, Fernandez L, Gamez R, Illnait J, Fernandez C. Source: Angiology. 2001 February; 52(2): 115-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11228084

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A new device for the measurement of disease severity in patients with intermittent claudication. Author(s): Coughlin PA, Kent PJ, Turton EP, Byrne P, Berridge DC, Scott DJ, Kester RC. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2001 December; 22(6): 516-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11735200

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A new study demonstrates the efficacy of naftidrofuryl in the treatment of intermittent claudication. Findings of the Naftidrofuryl Clinical Ischemia Study (NCIS). Author(s): Kieffer E, Bahnini A, Mouren X, Gamand S. Source: International Angiology : a Journal of the International Union of Angiology. 2001 March; 20(1): 58-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11342997

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A primary care walking exercise program for patients with intermittent claudication. Author(s): Wullink M, Stoffers HE, Kuipers H. Source: Medicine and Science in Sports and Exercise. 2001 October; 33(10): 1629-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11581544

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A randomised, double blind, placebo-controlled study to determine the efficacy of immune modulation therapy in the treatment of patients suffering from peripheral arterial occlusive disease with intermittent claudication. Author(s): McGrath C, Robb R, Lucas AJ, Stewart AH, Underwood CL, Horridge JK, Lamont PM, Smith FC, Baird RN. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2002 May; 23(5): 381-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12027463

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A rational approach to diagnosis and treatment of intermittent claudication. Author(s): Fernandez BB Jr. Source: The American Journal of the Medical Sciences. 2002 May; 323(5): 244-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12018666

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A role for near infrared spectroscopy in the assessment of intermittent claudication. Author(s): Seifalian AM, Atwal A, White S, Mikhailidis DP, Baker D, Hamilton G. Source: International Angiology : a Journal of the International Union of Angiology. 2001 December; 20(4): 301-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11782696

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An incremental test to identify the pain threshold speed in patients with intermittent claudication. Author(s): Manfredini F, Mangolini C, Mascoli F, Mazzoni G, Cristina M, Manfredini R, Conconi F. Source: Circulation Journal : Official Journal of the Japanese Circulation Society. 2002 December; 66(12): 1124-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12499618

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An unusual cause of claudication. Author(s): Shaw JA, Gravereaux EC, Winters GL, Eisenhauer AC. Source: Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 2003 December; 60(4): 562-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14624442

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An unusual cause of ischemic claudication: a case report. Author(s): Fredericson M, Waite BL. Source: Archives of Physical Medicine and Rehabilitation. 2003 May; 84(5): 766-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12736894

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Angiogenesis with recombinant fibroblast growth factor-2 for claudication. Author(s): Williams D, Davenport K, Tan Y. Source: Lancet. 2003 January 18; 361(9353): 256; Author Reply 256. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12547562

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Angioplasty for intermittent claudication: has the balloon finally burst? Author(s): Buckenham T. Source: N Z Med J. 2003 January 24; 116(1168): U304. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12601427

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Angioplasty for the treatment of buttock claudication caused by internal iliac artery stenoses. Author(s): Kofoed SC, Bismuth J, Just S, Baekgaard N. Source: Annals of Vascular Surgery. 2001 May; 15(3): 396-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11414094

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Anticoagulants (heparin, low molecular weight heparin and oral anticoagulants) for intermittent claudication. Author(s): Cosmi B, Conti E, Coccheri S. Source: Cochrane Database Syst Rev. 2001; (3): Cd001999. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11687006

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Aortic flap valve presenting as neurogenic claudication: a case report. Author(s): Lakdawala RH, Rahmat R, Tan L, Wong HK. Source: Spine. 2004 February 15; 29(4): E79-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15094550

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Assessment and management of intermittent claudication: importance of secondary prevention. Author(s): Donnelly R. Source: Int J Clin Pract Suppl. 2001 April; (119): 2-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11355275

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Assessment of generic health-related quality of life in patients with intermittent claudication. Author(s): Hicken GJ, Lossing AG, Ameli M. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2000 October; 20(4): 336-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11035965

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Atypical claudication associated with overuse injury in patients with chronic compartment, functional entrapment, and medial tibial stress syndromes. Author(s): Turnipseed WD. Source: Cardiovascular Surgery (London, England). 2003 October; 11(5): 421-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12958556

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Baastrup's disease as a cause of neurogenic claudication: a case report. Author(s): Rajasekaran S, Pithwa YK. Source: Spine. 2003 July 15; 28(14): E273-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865862

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Balloon dilatation in the treatment of early intermittent claudication. Author(s): Hare WS, Thomson KR, Field PL, Robertson DB. Source: The Medical Journal of Australia. 1981 October 3; 2(7): 331-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6457968

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Basic data related to the natural history of intermittent claudication. Author(s): McDaniel MD, Cronenwett JL. Source: Annals of Vascular Surgery. 1989 July; 3(3): 273-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2673321

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Basic fibroblast growth factor in patients with intermittent claudication: results of a phase I trial. Author(s): Lazarous DF, Unger EF, Epstein SE, Stine A, Arevalo JL, Chew EY, Quyyumi AA. Source: Journal of the American College of Cardiology. 2000 October; 36(4): 1239-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11028477

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Beneficial effects of exercise beyond the pain threshold in intermittent claudication. Author(s): Carlon R, Morlino T, Maiolino P. Source: Ital Heart J. 2003 February; 4(2): 113-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12762274

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Beneficial effects of intermittent suction and pressure treatment in intermittent claudication. Author(s): Mehlsen J, Himmelstrup H, Himmelstrup B, Winther K, Trap-Jensen J. Source: Angiology. 1993 January; 44(1): 16-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8424580

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Benefits of arterial reconstruction in claudication. Author(s): Ohta T, Kato R, Sugimoto I, Hida K, Hachiya J, Mihara E, Hasegawa T, Imamura Y, Ishibashi H, Hosaka M, et al. Source: Surgery Today. 1995; 25(10): 891-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8574055

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Beraprost for the treatment of intermittent claudication. Author(s): Cooper LT. Source: Journal of the American College of Cardiology. 2003 May 21; 41(10): 1687-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12767647

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Beta blockade and intermittent claudication. Author(s): Lepantalo M. Source: Acta Med Scand Suppl. 1985; 700: 1-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2865873

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beta blockade and intermittent claudication: placebo controlled trial of atenolol and nifedipine and their combination. Author(s): Solomon SA, Ramsay LE, Yeo WW, Parnell L, Morris-Jones W. Source: Bmj (Clinical Research Ed.). 1991 November 2; 303(6810): 1100-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1747577

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Beta-adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease. A meta-analysis of randomized controlled trials. Author(s): Radack K, Deck C. Source: Archives of Internal Medicine. 1991 September; 151(9): 1769-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1679624

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Beta-adrenergic blockers and intermittent claudication. Time for reappraisal. Author(s): Thadani U, Whitsett TL. Source: Archives of Internal Medicine. 1991 September; 151(9): 1705-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1679623

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Bilateral buttock pain caused by aortic stenosis: a case report of claudication of the buttock. Author(s): Laslett M. Source: Manual Therapy. 2000 November; 5(4): 227-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11052902

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Blood flow measurement in patients with intermittent claudication. Author(s): Davies WT. Source: Angiology. 1980 March; 31(3): 164-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7369547

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Blood viscosity during long-term treatment with ticlopidine in patients with intermittent claudication. A double-blind study. Author(s): Fagher B, Persson S, Persson G, Larsson H. Source: Angiology. 1993 April; 44(4): 300-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8457081

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Blood viscosity of patients with intermittent claudication--concept of "rheological claudication". Author(s): Dormandy J, Hoare E, Postlethwaite J. Source: Biorheology. 1976 June; 13(3): 161-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=953251

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Buflomedil for intermittent claudication. Author(s): De Backer TL, Vander Stichele RH, Bogaert MG. Source: Cochrane Database Syst Rev. 2001; (1): Cd000988. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11279700

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Buttock claudication from isolated bilateral internal iliac arterial stenoses. Author(s): Hodgson KJ, Sumner DS. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 1988 March; 7(3): 446-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2964534

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Buttock claudication from isolated stenosis of the gluteal artery. Author(s): Batt M, Desjardin T, Rogopoulos A, Hassen-Khodja R, Le Bas P. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 1997 March; 25(3): 584-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9081144

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Buttock claudication secondary to isolated internal iliac artery stenosis. Author(s): Elsharawy MA, Cheatle TR. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2000 January; 19(1): 87-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10706843

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Can claudication be improved with medication? Author(s): Conners MS, Money SR. Source: Semin Vasc Surg. 2002 December; 15(4): 237-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12478498

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Case Number 27: Jaw claudication in Takayasu's disease. Author(s): Jeurissen SE, Liauw L, Willems LN, Huizinga TW. Source: Annals of the Rheumatic Diseases. 2003 October; 62(10): 922. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12972467

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Causes of late mortality in patients with disabling intermittent claudication. Author(s): Kobayashi M, Shindo S, Kubota K, Kojima A, Ishimoto T, Iyori K, Tada Y. Source: Japanese Circulation Journal. 2000 December; 64(12): 925-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11194284

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Cilostazol in intermittent claudication. Author(s): Cariski AT, Lindmayer K. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2002 January 1; 59(1): 81-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11813475

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Cilostazol treatment of claudication in diabetic patients. Author(s): Rendell M, Cariski AT, Hittel N, Zhang P. Source: Current Medical Research and Opinion. 2002; 18(8): 479-87. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12564659

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Cilostazol: a novel treatment option in intermittent claudication. Author(s): Cariski AT. Source: Int J Clin Pract Suppl. 2001 April; (119): 11-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11355274

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Cilostazol: an "intermittent claudication" remedy for the management of third-degree AV block. Author(s): Madias JE. Source: Chest. 2003 April; 123(4): 979-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12684279

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Cilostazol: treatment of intermittent claudication. Author(s): Reilly MP, Mohler ER 3rd. Source: The Annals of Pharmacotherapy. 2001 January; 35(1): 48-56. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11197586

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Claudication type lower limb pain in an athlete without atherosclerotic risk factors: a case of cystic adventitial disease of the popliteal artery. Author(s): Van Iseghem BW, Gryspeerdt SS, Baekelandt MB, van Holsbeeck BG, Buyse AM, Gellens PH, Lefere PA. Source: Jbr-Btr. 2003 September-October; 86(5): 272-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14651082

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Clinical and hemorheological effects of buflomedil in diabetic subjects with intermittent claudication. Author(s): Diamantopoulos EJ, Grigoriadou M, Ifanti G, Raptis SA. Source: International Angiology : a Journal of the International Union of Angiology. 2001 December; 20(4): 337-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11782701

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Clinical manifestation of atherosclerotic peripheral arterial disease and the role of cilostazol in treatment of intermittent claudication. Author(s): Grouse JR 3rd, Allan MC, Elam MB. Source: Journal of Clinical Pharmacology. 2002 December; 42(12): 1291-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12463722

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Color Doppler used to detect kinking and intravascular lesions in the iliac arteries in endurance athletes with claudication. Author(s): Schep G, Bender MH, Schmikli SL, Wijn PF. Source: European Journal of Ultrasound : Official Journal of the European Federation of Societies for Ultrasound in Medicine and Biology. 2001 December; 14(2-3): 129-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11704430

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Comorbidities and exercise capacity in older patients with intermittent claudication. Author(s): Katzel LI, Sorkin JD, Powell CC, Gardner AW. Source: Vascular Medicine (London, England). 2001; 6(3): 157-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11789970

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Comparative effects of cilostazol and other therapies for intermittent claudication. Author(s): Dawson DL. Source: The American Journal of Cardiology. 2001 June 28; 87(12A): 19D-27D. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11434896

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Comparison of preference-based utilities of the Short-Form 36 Health Survey and Health Utilities Index before and after treatment of patients with intermittent claudication. Author(s): Bosch JL, Halpern EF, Gazelle GS. Source: Medical Decision Making : an International Journal of the Society for Medical Decision Making. 2002 September-October; 22(5): 403-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12365482

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Comparison of the Health Utilities Index Mark 3 (HUI3) and the EuroQol EQ-5D in patients treated for intermittent claudication. Author(s): Bosch JL, Hunink MG. Source: Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 2000; 9(6): 591-601. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11236850

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Comparison of the long-term results between surgical and conservative treatment in patients with intermittent claudication. Author(s): Mori E, Komori K, Kume M, Yamaoka T, Shoji T, Furuyama T, Inoguchi H. Source: Surgery. 2002 January; 131(1 Suppl): S269-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11821823

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Cost-effectiveness of diagnostic imaging work-up and treatment for patients with intermittent claudication in The Netherlands. Author(s): Visser K, de Vries SO, Kitslaar PJ, van Engelshoven JM, Hunink MG. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 March; 25(3): 213-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12623332

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Cost-effectiveness targets for multi-detector row CT angiography in the work-up of patients with intermittent claudication. Author(s): Visser K, Kock MC, Kuntz KM, Donaldson MC, Gazelle GS, Hunink MG. Source: Radiology. 2003 June; 227(3): 647-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12773672

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Decisions about treatment of aortoiliac claudication: the current practice among Swedish vascular surgeons. Author(s): Troeng T, Weibull H, Lyttkens CH, Janzon L, Lindgren B, Enemark U. Source: The European Journal of Surgery = Acta Chirurgica. 1997 September; 163(9): 643-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9311470

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Delayed respiratory response to exercise of short duration in patients with severe intermittent claudication due to bilateral atherosclerotic vascular disease: normalization after aorto-bifemoral bypass operation. Author(s): Refsum HE. Source: Clinical Physiology (Oxford, England). 1999 September; 19(5): 394-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10516890

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Design of the therapeutic angiogenesis with recombinant fibroblast growth factor-2 for intermittent claudication (TRAFFIC) trial. Author(s): Lederman RJ, Tenaglia AN, Anderson RD, Hermiller JB, Rocha-Singh K, Mendelsohn FO, Hiatt WR, Moon T, Whitehouse MJ, Annex BH. Source: The American Journal of Cardiology. 2001 July 15; 88(2): 192-5, A6-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11448424

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Detection and treatment of claudication due to functional iliac obstruction in top endurance athletes: a prospective study. Author(s): Schep G, Bender MH, van de Tempel G, Wijn PF, de Vries WR, Eikelboom BC. Source: Lancet. 2002 February 9; 359(9305): 466-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11853791

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Determinants of fibrinogen in an Italian population suffering from claudication. Lower fibrinogen in the south compared to middle and north of Italy. The ADEP Group. Author(s): Basili S, Milani M, Longoni A, Vieri M, Iuliano L, Violi F. Source: Haematologica. 1998 August; 83(8): 701-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9793253

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Diagnosis of intermittent vascular claudication in a patient with a diagnosis of sciatica. Author(s): Gray JC. Source: Physical Therapy. 1999 June; 79(6): 582-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10372869

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Diagnostic imaging in patients with claudication. American College of Radiology. ACR Appropriateness Criteria. Author(s): Bettmann MA, Boxt LM, Gomes AS, Grollman J, Henkin RE, Higgins CB, Kelley MJ, Needleman L, Pagan-Marin H, Polak JF, Stanford W, Levin DC, Gardiner GA. Source: Radiology. 2000 June; 215 Suppl: 61-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11037406

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Differential diagnosis of intermittent claudication and the adequacy of epidemiological studies. Author(s): Dormandy JA, Loh A. Source: Ann Chir Gynaecol. 1992; 81(2): 112-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1622061

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Differential effects of cilostazol and pentoxifylline on vascular endothelial growth factor in patients with intermittent claudication. Author(s): Lee TM, Su SF, Tsai CH, Lee YT, Wang SS. Source: Clinical Science (London, England : 1979). 2001 September; 101(3): 305-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11524048

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Differential lipogenic effects of cilostazol and pentoxifylline in patients with intermittent claudication: potential role for interleukin-6. Author(s): Lee TM, Su SF, Hwang JJ, Tseng CD, Chen MF, Lee YT, Wang SS. Source: Atherosclerosis. 2001 October; 158(2): 471-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11583728

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Disease-specific quality of life assessment in intermittent claudication: review. Author(s): Mehta T, Venkata Subramaniam A, Chetter I, McCollum P. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 March; 25(3): 202-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12623330

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Do patients with intermittent claudication need surgical treatment? Author(s): Okadome K, Funahashi S, Odashiro T, Komori K, Akazawa K, Sugimachi K. Source: International Angiology : a Journal of the International Union of Angiology. 1994 June; 13(2): 103-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7963867

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Does evidence exist on whether specific interventions can improve adherence to a home exercise program in a patient with intermittent claudication? Author(s): Buck M, Ciccone CD. Source: Physical Therapy. 2004 May; 84(5): 465-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15113279

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Does supervised exercise offer adjuvant benefit over exercise advice alone for the treatment of intermittent claudication? A randomised trial. Author(s): Cheetham DR, Burgess L, Ellis M, Williams A, Greenhalgh RM, Davies AH. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2004 January; 27(1): 17-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14652832

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Dorsal extradural lipoma as cause of spinal claudication. Case report and review of the literature. Author(s): Frank AM, Trappe AE, Goebel WE. Source: Zentralblatt Fur Neurochirurgie. 1998; 59(1): 23-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9577928

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Double-blind comparison of captopril with nifedipine in hypertension complicated by intermittent claudication. Author(s): Roberts DH, Tsao Y, Linge K, McLoughlin GA, Breckenridge A. Source: Angiology. 1992 September; 43(9): 748-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1514711

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Double-blind, controlled, multicenter study of indobufen versus placebo in patients with intermittent claudication. Author(s): Tonnesen KH, Albuquerque P, Baitsch G, Gomez Alonso A, Ibanez F, Kester RC, Leveson S, Poredos P. Source: International Angiology : a Journal of the International Union of Angiology. 1993 December; 12(4): 371-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8207316

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Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Author(s): Willen J, Danielson B, Gaulitz A, Niklason T, Schonstrom N, Hansson T. Source: Spine. 1997 December 15; 22(24): 2968-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9431634

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Effect of cilostazol on treadmill walking, community-based walking ability, and health-related quality of life in patients with intermittent claudication due to peripheral arterial disease: meta-analysis of six randomized controlled trials. Author(s): Regensteiner JG, Ware JE Jr, McCarthy WJ, Zhang P, Forbes WP, Heckman J, Hiatt WR. Source: Journal of the American Geriatrics Society. 2002 December; 50(12): 1939-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12473004

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Effect of simvastatin versus placebo on treadmill exercise time until the onset of intermittent claudication in older patients with peripheral arterial disease at six months and at one year after treatment. Author(s): Aronow WS, Nayak D, Woodworth S, Ahn C. Source: The American Journal of Cardiology. 2003 September 15; 92(6): 711-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12972114

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Effects of home versus supervised exercise for patients with intermittent claudication. Author(s): Savage P, Ricci MA, Lynn M, Gardner A, Knight S, Brochu M, Ades P. Source: Journal of Cardiopulmonary Rehabilitation. 2001 May-June; 21(3): 152-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11409225

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Effects of long-term exercise rehabilitation on claudication distances in patients with peripheral arterial disease: a randomized controlled trial. Author(s): Gardner AW, Katzel LI, Sorkin JD, Goldberg AP. Source: Journal of Cardiopulmonary Rehabilitation. 2002 May-June; 22(3): 192-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12042688

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Effects of policosanol and lovastatin in patients with intermittent claudication: a double-blind comparative pilot study. Author(s): Castano G, Mas R, Fernandez L, Gamez R, Illnait J. Source: Angiology. 2003 January; 54(1): 25-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12593493

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Effects of simvastatin on walking performance and symptoms of intermittent claudication in hypercholesterolemic patients with peripheral vascular disease. Author(s): Mondillo S, Ballo P, Barbati R, Guerrini F, Ammaturo T, Agricola E, Pastore M, Borrello F, Belcastro M, Picchi A, Nami R. Source: The American Journal of Medicine. 2003 April 1; 114(5): 359-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12714124

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Efficacy of a short-course intensive rehabilitation program in patients with moderateto-severe intermittent claudication. Author(s): Ambrosetti M, Salerno M, Tramarin R, Pedretti RF. Source: Ital Heart J. 2002 August; 3(8): 467-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12407823

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Endovascular and surgical revascularization for patients with intermittent claudication. Author(s): Comerota AJ. Source: The American Journal of Cardiology. 2001 June 28; 87(12A): 34D-43D. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11434898

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Endovascular stents for intermittent claudication. Author(s): Bachoo P, Thorpe P. Source: Cochrane Database Syst Rev. 2003; (1): Cd003228. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12535463

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Evaluation of buttock claudication with hypogastric artery stump pressure measurement and near infrared spectroscopy after abdominal aortic aneurysm repair. Author(s): Sugano N, Inoue Y, Iwai T. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 July; 26(1): 45-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12819647

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Evaluation of walking capacity over time in 500 patients with intermittent claudication who underwent clinical treatment. Author(s): Wolosker N, Nakano L, Rosoky RA, Puech-Leao P. Source: Archives of Internal Medicine. 2003 October 27; 163(19): 2296-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14581248

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Evidence-based symptom relief of intermittent claudication: efficacy and safety of cilostazol. Author(s): Donnelly R. Source: Diabetes, Obesity & Metabolism. 2002 March; 4 Suppl 2: S20-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12180354

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Exaggerated endothelin release in response to acute mental stress in patients with intermittent claudication. Author(s): Mangiafico RA, Malatino LS, Attina T, Messina R, Fiore CE. Source: Angiology. 2002 July-August; 53(4): 383-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12143942

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Exclusively extradural arteriovenous malformation with neurogenic claudication. Case illustration. Author(s): Niizuma K, Fujimura M, Takahashi T, Takahashi A, Watanabe M, Tominaga T. Source: Journal of Neurosurgery. 2004 April; 100(4 Suppl): 397. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15070153

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Exercise for intermittent claudication: walking for life? Author(s): Eberhardt RT. Source: Journal of Cardiopulmonary Rehabilitation. 2002 May-June; 22(3): 199-200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12042689

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Exercise increases soluble adhesion molecules ICAM-1 and VCAM-1 in patients with intermittent claudication. Author(s): Brevetti G, De Caterina M, Martone VD, Ungaro B, Corrado F, Silvestro A, de Cristofaro T, Scopacasa F. Source: Clinical Hemorheology and Microcirculation. 2001; 24(3): 193-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11455059

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Exercise rehabilitation improves functional outcomes and peripheral circulation in patients with intermittent claudication: a randomized controlled trial. Author(s): Gardner AW, Katzel LI, Sorkin JD, Bradham DD, Hochberg MC, Flinn WR, Goldberg AP. Source: Journal of the American Geriatrics Society. 2001 June; 49(6): 755-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11454114

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Exercise training and smoking cessation as the cornerstones of managing claudication. Author(s): Christman SK, Ahijevych K, Buckworth J. Source: The Journal of Cardiovascular Nursing. 2001 July; 15(4): 64-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11419666

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Exercise training for claudication. Author(s): Stewart KJ, Hiatt WR, Regensteiner JG, Hirsch AT. Source: The New England Journal of Medicine. 2002 December 12; 347(24): 1941-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12477945

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Exercise training reduces the acute inflammatory response associated with claudication. Author(s): Turton EP, Coughlin PA, Kester RC, Scott DJ. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2002 April; 23(4): 309-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11991691

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Factors of prognostic importance for subsequent rest pain in patients with intermittent claudication. Author(s): Jonason T, Ringqvist I. Source: Acta Med Scand. 1985; 218(1): 27-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4050550

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Failure of pentoxifylline or cilostazol to improve blood and plasma viscosity, fibrinogen, and erythrocyte deformability in claudication. Author(s): Dawson DL, Zheng Q, Worthy SA, Charles B, Bradley DV Jr. Source: Angiology. 2002 September-October; 53(5): 509-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12365857

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Fate in intermittent claudication: outcome and risk factors. Author(s): Jelnes R, Gaardsting O, Hougaard Jensen K, Baekgaard N, Tonnesen KH, Schroeder T. Source: British Medical Journal (Clinical Research Ed.). 1986 November 1; 293(6555): 1137-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3094806

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Femoral artery wall morphology, hemostatic factors and intermittent claudication: ultrasound study in men at high and low risk for atherosclerotic disease. Author(s): Agewall S, Wikstrand J, Wendelhag I, Tengborn L, Fagerberg B. Source: Haemostasis. 1996 January-February; 26(1): 45-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8698278

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Femorofemoral crossover grafts for claudication: a safe and reliable procedure. Author(s): Berce M, Sayers RD, Miller JH. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 1996 November; 12(4): 437-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8980433

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Femoropopliteal angioplasty in patients with claudication: primary and secondary patency in 140 limbs with 1-3-year follow-up. Author(s): Matsi PJ, Manninen HI, Vanninen RL, Suhonen MT, Oksala I, Laakso M, Hakkarainen T, Soimakallio S. Source: Radiology. 1994 June; 191(3): 727-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8184053

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Femoropopliteal arterial reconstruction with intraoperative iliac transluminal angioplasty for disabling claudication: results of a combined approach. Author(s): van der Vliet JA, Mulling FJ, Heijstraten FM, Reinaerts HH, Buskens FG. Source: Eur J Vasc Surg. 1992 November; 6(6): 607-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1451815

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Femoropopliteal bypass for claudication: vein vs. PTFE. Author(s): Allen BT, Reilly JM, Rubin BG, Thompson RW, Anderson CB, Flye MW, Sicard GA. Source: Annals of Vascular Surgery. 1996 March; 10(2): 178-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8733871

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Femoropopliteal bypass grafting for intermittent claudication: is pessimism warranted? Author(s): Donaldson MC, Mannick JA. Source: Archives of Surgery (Chicago, Ill. : 1960). 1980 June; 115(6): 724-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7387359

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Femoropopliteal reconstruction for claudication. The risk to life and limb. Author(s): Kent KC, Donaldson MC, Attinger CE, Couch NP, Mannick JA, Whittemore AD. Source: Archives of Surgery (Chicago, Ill. : 1960). 1988 October; 123(10): 1196-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3178466

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Femoropopliteal vein grafts for intermittent claudication. Author(s): King RB, Myers KA, Scott DF, Devine TJ, Johnson N, Morris PJ. Source: The British Journal of Surgery. 1980 July; 67(7): 489-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7417750

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Femorotibial bypass for claudication: do results justify an aggressive approach? Author(s): Conte MS, Belkin M, Donaldson MC, Baum P, Mannick JA, Whittemore AD. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 1995 June; 21(6): 873-80; Discussion 880-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7776466

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Fibrinogen in relation to personal history of prevalent hypertension, diabetes, stroke, intermittent claudication, coronary heart disease, and family history: the Scottish Heart Health Study. Author(s): Lee AJ, Lowe GD, Woodward M, Tunstall-Pedoe H. Source: British Heart Journal. 1993 April; 69(4): 338-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8489866

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Fibrositic myofascial pain in intermittent claudication: significance of trigger areas in the calf. Author(s): Bartoli V, Dorigo B, Grisillo D, Beconi D. Source: Angiology. 1980 January; 31(1): 11-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7369534

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Fitting multistate transition models with autoregressive logistic regression: supervised exercise in intermittent claudication. Author(s): de Vries SO, Fidler V, Kuipers WD, Hunink MG. Source: Medical Decision Making : an International Journal of the Society for Medical Decision Making. 1998 January-March; 18(1): 52-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9456209

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Functional benefits of peripheral vascular bypass surgery for patients with intermittent claudication. Author(s): Regensteiner JG, Hargarten ME, Rutherford RB, Hiatt WR. Source: Angiology. 1993 January; 44(1): 1-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8424578

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Functional improvements following StairMaster vs. treadmill exercise training for patients with intermittent claudication. Author(s): Jones PP, Skinner JS, Smith LK, John FM, Bryant CX. Source: Journal of Cardiopulmonary Rehabilitation. 1996 January-February; 16(1): 47-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8907442

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Functional outcome after surgical treatment for intermittent claudication. Author(s): Zannetti S, L'Italien GJ, Cambria RP. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 1996 July; 24(1): 65-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8691530

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Functional status and walking ability after lower extremity bypass grafting or angioplasty for intermittent claudication: results from a prospective outcomes study. Author(s): Feinglass J, McCarthy WJ, Slavensky R, Manheim LM, Martin GJ. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2000 January; 31(1 Pt 1): 93-103. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10642712

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Gait alterations associated with walking impairment in people with peripheral arterial disease with and without intermittent claudication. Author(s): McDermott MM, Ohlmiller SM, Liu K, Guralnik JM, Martin GJ, Pearce WH, Greenland P. Source: Journal of the American Geriatrics Society. 2001 June; 49(6): 747-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11454113

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Gait analysis of patients with neurogenic intermittent claudication. Author(s): Suda Y, Saitou M, Shibasaki K, Yamazaki N, Chiba K, Toyama Y. Source: Spine. 2002 November 15; 27(22): 2509-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12435983

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Gait characteristics of patients with claudication. Author(s): Scherer SA, Bainbridge JS, Hiatt WR, Regensteiner JG. Source: Archives of Physical Medicine and Rehabilitation. 1998 May; 79(5): 529-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9596393

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Gd-DTPA enhanced MR of the lumbar spinal canal in patients with claudication. Author(s): Jinkins JR. Source: Journal of Computer Assisted Tomography. 1993 July-August; 17(4): 555-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8331225

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Giant cell (temporal) arteritis diagnosed following upper limb claudication. Author(s): De Bruyne L, Pauwels W, Raat F, Mast A. Source: Acta Clin Belg. 2001 November-December; 56(6): 370-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11881323

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Giant cell arteritis as a cause of intermittent claudication. Author(s): Desmond J, Hussain ST, Colin JF. Source: Hosp Med. 1999 April; 60(4): 302. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10396440

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Giant cell arteritis diagnosed following arm claudication. Author(s): Petrie JP, Sheppeard H. Source: Aust N Z J Med. 1984 June; 14(3): 275-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6594121

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Giant cell arteritis in a 20-year-old black man: a cause of intermittent calf claudication. Author(s): Fiore W, Penn TE, Quill T, Lebowitz E, Rivers RJ Jr. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 1986 August; 4(2): 192-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3735574

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Giant cell arteritis presenting as limb claudication. Author(s): Watts RA, Coppen M, Bhalla AK, Binder AI. Source: Journal of the Royal Society of Medicine. 1989 January; 82(1): 51-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2647984

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Giant cell arteritis presenting as limb claudication. Report and review of the literature. Author(s): Walz-Leblanc BA, Ameli FM, Keystone EC. Source: The Journal of Rheumatology. 1991 March; 18(3): 470-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1856819

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Giant cell arteritis presenting with arm claudication. Author(s): Kelly J, Rudd AG. Source: Age and Ageing. 2001 March; 30(2): 167-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11395348

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Glucose tolerance, plasma insulin, and lipids in intermittent claudication with reference to muscle metabolism. Author(s): Holm J, Dahllof AG, Bjorntorp P, Schersten T. Source: Metabolism: Clinical and Experimental. 1973 November; 23(2): 1395-402. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4749542

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Grand Rounds. University of Kentucky Department of Surgery. Claudication in a teenager due to potential artery entrapment syndrome. Author(s): Sachatello CR. Source: J Ky Med Assoc. 1979 November; 77(11): 584-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=512458

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Ground reaction force pattern in limbs with intermittent claudication. Author(s): Ayzin Rosoky RM, Wolosker N, Muraco-Netto B, Puech-Leao P. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2000 September; 20(3): 254-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10986024

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Haemostatic and rheological factors in intermittent claudication: the influence of smoking and extent of arterial disease. Author(s): Lee AJ, Fowkes FG, Rattray A, Rumley A, Lowe GD. Source: British Journal of Haematology. 1996 January; 92(1): 226-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8562400

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Heart and carotid artery disease in stroke patients with intermittent claudication. Author(s): Liu XF, van Melle G, Bogousslavsky J. Source: European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies. 2000 September; 7(5): 459-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11054127

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Helicobacter pylori seropositivity is associated with enhanced platelet activation in patients with intermittent claudication. Author(s): Cassar K, Bachoo P, Ford I, McGee M, Greaves M, Brittenden J. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2004 March; 39(3): 560-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14981449

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Hematocrit dependent changes of muscle tissue oxygen supply in the lower limb muscle of patients with intermittent claudication. Author(s): Hoffkes HG, Ehrly AM. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 1992; 21(4): 350-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1485467

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Hemiplegia and contralateral upper limb claudication--a case of dual disability from pseudoaneurysm of the brachiocephalic artery: a brief report. Author(s): Harvey RL. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1999 January-February; 78(1): 56-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9923430

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Hemostasis and fibrinolysis in patients with intermittent claudication: effects of prostaglandin E1. Author(s): Weiss C, Regele S, Velich T, Bartsch P, Weiss T. Source: Prostaglandins, Leukotrienes, and Essential Fatty Acids. 2000 November; 63(5): 271-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11090253

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Heparan sulfate in the treatment of intermittent claudication: results of a randomized, double-blind, placebo-controlled multicenter trial. Author(s): Messa GL, Gelso E. Source: Drugs Exp Clin Res. 2002; 28(1): 37-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12073766

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High density lipoprotein cholesterol and arteriography in intermittent claudication. Author(s): Horby J, Grande P, Vestergaard A, Grauholt AM. Source: Eur J Vasc Surg. 1989 August; 3(4): 333-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2767255

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High prevalence of coronary heart disease in patients with intermittent claudication. A preliminary report. Author(s): Stavenow L, Karlsson S, Lilja B, Lindgarde F. Source: Acta Chir Scand. 1988 July-August; 154(7-8): 447-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3055777

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Hip pain caused by buttock claudication. Relief of symptoms by transluminal angioplasty. Author(s): Smith G, Train J, Mitty H, Jacobson J. Source: Clinical Orthopaedics and Related Research. 1992 November; (284): 176-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1395290

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Histochemical changes in striated muscle in patients with intermittent claudication. Author(s): Makitie J, Teravainen H. Source: Archives of Pathology & Laboratory Medicine. 1977 December; 101(12): 658-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=579309

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HLA antigens, blood groups and serum protein groups in patients with intermittent claudication. Author(s): Norrgard O, Beckman G, Cedergren B. Source: Human Heredity. 1989; 39(4): 192-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2583730

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Home-training of patients with intermittent claudication. Author(s): Jonason T, Ringqvist I, Oman-Rydberg A. Source: Scandinavian Journal of Rehabilitation Medicine. 1981; 13(4): 137-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7347434

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Hyperhomocyst(e)inaemia: an independent risk factor for intermittent claudication. Author(s): Molgaard J, Malinow MR, Lassvik C, Holm AC, Upson B, Olsson AG. Source: Journal of Internal Medicine. 1992 March; 231(3): 273-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1556525

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Hypertensive patients with Raynaud's phenomenon or intermittent claudication and their treatment with ketanserin. Author(s): van Oene JC. Source: Drugs. 1988; 36 Suppl 1: 148-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3240729

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Hypogastric artery coil embolization prior to endoluminal repair of aneurysms and fistulas: buttock claudication, a recognized but possibly preventable complication. Author(s): Cynamon J, Lerer D, Veith FJ, Taragin BH, Wahl SI, Lautin JL, Ohki T, Sprayregen S. Source: Journal of Vascular and Interventional Radiology : Jvir. 2000 May; 11(5): 573-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10834487

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Images in vascular medicine. An unusual case of claudication. Author(s): Erel H, Prince MR, Rajagopalan S. Source: Vascular Medicine (London, England). 2002 February; 7(1): 55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12083736

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Impaired balance and higher prevalence of falls in subjects with intermittent claudication. Author(s): Gardner AW, Montgomery PS. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2001 July; 56(7): M454-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11445605

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Improved functional outcomes following exercise rehabilitation in patients with intermittent claudication. Author(s): Gardner AW, Katzel LI, Sorkin JD, Killewich LA, Ryan A, Flinn WR, Goldberg AP. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2000 October; 55(10): M570-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11034229

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Improvement in claudication after angioplasty of distal ostial collateral stenosis in patients with long-segment occlusion of the femoral artery. Author(s): Muller-Buhl U, Strecker EP, Gottmann D, Vetter S, Boos IB. Source: Cardiovascular and Interventional Radiology. 2000 November-December; 23(6): 447-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11232892

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Incidence and management of intermittent claudication in primary care in The Netherlands. Author(s): Meijer WT, Cost B, Bernsen RM, Hoes AW. Source: Scandinavian Journal of Primary Health Care. 2002 March; 20(1): 33-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12086281

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Increasing exercise tolerance of persons limited by claudication pain using polestriding. Author(s): Langbein WE, Collins EG, Orebaugh C, Maloney C, Williams KJ, Littooy FN, Edwards LC. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2002 May; 35(5): 887-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12021703

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Indications for and limitations of exercise training in patients with intermittent claudication. Author(s): Ohta T, Sugimoto I, Takeuchi N, Hosaka M, Ishibashi H. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 2002 February; 31(1): 23-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11951694

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Influence of upper- and lower-limb exercise training on cardiovascular function and walking distances in patients with intermittent claudication. Author(s): Walker RD, Nawaz S, Wilkinson CH, Saxton JM, Pockley AG, Wood RF. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2000 April; 31(4): 662-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10753273

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Infrainguinal revascularization because of claudication: total long-term outcome of endovascular and surgical treatment. Author(s): Jamsen TS, Manninen HI, Tulla HE, Jaakkola PA, Matsi PJ. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 April; 37(4): 808-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12663981

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Inhibition of adenosine uptake and augmentation of ischemia-induced increase of interstitial adenosine by cilostazol, an agent to treat intermittent claudication. Author(s): Liu Y, Fong M, Cone J, Wang S, Yoshitake M, Kambayashi J. Source: Journal of Cardiovascular Pharmacology. 2000 September; 36(3): 351-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10975593

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Intermittent claudication in diabetics: treatment with exercise and pentoxifylline--a 6month, controlled, randomized trial. Author(s): Belcaro G, Nicolaides AN, Griffin M, De Sanctis MT, Cesarone MR, Incandela L, Ippolito E, Pomante P, Geroulakos G, Ramaswami G. Source: Angiology. 2002 January-February; 53 Suppl 1: S39-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11865835

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Intermittent claudication unmasking underlying Fabry's disease. Author(s): Diamantopoulos EJ, Andreadis EA, Vassilopoulos CV, Marakomichelakis GE. Source: International Angiology : a Journal of the International Union of Angiology. 2002 June; 21(2): 201-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12110785

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Intermittent claudication. Author(s): Bick C. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2003 July 2-8; 17(42): 45-52; Quiz 53-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12874927

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Intermittent claudication: an objective office-based assessment. Author(s): McPhail IR, Spittell PC, Weston SA, Bailey KR. Source: Journal of the American College of Cardiology. 2001 April; 37(5): 1381-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11300450

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Intermittent claudication: effective medical management of a common circulatory problem. Author(s): Beebe HG. Source: The American Journal of Cardiology. 2001 June 28; 87(12A): 14D-18D. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11434895

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Intermittent claudication: how should we react to this symptom? Author(s): Bounameaux H. Source: European Heart Journal. 2002 July; 23(13): 1002-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12093051

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Intermittent claudication: magnitude of the problem, patient evaluation, and therapeutic strategies. Author(s): Schmieder FA, Comerota AJ. Source: The American Journal of Cardiology. 2001 June 28; 87(12A): 3D-13D. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11434894

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Intermittent claudication: pharmacoeconomic and quality-of-life aspects of treatment. Author(s): Brevetti G, Annecchini R, Bucur R. Source: Pharmacoeconomics. 2002; 20(3): 169-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11929347

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International validation of the CLAU-S quality-of-life questionnaire for use in patients with intermittent claudication. Author(s): Marquis P, Comte S, Lehert P. Source: Pharmacoeconomics. 2001; 19(6): 667-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11456214

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Is cilostazol more effective than pentoxifylline in the treatment of symptoms of intermittent claudication? Author(s): Weismantel D. Source: The Journal of Family Practice. 2001 February; 50(2): 181. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11219570

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Jaw and leg claudication in a patient with temporal arteritis, chronic sialoadenitis and previous hepatitis C virus infection. Author(s): Ferraccioli GF, Mariuzzi L, Damato R, Rocco M, Pirisi M, Beltrami CA. Source: Clin Exp Rheumatol. 1998 July-August; 16(4): 463-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9706429

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Jaw claudication and amaurosis fugax secondary to atheromatous disease of the carotid arteries. Author(s): Webster G, Beynon HL, Walport MJ. Source: British Journal of Rheumatology. 1994 July; 33(7): 691-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8019808

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Jaw claudication in primary amyloidosis: unusual presentation of a rare disease. Author(s): Churchill CH, Abril A, Krishna M, Callman ML, Ginsburg WW. Source: The Journal of Rheumatology. 2003 October; 30(10): 2283-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14528530

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Jaw claudication in primary systemic amyloidosis. Author(s): Gertz MA, Kyle RA, Griffing WL, Hunder GG. Source: Medicine; Analytical Reviews of General Medicine, Neurology, Psychiatry, Dermatology, and Pediatrics. 1986 May; 65(3): 173-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3702668

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Jaw claudication. Its value as a diagnostic clue. Author(s): Goodman BW Jr, Shepard FA. Source: Postgraduate Medicine. 1983 February; 73(2): 177-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6823455

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Jean-Francois Bouley (Bouley jeune). Pioneer investigator in intermittent claudication. Author(s): Sugar O. Source: Spine. 1994 February 1; 19(3): 346-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8171369

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Kallikreinogen-kallikrein system during muscular work in patients with intermittent claudication: influence of tauring treatment. Author(s): Franchi G, Fanciullacci M, Curradi C, Nuzzaci G, Monetti MG, Caternolo M. Source: Advances in Experimental Medicine and Biology. 1976; 70(00): 323-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=937138

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Ketanserin in intermittent claudication. Author(s): Ramsay LE. Source: Lancet. 1986 March 15; 1(8481): 619. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2869328

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Ketanserin in intermittent claudication. Author(s): Fonseca V, Ramage AG, Mikhailidis DP, Barradas MA, Jeremy JY, Dandona P. Source: Lancet. 1984 November 24; 2(8413): 1212-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6150255

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Ketanserin in intermittent claudication. A double-blind placebo-controlled study. Author(s): Clement DL, Duprez D, Van Wassenhove A, Brusselmans F. Source: International Angiology : a Journal of the International Union of Angiology. 1989 April-June; 8(2): 92-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2681451

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Ketanserin in intermittent claudication: effect on walking distance, blood pressure, and cardiovascular complications. Author(s): Thulesius O, Lundvall J, Kroese A, Stranden E, Hallbook T, Brunes L, Gjores JE, Akesson H, Einarsson E, Ohlin P, et al. Source: Journal of Cardiovascular Pharmacology. 1987 June; 9(6): 728-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2442541

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Kinetic analysis of the gait in patients with hemiparesis and in patients with intermittent claudication. Author(s): Carlsoo S, Dahlof AG, Holm J. Source: Scandinavian Journal of Rehabilitation Medicine. 1974; 6(4): 166-79. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4458059

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Laser Doppler flowmetry, transcutaneous oxygen pressure and thermal clearance in patients with vascular intermittent claudication. Author(s): Saumet JL, Fabry R, Girard P, Saumet M, Abraham P, Schaff G. Source: Int J Microcirc Clin Exp. 1993 April; 12(2): 173-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8500976

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Late recurrence of spinal stenosis and claudication after laminectomy due to an ossified extradural pseudocyst. Author(s): Shimazaki K, Nishida H, Harada Y, Hirohata K. Source: Spine. 1991 February; 16(2): 221-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1901426

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Leg blood flow and long-term cardiovascular prognosis in men with typical and atypical intermittent claudication. Author(s): Ogren M, Hedblad B, Engstrom G, Janzon L. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 September; 26(3): 272-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14509890

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Lipoprotein (a) and development of intermittent claudication and major cardiovascular events in men and women: the Edinburgh Artery Study. Author(s): Price JF, Lee AJ, Rumley A, Lowe GD, Fowkes FG. Source: Atherosclerosis. 2001 July; 157(1): 241-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11427227

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Lipoprotein(a) distribution in a French Canadian population and its relation to intermittent claudication (the Quebec Cardiovascular Study) Author(s): Cantin B, Moorjani S, Dagenais GR, Lupien PJ. Source: The American Journal of Cardiology. 1995 June 15; 75(17): 1224-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7778544

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Long-term outcome of patients with claudication after balloon angioplasty of the femoropopliteal arteries. Author(s): Jamsen TS, Manninen HI, Jaakkola PA, Matsi PJ. Source: Radiology. 2002 November; 225(2): 345-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12409565

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Lower extremity strength deficits in peripheral arterial occlusive disease patients with intermittent claudication. Author(s): Scott-Okafor HR, Silver KK, Parker J, Almy-Albert T, Gardner AW. Source: Angiology. 2001 January; 52(1): 7-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11205935

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Lower limb bypass for intermittent claudication. Is it really worth the risk? Author(s): Maharaj D, Shah D, Chang BB, Darling RC 3rd, Naraynsingh V. Source: The West Indian Medical Journal. 2001 December; 50(4): 273. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11993015

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Lumbar epidural lipomatosis causing neurogenic claudication in two obese patients. Author(s): van Rooij WJ, Borstlap AC, Canta LR, Tijssen CC. Source: Clinical Neurology and Neurosurgery. 1994 May; 96(2): 181-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7924088

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Lumbar stenosis with osteoporotic compression fracture and neurogenic claudication. Author(s): Sills AK. Source: Journal of Spinal Disorders. 1993 June; 6(3): 269-70; Discussion 270-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8347980

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Management of acute-onset claudication. Author(s): Mokete MM, Earnshaw JJ. Source: Cardiovascular Surgery (London, England). 2001 June; 9(3): 209-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11336842

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Management of intermittent claudication (Br J Surg 2002; 89: 529-31). Author(s): Vig S, Meyer F, Bell R, McGuiness C, Burnand KG. Source: The British Journal of Surgery. 2002 October; 89(10): 1324; Author Reply 1324-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12296910

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Management of intermittent claudication (Br J Surg 2002; 89: 529-31). Author(s): Ingle H, Bell PR. Source: The British Journal of Surgery. 2002 October; 89(10): 1323-4; Author Reply 13245. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12296907

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Management of intermittent claudication (Br J Surg 2002; 89: 529-31). Author(s): Evans J, Bhardwaj N, Loftus IM, Thompson MM. Source: The British Journal of Surgery. 2002 October; 89(10): 1323; Author Reply 1324-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12296906

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Management of intermittent claudication. Author(s): Brook RD, Weder AB, Grossman PM, Rajagopalan S. Source: Cardiology Clinics. 2002 November; 20(4): 521-34. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12472040

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Management of patients with intermittent claudication. Author(s): Olin JW. Source: Int J Clin Pract. 2002 November; 56(9): 687-93. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12469984

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Management of secondary risk factors in patients with intermittent claudication. Author(s): Cassar K, Coull R, Bachoo P, Macaulay E, Brittenden J. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 September; 26(3): 262-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14509888

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Management options for patients with intermittent claudication. Author(s): Dorgan S. Source: British Journal of Nursing (Mark Allen Publishing). 2004 April 22-May 12; 13(8): 448-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15150459

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Medical treatment of peripheral arterial disease and claudication. Author(s): Hiatt WR. Source: The New England Journal of Medicine. 2001 May 24; 344(21): 1608-21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11372014

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Meta-analysis of results from eight randomized, placebo-controlled trials on the effect of cilostazol on patients with intermittent claudication. Author(s): Thompson PD, Zimet R, Forbes WP, Zhang P. Source: The American Journal of Cardiology. 2002 December 15; 90(12): 1314-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12480040

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Naftidrofuryl can enhance the quality of life in patients with intermittent claudication. Author(s): Spengel F, Brown TM, Poth J, Lehert P. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 1999 August; 28(3): 207-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10483329

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Natural history of claudication: long-term serial follow-up study of 1244 claudicants. Author(s): Aquino R, Johnnides C, Makaroun M, Whittle JC, Muluk VS, Kelley ME, Muluk SC. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2001 December; 34(6): 962-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11743546

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Near infrared spectroscopy for noninvasive assessment of claudication. Author(s): Kooijman HM, Hopman MT, Colier WN, van der Vliet JA, Oeseburg B. Source: The Journal of Surgical Research. 1997 September; 72(1): 1-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9344707

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Near-infrared spectroscopy grades the severity of intermittent claudication in diabetics more accurately than ankle pressure measurement. Author(s): Komiyama T, Shigematsu H, Yasuhara H, Muto T. Source: The British Journal of Surgery. 2000 April; 87(4): 459-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10759743

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Neurilemoma of the tibial nerve causing intermittent claudication. Case report. Author(s): Leblebicioglu G, Atay A, Doral MN, Dogan R, Yilmaz M. Source: Am J Knee Surg. 2001 Summer; 14(3): 181-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11491430

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Neurogenic claudication secondary to vascular disease. Author(s): Murphy MA, Denton MJ, Scott DF. Source: The Australian and New Zealand Journal of Surgery. 1992 February; 62(2): 1547. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1586306

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Neurogenic intermittent claudication related to spinal stenosis. Author(s): Chung CT, Chou CS, Ho YJ, Lee SK. Source: Zhonghua Yi Xue Za Zhi (Taipei). 2000 November; 63(11): 809-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11155757

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New treatment options in intermittent claudication: the US experience. Author(s): Hiatt WR. Source: Int J Clin Pract Suppl. 2001 April; (119): 20-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11355276

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Nomograms used to define the short-term treatment with PGE(1) in patients with intermittent claudication and critical ischemia. The ORACL.E (Occlusion Revascularization in the Atherosclerotic Critical Limb) Study Group. The European Study. Author(s): Belcaro G, Nicolaides AN, Cipollone G, Laurora G, Incandela L, Cazaubon M, Barsotti A, Ledda A, Errichi BM, Cornelli U, Dugall M, Corsi M, Mezzanotte L, Geroulakos G, Fisher C, Szendro G, Simeone E, Cesarone MR, Bucci M, Agus G, De Sanctis MT, Ricci A, Ippolito E, Vasdekis S, Christopoulos D, Helmis H. Source: Angiology. 2000 August; 51(8 Pt 2): S3-13; Discussion S14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10959506

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Non-vascular claudication: a clinical conundrum. Author(s): Fasih T, Pickin M, Cuschieri RJ. Source: Int J Clin Pract. 2003 March; 57(2): 87-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12661788

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Observations on changes in intermittent claudication after the administration of creatine phosphate. Author(s): Favilli S, Iacopetti L, Fradella GA, Righi D, Nuzzaci G. Source: Pharmatherapeutica. 1982; 3(4): 221-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7146037

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Occlusion of external carotid artery causing intermittent claudication of the masseter. Author(s): Lewis RR, Beasley MG, MacLean KS. Source: British Medical Journal. 1978 December 9; 2(6152): 1611. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=728751

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Optimal hematocrit in patients with intermittent claudication. Exercise-induced muscle tissue oxygen pressure after stepwise hemodilution. Author(s): Hoffkes HG, Saeger-Lorenz K, Ehrly AM. Source: Acta Medica Austriaca. 1991; 18 Suppl 1: 16-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1950385

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Options in the management of claudication. Author(s): Charlesworth D. Source: Br J Hosp Med. 1986 November; 36(5): 361-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3790860

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Oral Beraprost sodium, a prostaglandin I(2) analogue, for intermittent claudication: a double-blind, randomized, multicenter controlled trial. Beraprost et Claudication Intermittente (BERCI) Research Group. Author(s): Lievre M, Morand S, Besse B, Fiessinger JN, Boissel JP. Source: Circulation. 2000 July 25; 102(4): 426-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10908215

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Oral vasoactive medication in intermittent claudication: utile or futile? Author(s): De Backer TL, Vander Stichele RH, Warie HH, Bogaert MG. Source: European Journal of Clinical Pharmacology. 2000 June; 56(3): 199-206. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10952473

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Outcome events in patients with claudication: a 15-year study in 2777 patients. Author(s): Muluk SC, Muluk VS, Kelley ME, Whittle JC, Tierney JA, Webster MW, Makaroun MS. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2001 February; 33(2): 251-7; Discussion 257-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11174775

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Outcome of conservative therapy of patients with severe intermittent claudication. Author(s): Amighi J, Sabeti S, Schlager O, Francesconi M, Ahmadi R, Minar E, Schillinger M. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2004 March; 27(3): 254-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14760593

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Overcoming the threat of cardiovascular disease. Health education programme among people with intermittent claudication. Author(s): Galvin KT, Gorst KL, Kester RC. Source: Prof Nurse. 1991 June; 6(9): 493-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2034695

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Oxygen saturation measurement of calf muscle during exercise in intermittent claudication. Author(s): Komiyama T, Onozuka A, Miyata T, Shigematsu H. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2002 May; 23(5): 388-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12027464

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Pathologic quiz case: leg claudication in young patients. Author(s): Veinot JP, Lamba M. Source: Archives of Pathology & Laboratory Medicine. 2001 June; 125(6): 831-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11371244

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PGE(1) treatment of severe intermittent claudication (short-term versus long-term, associated with exercise)--efficacy and costs in a 20-week, randomized trial. Author(s): Belcaro G, Nicolaides AN, Agus G, Cesarone MR, Geroulakos G, Pellegrini L, De Sanctis MT, Incandela L, Ricci A, Mondani P, De Angelis R, Ippolito E, Barsotti A, Vasdekis S, Ledda A, Christopoulos D, Errichi BM, Helmis H, Cornelli U, Ramaswami G, Dugall M, Bucci M, Martines G, Ferrari PG, Corsi M, Di Francescantonio D. Source: Angiology. 2000 August; 51(8 Pt 2): S15-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10959507

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Pharmacologic treatment for intermittent claudication. Author(s): Dean SM. Source: Vascular Medicine (London, England). 2002; 7(4): 301-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12710846

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Physiological and symptomatic responses to cycling and walking in intermittent claudication. Author(s): Askew CD, Green S, Hou XY, Walker PJ. Source: Clinical Physiology and Functional Imaging. 2002 September; 22(5): 348-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12487008

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Platelets' glycoproteins and their ligands in patients with intermittent claudication. Author(s): Gosk-Bierska I, Adamiec R, Szuba A. Source: International Angiology : a Journal of the International Union of Angiology. 2003 June; 22(2): 164-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865882

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Predictors of treatment outcome in intermittent claudication. Author(s): Taft C, Sullivan M, Lundholm K, Karlsson J, Gelin J, Jivegard L. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2004 January; 27(1): 24-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14652833

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Pretreatment imaging workup for patients with intermittent claudication: a costeffectiveness analysis. Author(s): Visser K, Kuntz KM, Donaldson MC, Gazelle GS, Hunink MG. Source: Journal of Vascular and Interventional Radiology : Jvir. 2003 January; 14(1): 5362. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12525586

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Propionyl-L-carnitine improves exercise performance and functional status in patients with claudication. Author(s): Hiatt WR, Regensteiner JG, Creager MA, Hirsch AT, Cooke JP, Olin JW, Gorbunov GN, Isner J, Lukjanov YV, Tsitsiashvili MS, Zabelskaya TF, Amato A. Source: The American Journal of Medicine. 2001 June 1; 110(8): 616-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11382369

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Prostanoids for intermittent claudication. Author(s): Reiter M, Bucek RA, Stumpflen A, Minar E. Source: Cochrane Database Syst Rev. 2004; (1): Cd000986. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14973962

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Prostanoids in the treatment of intermittent claudication--a meta-analysis. Author(s): Reiter M, Bucek RA, Stumpflen A, Dirisamer A, Minar E. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 2002 November; 31(4): 219-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12510544

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Quality of life after treatment of intermittent claudication. Author(s): Tisi PV, Shearman CP. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 1996 November; 12(4): 509-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8980450

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Quality of life and objective disease criteria in patients with intermittent claudication in general practice. Author(s): Muller-Buhl U, Engeser P, Klimm HD, Wiesemann A. Source: Family Practice. 2003 February; 20(1): 36-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12509368

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Quality of life changes after angioplasty for claudication: medium-term results affected by comorbid conditions. Author(s): Cook TA, Galland RB. Source: Cardiovascular Surgery (London, England). 1997 August; 5(4): 424-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9350800

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Quality of life following percutaneous transluminal angioplasty for claudication. Author(s): Tisi PV, Shearman CP. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 1996 November; 12(4): 509-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8980451

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Quality of life following percutaneous transluminal angioplasty for claudication. Author(s): Cook TA, O'Regan M, Galland RB. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 1996 February; 11(2): 191-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8616651

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Quality of life in a group of patients with intermittent claudication. Author(s): Ponte E, Cattinelli S. Source: Angiology. 1996 March; 47(3): 247-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8638867

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Quality of life in patients with intermittent claudication using the World Health Organisation (WHO) questionnaire. Author(s): Breek JC, Hamming JF, De Vries J, Aquarius AE, van Berge Henegouwen DP. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2001 February; 21(2): 118-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11237783

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Quality of life in patients with intermittent claudication. Author(s): Hicken G, Ameli M. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 1996 November; 12(4): 511-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8980453

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Quality of life in patients with intermittent claudication. Author(s): Khaira HS, Hanger R, Shearman CP. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 1996 January; 11(1): 65-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8564489

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Quality of life in patients with intermittent claudication: relationship with laboratory exercise performance. Author(s): Barletta G, Perna S, Sabba C, Catalano A, O'Boyle C, Brevetti G. Source: Vascular Medicine (London, England). 1996; 1(1): 3-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9546911

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Randomized placebo-controlled, double-blind trial of ketanserin in treatment of intermittent claudication. Author(s): Walden R, Bass A, Rabi I, Adar R. Source: The Journal of Cardiovascular Surgery. 1991 November-December; 32(6): 737-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1752890

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Randomized trial of the effects of low-dose calcium-heparin in patients with peripheral arterial disease and claudication. Italian CAP Study Group. Author(s): Antonicelli R, Sardina M, Scotti A, Bonizzoni E, Paciaroni E. Source: The American Journal of Medicine. 1999 September; 107(3): 234-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10492316

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Recurrent symptoms following lower extremity angioplasty: claudication and threatened limb. American College of Radiology. ACR Appropriateness Criteria. Author(s): Grollman J, Levin DC, Bettmann MA, Gomes AS, Henkin RE, Hessel SJ, Higgins CB, Kelley MJ, Needleman L, Polak JF, Stanford W, Wexler L, Abbott W, Port S. Source: Radiology. 2000 June; 215 Suppl: 95-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11037412

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Regional angiogenesis with vascular endothelial growth factor in peripheral arterial disease: a phase II randomized, double-blind, controlled study of adenoviral delivery of vascular endothelial growth factor 121 in patients with disabling intermittent claudication. Author(s): Rajagopalan S, Mohler ER 3rd, Lederman RJ, Mendelsohn FO, Saucedo JF, Goldman CK, Blebea J, Macko J, Kessler PD, Rasmussen HS, Annex BH. Source: Circulation. 2003 October 21; 108(16): 1933-8. Epub 2003 September 22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14504183

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Relationship between intermittent claudication, inflammation, thrombosis, and recurrent cardiac events among survivors of myocardial infarction. Author(s): Narins CR, Zareba W, Moss AJ, Marder VJ, Ridker PM, Krone RJ, Lichstein E. Source: Archives of Internal Medicine. 2004 February 23; 164(4): 440-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14980996

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Relief of buttock claudication by percutaneous recanalization of an occluded superior gluteal artery. Author(s): Senechal Q, Auguste MC, Louail B, Lagneau P, Pernes JM. Source: Cardiovascular and Interventional Radiology. 2000 May-June; 23(3): 226-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10821899

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Relieving intermittent claudication: a nursing approach. Author(s): Bryant JL, Turkoski BB. Source: Journal of Vascular Nursing : Official Publication of the Society for Peripheral Vascular Nursing. 1999 December; 17(4): 81-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10818885

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Reproducibility of constant-load treadmill testing with various treadmill protocols and predictability of treadmill test results in patients with intermittent claudication. Author(s): Degischer S, Labs KH, Aschwanden M, Tschoepl M, Jaeger KA. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2002 July; 36(1): 83-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12096262

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Response to exercise rehabilitation in smoking and nonsmoking patients with intermittent claudication. Author(s): Gardner AW, Killewich LA, Montgomery PS, Katzel LI. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2004 March; 39(3): 531-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14981444

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Reversible prolongation of motor conduction time after transcranial magnetic brain stimulation after neurogenic claudication in spinal stenosis. Author(s): Lang E, Hilz MJ, Erxleben H, Ernst M, Neundorfer B, Liebig K. Source: Spine. 2002 October 15; 27(20): 2284-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12394909

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Screening patients with claudication from femoropopliteal disease before angioplasty using Doppler colour flow imaging. Author(s): Whyman MR, Gillespie I, Ruckley CV, Allan PL, Fowkes FG. Source: The British Journal of Surgery. 1992 September; 79(9): 907-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1422752

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Secondary prevention may help intermittent claudication. Author(s): Vass A, Leng G, Papacosta O, Walker M, Lennon L, Whincup PH. Source: Bmj (Clinical Research Ed.). 2001 March 17; 322(7287): 673. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11250858

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Severe potential consequences of delayed diagnosis in patients with hip claudication. Author(s): Enzler MA, Leu AJ, Klotz HP, Steiger UJ. Source: Archives of Orthopaedic and Trauma Surgery. 2002 December; 122(9-10): 535-7. Epub 2002 September 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12483338

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Sex differences in claudication pain in subjects with peripheral arterial disease. Author(s): Gardner AW. Source: Medicine and Science in Sports and Exercise. 2002 November; 34(11): 1695-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12439070

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Short-range intermittent claudication and rest pain: microcirculatory effects of pentoxifylline in a randomized, controlled trial. Author(s): Incandela L, De Sanctis MT, Cesarone MR, Belcaro G, Nicolaides AN, Geroulakos G, Ramaswami G. Source: Angiology. 2002 January-February; 53 Suppl 1: S27-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11865832

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Split cord malformation with diastematomyelia presenting as neurogenic claudication in an adult: a case report. Author(s): Kaminker R, Fabry J, Midha R, Finkelstein JA. Source: Spine. 2000 September 1; 25(17): 2269-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10973414

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Spontaneous infrarenal abdominal aortic dissection presenting as claudication: case report and review of the literature. Author(s): Farber A, Lauterbach SR, Wagner WH, Cossman DV, Long B, Cohen JL, Levin PM. Source: Annals of Vascular Surgery. 2004 January; 18(1): 4-10. Epub 2004 January 12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14712378

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Sulodexide in the treatment of intermittent claudication. Results of a randomized, double-blind, multicentre, placebo-controlled study. Author(s): Coccheri S, Scondotto G, Agnelli G, Palazzini E, Zamboni V; Arterial Arm of the Suavis (Sulodexide Arterial Venous Italian Study) group. Source: European Heart Journal. 2002 July; 23(13): 1057-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12093059

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Synovial cyst of the pes anserinus in a patient with rheumatoid arthritis presenting as intermittent claudication. Author(s): Dudkiewicz I, Chechik A, Blankstein A, Salai M. Source: Isr Med Assoc J. 2000 October; 2(10): 778-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11344733

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Systemic effects of intermittent claudication. Author(s): Turton EP, Scott DJ. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2002 June; 23(6): 570-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12146457

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The "galloping" history of intermittent claudication. Author(s): Bollinger A, Eckert J, Ruttimann B, Becker F. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 2000 November; 29(4): 295-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11141657

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The inflammatory response to upper and lower limb exercise and the effects of exercise training in patients with claudication. Author(s): Nawaz S, Walker RD, Wilkinson CH, Saxton JM, Pockley AG, Wood RF. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2001 February; 33(2): 392-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11174795

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The influence of iloprost on blood rheology and tissue perfusion in patients with intermittent claudication. Author(s): Ciuffetti G, Sokola E, Lombardini R, Pasqualini L, Pirro M, Mannarino E. Source: Kardiologia Polska. 2003 September; 59(9): 197-204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14618196

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The practical management of claudication. Author(s): Davies A. Source: Bmj (Clinical Research Ed.). 2000 October 14; 321(7266): 911-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11030662

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The role of comorbidity in the assessment of intermittent claudication in older adults. Author(s): Newman AB, Naydeck BL, Sutton-Tyrrell K, Polak JF, Kuller LH; Cardiovascular Health Study Research Group. Source: Journal of Clinical Epidemiology. 2001 March; 54(3): 294-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11223327

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The vascular nurse in practice: Results of prescribed exercise training in patients with intermittent claudication. Author(s): Spronk S, Dolman W, Boelhouwer RU, Veen HF, den Hoed PT. Source: Journal of Vascular Nursing : Official Publication of the Society for Peripheral Vascular Nursing. 2003 December; 21(4): 141-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14652591

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Treatment efficacy of intermittent claudication by invasive therapy, supervised physical exercise training compared to no treatment in unselected randomised patients II: one-year results of health-related quality of life. Author(s): Taft C, Karlsson J, Gelin J, Jivegard L, Sandstrom R, Arfvidsson B, Dahllof AG, Lundholm K, Sullivan M. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2001 August; 22(2): 114-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11472043

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Treatment efficacy of intermittent claudication by surgical intervention, supervised physical exercise training compared to no treatment in unselected randomised patients I: one year results of functional and physiological improvements. Author(s): Gelin J, Jivegard L, Taft C, Karlsson J, Sullivan M, Dahllof AG, Sandstrom R, Arfvidsson B, Lundholm K. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2001 August; 22(2): 107-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11472042

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Treatment of intermittent claudication with pentoxifylline and cilostazol. Author(s): Tjon JA, Riemann LE. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2001 March 15; 58(6): 485-93; Quiz 4946. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11286146

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Trial of a novel prostacyclin analog, UT-15, in patients with severe intermittent claudication. Author(s): Mohler ER 3rd, Klugherz B, Goldman R, Kimmel SE, Wade M, Sehgal CM. Source: Vascular Medicine (London, England). 2000; 5(4): 231-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11213235

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Ultrasound screening of the abdominal aorta in patients with intermittent claudication. Author(s): Bengtsson H, Ekberg O, Aspelin P, Kallero S, Bergqvist D. Source: Eur J Vasc Surg. 1989 December; 3(6): 497-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2696647

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Unknown case. Spinal claudication caused by an arachnoid cyst. Author(s): Karnezis IA, Crawshaw CC. Source: Spine. 2001 December 15; 26(24): 2757-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11740369

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Update on some epidemiologic features of intermittent claudication: the Framingham Study. Author(s): Kannel WB, McGee DL. Source: Journal of the American Geriatrics Society. 1985 January; 33(1): 13-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3965550

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Upper extremity claudication 10 years after a Blalock-Taussig shunt treated with a carotid-to-subclavian graft. Author(s): Watkins MT, Ricotta JJ, Manning JA, Stewart S. Source: The Annals of Thoracic Surgery. 1988 April; 45(4): 445-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3355288

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Upper extremity claudication: a case study. Author(s): Flinn RS. Source: Spvn. 1989 December; 7(4): 9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2627311

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Urinary microalbumin as a marker for intermittent claudication. Author(s): Tisi PV, Shearman CP, Gosling P. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 1997 February; 13(2): 253. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9091168

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Urinary microalbumin as a marker for intermittent claudication. Author(s): Matsushita M, Nishikimi N, Sakurai T, Yano T, Nimura Y. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 1996 May; 11(4): 421-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8846175

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Use of arteriography for the initial evaluation of patients with intermittent lower limb claudication. Author(s): Wolosker N, Rosoky RA, Nishinari K, Nakano L. Source: Sao Paulo Medical Journal = Revista Paulista De Medicina. 2001 March; 119(2): 59-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11276167

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Utility of routine carotid duplex screening in patients who have claudication. Author(s): Marek J, Mills JL, Harvich J, Cui H, Fujitani RM. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 1996 October; 24(4): 572-7; Discussion 577-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8911405

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Value of a grocery cart and walker in identification and management of symptomatic spinal stenosis in diabetic patients presenting with peripheral neuropathy or claudication. Author(s): Goldman SM. Source: Diabetes Care. 2003 June; 26(6): 1943. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12766143

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Value of a supervised exercise program for the therapy of arterial claudication. Author(s): Patterson RB, Pinto B, Marcus B, Colucci A, Braun T, Roberts M. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 1997 February; 25(2): 312-8; Discussion 318-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9052565

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Variability of TcPO2-measurements at 37 degrees C and 44 degrees C in patients with claudication in consideration of provocation tests. Author(s): Caspary L, Creutzig A, Alexander K. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 1993; 22(2): 129-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8322501

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Vascular claudication: how to individualize treatment. Author(s): Gray BH, Sullivan TM. Source: Cleve Clin J Med. 1997 September; 64(8): 429-36. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9308219

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Venous claudication in a child with thrombophilia. Author(s): Best IM, Bumpers HL. Source: The American Surgeon. 2002 January; 68(1): 41-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12467315

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Venous claudication in iliofemoral thrombosis: long-term effects on venous hemodynamics, clinical status, and quality of life. Author(s): Delis KT, Bountouroglou D, Mansfield AO. Source: Annals of Surgery. 2004 January; 239(1): 118-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14685109

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Venous claudication successfully treated by distal superficial femoral-to-greater saphenous venous bypass. Author(s): Annous MO, Queral LA. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 1985 November; 2(6): 870-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4057445

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Vertebral hemangioma presenting with intermittent claudication. Author(s): Yazici M, Iyigun OL, Gulman B, Rakunt C, Cizmeli O. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 1996; 5(2): 131-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8724195

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Vitamin C prevents endothelial dysfunction induced by acute exercise in patients with intermittent claudication. Author(s): Silvestro A, Scopacasa F, Oliva G, de Cristofaro T, Iuliano L, Brevetti G. Source: Atherosclerosis. 2002 December; 165(2): 277-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12417278

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Vitamin E for intermittent claudication. Author(s): Kleijnen J, Mackerras D. Source: Cochrane Database Syst Rev. 2000; (2): Cd000987. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10796571

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Walking ability and ankle systolic pressures: observations in patients with intermittent claudication in a short-term walking exercise program. Author(s): Carter SA, Hamel ER, Paterson JM, Snow CJ, Mymin D. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 1989 December; 10(6): 642-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2585653

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Walking and cycling tests in neurogenic and intermittent claudication. Author(s): Dong G, Porter RW. Source: Spine. 1989 September; 14(9): 965-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2551051

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Walking capacity of patients with intermittent claudication during chronic antihypertensive treatment with metoprolol and methyldopa. Author(s): Lepantalo M, von Knorring J. Source: Clinical Physiology (Oxford, England). 1984 August; 4(4): 275-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6380905

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Walking distance and arterial flow during long term treatment of intermittent claudication with d-a-tocopherol. Author(s): Haeger K. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 1973; 2(3): 280-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4745137

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Walking training for intermittent claudication in diabetes. Author(s): Ubels FL, Links TP, Sluiter WJ, Reitsma WD, Smit AJ. Source: Diabetes Care. 1999 February; 22(2): 198-201. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10333933

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What constitutes proper evaluation for the patient with intermittent claudication? Author(s): Lennihan R Jr, Mackereth M. Source: Vascular Surgery. 1977 September-October; 11(5): 278-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=615381

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Why is training effective in the treatment of patients with intermittent claudication? Author(s): Remijnse-Tamerius HC, Duprez D, De Buyzere M, Oeseburg B, Clement DL. Source: International Angiology : a Journal of the International Union of Angiology. 1999 June; 18(2): 103-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10424365

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

Finding Nutrition Studies on Claudication The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “claudication” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

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

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

Changes in energy metabolism of calf muscle in patients with intermittent claudication assessed by 31P magnetic resonance spectroscopy: a phase II open study. Author(s): MRC Biochemical and Clinical Magnetic Resonance Unit, Oxford Radcliffe Hospital Trust, UK. Source: Taylor, D J Amato, A Hands, L J Kemp, G J Ramaswami, G Nicolaides, A Radda, G K Vasc-Med. 1996; 1(4): 241-5 1358-863X

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Effect of cloricromene on intermittent claudication. A randomized, double-blind, placebo-controlled trial in patients treated with aspirin: effect on claudication distance and quality of life. CRAMPS Investigator Group. Cloricromene Randomized Arteriopathy Multicenter Prospective Study. Author(s): Institute of Internal and Vascular Medicine, University of Perugia, Italy. Source: Gresele, P Migliacci, R Di Sante, G Nenci, G G Vasc-Med. 2000; 5(2): 83-9 1358863X

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Pharmacologic treatment of intermittent claudication with special emphasis on pentoxifylline. Source: Hartshorn, J C Deans, K W J-Cardiovasc-Nurs. 1987 February; 1(2): 65-8 08894655

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Progress in the prostaglandin E1-therapy of the intermittent claudication by means of bolus injections of LIPO-prostaglandin E1 (LIPO-PGE1). Author(s): III Medizinische Klinik, Universitatskliniken des Saarlandes, Homburg/Saar, Germany. Source: Scheffler, P Gross, J Markwirth, T Maier, J Schieffer, H Eur-J-Clin-Pharmacol. 1996; 51(3-4): 235-9 0031-6970

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The effects of OP-1206 alpha-CD on walking dysfunction in the rat neuropathic intermittent claudication model. Author(s): Discovery Research Laboratories III, Minase Research Institute, Ono Pharmaceutical Co, Ltd., 3-1-1 Sakurai Shimamoto-cho, Mishima-gun, Osaka 618-8585, Japan. Source: Nakai, Katsuhiko Takenobu, Yoshifumi Eguchi, Kazuhide Takimizu, Hideyuki Honjo, Kaneyoshi Akimaru, Shinji Maegawa, Hitoshi Marsala, Martin Katsube, Nobuo Anesth-Analg. 2002 June; 94(6): 1537-41, table of contents 0003-2999

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Thermal biofeedback for claudication in diabetes: a literature review and case study. Author(s): Dept. of Psychiatry, University of Chicago Hospitals, Chicago, IL, [email protected] Source: Aikens, J E Altern-Med-Revolume 1999 April; 4(2): 104-10 1089-5159

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Treatment of intermittent claudication with pentoxifylline: a 12-month, randomized trial--walking distance and microcirculation. Author(s): Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Pe, Italy. Source: De Sanctis, M T Cesarone, M R Belcaro, G Nicolaides, A N Griffin, M Incandela, L Bucci, M Geroulakos, G Ramaswami, G Vasdekis, S Agus, G Bavera, P Ippolito, E Angiology. 2002 Jan-February; 53 Suppl 1: S7-12 0003-3197

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Treatment of long-distance intermittent claudication with pentoxifylline: a 12-month, randomized trial. Author(s): Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Pe, Italy.

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Source: De Sanctis, M T Cesarone, M R Belcaro, G Nicolaides, A N Griffin, M Incandela, L Bucci, M Geroulakos, G Ramaswami, G Vasdekis, S Agus, G Bavera, P Ippolito, E Angiology. 2002 Jan-February; 53 Suppl 1: S13-7 0003-3197 •

Treatment of severe intermittent claudication with pentoxifylline: a 40-week, controlled, randomized trial. Author(s): Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Pe, Italy. Source: Cesarone, M R Belcaro, G Nicolaides, A N Griffin, M De Sanctis, M T Incandela, L Geroulakos, G Ramaswami, G Cazaubon, M Barsotti, A Vasdekis, S Bavera, P Ippolito, E Angiology. 2002 Jan-February; 53 Suppl 1: S1-5 0003-3197

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The following is a specific Web list relating to claudication; 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: •

Vitamins Niacin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,892,00.html Vitamin B3 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B3 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin E Source: Healthnotes, Inc.; www.healthnotes.com

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Minerals Carnitine Source: Prima Communications, Inc.www.personalhealthzone.com L-Carnitine Source: Healthnotes, Inc.; www.healthnotes.com Magnesium Source: Healthnotes, Inc.; www.healthnotes.com

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Food and Diet Garlic Alternative names: Allium sativum Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND CLAUDICATION Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to claudication. 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 claudication 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 “claudication” (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 claudication: •

A botanical compound, Padma 28, increases walking distance in stable intermittent claudication. Author(s): Drabaek H, Mehlsen J, Himmelstrup H, Winther K. Source: Angiology. 1993 November; 44(11): 863-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8239057

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A clinical trial of Gingkco Biloba Extract in patients with intermittent claudication. Author(s): Thomson GJ, Vohra RK, Carr MH, Walker MG. Source: International Angiology : a Journal of the International Union of Angiology. 1990 April-June; 9(2): 75-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2254678

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Chelation therapy for intermittent claudication. Author(s): Godfrey ME, Frackleton JP, Chappell LT.

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Source: N Z Med J. 1994 November 23; 107(990): 495. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7970372 •

Chelation therapy for intermittent claudication. A double-blind, randomized, controlled trial. Author(s): van Rij AM, Solomon C, Packer SG, Hopkins WG. Source: Circulation. 1994 September; 90(3): 1194-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8087928

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Chelation therapy for intermittent claudication: a double-blind, randomized, controlled trial. Author(s): Lyngdorf P, Guldager B, Holm J, Jorgensen SJ, Jelnes R. Source: Circulation. 1996 January 15; 93(2): 395-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8548917

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Chelation therapy for intermittent claudication-a reappraisal. Author(s): Godfrey ME, Chappell LT. Source: N Z Med J. 1996 March 8; 109(1017): 83. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8606830

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Clinical efficacy of ozonated autohemotherapy in hemodialyzed patients with intermittent claudication: an oxygen-controlled study. Author(s): Biedunkiewicz B, Tylicki L, Nieweglowski T, Burakowski S, Rutkowski B. Source: Int J Artif Organs. 2004 January; 27(1): 29-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14984181

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Demonstration of the efficacy of ginkgo biloba special extract EGb 761 on intermittent claudication--a placebo-controlled, double-blind multicenter trial. Author(s): Peters H, Kieser M, Holscher U. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 1998 May; 27(2): 106-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9612115

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Diagnosis and medical management of patients with intermittent claudication. Author(s): LaPerna L. Source: J Am Osteopath Assoc. 2000 October; 100(10 Su Pt 2): S10-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11105462

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EDTA treatment of intermittent claudication--a double-blind, placebo-controlled study. Author(s): Guldager B, Jelnes R, Jorgensen SJ, Nielsen JS, Klaerke A, Mogensen K, Larsen KE, Reimer E, Holm J, Ottesen S.

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Source: Journal of Internal Medicine. 1992 March; 231(3): 261-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1556523 •

Effect of alpha-tocopherol (vitamin E) and beta-carotene supplementation on the incidence of intermittent claudication in male smokers. Author(s): Tornwall M, Virtamo J, Haukka JK, Aro A, Albanes D, Edwards BK, Huttunen JK. Source: Arteriosclerosis, Thrombosis, and Vascular Biology. 1997 December; 17(12): 3475-80. Erratum In: Arterioscler Thromb Vasc Biol 1998 July; 18(7): 1197. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9437195

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Effects of serial percutaneous application of carbon dioxide in intermittent claudication: results of a controlled trial. Author(s): Hartmann BR, Bassenge E, Hartmann M. Source: Angiology. 1997 November; 48(11): 957-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9373047

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Fish oil supplementation in patients with stable claudication. Author(s): Gans RO, Bilo HJ, Weersink EG, Rauwerda JA, Fonk T, Popp-Snijders C, Donker AJ. Source: American Journal of Surgery. 1990 November; 160(5): 490-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2240382

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Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials. Author(s): Pittler MH, Ernst E. Source: The American Journal of Medicine. 2000 March; 108(4): 276-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11014719

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Hydrotherapy of patients with intermittent claudication: a novel approach to improve systolic ankle pressure and reduce symptoms. Author(s): Elmstahl S, Lilja B, Bergqvist D, Brunkwall J. Source: International Angiology : a Journal of the International Union of Angiology. 1995 December; 14(4): 389-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8708433

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Hypnosis in intermittent claudication; report of a case. Author(s): NALLAPA JS. Source: Ind Med Gaz. 1952 February; 87(2): 43-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14937799

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Is gingko biloba more effective than placebo for the treatment of intermittent claudication? Author(s): Reust CE, Stevermer JJ. Source: The Journal of Family Practice. 2000 July; 49(7): 657. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10923580

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Is intermittent claudication in patients with peripheral arterial occlusive disease relieved under hyperbaric conditions? Author(s): Sakurai T, Mano N, Matsushita M, Nishikimi N, Nimura Y, Takashashi H. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 1997 November; 26(4): 317-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9409184

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Leg showering therapy in patients with intermittent claudication. Author(s): Bornmyr S, Svensson H, Bergovist D, Lilja B. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 1991; 20(3): 270-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1950146

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Metal excretion and magnesium retention in patients with intermittent claudication treated with intravenous disodium EDTA. Author(s): Guldager B, Jorgensen PJ, Grandjean P. Source: Clinical Chemistry. 1996 December; 42(12): 1938-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8969629

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Pharmacological management of intermittent claudication: a meta-analysis of randomised trials. Author(s): Moher D, Pham B, Ausejo M, Saenz A, Hood S, Barber GG. Source: Drugs. 2000 May; 59(5): 1057-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10852639

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Progress in the prostaglandin E1-therapy of the intermittent claudication by means of bolus injections of LIPO-prostaglandin E1 (LIPO-PGE1). Author(s): Scheffler P, Gross J, Markwirth T, Maier J, Schieffer H. Source: European Journal of Clinical Pharmacology. 1996; 51(3-4): 235-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9010691

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Prospective study of diet, lifestyle, and intermittent claudication in male smokers. Author(s): Tornwall ME, Virtamo J, Haukka JK, Aro A, Albanes D, Huttunen JK. Source: American Journal of Epidemiology. 2000 May 1; 151(9): 892-901. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10791562

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Severe claudication of the lower limbs. Author(s): Rozier CK. Source: Physical Therapy. 1976 June; 56(6): 687-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1273103

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The comprehensiveness of Medline and Embase computer searches. Searches for controlled trials of homoeopathy, ascorbic acid for common cold and ginkgo biloba for cerebral insufficiency and intermittent claudication. Author(s): Kleijnen J, Knipschild P. Source: Pharm Weekbl Sci. 1992 October 16; 14(5): 316-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1437515

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The effect of a high fibre, low fat, low sodium diet on diabetics with intermittent claudication. Author(s): Pacy PJ, Dodson PM, Taylor MP. Source: Br J Clin Pract. 1986 August; 40(8): 313-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3017394

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The effect of alpha-tocopherol and beta-carotene supplementation on symptoms and progression of intermittent claudication in a controlled trial. Author(s): Tornwall ME, Virtamo J, Haukka JK, Aro A, Albanes D, Huttunen JK. Source: Atherosclerosis. 1999 November 1; 147(1): 193-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10525141

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The effect of dextran-40 on capillary blood flow and capillary diffusion capacity in the anterior tibial muscle of subjects with intermittent claudication. Author(s): Amtoft A. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 1973 May; 31(3): 263-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4201953

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The role of the Doppler in the differential diagnosis of lower extremity claudication syndromes. Author(s): Terenzi TJ. Source: Journal of Manipulative and Physiological Therapeutics. 1990 May; 13(4): 215-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2191068

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Thermal biofeedback for claudication in diabetes: a literature review and case study. Author(s): Aikens JE. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 1999 April; 4(2): 104-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10231610

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Thermal biofeedback in the treatment of intermittent claudication in diabetes: a case study. Author(s): Saunders JT, Cox DJ, Teates CD, Pohl SL. Source: Biofeedback Self Regul. 1994 December; 19(4): 337-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7880909

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Unilateral intermittent claudication of the left lower extremity. Author(s): Downs SE. Source: Journal of Manipulative and Physiological Therapeutics. 1988 August; 11(4): 322-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3171415

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 claudication; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Atherosclerosis Source: Healthnotes, Inc.; www.healthnotes.com

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Atherosclerosis and Heart Disease Prevention Source: Prima Communications, Inc.www.personalhealthzone.com Intermittent Claudication Source: Healthnotes, Inc.; www.healthnotes.com Intermittent Claudication Alternative names: Peripheral Vascular Disease Source: Prima Communications, Inc.www.personalhealthzone.com Peripheral Vascular Disease Source: Healthnotes, Inc.; www.healthnotes.com •

Herbs and Supplements Amino Acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10003,00.html Amino Acids Overview Source: Healthnotes, Inc.; www.healthnotes.com Arginine Source: Healthnotes, Inc.; www.healthnotes.com Arginine Source: Prima Communications, Inc.www.personalhealthzone.com Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Ginkgo Alternative names: Ginkgo biloba Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Ginkgo Source: Prima Communications, Inc.www.personalhealthzone.com Ginkgo Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Ginkgo Biloba Source: Healthnotes, Inc.; www.healthnotes.com Ginkgo Biloba Source: Integrative Medicine Communications; www.drkoop.com Ginkgo Biloba Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,788,00.html Maidenhair Tree Source: Integrative Medicine Communications; www.drkoop.com Pentoxifylline Source: Healthnotes, Inc.; www.healthnotes.com Ticlopidine Source: Healthnotes, Inc.; www.healthnotes.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. PATENTS ON CLAUDICATION Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.5 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “claudication” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on claudication, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Claudication By performing a patent search focusing on claudication, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 5Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on claudication: •

Assessing arterial systems Inventor(s): Reddy; Daniel J. (Detroit, MI) Assignee(s): Henry Ford Hospital (Detroit, MI) Patent Number: 4,454,885 Date filed: June 22, 1981 Abstract: A method and apparatus of assessing peripheral arterial systems comprising positioning a patient on an examining table in supine position with the legs of the patient flexed, positioning a treadle mechanism on the table so that the resiliently mounted foot pedals thereof are engaged by the feet of the patient, causing the patient to successively depress and release successive left and right foot pedals for a predetermined time or until claudication occurs, and thereafter making systolic pressure measurements on the legs of the patient. Excerpt(s): This invention relates to assessing the arterial system of patients for determining arterial problems. The value of post-exercise doppler systolic pressure measurements to thoroughly assess the peripheral arterial system is well known. A number of exercise techniques are known. These include treadmill walking, post occlusive reactive hyperemia, ankle flexion maneuvers, toelifts, walking and climbing stairs. The most commonly used techniques are the constant-load treadmill and reactive hyperemia. In the use of the constant-load treadmill technique some problems have been encountered. Principally, it has been found that a number of patients are unable to safely tolerate the treadmill exercise because of cardiac, pulmonary or neuromuscular conditions. The unilateral amputee, uncooperative or debilitated patients also present particular problems. Web site: http://www.delphion.com/details?pn=US04454885__

•

Metformin formulations and method for treating intermittent claudication employing same Inventor(s): Rogosky; Karen M. (Robbinsville, NJ) Assignee(s): Bristol-Myers Squibb Company (Princeton, NJ) Patent Number: 6,100,300 Date filed: April 28, 1998 Abstract: Novel metformin formulations are provided which include metformin or metformin salts preferably the hydrochloride salt in doses below that employed for treating diabetes such as metformin in daily amounts of 400 mg or below. A method for treating peripheral vascular disease including intermittent claudication employing such metformin formulations is also provided. Excerpt(s): The present invention relates to novel metformin formulations which include metformin and salts thereof, preferably the hydrochloride salt, preferably in amounts below the threshold levels for treating diabetes, and to a method for treating peripheral vascular disease including intermittent claudication employing such metformin formulations. The biguanide antihyperglycemic agent metformin is concurrently

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marketed in the U.S. in the form of its hydrochloride salt (Glucophage.TM., BristolMyers Squibb Company). U.S. Pat. No. 4,028,402 discloses the dichloroacetic acid salt of metformin. Web site: http://www.delphion.com/details?pn=US06100300__ •

Method for treating vascular disease Inventor(s): Brevetti; Gregorio (Naples, IT) Assignee(s): Sigma Tau, Industrie Farmaceutiche Riunite SpA (Rome, IT) Patent Number: 4,968,719 Date filed: April 3, 1989 Abstract: L-carnitine is effective for the treatment of peripheral vascular diseases, such as intermittent claudication. Administration of L-carnitine to patients suffering from intermittent claudication results in a significant increase in the distance the patients can walk before experiencing claudication. Excerpt(s): The present invention relates to a method for treating peripheral vascular diseases. The most important problem in the treatment of obstructive vascular disease is to make the energy supply adequate to the metabolic demand in the hypoxic area. In peripheral vascular disease, this goal has been sought only by interventions aimed at increasing the blood flow to the ischemic muscle. Vasodilators are the most often used drugs in the therapy of chronic obstructive vascular disease, although their efficacy is far from being proved (see J. D. Coffmann, et al., Ann. Intern. Med., 76, 35 (1972); and V. Hansteen, et al., Acta Med. Scand. [Suppl.], 556, 3 (1974)). Much more effective seem to be drugs capable of reducing blood viscosity. Among these, pentoxifylline has been demonstrated to increase walking distance (see G. Brevetti, et al., Il Progresso Medico, 35, 363 (1979); and J. M. Porter, et al., Am. Heart J., 104, 66 (1982)) as a result of increased blood flow and enhanced tissue oxygenation in the affected limb (see G. Brevetti, et al., in Adaptability of Vascular Wall, Z. Reims, et al., eds., Springer-Verlag, Berlin, 1980, p. 555; and A. M. Ehrly, J. Med., 10, 331 (1979)). Other reports, however, failed to demonstrate any objective benefit (see A. Mashiah, et al., Br. J. Surg., 65, 342 (1978)). Web site: http://www.delphion.com/details?pn=US04968719__

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Therapeutical method for treating chronic arteriosclerosis obliterans Inventor(s): Corsi; Marco (Rome, IT) Assignee(s): Sigma-Tau Industrie Farmaceutiche Riunite S.p.A. (Rome, IT) Patent Number: 5,811,457 Date filed: September 16, 1996 Abstract: A therapeutical method for treating chronic arteriosclerosis obliterans in particularly selected patients with severely disabling intermittent claudication is disclosed, which comprises administering propionyl L-carnitine or a pharmacologically acceptable salts thereof. Excerpt(s): 1. Field of the invention. The present invention relates to a therapeutical method for treating patients suffering from chronic arteriosclerosis obliterans at stage II of Leriche Fontaine's classification. More specifically, the present invention relates to a

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therapeutical method for the selective treatment of those patients showing the symptom of a severely disabling intermittent claudication (hereinbelow shortly referred to as "patients with intermittent claudication") wherein the expression "severely disabling" shall be subsequently rigorously defined with reference to the guidelines on the efficacy of candidate drugs issued by the Regulatory Authorities on medicinal products. Web site: http://www.delphion.com/details?pn=US05811457__ •

Therapeutics for diabetic complications Inventor(s): Koga; Hiroshi (Tokyo, JP) Assignee(s): Chugai Seiyaku Kabushiki Kaisha (Tokyo, JP) Patent Number: 6,218,411 Date filed: February 8, 2000 Abstract: An agent for treating or ameliorating diabetic complications which contains at least one potassium channel activator as an active ingredient. The drug is expected to show a therapeutic or ameliorating action on diabetic complications such as retinopathy, neuropathy, nephropathy, peripheral circulation disorders, and skin ulcerations; it also proves effective in preventing, ameliorating, alleviating and gaining recovery from various symptoms and abnormalities caused by those diseases, as exemplified by blindness, proteinurea, pain, numbness, psychroesthesia, intermittent claudication and gangrene. Excerpt(s): This invention relates to agents for treating or ameliorating diabetic complications that are characterized by containing at least one potassium channel activator as an active ingredient. More particularly, the invention relates to treating or ameliorating agents that contain nicorandil, pinacidil, cromakalim or other potassium channel activators as an active ingredient and which are effective against diabetic complications such as retinopathy, neuropathy, nephropathy, peripheral circulation disorders and skin ulcerations. Diabetes mellitus is one of the diseases that have recently seen the most dramatic increase in the number of patients in Japan and five to six million patients, including those undiagnosed, are estimated to exist. The number of patients with diabetes mellitus is almost comparable to those of patients with hyperlipidemia and hypertension. The cases of diabetes mellitus will certainly continue to increase in the years to come and may even double or triple sometime around 2010. For the treatment of diabetes mellitus, two things are the most important, i.e., effective control of blood glucose levels and retarding the development and progression of complications such as retinopathy, neuropathy, nephropathy, peripheral circulation disorders and skin ulcerations. Web site: http://www.delphion.com/details?pn=US06218411__

Patent Applications on Claudication As of December 2000, U.S. patent applications are open to public viewing.6 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take

6

This has been a common practice outside the United States prior to December 2000.

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several years.) The following patent applications have been filed since December 2000 relating to claudication: •

Compositions and methods for treating peripheral vascular disease Inventor(s): Coolidge, Thomas R.; (Falls Village, CT), Hathaway, David R.; (Lincoln, NE) Correspondence: Mckee, Voorhees & Sease, P.L.C.; Attn: Bionebraska; 801 Grand Avenue, Suite 3200; Des Moines; IA; 50309-2721; US Patent Application Number: 20030073626 Date filed: March 5, 2002 Abstract: The present invention relates to methods of treating intermittent claudication comprising administering glucagon-like peptide-1 (GLP-1) molecules to subjects suffering therefrom. Excerpt(s): This application is a continuation-in-part of U.S. application Ser. No. 09/851,738, filed May 9, 2001, now pending, which is a divisional of U.S. application Ser. No. 09/302,596, filed Apr. 30, 1999, now issued as U.S. Pat. No. 6,284,725, the entire disclosure of both of which are incorporated by reference herein. The present invention relates to endocrinology, physiology and pharmacology. More particularly, it relates to methods and compositions for treating subjects suffering from intermittent claudication, typically associated with peripheral vascular disease (PVD). Peripheral vascular disease (PVD) is a common disease caused by atherosclerotic narrowing of the arteries of the lower extremities (Cooke, J. P., et al., Vasc. Med. 2:227-230 (1997); Brass, E. P. et al., Vasc. Med. 5:55-59 (2000); Hiatt, W. R., et al., IJCP Suppl. 119:20-27 (2001)). This disease affects 5% of all men and 2.5% of all women over the age of 60 in America (Weitz, J. I., et al., Circulation 94:3026-3049 (1996); Dawson, D. L. et al., Am. J. Med. 109:523-530 (2000)). In the United States, the prevalence of PVD is approximately 3 million and the incidence is 1 million new cases/year. Thus, the prevalence of this disease is increasing and will continue to increase as the population ages (Weitz, J. I. et al., supra). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Methods and compositions for the treatment of peripheral artery disease Inventor(s): Whitehouse, Martha Jo; (San Francisco, CA) Correspondence: Chiron Corporation; Intellectual Property Department; P.O. Box 8097; Emeryville; CA; 94662-8097; US Patent Application Number: 20020115603 Date filed: June 21, 2001 Abstract: Compositions and methods for treating peripheral artery disease in a patient are provided. Compositions comprise recombinant fibroblast growth factor-2. Fibroblast growth factor, such as FGF-2, is administered in therapeutically effective amounts to treat or prevent peripheral artery disease including claudication and critical limb ischemia. Pharmaceutical compositions comprising a therapeutically effective amount of FGF-2 and a pharmaceutically acceptable carrier are also provided. The methods of the invention to treat peripheral artery disease and claudication comprise administering at least a single dose of a pharmaceutical composition comprising the FGF, such as FGF-2, via intra-arterial, intravenous, or intramuscular infusion to the patient. It is recognized that increased benefits may result from multiple dosing, including intermittent dosing.

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Excerpt(s): This application claims the benefit of U.S. Provisional Application Serial Nos. 60/213,504, filed Jun. 22, 2000, 60/264,572, filed Jan. 26, 2001, and 60/276,549, filed Mar. 16, 2001, each of which is entitled "Methods and Compositions for the Treatment of Peripheral Artery Disease," the contents of which are herein incorporated by reference in their entirety. The invention relates to methods and pharmaceutical compositions for treating peripheral artery disease, particularly the administration of compositions that contain recombinant fibroblast growth factor-2 (rFGF-2). Coronary artery disease (CAD) and peripheral artery disease (PAD) are conditions characterized by insufficient blood flow, usually secondary to atherosclerosis. Symptoms of ischemia (angina pectoris for CAD or intermittent claudication for PAD) are brought on by stress and relieved by rest. In CAD, symptoms may become life threatening due to myocardial infarction, arrhythmia, and progressive heart failure. In PAD, symptoms are less likely to be life threatening except when critical limb ischemia develops, but the risk of adverse cardiovascular events and death is increased. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Therapeutic agent for intermittent claudication Inventor(s): Hirose, Ken; (Kawasaki-Shi, JP), Kihara, Hideaki; (Kawasaki-Shi, JP), Komiyama, Takashi; (Tokyo, JP), Sigematsu, Hiroshi; (Tokyo, JP), Yoshimoto, Ryota; (Kawasaki-Shi, JP) Correspondence: Oblon Spivak Mcclelland Maier & Neustadt PC; Fourth Floor; 1755 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20020037906 Date filed: August 22, 2001 Abstract: A compound 1-formyl-N-(2-(4-(5H-dibenzo[a,d]cyclohepten-5-ylidene)-1piper- idinyl)) ethyl isonipecotic acid amide or an analog thereof or a pharmaceutically acceptable salt thereof provides a therapeutic agent for treating a patient suffering from intermittent claudication. Excerpt(s): The present invention relates to a drug for treating a patient suffering from intermittent claudication and more specifically to a drug for treating a patient suffering from intermittent claudication caused by, in particular, peripheral circulatory disorders such as arteriosclerosis obliterans or thromboangiitis obliterans. The intermittent claudication means a symptom in which the following two conditions are repeated: the difficulty of continuous walking due to the malaise and pains of the lower limb muscles caused after the locomotion of a constant distance and the alleviation of these symptoms or a condition ready for walking again after the rest for several minutes. One of the causes thereof may be peripheral arterial occlusive disease induced by the vasculopathy such as arteriosclerosis obliterans, thromboangiitis obliterans, aortitis syndrome, Behcet's disease and collagenosis. It would generally be recognized that the amount of blood required for the muscular motion is reduced to a relatively low level due to these peripheral circulatory disorders {the degree of oxygen saturation in tissues (tissue oxygen saturation) is reduced}, metabolites such as lactic acid are accumulated in the muscles to thus stimulate terminals of sensory nerves and thus it becomes difficult to continue walking due to the pain. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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•

Use of glycogen phosphorylase inhibitors for treatment of cardiovascular diseases Inventor(s): Dragsted, Nils; (Stenlose, DK), Iversen, Lars; (Hvidovre, DK), Kristiansen, Marit; (Soborg, DK), Nyborg, Niels Chresten Berg; (Horsholm, DK), Rytved, Klaus Asger; (Bagsvaerd, DK) Correspondence: Reza Green, ESQ.; Novo Nordisk Pharmaceuticals, INC.; 100 College Road West; Princeton; NJ; 08540; US Patent Application Number: 20040082641 Date filed: May 5, 2003 Abstract: The present invention provides methods of treatment and prevention of early cardiac and early cardiovascular diseases, for instance of ischemic origin, such as left ventricular hypertrophy, coronary artery disease, essential hypertension, acute hypertensive emergency, cardiomyopathy, heart insufficiency, exercise tolerance, chronic heart failure, arrhythmia, cardiac dysrhythmia, syncopy, arteriosclerosis, mild chronic heart failure, angina pectoris, cardiac bypass reocclusion, intermittent claudication (arteriosclerosis oblitterens), diastolic dysfunction and systolic dysfunction, as well as improving the success of heart transplantations, through administration of glycogen phosphorylase inhibitor compounds. Excerpt(s): This application claims priority under 35 U.S.C. 119 of Danish application PA 2002 01630, filed Oct. 28, 2002, and of U.S. Provisional application 60/422081 filed Oct. 29, 2002, the contents of which are fully incorporated herein by reference. The present invention relates to methods for treatment and/or prevention of early cardiac and cardiovascular diseases, for instance of ischemic origin, by administration of a glycogen phosphorylase inhibitor. Cardiac and cardiovascular diseases, such as ventricular hypertrophy, coronary artery disease, essential hypertension, acute hypertensive emergency, cardiomyopathy, heart insufficiency, exercise tolerance, chronic heart failure, arrhythmia, cardiac dysrhythmia, syncopy, arteriosclerosis, mild chronic heart failure, angina pectoris, cardiac bypass reocclusion, intermittent claudication (arteriosclerosis oblitterens), diastolic dysfunction and systolic dysfunction, are among the most common causes of death in the industrialised world. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with claudication, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “claudication” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on claudication. You can also use this procedure to view pending patent applications concerning claudication. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON CLAUDICATION Overview This chapter provides bibliographic book references relating to claudication. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on claudication 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 “claudication” (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 claudication: •

Peripheral Arterial Disease: Diagnosis and Treatment Source: Totowa NJ: Humana Press. 2003. 368 p. Contact: Available from Humana Press. 999 Riverview Drive, Suite 208, Totowa, NJ 07512. (973) 256-1699. Fax (973) 256-8341. E-mail: [email protected]. Website: www.humanapress.com. PRICE: $89.55. ISBN: 588290522. Summary: This textbook acquaints physicians with all aspects of peripheral arterial disease (PAD), defined as narrowing (stenosis) or blockage (occlusion) within the arteries of the lower extremities. PAD is caused by both modifiable (diabetes, smoking, hypertension) and nonmodifiable (family history, age, gender) factors. Due to the limitations of medical therapy, there is now a special emphasis on prevention of PAD and a special emphasis on risk factors and their treatment. The text includes seventeen chapters: the etiology and pathogenesis of atherosclerosis, the epidemiology and natural history of PAD, clinical evaluation of intermittent claudication, hemodynamics and the

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vascular laboratory, vascular imaging, chronic critical limb ischemia (lack of blood flow), acute limb ischemia, exercise rehabilitation for intermittent claudication, treatment of risk factors and antiplatelet therapy, pharmacotherapy for intermittent claudication, angiogenesis and gene therapy, endovascular therapy, surgical revascularization, perioperative cardiac evaluation and management for vascular surgery, special consideration for the diabetic foot, arterial vascular disease in women, atheromatous embolism, thromboangiitis obliterans (Buerger's disease), and large-vessel vasculitis. Each chapter concludes with extensive references and a subject index concludes the textbook.

Chapters on Claudication In order to find chapters that specifically relate to claudication, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and claudication using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “claudication” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on claudication: •

Giant Cell Arteritis (Temporal Arteritis) Source: in Bork, K., et al. Diseases of the Oral Mucosa and the Lips. Philadelphia, PA: W.B. Saunders Company. 1993. p. 218-219. Contact: Available from W.B. Saunders Company. Book Orders Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32821-9854. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $95.00 plus shipping and handling. ISBN: 0721640397. Summary: This chapter on giant cell arteritis, or temporal arteritis, is from a textbook of diseases of the oral mucosa and the lips. Giant cell arteritis is a widespread inflammatory arteritis. The disease is found mainly in older women and is closely related to polymyalgia rheumatica. The chapter covers the clinical features, oral features, diagnosis, and therapy of giant cell arteritis. The most common clinical feature is a sharp unilateral headache concentrated on the temple. Another common finding is claudication of the jaw muscle on chewing. The crucial problem is involvement of the central artery of the optic nerve leading to initially transitory but eventually permanent blindness. The most common oral finding is unilateral tongue necrosis. Initially the patient has episodes of unilateral tongue pain and difficulty speaking. There may also be episodes of pallor due to the insufficient blood supply to the tongue. As the process progresses (and this may occur very rapidly), the artery closes, leading to infarction and necrosis (tissue death). The necrosis of the tongue produces a large, heavily coated ulcer that heals slowly over months. Despite the amazing regenerative ability of the oral cavity, scarring and impaired function are to be expected. Treatment involves high doses of oral or intravenous corticosteroids. Once improvement is obtained, a lower maintenance dose, often even alternate day therapy, can control the disorder. 1 figure. 16 references.

Books

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Peripheral Vascular Disease and Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 401-408. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book). Summary: This chapter on peripheral vascular disease in diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. Lower extremity arterial disease (LEAD) is clinically identified by intermittent claudication (pain upon walking or use of the legs that ceases with rest) and or absence of peripheral pulse in the lower legs and feet. With the use of doppler technology and blood pressure measurements of the extremity, LEAD can be identified noninvasively before clinical manifestation. Ultrasound with duplex scanning can also detect occlusive LEAD noninvasively, while angiography remains the gold standard for identification and diagnosis of LEAD. The incidence and prevalence of LEAD increase with age in both diabetic and nondiabetic subjects and, in those with diabetes, increase with duration of diabetes. Diabetes is an important risk factor for LEAD. Hypertension, smoking, and hyperlipidemia, which are frequently present in patients with diabetes, contribute additional risk for vascular disease. LEAD in diabetes is compounded by the presence of peripheral neuropathy and by susceptibility to infection. These confounding factors in patients with diabetes contribute to progression of LEAD to foot ulcerations, gangrene, and ultimately to amputation of part of the affected extremity. Diabetes accounts for approximately 50 percent of all nontraumatic amputations in the United States. Mortality is increased in patients with LEAD, particularly if foot ulcerations, infection, or gangrene occur. Three-year survival after an amputation is less than 50 percent. Prevention is an important component of LEAD management. By the time LEAD becomes clinically manifest, it may be too late to salvage an extremity, or it may require more costly resources to improve the circulatory health of the extremity. 4 tables. 30 references. (AA-M).

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

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

Atorvastatin relieves claudication symptoms of peripheral artery disease Source: Reuters Medical News Date: September 01, 2003

•

Moderate alcohol consumption reduces intermittent claudication risk Source: Reuters Medical News Date: December 20, 2000

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•

L-arginine infusion reduces intermittent claudication symptoms Source: Reuters Medical News Date: November 03, 1998

•

Risk Profile For Development Of Intermittent Claudication Published Source: Reuters Medical News Date: July 15, 1997 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 “claudication” (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 “claudication” (or synonyms). If you know the name of a company that is relevant to claudication, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.

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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 “claudication” (or synonyms).

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

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to claudication: Anticoagulants •

Systemic - U.S. Brands: Coumadin; Miradon http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202050.html

Cilostazol •

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

Pentoxifylline •

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

Ticlopidine •

Systemic - U.S. Brands: Ticlid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202637.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.

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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 Institute7: •

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/

7

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/

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 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:9 •

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

8

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). 9 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 Gateway10 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.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “claudication” (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 7447 36 962 12 21 8478

HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 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.14 Simply search by “claudication” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

10

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

11

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

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 Biologists15 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.16 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.17 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/.

15 Adapted 16

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. 17 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 claudication 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 claudication. 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 claudication. 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 “claudication”:

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Circulatory Disorders http://www.nlm.nih.gov/medlineplus/circulatorydisorders.html Exercise and Physical Fitness http://www.nlm.nih.gov/medlineplus/exerciseandphysicalfitness.html Leg Injuries and Disorders http://www.nlm.nih.gov/medlineplus/leginjuriesanddisorders.html Peripheral Nerve Disorders http://www.nlm.nih.gov/medlineplus/peripheralnervedisorders.html Spinal Stenosis http://www.nlm.nih.gov/medlineplus/spinalstenosis.html

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

Diagnosis/Symptoms Leg Problems Source: American Academy of Family Physicians http://familydoctor.org/541.xml MR Imaging (MRI)-Musculoskeletal Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/mr_musculoskeletal.htm Radiography (X-ray) - Bone Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/bone_radiography.htm

•

Treatment Bone Lengthening Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=310&topcategory=Abou t%2520Orthopaedics

•

Children Growing Out of It: Leg and Foot Development in the Growing Child Source: Shriners Hospitals for Children http://www.shrinershq.org/patientedu/legfoot.html Pediatric Thighbone Fracture Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=251&topcategory=Foot What a Pain! Kids and Growing Pains Source: Nemours Foundation http://kidshealth.org/kid/ill_injure/aches/growing_pains.html Your Child Has Been Diagnosed with Bowed Legs (Genu Varum) Source: Shriners Hospitals for Children http://www.shrinershq.org/patientedu/bowedlegs.html

Patient Resources

•

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Latest News “Safe” Levels of Lead, Cadmium May Raise Risk of Peripheral Artery Disease Source: 06/07/2004, American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3022500 'Safe' Levels of Lead Not Necessarily So Source: 06/08/2004, United Press International http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_18260 .html Surgery Not Always Needed for Achilles Tendon Tear Source: 06/28/2004, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_18624 .html

•

Organizations American Academy of Orthopaedic Surgeons http://www.aaos.org/ Legs for Life Source: Society of Interventional Radiology http://www.legsforlife.org/ National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/

•

Prevention/Screening Know Your Risk: Peripheral Vascular Disease (PVD) Self-Test Source: Society of Interventional Radiology http://www.legsforlife.org/selftest.shtml

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 National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “claudication” (or synonyms). The following was recently posted:

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•

Claudication

ACR Appropriateness Criteriatm for recurrent symptoms following lower extremity angioplasty: claudication and threatened limb Source: American College of Radiology - Medical Specialty Society; 1998 (revised 2002); 5 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3561&nbr=2787&a mp;string=claudication 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 claudication. 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 claudication. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with claudication. 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 claudication. For more information, see

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the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “claudication” (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 “claudication”. 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 “claudication” (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 “claudication” (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.18

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

18

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)19: •

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/

19

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/

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Basic Guidelines for Claudication Buerger's disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000172.htm Peripheral vascular disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000170.htm

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Signs & Symptoms for Claudication Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Hair loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003246.htm Loss of hair Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003246.htm

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Muscle atrophy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003188.htm Pallor Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003244.htm Rubor Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Tiredness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Ulcers Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003228.htm •

Diagnostics and Tests for Claudication Angiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003327.htm Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003330.htm Pulse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm

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Surgery and Procedures for Claudication Angioplasty Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002953.htm

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Background Topics for Claudication Cigarette smoking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002032.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Noninvasive Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002269.htm Peripheral Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002273.htm

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

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

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

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

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

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CLAUDICATION 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] Abscess: A localized, circumscribed collection of pus. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [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] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

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

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substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [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] Amaurosis: Partial or total blindness from any cause. [NIH] Amaurosis Fugax: Partial amaurosis, which is sudden and transitory, and associated with headache, vertigo, and nausea. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [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] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile

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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] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] 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] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Anginal: Pertaining to or characteristic of angina. [EU] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Antibiotics: Substances produced by microorganisms that can inhibit or suppress the growth of other microorganisms. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulants: Agents that prevent blood clotting. Naturally occurring agents in the blood are included only when they are used as drugs. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are

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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] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Aortitis: Inflammation of the wall of the aorta. [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] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] 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] Arteriography: A procedure to x-ray arteries. The arteries can be seen because of an injection of a dye that outlines the vessels on an x-ray. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Arteriosclerosis Obliterans: Arteriosclerosis in which proliferation of the intima leads to occlusion of the lumen of the arteries. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arteriovenous Fistula: An abnormal communication between an artery and a vein. [NIH] Arteritis: Inflammation of an artery. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is

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considered an antioxidant. [NIH] 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] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [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] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary Artery: The continuation of the subclavian artery; it distributes over the upper limb, axilla, chest and shoulder. [NIH] Axillary Vein: The venous trunk of the upper limb; a continuation of the basilar and brachial veins running from the lower border of the teres major muscle to the outer border of the first rib where it becomes the subclavian vein. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Baroreflex: A negative feedback system which buffers short-term changes in blood pressure. Increased pressure stretches blood vessels which activates pressoreceptors (baroreceptors) in the vessel walls. The net response of the central nervous system is a reduction of central sympathetic outflow. This reduces blood pressure both by decreasing peripheral vascular resistance and by lowering cardiac output. Because the baroreceptors are tonically active, the baroreflex can compensate rapidly for both increases and decreases in blood pressure. [NIH]

Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU]

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Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Groups: The classification systems (or schemes) of the different antigens located on erythrocytes.The antigens are the phenotypic expression of the genetic differences characteristic of specific blood groups. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Viscosity: The internal resistance of the blood to shear forces. The in vitro measure of whole blood viscosity is of limited clinical utility because it bears little relationship to the actual viscosity within the circulation, but an increase in the viscosity of circulating blood can contribute to morbidity in patients suffering from disorders such as sickle cell anemia and polycythemia. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bolus injection: The injection of a drug (or drugs) in a high quantity (called a bolus) at once,

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the opposite of gradual administration (as in intravenous infusion). [EU] 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] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Artery: The continuation of the axillary artery; it branches into the radial and ulnar arteries. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]

Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cadaver: A dead body, usually a human body. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [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] Cardiac: Having to do with the heart. [NIH]

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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] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carotid Arteries: Either of the two principal arteries on both sides of the neck that supply blood to the head and neck; each divides into two branches, the internal carotid artery and the external carotid artery. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] 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 Division: The fission of a cell. [NIH]

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Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] 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] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] 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] Chondrocytes: Polymorphic cells that form cartilage. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH]

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Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] 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] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in

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addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Constriction: The act of constricting. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

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 Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD

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results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] 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] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH]

Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [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] 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] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dentists: Individuals licensed to practice dentistry. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Foot: Ulcers of the foot as a complication of diabetes. Diabetic foot, often with infection, is a common serious complication of diabetes and may require hospitalization and disfiguring surgery. The foot ulcers are probably secondary to neuropathies and vascular problems. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH]

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Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] 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] 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] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [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] Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] 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] Duct: A tube through which body fluids pass. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus 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] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear

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particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]

Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] 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] Epidemiological: Relating to, or involving epidemiology. [EU] 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] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most

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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] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epoprostenol: A prostaglandin that is biosynthesized enzymatically from prostaglandin endoperoxides in human vascular tissue. It is a potent inhibitor of platelet aggregation. The sodium salt has been also used to treat primary pulmonary hypertension. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythema Nodosum: An erythematous eruption commonly associated with drug reactions or infection and characterized by inflammatory nodules that are usually tender, multiple, and bilateral. These nodules are located predominantly on the shins with less common occurrence on the thighs and forearms. They undergo characteristic color changes ending in temporary bruise-like areas. This condition usually subsides in 3-6 weeks without scarring or atrophy. [NIH] Erythrocyte Deformability: Ability of erythrocytes to change shape as they pass through narrow spaces, such as the microvasculature. [NIH] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exercise Tolerance: The exercise capacity of an individual as measured by endurance (maximal exercise duration and/or maximal attained work load) during an exercise test. [NIH]

Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

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Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Fibroblast Growth Factor: Peptide isolated from the pituitary gland and from the brain. It is a potent mitogen which stimulates growth of a variety of mesodermal cells including chondrocytes, granulosa, and endothelial cells. The peptide may be active in wound healing and animal limb regeneration. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Fistulas: An abnormal passage from one hollow structure of the body to another, or from a hollow structure to the surface, formed by an abscess, disease process, incomplete closure of a wound, or by a congenital anomaly. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH]

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Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gangrene: Death and putrefaction of tissue usually due to a loss of blood supply. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: 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] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] Ginkgo biloba: Exclusive species of the genus Ginkgo, family Ginkgoacea. It produces extracts of medicinal interest. Ginkgo may refer to the genus or species. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

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] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH]

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Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [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] Hair Cells: Mechanoreceptors located in the organ of Corti that are sensitive to auditory stimuli and in the vestibular apparatus that are sensitive to movement of the head. In each case the accessory sensory structures are arranged so that appropriate stimuli cause movement of the hair-like projections (stereocilia and kinocilia) which relay the information centrally in the nervous system. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Transplantation: The transference of a heart from one human or animal to another. [NIH]

Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hemiparesis: The weakness or paralysis affecting one side of the body. [NIH] Hemodilution: Reduction of blood viscosity usually by the addition of cell free solutions. Used clinically l) in states of impaired microcirculation, 2) for replacement of intraoperative blood loss without homologous blood transfusion, and 3) in cardiopulmonary bypass and hypothermia. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated

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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] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] 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] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] 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] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] 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] 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

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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] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypoxic: Having too little oxygen. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Iliac Artery: Either of two large arteries originating from the abdominal aorta; they supply blood to the pelvis, abdominal wall and legs. [NIH] Iloprost: An eicosanoid, derived from the cyclooxygenase pathway of arachidonic acid metabolism. It is a stable and synthetic analog of epoprostenol, but with a longer half-life than the parent compound. Its actions are similar to prostacyclin. Iloprost produces vasodilation and inhibits platelet aggregation. [NIH] 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] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] 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] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be

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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]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] 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] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intermittent Claudication: A symptom complex characterized by leg pain and weakness brought on by walking, with the disappearance of the symptoms following a brief rest. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [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] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

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Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] 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] Ketanserin: A selective serotonin receptor antagonist with weak adrenergic receptor blocking properties. The drug is effective in lowering blood pressure in essential hypertension. It also inhibits platelet aggregation. It is well tolerated and is particularly effective in older patients. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Ligands: A RNA simulation method developed by the MIT. [NIH] Lipid: Fat. [NIH] Lipoma: A benign tumor composed of fat cells. [NIH] Lipomatosis: A disorder consisting of the accumulation of abnormal localized, or tumor-like fat in the tissues. [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] Liposomal: A drug preparation that contains the active drug in very tiny fat particles. This fat-encapsulated drug is absorbed better, and its distribution to the tumor site is improved. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified

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who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Lovastatin: A fungal metabolite isolated from cultures of Aspergillus terreus. The compound is a potent anticholesteremic agent. It inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It also stimulates the production of low-density lipoprotein receptors in the liver. [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] 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] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysosome: A sac-like compartment inside a cell that has enzymes that can break down cellular components that need to be destroyed. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Magnetic Resonance Spectroscopy: Spectroscopic method of measuring the magnetic moment of elementary particles such as atomic nuclei, protons or electrons. It is employed in clinical applications such as NMR Tomography (magnetic resonance imaging). [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

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

Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mechanoreceptors: Cells specialized to transduce mechanical stimuli and relay that

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information centrally in the nervous system. Mechanoreceptors include hair cells, which mediate hearing and balance, and the various somatosensory receptors, often with nonneural accessory structures. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Membrane: A very thin layer of tissue that covers a surface. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Methyldopa: An alpha-2 adrenergic agonist that has both central and peripheral nervous system effects. Its primary clinical use is as an antihypertensive agent. Before its alphaadrenergic actions became clear, methyldopa was thought to act by inhibiting decarboxylation of DOPA leading to depletion of norepinephrine or by conversion to and release as the false transmitter alpha-methylnorepinephrine. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] 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] 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] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA,

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can be made up of many thousands of atoms. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucociliary: Pertaining to or affecting the mucus membrane and hairs (including eyelashes, nose hair, .): mucociliary clearing: the clearance of mucus by ciliary movement ( particularly in the respiratory system). [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Muscle Denervation: The resection or removal of the innervation of a muscle or muscle tissue. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Myelography: X-ray visualization of the spinal cord following injection of contrast medium into the spinal arachnoid space. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopathy: Any disease of a muscle. [EU] 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] Nephropathy: Disease of the kidneys. [EU] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and

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ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Niacinamide: An important compound functioning as a component of the coenzyme NAD. Its primary significance is in the prevention and/or cure of blacktongue and pellagra. Most animals cannot manufacture this compound in amounts sufficient to prevent nutritional deficiency and it therefore must be supplemented through dietary intake. [NIH] Nicorandil: A derivative of the niacinamide that is structurally combined with an organic nitrate. It is a potassium-channel opener that causes vasodilatation of arterioles and large coronary arteries. Its nitrate-like properties produce venous vasodilation through stimulation of guanylate cyclase. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful antianginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [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] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the

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retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Pain Threshold: Amount of stimulation required before the sensation of pain is experienced. [NIH]

Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pallor: A clinical manifestation consisting of an unnatural paleness of the skin. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]

Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Particle: A tiny mass of material. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] 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] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pentoxifylline: A methylxanthine derivative that inhibits phosphodiesterase and affects blood rheology. It improves blood flow by increasing erythrocyte and leukocyte flexibility. It also inhibits platelet aggregation. Pentoxifylline modulates immunologic activity by stimulating cytokine production. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] 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

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vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [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] Phosphorylase: An enzyme of the transferase class that catalyzes the phosphorylysis of a terminal alpha-1,4-glycosidic bond at the non-reducing end of a glycogen molecule, releasing a glucose 1-phosphate residue. Phosphorylase should be qualified by the natural substance acted upon. EC 2.4.1.1. [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] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

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Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Polymyalgia Rheumatica: A syndrome in the elderly characterized by proximal joint and muscle pain, high erythrocyte sedimentation rate, and a self-limiting course. Pain is usually accompanied by evidence of an inflammatory reaction. Women are affected twice as commonly as men and Caucasians more frequently than other groups. The condition is frequently associated with temporal arteritis and some theories pose the possibility that the two diseases arise from a single etiology or even that they are the same entity. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Popliteal: Compression of the nerve at the neck of the fibula. [NIH] Popliteal Artery: The continuation of the femoral artery coursing through the popliteal fossa; it divides into the anterior and posterior tibial arteries. [NIH] 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] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH]

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Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Pressoreceptors: Receptors in the vascular system, particularly the aorta and carotid sinus, which are sensitive to stretch of the vessel walls. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] 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] 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] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [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).

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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] 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] 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] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] 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] 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]

Putrefaction: The process of decomposition of animal and vegetable matter by living organisms. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the

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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] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [NIH]

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] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [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 Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Receptivity: The condition of the reproductive organs of a female flower that permits effective pollination. [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 in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refractory: Not readily yielding to treatment. [EU] 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] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and

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progressive renal glomerular tubular or interstitial disease. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinal Ganglion Cells: Cells of the innermost nuclear layer of the retina, the ganglion cell layer, which project axons through the optic nerve to the brain. They are quite variable in size and in the shapes of their dendritic arbors, which are generally confined to the inner plexiform layer. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retreatment: The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rheology: The study of the deformation and flow of matter, usually liquids or fluids, and of the plastic flow of solids. The concept covers consistency, dilatancy, liquefaction, resistance to flow, shearing, thixotrophy, and viscosity. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH]

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Ribose: A pentose active in biological systems usually in its D-form. [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] Rosiglitazone: A drug taken to help reduce the amount of sugar in the blood. Rosiglitazone helps make insulin more effective and improves regulation of blood sugar. It belongs to the family of drugs called thiazolidinediones. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sedimentation: The act of causing the deposit of sediment, especially by the use of a centrifugal machine. [EU] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] 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] Simvastatin: A derivative of lovastatin and potent competitive inhibitor of 3-hydroxy-3methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It may also interfere with steroid hormone production. Due to the induction of hepatic LDL receptors, it increases breakdown of LDL-cholesterol (lipoproteins, LDL cholesterol). [NIH]

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Sinusitis: An inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism. [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] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Security: Government sponsored social insurance programs. [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] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spinal Stenosis: Narrowing of the spinal canal. [NIH]

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Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] 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] Steady state: Dynamic equilibrium. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] 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] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stump: The end of the limb after amputation. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclavian: The direct continuation of the axillary vein at the lateral border of the first rib. It passes medially to join the internal jugular vein and form the brachiocephalic vein on each side. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Supine: Having the front portion of the body upwards. [NIH]

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Supine Position: The posture of an individual lying face up. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow. [NIH] Systolic pressure: The highest pressure to which blood pressure rises with the contraction of the ventricles. [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] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [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] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombophilia: A disorder of hemostasis in which there is a tendency for the occurrence of thrombosis. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tibial Nerve: The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot. [NIH] Ticlopidine: Ticlopidine is an effective inhibitor of platelet aggregation. The drug has been found to significantly reduce infarction size in acute myocardial infarcts and is an effective antithrombotic agent in arteriovenous fistulas, aorto-coronary bypass grafts, ischemic heart disease, venous thrombosis, and arteriosclerosis. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [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] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH]

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Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Traction: The act of pulling. [NIH] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Ulcer: A localized necrotic lesion of the skin or a mucous surface. [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] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH]

Dictionary 155

Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular endothelial growth factor: VEGF. A substance made by cells that stimulates new blood vessel formation. [NIH] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasculitis: Inflammation of a blood vessel. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] 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] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others.

156

Claudication

[NIH]

Wound Healing: Restoration of integrity to traumatized tissue. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

157

INDEX A Abdomen, 117, 138, 143, 152 Abdominal, 28, 53, 55, 117, 136, 143 Abscess, 117, 132 Adenine, 117 Adenosine, 39, 117, 144 Adjuvant, 8, 26, 117 Adrenal Glands, 117, 118 Adrenergic, 20, 117, 118, 121, 131, 138, 140, 146 Adverse Effect, 117, 150 Aerobic, 5, 8, 117, 131 Aerobic Exercise, 8, 117 Affinity, 117, 151 Agar, 117, 145 Agonist, 117, 140 Airway, 6, 118 Albumin, 118, 140 Algorithms, 118, 122 Alkaline, 118, 123 Alpha-1, 118, 144 Alprenolol, 118, 140 Alternative medicine, 86, 118 Amaurosis, 41, 118 Amaurosis Fugax, 41, 118 Ameliorating, 76, 118 Amino Acids, 14, 71, 118, 143, 145, 147 Amputation, 6, 10, 11, 12, 83, 118, 152 Amyloid, 118 Amyloidosis, 41, 118 Anaesthesia, 118, 136 Anal, 119, 138 Analog, 55, 78, 119, 136 Anatomical, 13, 119, 125, 129, 136, 150 Anemia, 14, 119, 122, 132, 134 Anesthesia, 12, 118, 119, 130 Aneurysm, 119, 120, 155 Angina, 78, 79, 119, 140, 146 Angina Pectoris, 78, 79, 119, 140, 146 Anginal, 118, 119, 142 Angiography, 6, 12, 17, 24, 83, 114, 119 Angioplasty, 7, 17, 18, 31, 33, 36, 38, 43, 50, 51, 52, 104, 114, 119 Anions, 118, 119, 138 Ankle, 4, 7, 10, 45, 58, 67, 74, 119 Antibiotics, 6, 119 Antibody, 117, 119, 126, 135, 136, 137, 151 Anticoagulants, 18, 90, 119

Antigen, 117, 119, 126, 135, 136, 137 Antihypertensive, 59, 118, 119, 140 Anti-inflammatory, 119, 121 Anti-Inflammatory Agents, 119, 121 Antioxidant, 119, 121 Antithrombotic, 120, 153 Aorta, 55, 120, 124, 136, 146, 155 Aortic Aneurysm, 6, 28, 120 Aortitis, 78, 120 Apolipoproteins, 120, 138 Applicability, 9, 120 Aqueous, 120, 121 Arachidonic Acid, 120, 136, 146 Arginine, 71, 86, 120 Arteries, 7, 9, 23, 43, 77, 81, 120, 122, 123, 124, 127, 136, 139, 141, 142, 145 Arteriography, 36, 56, 120 Arterioles, 120, 122, 123, 140, 141, 142, 155 Arteriolosclerosis, 120 Arteriosclerosis, 67, 75, 78, 79, 120, 141, 153 Arteriosclerosis Obliterans, 75, 78, 120 Arteriovenous, 29, 120, 140, 153 Arteriovenous Fistula, 120, 153 Arteritis, 3, 33, 34, 40, 82, 120, 145 Ascorbic Acid, 69, 120, 136 Aspirin, 62, 121 Asymptomatic, 10, 13, 121 Atenolol, 20, 121 Atmospheric Pressure, 121, 136 Atrophy, 114, 121, 131 Atypical, 18, 42, 121 Axillary, 121, 123, 152 Axillary Artery, 121, 123 Axillary Vein, 121, 152 Axons, 121, 143, 149, 151 B Back Pain, 13, 121 Bacteria, 119, 121, 130, 140, 154 Baroreflex, 5, 121 Base, 5, 7, 117, 121, 138, 153 Benign, 120, 121, 134, 138 Benign tumor, 121, 138 Bilateral, 20, 21, 24, 121, 131 Bioavailability, 12, 121 Biological therapy, 122, 134 Biological Transport, 122, 129 Biopsy, 122, 143

158

Claudication

Biosynthesis, 120, 122, 139, 150 Biotechnology, 15, 86, 97, 122 Bladder, 122, 132, 142, 154 Blood Cell Count, 122, 134 Blood Coagulation, 122, 123 Blood Glucose, 76, 122, 135, 137 Blood Groups, 37, 122 Blood pressure, 5, 42, 83, 114, 119, 121, 122, 123, 124, 136, 138, 142, 144, 151, 153 Blood transfusion, 122, 134 Blood vessel, 14, 119, 121, 122, 124, 125, 130, 138, 144, 151, 152, 153, 155 Blood Viscosity, 11, 75, 122, 134 Blood Volume, 5, 122 Body Fluids, 122, 123, 129, 151 Bolus, 62, 68, 122 Bolus infusion, 122 Bolus injection, 62, 68, 122 Bone Marrow, 14, 123, 133, 139, 141 Brachial, 4, 7, 10, 11, 121, 123 Brachial Artery, 11, 123 Bronchi, 123, 131 Bronchitis, 6, 123 Buffers, 121, 123 Bypass, 8, 11, 24, 31, 32, 33, 43, 58, 79, 123, 153 C Cadaver, 7, 123 Calcification, 120, 123 Calcium, 7, 14, 51, 123, 126, 142 Capillary, 9, 15, 69, 123, 155 Captopril, 27, 123 Carbohydrate, 6, 123 Carbon Dioxide, 67, 123, 128, 149 Cardiac, 14, 17, 51, 74, 79, 82, 121, 123, 124, 131, 140, 141, 152 Cardiac Output, 121, 124 Cardiomyopathy, 79, 124 Cardiopulmonary, 5, 8, 27, 28, 29, 32, 124, 134 Cardiopulmonary Bypass, 124, 134 Cardiorespiratory, 117, 124 Cardioselective, 121, 124, 146 Cardiovascular disease, 47, 79, 124 Carnitine, 12, 49, 64, 75, 124 Carotene, 67, 69, 71, 124, 149 Carotid Arteries, 41, 124 Case report, 3, 17, 18, 20, 26, 45, 53, 124, 126 Case series, 124, 126 Catecholamine, 124, 144 Catheterization, 17, 119, 124

Cations, 124, 138 Cauda Equina, 124, 150 Cell Division, 121, 124, 125, 134, 145 Cell proliferation, 120, 125 Cell Survival, 125, 134 Central Nervous System, 121, 125, 129, 133, 134, 143, 150 Central Nervous System Infections, 125, 134 Centrifugation, 125, 134 Cerebral, 14, 69, 125, 131 Cerebrospinal, 125, 150 Cerebrospinal fluid, 125, 150 Cerebrovascular, 10, 124, 125 Cerebrum, 125 Cervix, 125, 132 Character, 119, 125, 128 Chin, 125, 140 Cholesterol, 36, 125, 127, 138, 139, 150, 152 Cholesterol Esters, 125, 138 Chondrocytes, 125, 132 Chronic, 6, 12, 18, 40, 59, 75, 79, 82, 121, 125, 129, 137, 138, 139, 151, 152 Chylomicrons, 125, 138 Clamp, 14, 125 Clear cell carcinoma, 125, 128 Clinical Medicine, 126, 146 Clinical study, 9, 126, 127 Clinical trial, 4, 7, 12, 65, 97, 126, 127, 129, 141, 147, 148 Cloning, 122, 126 Coenzyme, 120, 126, 139, 142, 150 Collagen, 7, 126, 132, 145, 146 Comorbidity, 54, 126 Complement, 126, 127 Complementary and alternative medicine, 65, 72, 126 Complementary medicine, 65, 127 Computational Biology, 97, 127 Concomitant, 15, 127 Conduction, 13, 52, 127 Confounding, 83, 127 Congestion, 127, 131 Connective Tissue, 120, 123, 126, 127, 128, 132, 139, 153 Constriction, 127, 138 Contraindications, ii, 127 Contralateral, 7, 36, 127, 142 Contrast medium, 119, 127, 141 Control group, 8, 10, 127, 146 Controlled clinical trial, 8, 127, 148 Controlled study, 16, 42, 51, 53, 66, 127

159

Coronary, 6, 32, 36, 78, 79, 119, 124, 127, 128, 141, 142, 153 Coronary Circulation, 119, 127 Coronary heart disease, 6, 32, 36, 124, 127 Coronary Thrombosis, 128, 141 Corticosteroids, 82, 128 Cranial, 128, 134, 142, 143, 144 Craniocerebral Trauma, 128, 134 Creatine, 46, 128 Creatinine, 128 Curative, 128, 153 Cyclic, 128, 134, 144, 146 Cyst, 54, 56, 128 Cytokine, 11, 15, 128, 143 D Decarboxylation, 128, 140 Degenerative, 13, 128, 135, 149 Dentists, 3, 128 Dermis, 128, 154 DES, 62, 128 Diabetes Mellitus, 12, 76, 128, 133, 135 Diabetic Foot, 82, 128 Diagnostic Imaging, 24, 128 Diagnostic procedure, 73, 86, 128 Diastole, 129 Diastolic, 79, 129, 136 Diffusion, 69, 122, 129 Dilatation, Pathologic, 129, 155 Dilation, 129, 155 Direct, iii, 12, 89, 126, 129, 148, 152, 153 Discrete, 129, 153 Disease Progression, 9, 129 Dissection, 53, 129 Distal, 38, 58, 129, 144, 147 Double-blind, 20, 27, 28, 36, 42, 47, 51, 53, 62, 66, 129 Drug Interactions, 90, 129 Drug Tolerance, 129, 153 Duct, 124, 129, 152 E Efferent, 129, 141, 151 Efficacy, 12, 16, 28, 29, 48, 55, 66, 75, 76, 129, 154 Elasticity, 120, 129 Elastin, 126, 129 Electrolyte, 129, 145, 151 Electrons, 120, 121, 129, 138, 139, 148 Elementary Particles, 129, 139, 147 Emboli, 37, 130 Embolism, 82, 130 Embolization, 37, 130 Embolus, 130, 136

Embryo, 130, 136 Encapsulated, 130, 138 Endarterectomy, 119, 130 Endocrine System, 130 Endocrinology, 77, 130 Endothelial cell, 14, 130, 132 Endothelium, 11, 130 Endothelium, Lymphatic, 130 Endothelium, Vascular, 130 Environmental Health, 96, 98, 130 Enzymatic, 123, 124, 126, 130, 132, 149 Enzyme, 126, 130, 133, 134, 139, 144, 147, 148, 149, 150, 153, 155 Epidemiological, 25, 130 Epidural, 43, 130 Epinephrine, 117, 130, 142 Epithelial, 6, 122, 131, 135 Epithelial Cells, 6, 131, 135 Epithelium, 130, 131 Epoprostenol, 131, 136 Erythema, 6, 131 Erythema Nodosum, 6, 131 Erythrocyte Deformability, 30, 131 Erythrocyte Volume, 122, 131 Erythrocytes, 119, 122, 123, 131 Exercise Test, 131 Exercise Tolerance, 38, 79, 131 Exogenous, 9, 123, 131 Extracellular, 14, 118, 127, 131, 132, 151 Extremity, 6, 7, 8, 10, 11, 13, 33, 43, 51, 56, 69, 70, 83, 104, 131, 150 F Family Planning, 97, 131 Fat, 69, 120, 123, 124, 127, 130, 131, 138, 151 Fatigue, 113, 131, 134 Fatty acids, 118, 132, 146 Femoral, 7, 9, 31, 38, 58, 124, 132, 145 Femoral Artery, 7, 9, 38, 124, 132, 145 Femur, 132 Fibrin, 122, 132, 153 Fibrinogen, 25, 30, 32, 132, 153 Fibrinolysis, 36, 132 Fibroblast Growth Factor, 17, 19, 25, 77, 78, 132 Fibroblasts, 132, 137 Fibrosis, 132, 150 Fibula, 132, 145 Fistulas, 37, 132 Flexion, 13, 74, 132 Folate, 10, 132 Fold, 6, 132

160

Claudication

Folic Acid, 10, 132 Foot Ulcer, 83, 128, 132 Forearm, 13, 122, 132 Fossa, 132, 145 Fundus, 132 G Gait, 33, 42, 133 Gallbladder, 117, 132, 133 Gangrene, 12, 76, 83, 133 Gas, 123, 129, 133, 135, 152 Gastric, 124, 133 Gastrointestinal, 131, 133, 150, 152 Gastrointestinal tract, 133, 150, 152 Gene, 15, 82, 122, 133 Gene Expression, 133 Gene Therapy, 82, 133 Ginkgo biloba, 66, 67, 69, 71, 133 Glomerular, 133, 149 Glucose, 11, 34, 120, 122, 128, 133, 135, 137, 144 Glucose Intolerance, 128, 133 Glucuronic Acid, 133, 135 Glutamic Acid, 132, 133, 142, 146 Glycogen, 79, 133, 144 Glycoprotein, 132, 133 Glycosidic, 133, 144 Governing Board, 134, 146 Graft, 11, 13, 56, 134 Grafting, 12, 15, 31, 33, 134 Grasses, 132, 134 Growth factors, 9, 14, 134 Guanylate Cyclase, 134, 142 H Hair Cells, 134, 140 Half-Life, 134, 136 Headache, 82, 118, 134 Headache Disorders, 134 Heart attack, 124, 134 Heart failure, 4, 5, 78, 79, 134 Heart Transplantation, 79, 134 Hematocrit, 35, 47, 122, 134 Hemiparesis, 42, 134 Hemodilution, 47, 134 Hemodynamics, 57, 81, 134 Hemoglobin, 119, 122, 131, 134, 135 Hemoglobinopathies, 133, 135 Hemorrhage, 128, 134, 135, 152 Hemostasis, 36, 135, 150, 153 Heparin, 18, 51, 135 Hepatic, 118, 135, 150 Hepatitis, 40, 135 Hepatocytes, 135

Heredity, 37, 133, 135 Homologous, 133, 134, 135 Hormonal, 121, 135 Hormone, 128, 130, 135, 137, 149, 150 Hybridomas, 135, 137 Hydrogen, 121, 123, 135, 140, 147 Hydrophobic, 135, 138 Hydroxylysine, 126, 135 Hydroxyproline, 126, 135 Hyperbaric, 68, 136 Hyperbaric oxygen, 136 Hyperlipidemia, 76, 83, 136 Hypersensitivity, 136, 149 Hypertension, 5, 12, 27, 32, 76, 79, 81, 83, 120, 124, 131, 134, 136, 138, 140, 146 Hypertrophy, 13, 79, 136 Hypothermia, 134, 136 Hypoxic, 75, 136 I Idiopathic, 136, 150 Iliac Artery, 18, 21, 132, 136 Iloprost, 54, 136 Immune response, 117, 119, 136, 155 Immune system, 122, 136, 139, 154, 155 Immunologic, 136, 143 Immunology, 117, 136 Impairment, 4, 33, 136 In vitro, 9, 12, 15, 122, 133, 136 In vivo, 9, 12, 133, 135, 136 Incision, 136, 137 Induction, 5, 136, 150 Infarction, 82, 136, 153 Infection, 6, 40, 83, 122, 128, 131, 136, 138, 139, 142, 148, 149, 152, 155 Inflammation, 7, 11, 51, 118, 119, 120, 121, 123, 132, 135, 137, 145, 149, 155 Infusion, 15, 77, 86, 123, 137 Innervation, 137, 141, 150, 153 Inotropic, 121, 137 Insulin, 11, 34, 137, 150 Insulin-dependent diabetes mellitus, 137 Interleukin-6, 26, 137 Intermittent, 5, 7, 10, 11, 12, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 65, 66, 67, 68, 69, 70, 71, 74, 75, 76, 77, 78, 79, 81, 83, 85, 86, 137 Internal Medicine, 20, 29, 37, 51, 67, 130, 137 Interstitial, 39, 137, 149

161

Intervertebral, 137, 139, 148, 150 Intervertebral Disk Displacement, 137, 139, 148, 150 Intestinal, 124, 137 Intestines, 117, 125, 133, 137 Intracellular, 137, 145, 146 Intramuscular, 5, 77, 137 Intravascular, 6, 23, 137 Intravenous, 68, 77, 82, 123, 137 Invasive, 12, 55, 137, 139 Involuntary, 138, 141, 148 Ion Channels, 14, 138 Ions, 14, 121, 123, 129, 135, 138 Ischemia, 7, 8, 9, 11, 12, 14, 15, 16, 39, 46, 77, 78, 82, 121, 138 K Kb, 96, 138 Ketanserin, 37, 41, 42, 51, 138 L Latency, 13, 138 Leprosy, 132, 138 Lesion, 7, 132, 138, 154 Leukemia, 133, 138 Ligaments, 127, 138 Ligands, 48, 138 Lipid, 7, 120, 137, 138 Lipoma, 26, 138 Lipomatosis, 43, 138 Lipoprotein, 36, 43, 138, 139 Liposomal, 12, 138 Liver, 117, 118, 120, 124, 132, 133, 135, 138, 139, 149, 150 Localized, 117, 118, 130, 137, 138, 145, 154 Locomotion, 78, 138, 145 Longitudinal study, 13, 138 Lovastatin, 28, 139, 150 Low Back Pain, 13, 139 Low-density lipoprotein, 138, 139 Lumbar, 16, 27, 33, 43, 121, 124, 137, 139, 150, 153 Lymph, 121, 130, 139, 150 Lymph node, 121, 139, 150 Lymphatic, 130, 137, 139, 152 Lymphoid, 128, 139 Lysosome, 6, 139 M Macrophage, 11, 139 Magnetic Resonance Imaging, 6, 7, 11, 139 Magnetic Resonance Spectroscopy, 62, 139 Malaise, 3, 78, 139 Malformation, 29, 53, 139

Malnutrition, 118, 121, 139 Manifest, 83, 139 Mechanoreceptors, 5, 134, 139 Medial, 18, 120, 140, 142, 153 Mediate, 140 MEDLINE, 97, 140 Megaloblastic, 132, 140 Membrane, 126, 138, 140, 141, 144, 149 Mental, iv, 4, 29, 96, 98, 125, 131, 140, 147, 154 Mental Health, iv, 4, 96, 98, 140, 147 Meta-Analysis, 20, 27, 49, 67, 68, 140 Metabolite, 139, 140 Methyldopa, 59, 140 Metoprolol, 59, 140 Microbe, 140, 154 Microbiology, 121, 140 Microcirculation, 29, 62, 134, 140 Microorganism, 140, 143, 155 Mitochondrial Swelling, 140, 141 Mobility, 11, 140 Modification, 4, 7, 140, 147 Molecular, 4, 8, 14, 18, 97, 99, 122, 127, 132, 135, 140, 154 Molecule, 119, 121, 126, 133, 135, 140, 144, 148 Monocytes, 137, 141 Morphology, 6, 7, 31, 141 Motor Activity, 5, 141 Motor nerve, 13, 141 Mucins, 141 Mucociliary, 141, 151 Mucosa, 82, 141 Multicenter study, 27, 141 Muscle Denervation, 13, 141 Mutagenesis, 14, 141 Mutagens, 141 Myelography, 27, 141 Myocardial infarction, 6, 10, 51, 78, 128, 141, 146 Myocardial Ischemia, 119, 141 Myocardium, 119, 141 Myopathy, 8, 141 N Nausea, 118, 141, 154 Necrosis, 82, 136, 141, 150 Nephropathy, 76, 141 Nervous System, 125, 134, 140, 141, 142, 144 Neural, 118, 140, 142 Neurogenic, 13, 16, 18, 27, 29, 33, 43, 46, 52, 53, 58, 142

162

Claudication

Neuromuscular, 74, 142 Neuronal, 14, 142 Neurons, 142, 151, 153 Neuropathy, 3, 76, 142, 144, 150 Neurotransmitter, 117, 133, 138, 142 Niacinamide, 142 Nicorandil, 76, 142 Nifedipine, 20, 27, 142 Norepinephrine, 117, 140, 142 Nuclear, 129, 141, 142, 149 Nuclei, 129, 133, 139, 142, 143, 147 Nucleus, 128, 130, 137, 141, 142, 147 O Optic Chiasm, 142, 143 Optic Nerve, 82, 142, 149 Oxygen Consumption, 5, 11, 131, 143, 149 Oxygenation, 75, 143 P Pain Threshold, 17, 19, 143 Palliative, 143, 153 Pallor, 82, 114, 143 Pancreas, 117, 137, 143 Pancreatic, 124, 143 Paralysis, 134, 143 Paranasal Sinuses, 143, 151 Parotid, 143, 150 Paroxysmal, 119, 134, 143 Particle, 8, 143, 151 Patch, 14, 143, 154 Pathogen, 6, 143 Pathologic, 48, 122, 127, 136, 143 Pathophysiology, 4, 143 Pelvis, 117, 136, 139, 143, 154 Pentoxifylline, 15, 26, 30, 39, 40, 53, 55, 62, 63, 72, 75, 90, 143 Peptide, 77, 132, 143, 145, 147 Percutaneous, 50, 52, 67, 143 Perfusion, 12, 15, 54, 143 Perioperative, 12, 82, 144 Peripheral blood, 14, 144 Peripheral Nervous System, 140, 142, 144 Peripheral Neuropathy, 57, 83, 144 Peripheral Vascular Disease, 28, 71, 74, 75, 77, 83, 103, 144 Pharmacologic, 48, 62, 119, 134, 144, 154 Pharmacotherapy, 4, 22, 82, 144 Phosphodiesterase, 143, 144 Phospholipids, 131, 138, 144 Phosphorus, 123, 144 Phosphorylase, 79, 144 Physical Examination, 13, 144

Physiologic, 117, 122, 128, 134, 144, 146, 148 Physiology, 5, 24, 48, 59, 77, 130, 144 Pigments, 124, 144, 149 Pilot study, 13, 28, 145 Pituitary Gland, 132, 145 Plants, 123, 133, 141, 142, 144, 145, 154 Plaque, 6, 119, 145 Plasma, 9, 11, 30, 34, 118, 122, 125, 130, 132, 133, 135, 140, 145, 149 Plasma Volume, 122, 145 Platelet Activation, 35, 145 Platelet Aggregation, 131, 136, 138, 143, 145, 153 Platelets, 48, 145, 150 Pneumonia, 6, 127, 145 Polymyalgia Rheumatica, 82, 145 Polypeptide, 126, 132, 145 Popliteal, 22, 145 Popliteal Artery, 22, 145 Posterior, 119, 121, 143, 145, 150 Postnatal, 145, 152 Potassium, 76, 142, 145 Practicability, 145, 154 Practice Guidelines, 98, 103, 146 Precursor, 14, 120, 130, 142, 146, 154 Pressoreceptors, 121, 146 Prevalence, 36, 37, 77, 83, 146 Primary endpoint, 7, 10, 146 Progression, 7, 9, 11, 69, 76, 83, 146 Progressive, 8, 10, 78, 120, 129, 141, 145, 146, 148 Projection, 142, 143, 146 Proline, 126, 135, 146 Propranolol, 121, 146 Prospective study, 25, 68, 138, 146 Prostaglandin, 36, 47, 62, 68, 131, 146 Prostaglandins A, 146, 147 Protein C, 118, 120, 138, 147 Protein S, 122, 147 Proteins, 118, 119, 120, 126, 130, 140, 143, 145, 147, 150 Proteolytic, 118, 126, 132, 147 Protocol, 11, 147 Protons, 14, 135, 139, 147, 148 Proximal, 129, 145, 147 Psychic, 140, 147 Public Health, 6, 11, 98, 147 Public Policy, 97, 147 Pulmonary, 74, 122, 131, 147, 155 Pulmonary Artery, 122, 147, 155 Pulse, 83, 114, 147

163

Putrefaction, 133, 147 Q Quality of Life, 8, 11, 18, 24, 26, 27, 45, 55, 57, 62, 147 R Race, 7, 147 Radiation, 119, 130, 136, 147, 156 Radiculopathy, 148, 150 Radiography, 102, 119, 148 Radiological, 102, 143, 148 Randomized, 4, 7, 8, 10, 20, 27, 28, 29, 36, 39, 45, 47, 48, 51, 53, 62, 63, 66, 67, 129, 148 Randomized Controlled Trials, 20, 27, 148 Receptivity, 9, 148 Receptor, 6, 9, 119, 138, 148, 150 Recombinant, 17, 25, 77, 78, 148 Recombination, 133, 148 Recurrence, 42, 148 Reductase, 139, 148, 150 Refer, 1, 126, 133, 138, 148, 154 Reflex, 5, 148 Refractory, 14, 148 Regeneration, 132, 148 Regimen, 7, 129, 144, 148, 149 Reinfection, 6, 148 Remission, 148 Renal failure, 12, 148 Renin, 123, 149 Renin-Angiotensin System, 123, 149 Resection, 141, 149 Respiration, 123, 149 Retina, 142, 143, 149, 150 Retinal, 142, 143, 149 Retinal Ganglion Cells, 143, 149 Retinopathy, 76, 149 Retreatment, 49, 149 Retroviral vector, 133, 149 Rheology, 54, 143, 149 Rheumatoid, 54, 149 Rheumatoid arthritis, 54, 149 Ribose, 117, 150 Risk factor, 9, 22, 30, 37, 44, 81, 83, 146, 150 Rod, 125, 150 Rosiglitazone, 11, 150 S Saphenous, 58, 150 Sarcoidosis, 6, 150 Sciatic Nerve, 150, 153 Sciatica, 25, 27, 150 Sclerosis, 120, 150

Screening, 52, 55, 57, 62, 63, 103, 126, 150 Sedimentation, 125, 145, 150 Serotonin, 138, 142, 144, 150, 154 Serous, 130, 150 Serum, 7, 37, 118, 126, 139, 150 Shunt, 56, 150 Side effect, 10, 89, 117, 122, 150, 154 Signs and Symptoms, 6, 148, 150 Simvastatin, 27, 28, 150 Sinusitis, 6, 151 Skeletal, 4, 11, 125, 151 Skeleton, 132, 146, 151 Skull, 128, 151, 153 Smoking Cessation, 30, 151 Social Environment, 147, 151 Social Security, 148, 151 Sodium, 14, 47, 69, 131, 151 Soft tissue, 123, 151 Somatic, 144, 151 Sound wave, 127, 151 Specialist, 105, 129, 151 Species, 131, 133, 147, 151, 155 Specificity, 5, 117, 151 Spinal cord, 123, 124, 125, 130, 141, 142, 144, 148, 150, 151 Spinal Nerve Roots, 148, 150, 151 Spinal Stenosis, 13, 16, 42, 46, 52, 57, 102, 151 Spleen, 118, 139, 150, 152 Sprains and Strains, 139, 152 Stabilization, 7, 152 Steady state, 5, 152 Steel, 125, 152 Stem Cells, 14, 152 Stenosis, 6, 10, 13, 20, 21, 38, 43, 81, 152 Stent, 7, 152 Steroid, 150, 152 Stimulus, 137, 138, 148, 152, 153 Stomach, 117, 132, 133, 135, 137, 141, 152 Stress, 18, 29, 78, 124, 141, 149, 152 Stricture, 152 Stroke, 6, 10, 14, 32, 35, 96, 124, 152 Stump, 12, 28, 152 Subacute, 137, 151, 152 Subarachnoid, 134, 152 Subclavian, 56, 121, 152 Subclinical, 137, 152 Suction, 19, 152 Supine, 74, 152, 153 Supine Position, 74, 153 Supplementation, 67, 69, 153 Symptomatic, 7, 9, 11, 13, 48, 57, 153

164

Claudication

Synapse, 117, 153, 154 Systemic, 4, 7, 41, 54, 90, 118, 120, 122, 131, 134, 137, 150, 153, 155 Systolic, 4, 58, 67, 74, 79, 136, 153 Systolic blood pressure, 4, 153 Systolic pressure, 58, 74, 153 T Temporal, 33, 40, 82, 134, 145, 153 Tendon, 5, 103, 153 Therapeutics, 11, 69, 70, 76, 90, 153 Thermal, 42, 62, 69, 70, 153 Thigh, 132, 153 Thoracic, 56, 121, 153 Threshold, 74, 136, 153 Thrombin, 132, 145, 147, 153 Thrombophilia, 57, 153 Thrombosis, 7, 51, 57, 67, 147, 152, 153 Tibial Nerve, 45, 150, 153 Ticlopidine, 20, 72, 90, 153 Tolerance, 13, 34, 133, 153 Tomography, 11, 33, 139, 153 Topical, 12, 154 Torsion, 136, 154 Toxic, iv, 10, 134, 142, 154 Toxicity, 12, 129, 154 Toxicology, 98, 154 Toxin, 153, 154 Traction, 125, 154 Transcutaneous, 42, 154 Transdermal, 12, 154 Transfection, 122, 133, 154 Transmitter, 138, 140, 142, 154 Trauma, 53, 141, 154 Treatment Outcome, 49, 154 Tryptophan, 126, 150, 154 Tunica, 130, 141, 154

U Ulcer, 82, 154 Ultrasonography, 11, 154 Uremia, 148, 154 Urine, 122, 128, 154 Uterus, 125, 132, 154, 155 V Vaccine, 6, 117, 147, 154 Vagina, 125, 128, 155 Vascular endothelial growth factor, 26, 51, 155 Vascular Resistance, 121, 155 Vasculitis, 82, 155 Vasoactive, 47, 155 Vasodilatation, 142, 155 Vasodilation, 11, 136, 142, 155 Vasodilator, 142, 155 Vein, 11, 31, 32, 119, 120, 121, 137, 142, 143, 150, 152, 155 Venous, 53, 57, 58, 120, 121, 122, 142, 147, 153, 155 Venous Thrombosis, 153, 155 Ventricle, 147, 153, 155 Ventricular, 79, 155 Venules, 122, 123, 130, 140, 155 Vertigo, 118, 155 Veterinary Medicine, 97, 155 Virulence, 6, 154, 155 Virus, 40, 125, 145, 149, 155 Visceral, 14, 155 Viscosity, 20, 21, 30, 122, 149, 155 Vitro, 135, 155 Vivo, 9, 14, 155 W White blood cell, 119, 139, 155 Wound Healing, 13, 132, 156 X X-ray, 102, 120, 127, 141, 142, 156

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