CYSTOCELE 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., 1960Cystocele: 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: 0-497-00329-5 1. Cystocele-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.
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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 cystocele. 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 CYSTOCELE ............................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Cystocele ....................................................................................... 6 The National Library of Medicine: PubMed .................................................................................. 7 CHAPTER 2. PATENTS ON CYSTOCELE ............................................................................................ 17 Overview...................................................................................................................................... 17 Patents on Cystocele .................................................................................................................... 17 Patent Applications on Cystocele................................................................................................. 18 Keeping Current .......................................................................................................................... 20 CHAPTER 3. BOOKS ON CYSTOCELE ................................................................................................ 21 Overview...................................................................................................................................... 21 Book Summaries: Federal Agencies.............................................................................................. 21 Chapters on Cystocele .................................................................................................................. 22 CHAPTER 4. MULTIMEDIA ON CYSTOCELE ..................................................................................... 23 Overview...................................................................................................................................... 23 Video Recordings ......................................................................................................................... 23 CHAPTER 5. PERIODICALS AND NEWS ON CYSTOCELE .................................................................. 25 Overview...................................................................................................................................... 25 News Services and Press Releases................................................................................................ 25 Newsletter Articles ...................................................................................................................... 26 Academic Periodicals covering Cystocele..................................................................................... 27 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 31 Overview...................................................................................................................................... 31 NIH Guidelines............................................................................................................................ 31 NIH Databases............................................................................................................................. 33 Other Commercial Databases....................................................................................................... 35 APPENDIX B. PATIENT RESOURCES ................................................................................................. 37 Overview...................................................................................................................................... 37 Patient Guideline Sources............................................................................................................ 37 Finding Associations.................................................................................................................... 40 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 43 Overview...................................................................................................................................... 43 Preparation................................................................................................................................... 43 Finding a Local Medical Library.................................................................................................. 43 Medical Libraries in the U.S. and Canada ................................................................................... 43 ONLINE GLOSSARIES.................................................................................................................. 49 Online Dictionary Directories ..................................................................................................... 49 CYSTOCELE DICTIONARY ......................................................................................................... 51 INDEX ................................................................................................................................................ 65
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with cystocele 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 cystocele, 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 cystocele, 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 cystocele. 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 cystocele, 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 cystocele. The Editors
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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON CYSTOCELE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on cystocele.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and cystocele, 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 “cystocele” (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: •
Practical Use of the Pessary Source: American Family Physician. 61(9): 2719-2726. May 1, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: Although many physicians are unfamiliar with the pessary, it remains an effective tool in the management of a number of gynecologic problems. The article reviews the practical use of the pessary, which is most commonly used in the management of pelvic support defects such as cystocele and rectocele. Pessaries can also be used in the treatment of stress urinary incontinence (SUI). Good candidates for a pessary trial might include a pregnant patient, an elderly woman in whom surgery would be risky, and a woman whose previous operation for stress incontinence failed.
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The wide variety of pessary styles may cause confusion for physicians during the initial selection of the pessary. However, an understanding of the different styles and their uses will enable physicians to make an appropriate choice. The authors review each type and note their uses; one illustration depicts most of the types in current use. Complications can be minimized with simple vaginal hygiene and regular followup visits. The authors conclude that incorporating the use of the pessary into a physician's practice requires minimal investment; however, it may significantly improve the lifestyle of patients who have limited therapeutic alternatives. 8 figures. 2 tables. 11 references. •
Transvaginal Surgery: New Concepts in Female Pelvic Floor Anatomy Source: Contemporary Urology. 8(5): 90-95. May 1996. Summary: Many urologists continue to devote a growing part of their practices to transvaginal surgery for resolving problems with female urinary incontinence, prolapse, diverticula, and periurethral masses. This article covers transvaginal surgery, stressing that the keys to success with such procedures are an adequate understanding of the anatomy, proper patient preparation, and availability of a few specialized instruments that can aid the urologist during the surgery itself. After reviewing these three factors, the authors describe their technique for performing a vaginal wall sling. The specialized instruments used for vaginal surgery include a weight vaginal speculum, a curved Lowsley retractor, sutures of number one Prolene, and a double-pronged needle carrier. The type of vaginal surgery chosen for a particular patient depends on the type of stress urinary incontinence (SUI) she has, as well as the degree of coexisting cystocele formation. An anterior vaginal wall sling is appropriate for the patient who has a minor cystocele and anatomic SUI or intrinsic sphincter dysfunction (ISD). When the cystocele is severe (grade IV), a specialized procedure is required that will correct defects of central and lateral support and also incorporate sutures supporting the mid-urethra and bladder neck. The authors conclude that the vaginal wall sling can be safely performed on an outpatient basis and is a highly successful way of treating SUI that results in a low incidence of associated morbidity. 8 figures. 1 table. 9 references. (AA-M).
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Complications of Periurethral Collagen Injection for Stress Urinary Incontinence Source: Journal of Urology. 159(3): 806-807. March 1998. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: Periurethral collagen injection has been advocated as a safe and effective method of treatment for stress urinary incontinence (SUI). This article reports on a study conducted to determine the complications associated with transurethral collagen injection for SUI treatment in women. The authors report the incidence and management of adverse effects. The prospective cohort study included a total of 337 women with at least a 1 year history, physical findings, and urodynamic abnormalities consistent with SUI, who required pads or protective clothing, and who had no or only grade 1 cystocele (hernia or bulge of the bladder through the wall of the vagina). A third party documented adverse effects at each followup. De novo (newly occurring) urinary urgency with incontinence was the most frequent and serious complication, occurring in 12.6 percent of patients, and in many the symptoms were irreversible. Hematuria (blood in the urine, 5 percent of patients) and urinary retention (urine remaining in the bladder after urination, 1.9 percent) were short lived and resolved spontaneously. Delayed reaction at the skin test site occurred in 0.9 percent of the patients (n = 3) and was
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associated with arthralgias (joint pain) in 2 patients. The authors conclude that, contrary to previous reports that periurethral collagen injection is complication free, they found an overall incidence of 20 percent risk of complications in any given individual. 12 references. •
Building Support for Your Pelvic Floor Source: Mayo Clinic Women's Healthsource. 5(3): 4-5. March 2001. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: The pelvic floor, including pelvic floor muscles, ligaments and other structures that support the uterus, bladder, vagina, and rectal area, often changes after pregnancy. This article discusses conditions that women may experience (called 'pelvic relaxation disorders') and strategies to rebuild the pelvic floor to help prevent future complications. The disorders include cystocele, a protrusion of the bladder behind the wall of the vagina; rectocele, a protrusion of the rectum that bulges into the vagina; enterocele, when the small intestine bulges into the top and upper back portion of the vaginal wall; and uterine prolapse, when the pelvic muscles and ligaments are stretched or weakened and the uterus descends partway or all of the way into the vaginal canal. Pregnancy is not the only cause of these conditions; normal aging, including diminishing levels of the female hormone estrogen, can also be a cause. Other risk factors include being overweight, repeated heavy lifting, or straining with bowel movements. Diagnosis can include patient history, physical exam, a defecating proctogram (x ray monitoring of defecation), and dynamic magnetic resonance imaging (MRI). Treatments can include Kegel exercise (to strengthen the pelvic floor muscles), reducing the strain on pelvic organs, a vaginal pessary to hold the uterus in place, and surgical repairs. Surgery must be individually tailored, taking into consideration all the pelvic organs that may be affected. One sidebar explains how to do Kegel exercises. 2 figures.
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Genital Prolapse With and Without Urinary Incontinence Source: Journal of Reproductive Medicine. 35(8): 792-798. August 1990. Summary: This article discusses procidentia, vaginal vault prolapse, and severe cystocele. These disorders can be associated with potential urinary incontinence, which becomes overt only after surgical repair of the genital prolapse. The normal support of the pelvic organs is provided by the pelvic diaphragm (levator ani and coccygeus muscles). The levator plate is a firm, muscular plate between the coccyx and anus formed by fusion of the levator ani muscles on each side. Recent investigators have indicated that the main mechanism for weakening the pelvic muscles occurs as a result of childbearing, when stretch injury of the pudendal nerve causes denervation of the muscles. This injury is aggravated with the changes of aging and has effects on anogenital prolapse and stress incontinence. There may be iatrogenic causes of both prolapse and stress incontinence when an operation produces a change in the direction of tissue forces or removes a prior barrier to incontinence. It is recommended that the evaluation of patients include the actual and potential aspects of genital prolapse and incontinence and that testing for stress incontinence be performed before and after reduction of the genital prolapse. It is suggested that surgical repair be planned carefully to correct all the significant and potential defects in the urogenital tract. Ideally a normal vaginal axis with adequate length will be restored, and urinary function will not be compromised. 6 figures. 1 table. 24 references. (AA-M)
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Pubovaginal Sling Surgery for Simple Stress Urinary Incontinence: Analysis by an Outcome Score Source: Journal of Urology. 165(5): 1597-1600. May 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study that assessed the results of pubovaginal sling surgery in women with simple stress urinary incontinence (SUI) using strict subjective and objective criteria. Simple incontinence was defined as sphincteric (bladder opening) incontinence with no concomitant urge incontinence, pipe stem or fixed scarred urethra, urethral or vesicovaginal fistula, urethral diverticulum, grade 3 or 4 cystocele, or neurogenic bladder. A total of 67 consecutive women (mean age 56 years plus or minus 11 years) who underwent pubovaginal sling surgery for simple sphincteric incontinence were prospectively followed for 12 to 50 months. Cure was defined as no urinary loss due to urge or stress incontinence, as documented by 24 hour diary and pad test, with the patient considering herself cured. Failure was defined as poor objective results with the patient considering surgery to have failed. Of the 67 patients, 46 (69 percent) had type II and 21 (31 percent) had type III incontinence. Preoperative diary and pad tests revealed a mean of 5.9 (plus or minus 3.6) stress incontinence episodes and a mean urinary loss of 91.8 grams (plus or minus 81.9 grams) per 24 hours. There were no major intraoperative, perioperative, or postoperative complications. Two patients (3 percent) had persistent minimal stress incontinence and 7 (10 percent) had new onset urge incontinence within 1 year after surgery. Overall using the strict criteria of the outcome score, 67 percent of the cases were classified as cured, and the remaining 33 percent were classified as improved. The degree of improvement was defined as a good, fair, and poor response in 21 percent, 9 percent, and 3 percent, respectively. Midterm outcome results defined by strict subjective and objective criteria confirm that the pubovaginal sling is highly effective and safe surgery for simple sphincteric incontinence. A followup of more than 5 years is required to establish the long term durability of this procedure. 2 tables. 11 references.
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Operations for the Treatment of Genuine Stress Incontinence in Female Patients Source: Wilmette, IL: Simon Foundation. 199x. 1 p. Contact: Available from Simon Foundation. P.O. Box 815, Wilmette, IL 60091. PRICE: $1. Summary: This brief article reviews the surgical interventions used to treat stress incontinence in females. The author also emphasizes the potential benefit from doing Kegel (pelvic floor) exercises. Surgical operations discussed include the abdominal suspension surgeries (Marshal-Marchetti-Krantz or Burch), the vaginal or needle suspensions (Stamey, Pereyra, or Raz), cystocele repair, vaginal hysterectomy, and rectocele repair.
Federally Funded Research on Cystocele The U.S. Government supports a variety of research studies relating to cystocele. 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 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
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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 cystocele. 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 cystocele.
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 cystocele, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “cystocele” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for cystocele (hyperlinks lead to article summaries): •
4-Defect repair of grade 4 cystocele. Author(s): Safir MH, Gousse AE, Rovner ES, Ginsberg DA, Raz S. Source: The Journal of Urology. 1999 February; 161(2): 587-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9915454
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A clinical and urodynamic study of patients with varying degrees of cystocele. Author(s): Cosimo O, Pierluigi P, Angelo ZM, Santa U, Gabriele F, Salvatore M. Source: Maturitas. 1997 June; 27(2): 125-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9255747
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A cystocele may compensate for latent stress incontinence by stretching the vaginal hammock. Author(s): Papa Petros PE. Source: Gynecologic and Obstetric Investigation. 1998; 46(3): 206-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9736806
(FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH). 3 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A new surgical technique for repairing cystocele in hysterectomized women. Author(s): Rosing U, Fianu S, Larsson B. Source: J Gynecol Surg. 1990 Winter; 6(4): 281-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10149766
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A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS). Author(s): Kobashi KC, Mee SL, Leach GE. Source: Urology. 2000 December 4; 56(6 Suppl 1): 9-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11114557
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A new vaginal procedure for cystocele repair and treatment of stress urinary incontinence. Author(s): Benizri EJ, Volpe P, Pushkar D, Chevallier D, Amiel J, Sanian H, Toubol J. Source: The Journal of Urology. 1996 November; 156(5): 1623-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8863553
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A simple method for the treatment of lower-third ureteric stones in female patients with cystocele. Author(s): Tuncay OL, Turan T, Bozbay C. Source: British Journal of Urology. 1998 January; 81(1): 159. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9467495
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Anterior and posterior cystocele: cystocele revisited; an account of the twilight hours of some antifacialists and facilists as I knew them. Author(s): Ball T. Source: Clinical Obstetrics and Gynecology. 1966 December; 9(4): 1062-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5958572
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Burch bladder neck suspension for cystocele repair: the necessity of combined vaginal procedures for severe cases. Author(s): Sekine H, Kojima S, Igarashi K, Toyoshima T, Hayashi T, Shimoji Y. Source: International Journal of Urology : Official Journal of the Japanese Urological Association. 1999 January; 6(1): 1-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10221857
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Canalicular cystocele. Author(s): Weinstein GS, Tse DT, Reese PD, Anderson RL. Source: Ophthalmologica. Journal International D'ophtalmologie. International Journal of Ophthalmology. Zeitschrift Fur Augenheilkunde. 1984; 189(1-2): 64-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6472808
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Colposuspension and the possibility of recurrent cystocele. Author(s): Domany B, Bodis J. Source: American Journal of Obstetrics and Gynecology. 1997 October; 177(4): 982-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9369864
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Computed tomography findings in scrotal cystocele. Author(s): Catalano O. Source: European Journal of Radiology. 1995 December 15; 21(2): 126-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8850507
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Cystocele. Etiology. Author(s): Schram M. Source: N Y State J Med. 1976 March; 76(3): 370-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1062689
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Cystocele--a radical cure by suturing lateral sulci of the vagina to the white line of pelvic fascia. 1909. Author(s): White GR. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1997; 8(5): 288-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9557993
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Demonstration of cystocele and uterine procedentia with renal scintigraphy. Author(s): Levey CS, Silverman ED. Source: Clinical Nuclear Medicine. 1998 August; 23(8): 543-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9712396
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Diagnosis of cystocele--the correlation between clinical and radiological evaluation. Author(s): Altman D, Mellgren A, Kierkegaard J, Zetterstrom J, Falconer C, Lopez A. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2004 January-February; 15(1): 3-9; Discussion 9. Epub 2003 December 20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14752591
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Emphysematous pyelonephritis in two diabetic patients with complete uterine prolapse and cystocele. Author(s): Jong IC, Huang JJ, Lan RR, Wang MC, Tseng CC, Chen KW. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 1998 December; 13(12): 3214-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9870495
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Endoscopic vesical neck and uterovaginal suspension for cystocele prolapse repair. Author(s): Sadoughi N, Pessis D. Source: Journal of the American College of Surgeons. 1994 April; 178(4): 326-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8149031
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Four-corner bladder and urethral suspension for moderate cystocele. Author(s): Raz S, Klutke CG, Golomb J. Source: The Journal of Urology. 1989 September; 142(3): 712-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2671413
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Hydronephrosis caused by cystocele. Treatment by colpopexy to sacral promontory. Author(s): Delaere K, Moonen W, Debruyne F, Jansen T. Source: Urology. 1984 October; 24(4): 364-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6237479
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In situ slings with concurrent cystocele repair. Author(s): Serels SR, Rackley RR, Appell RA. Source: Tech Urol. 1999 September; 5(3): 129-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10527254
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Incidence of recurrent cystocele after anterior colporrhaphy with and without concomitant transvaginal needle suspension. Author(s): Kohli N, Sze EH, Roat TW, Karram MM. Source: American Journal of Obstetrics and Gynecology. 1996 December; 175(6): 1476-80; Discussion 1480-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8987928
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Is transabdominal repair of mild to moderate cystocele necessary for correction of prolapse during a modified Burch procedure? Author(s): Lovatsis D, Drutz HP. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(3): 193-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11451008
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Long-term results of Burch colposuspension and anterior colpoperineorraphy in the treatment of stress urinary incontinence and cystocele. Author(s): Cugudda A, Terrone C, Crivellaro S, Rossetti SR. Source: Annales D'urologie. 2002 May; 36(3): 176-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12056090
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Massive scrotal cystocele with bladder cancer. Author(s): Papadimitriou SH, Chlepas MA, Kokinacos CP, Papadopoulos CB. Source: British Journal of Urology. 1991 March; 67(3): 330-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2021831
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Modified four corner bladder neck suspension in anatomical stress incontinence with moderate cystocele. Author(s): Atahan O, Kayigil O, Metin A. Source: International Urology and Nephrology. 1998; 30(4): 439-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9821046
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Obstructive uropathy from a cystocele. Author(s): Angel JR, Roberts JA. Source: Urology. 1981 February; 17(2): 186-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7467027
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Paravaginal defect repair in the treatment of female stress urinary incontinence and cystocele. Author(s): Bruce RG, El-Galley RE, Galloway NT. Source: Urology. 1999 October; 54(4): 647-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10510922
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Pelvic floor lesion (cystocele). Author(s): Hassan K, Ragi I, Taha MA. Source: J Egypt Med Assoc. 1966; 49(2): 192-201. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5959546
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Protective effect of suburethral slings on postoperative cystocele recurrence after reconstructive pelvic operation. Author(s): Goldberg RP, Koduri S, Lobel RW, Culligan PJ, Tomezsko JE, Winkler HA, Sand PK. Source: American Journal of Obstetrics and Gynecology. 2001 December; 185(6): 1307-12; Discussion 1312-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11744901
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Re: Treatment results using a mixed fiber mesh in patients with grade IV cystocele. Author(s): Garvin DD, Miller DA. Source: The Journal of Urology. 1999 October; 162(4): 1388. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10492211
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Role of the four-corner bladder neck suspension to correct stress incontinence with a mild to moderate cystocele. Author(s): Dmochowski RR, Zimmern PE, Ganabathi K, Sirls L, Leach GE. Source: Urology. 1997 January; 49(1): 35-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9000182
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Scrotal cystocele associated with bladder cancer diagnosed by ultrasonography. Author(s): Yagci C, Aytac S, Atasoy C. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 1996 November; 15(11): 793-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8908592
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Scrotal cystocele detected by sonography. Author(s): Weingardt JP, Russ PD, Ch'en IY, Robb LD, Pomerantz H. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 1996 July; 15(7): 539-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8803871
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Scrotal cystocele diagnosed by computed tomography. Author(s): Curry NS, O'Connor KF, Tubbs CO. Source: Urol Radiol. 1988; 9(4): 247-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3394189
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Scrotal cystocele with bladder calculi (case report). Author(s): Postma MP, Smith R. Source: Ajr. American Journal of Roentgenology. 1986 August; 147(2): 287-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3487944
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Scrotal cystocele. Author(s): Wood M. Source: Ariz Med. 1981 July; 38(7): 528-30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7271481
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Scrotal cystocele. Author(s): Croushore JH, Black RB. Source: The Journal of Urology. 1979 April; 121(4): 541-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=439240
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Scrotal cystocele: US and CT findings in two cases. Author(s): Casas JD, Mariscal A, Barluenga E. Source: Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society. 1998 January-February; 22(1): 53-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9745942
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Some aspects of large cystocele and its treatment by colpo- or hysteropexy to the sacral promontory. Author(s): Delaere KP, Moonen WA, Debruyne FM. Source: Acta Urol Belg. 1981 January; 49(1): 55-60. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7211619
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Standing cystourethrogram: an outcome measure after anti-incontinence procedures and cystocele repair in women. Author(s): Showalter PR, Zimmern PE, Roehrborn CG, Lemack GE. Source: Urology. 2001 July; 58(1): 33-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11445475
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Surgical repair of cystocele with mesh by the vaginal route. Author(s): de Tayrac R, Fernandez H. Source: American Journal of Obstetrics and Gynecology. 2002 April; 186(4): 852; Author Reply 852-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11967523
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Technique of combined pubovaginal sling and cystocele repair using a single piece of cadaveric dermal graft. Author(s): Chung SY, Franks M, Smith CP, Lee JY, Lu SH, Chancellor M. Source: Urology. 2002 April; 59(4): 538-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11927309
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The Bologna bladder neck suspension procedure for treatment of stress urinary incontinence associated with cystocele. Author(s): Giacalone PL, Laffargue F, Daures JP, Lombard I. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1998; 9(6): 370-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9891958
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The effects of severe cystocele on urogynecologic symptoms and findings. Author(s): Yalcin OT, Yildirim A, Hassa H. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 May; 80(5): 423-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11328218
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The interureteric ridge sign in a cystourethrographic study of cystocele. Author(s): Kormano M, Unnerus CE. Source: Ann Radiol (Paris). 1971 November-December; 14(11): 819-26. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5142286
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The risk of cystocele after sacrospinous ligament fixation. Author(s): Smilen SW, Saini J, Wallach SJ, Porges RF. Source: American Journal of Obstetrics and Gynecology. 1998 December; 179(6 Pt 1): 1465-71; Discussion 1471-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9855582
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The vaginal patch plastron for vaginal cure of cystocele. Preliminary results for 47 patients. Author(s): Cosson M, Collinet P, Occelli B, Narducci F, Crepin G. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 March; 95(1): 73-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11267724
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Transabdominal repair of cystocele by wedge colpectomy during combined abdominal-vaginal surgery. Author(s): Quadri G, Magatti F, Belloni C, Mattioli G. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 1997; 8(5): 278-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9557991
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Transabdominal repair of cystocele, a 20 year experience, compared with the traditional vaginal approach. Author(s): Macer GA. Source: American Journal of Obstetrics and Gynecology. 1978 May 15; 131(2): 203-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=645801
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Transabdominal repair of cystocele, a 20 year experience, compared with the traditional vaginal approach. Author(s): Macer GA. Source: Trans Pac Coast Obstet Gynecol Soc. 1978; 45: 116-20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=715862
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Treatment results using a mixed fiber mesh in patients with grade IV cystocele. Author(s): Migliari R, Usai E. Source: The Journal of Urology. 1999 April; 161(4): 1255-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10081880
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Urodynamic evaluation of voiding in women with cystocele. Author(s): Rosenzweig BA, Soffici AR, Thomas S, Bhatia NN. Source: J Reprod Med. 1992 February; 37(2): 162-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1538362
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Use of cadaveric solvent-dehydrated fascia lata for cystocele repair--preliminary results. Author(s): Groutz A, Chaikin DC, Theusen E, Blaivas JG. Source: Urology. 2001 August; 58(2): 179-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11489693
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Uterine prolapse and cystocele after an automobile accident. Author(s): Lohiya GS. Source: Annals of Emergency Medicine. 2003 December; 42(6): 850-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14669779
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Vaginal hysterectomy with repair of enterocele, cystocele, and rectocele. Author(s): Lee RA. Source: Clinical Obstetrics and Gynecology. 1993 December; 36(4): 967-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8293597
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Vaginal repair of high-grade cystocele. Author(s): Raz S, Sussman EM, Erickson DR. Source: Contemp Urol. 1991 May; 3(5): 80-94. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10148067
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Vesicosuspension for female stress incontinence and cystocele using pubic bone anchors. Author(s): Visser AJ, Heyns CF, Visser Jun AJ. Source: S Afr J Surg. 2001 November; 39(4): 129-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11820144
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CHAPTER 2. PATENTS ON CYSTOCELE 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.4 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 “cystocele” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on cystocele, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Cystocele By performing a patent search focusing on cystocele, 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
Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm. 4
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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on cystocele: •
Maternity brace Inventor(s): Alberts; Gina (5 North Villas, London NW1 9BJ, GB) Assignee(s): none reported Patent Number: 6,537,132 Date filed: October 26, 2000 Abstract: A maternity brace for providing support to the vulval and abdominal regions of a pregnant woman. The maternity brace has a central vulval panel and a pair of front and rear straps attached thereto. A body-encircling adjusting belt is in communication with the front and rear straps. An abdominal panel positioned between the two front straps applies a supporting force to the abdomen. A back panel along the back of the adjusting belt imparts stability to the lower back. The front and rear straps may be nonlinear to add comfort and support. Wearing the maternity brace improves the overall well-being of an expectant mother and helps to prevent varicose veins, stretch marks, back pain, cystocele, rectocele, hemorrhoids, increased wear on knee and hip joints, reduced blood circulation, and overall fatigue. Excerpt(s): The present invention relates to a support brace for providing support to the vulval and abdominal regions of a pregnant woman and for reducing or eliminating the deleterious effects of the increased body weight of pregnancy. The additional size and weight of the fetus in a pregnancy often impact negatively on several body parts and the overall well-being of an expectant mother. Varicose veins may develop. Hemorrhoids may form. Conditions such as cystocele and rectocele may occur. The additional weight of the fetus places a strain on the lower back and may cause poor posture and back pain. Knee and hip joints may fatigue from the extra stress. Stretch marks may appear in the abdominal region. Thus there is a need for therapies and other means to alleviate or prevent these conditions. Various types of supportive garments and girdles have been proposed to help reduce the deleterious effects of both fetal weight and additional body weight of the expectant mother. For example, Alberts U.S. Pat. No. 3,116,736 discloses a body support having both a vulval support for supporting the vulval region of the wearer and a girdle for providing beneficial support to the abdominal region. Castiglia U.S. Pat. No. 4,195,640 discloses a lower torso support appliance having both an inelastic front panel for engaging the abdominal region of the wearer and a rigid sheet-like member for engaging the lower back. Web site: http://www.delphion.com/details?pn=US06537132__
Patent Applications on Cystocele As of December 2000, U.S. patent applications are open to public viewing.5 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to cystocele:
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This has been a common practice outside the United States prior to December 2000.
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Method and apparatus for correction for gynecological pathologies including treatment of female cystocele Inventor(s): Beyar, Mordechay; (Caesarea, IL), Globerman, Oren; (Herzelia B., IL), Raz, Shlomo; (Los Angeles, CA) Correspondence: Oppenheimer Wolff & Donnelly Llp; 840 Newport Center Drive; Suite 700; Newport Beach; CA; 92660; US Patent Application Number: 20010023356 Date filed: December 27, 2000 Abstract: The present invention relates to apparatus and methods for treatment of male incontinence and a method for female cystocele repair in which a sling material is positioned between the descending rami of the pubic bone. In such an operation a "hammock-like" sling material is positioned below the urethra in males, or below the posterior bladder wall in the case of cystocele in females. Excerpt(s): The present invention relates to methods and devices for treatment of urinary pathologies. Male incontinence is a condition characterized by involuntary loss of urine, beyond the individual's control. One cause for this condition is damage to the urethral sphincter, such as can occur after prostatectomy, after radiation or after pelvic accidents. Other accepted reasons for male incontinence include bladder instability, over-flowing incontinence and fistulas. The present application is directed to the treatment of male urinary incontinence which is related to urethral sphincter damage. Currently, the treatment of choice involves implantation of a Kaufman Prosthesis, an artificial sphincter (such as AMS-800), and a sling procedure in which a sling is inserted beneath the urethra and advanced in the retro pubic space, and perforating the abdominal fascia, such as in female sling procedures. See, Joseph J. Kaufman and Shiomo Raz, Urethral compression procedure for the treatment of male urinary incontinence, Journal of Urology 121: 605-608 (1979). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Vaginal pessary Inventor(s): Gabel, Jonathan Bennett; (Randolph, NJ), Ulmsten, Ulf; (Dandervd, SE), Yang, Dachuan; (Hillsborough, NJ) Correspondence: Selitto, Behr & Kim; 203 Main Street; Metuchen; NJ; 08840; US Patent Application Number: 20030149334 Date filed: June 27, 2002 Abstract: A vaginal insert has a flexible body either in the form of a belt or a split cylinder. In either case, the insert may be coiled into a coiled state. The body has a reduced diameter when coiled and exhibits a resilient bias toward uncoiling and expanding in diameter from the coiled state. When the insert is inserted into the vagina of a patient, it expands and presses against the vaginal wall. This pressure in itself may be therapeutic, e.g., in treating cystocele and incontinence. A medicament may be conjoined with the insert that is introduced to the patient through contact with the insert. The insert can have a simultaneous mechanical and pharmacological effect, e.g., in the instance of treating incontinence with a drug and pressure. The belt-type body may incorporate mating ridges and grooves to keep the insert in a cylindrical
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configuration. Latch elements may be incorporated on the insert to support the insert in an expanded, partially uncoiled state. Excerpt(s): This is a continuation-in-part- to application Ser. No. 09/677,101 entitled "A Vaginal Pessary" and filed on Sep. 29, 2000. The present invention relates to a vaginal device for therapeutic and diagnostic purposes, and more particularly to a resilient vaginal insert that exerts pressure upon the vaginal walls to diagnose and treat various types of pelvic floor defects including urinary incontinence and also to a system for the controlled and sustained delivery of pharmacological compounds for treatment of various diseases inside or outside the genital tract. A significant number of women suffer from urinary stress incontinence, primarily as a consequence of stresses to the musculature of the pelvic floor and ligaments supporting the bladder experienced during childbirth. Surgical remedies and apparatus to aid this condition are known, such as that disclosed in U.S. Pat. No. 5,899,909 relating to a method and apparatus for placing a supportive surgical tape beneath the urethra. Surgery is contraindicated in some patients, however, due to intolerance to anesthesia, preference or other reasons. In addition to surgical treatments for incontinence, it has been known for many years that a suitably proportioned object placed within the vagina proximate to the urethra and/or bladder can be used to support, reposition and/or constrict the urethra and/or bladder to ameliorate incontinence. For example, an inflatable toroidal bladder (U.S. Pat. No. 5,007,894) and a five-sided plate with a U-shaped indentation for supporting/occluding the urethra (U.S. Pat. No. 4,139,006) have been proposed for vaginal insertion to treat incontinence. Certain of the proposed vaginal inserts are formed from resilient material, member with a bladder neck cradle (U.S. Pat. No. 5,036,867) and a folding insert having legs that resiliently urge against the vaginal wall to exert pressure on the urethra (U.S. Pat. No. 5,618,256). 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 cystocele, 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 “cystocele” (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 cystocele. You can also use this procedure to view pending patent applications concerning cystocele. 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 3. BOOKS ON CYSTOCELE Overview This chapter provides bibliographic book references relating to cystocele. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on cystocele 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 “cystocele” (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 cystocele: •
Glenn's Urologic Surgery. 5th ed Source: Philadelphia, PA: Lippincott Williams and Wilkins. 1998. 1149 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: This massive textbook on urologic surgery offers 137 chapters on every aspect of anesthesia, antibiosis, medical techniques, diagnostics, and the fundamental considerations and technical aspects of urologic surgery. The chapters are organized into 14 sections: adrenal, kidney, ureter and pelvis, bladder, prostate, urethra, vas deferens and seminal vesicle, testes, penis and scrotum, urinary diversion, pediatric urology, endoscopy, laparoscopy, and frontiers (future developments). Some specific topics covered are Cushing's disease, primary aldosteronism, nephrectomy (removal of the kidney), renovascular disease, renal trauma, kidney transplantation, ureteral
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reconstruction, cystectomy (bladder removal), bladder augmentation, fistula, interstitial cystitis, prostatectomy (removal of the prostate), prostatic ultrasound and needle biopsy, bladder neck suspension techniques, pelvic floor relaxation, cystocele, female urethral diverticula, vaginal hysterectomy, urethral stricture, vasectomy, simple orchiectomy (removal of the testes), scrotal trauma and reconstruction, Peyronie's disease, priapism, penile prosthesis, penile trauma, urinary diversion techniques, bladder replacement, congenital anomalies, patient selection, circumcision, cystoscopy, kidney stone treatment, urinary stone treatment, stents, and thermotherapy. Each chapter includes diagrams, tables, and a list of references. A detailed subject index concludes the textbook.
Chapters on Cystocele In order to find chapters that specifically relate to cystocele, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and cystocele 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 “cystocele” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on cystocele: •
Cystocele Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 361-371. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: A cystoscele is herniation of the urinary bladder through the weakened supportive fascia of the anterior vaginal compartment. Cystocele is one of the manifestations of pelvic floor relaxation and prolapse. This chapter on cystocele and its surgical correction is from an exhaustive textbook on urologic surgery. The authors stress it is important to ascertain the level of sphincteric competence preoperatively in any patient undergoing cystocele repair. The repair of cystocele is based on several factors: the presence or absence of urinary incontinence, the grade of the cystocele, the inherent pathophysiological fascial weakness (central or lateral), the bladder's emptying ability, and the associated vaginal or abdominal pathology to be repaired. The authors describe the surgical techniques used, including combined repair of lateral and central defects with mesh and vaginal wall sling, repair of lateral defect (six corner bladder suspension), and repair of a central defect. Complications associated with cystocele repair can be avoided by careful attention to detail during dissection of the cystocele and passage of the ligature carrier. Careful cystoscopic evaluation intraoperatively should alert the surgeon to many other potential complications. Postoperative bladder instability is a well documented complication of cystocele repair. Other potential complications are persistent pain, infection, bleeding, recurrent incontinence, vaginal stenosis or shortening, vesicovaginal fistula, ureterovaginal fistula, and dyspareunia (pain during sexual intercourse). 5 figures. 8 references.
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CHAPTER 4. MULTIMEDIA ON CYSTOCELE Overview In this chapter, we show you how to keep current on multimedia sources of information on cystocele. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Video Recordings An excellent source of multimedia information on cystocele is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “cystocele” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “cystocele” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on cystocele: •
Management of Female Stress Incontinence Source: Bellaire, TX: American Urological Association (AUA) Office of Education. 1992. (videocassette). Contact: Available from Karol Media. 350 North Pennsylvania Avenue, P.O. Box 7600, Wilkes-Barre, PA 18773-7600. (800) 608-0096. Fax (717) 822-8226. PRICE: $20.00. Item number 919-2065. Summary: This videocassette program, one of a series from the American Urological Association, presents seven surgical techniques for the management of female urinary stress incontinence. Included are bone fixation technique for transvaginal needle suspension; four-corner bladder suspension in the treatment of moderate cystocele; treatment of female diverticulum complicated by stress urinary incontinence; periurethral injection of cross-linked collagen; transvaginal placement of artificial urinary sphincter; and sling procedures in women. The video also features interviews
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with four of the urologists, who describe patient indications, details of the procedures they performed, and potential complications.
25
CHAPTER 5. PERIODICALS AND NEWS ON CYSTOCELE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover cystocele.
News Services and Press Releases One of the simplest ways of tracking press releases on cystocele 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 “cystocele” (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 cystocele. 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 “cystocele” (or synonyms). 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
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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 “cystocele” (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 “cystocele” (or synonyms). If you know the name of a company that is relevant to cystocele, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “cystocele” (or synonyms).
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “cystocele” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on cystocele:
Periodicals and News
•
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Pelvic Floor Weakness: When the Bottom Gives Way Source: Mayo Clinic Health Letter. 20(5): 4-5. May 2002. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This article, from a health information newsletter, reviews the problem of pelvic floor weakness. The strains of daily life and aging can be factors that weaken and stretch muscles, ligaments, nerves, and other tissues supporting the pelvic organs. Once identified, pelvic floor weakness can sometimes be managed with exercises and noninvasive therapies. Often, though, surgical treatment is preferred and even necessary. The article reviews the physiology and anatomy of the pelvic floor muscles, conditions that may result from weakened pelvic floor muscles (uterine prolapse, cystocele, rectocele, enterocele), the symptoms of those conditions, diagnostic tests that may be done, and treatment options. One sidebar reviews the use of Kegel exercises to strengthen the pelvic floor muscles. 1 figure.
•
Facts about Pessaries Source: Quality Care. 14(4): 6-7. Fall 1996. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. Web site: http://www.nafc.org. Summary: This newsletter article reviews the facts about pessaries, devices used inside the vagina for prolapse, cystocele, or rectocele. The article informs patients about different types of pessaries, including the donut style, the cube style, the inflato ball style, and incontinence ring and dish style. The article also describes a bladder neck support prosthesis called the Introl. The Introl is shaped like a ring with supports which fit up and behind the urethra. It can be used to help with managing incontinence caused by coughing, laughing, lifting, or other activities. The author also comments on the use of a tampon as a simple type of pessary for mild stress incontinence. One sidebar reviews important practical tips about pessary use. The author concludes that although their use may not be for everyone, pessaries provide conservative, nonsurgical choices for women with the problems of prolapse, cystocele, rectocele, or incontinence. The author stresses the importance of finding health care providers with whom one feels comfortable enough to discuss thoughts and concerns. (AA-M).
Academic Periodicals covering Cystocele Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to cystocele. In addition to these sources, you can search for articles covering cystocele 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
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periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute6: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
6
These publications are typically written by one or more of the various NIH Institutes.
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•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
Physician Resources
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.7 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:8 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 8 See http://www.nlm.nih.gov/databases/databases.html. 7
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The NLM Gateway9
The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.10 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “cystocele” (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 52964 89 901 6 0 53960
HSTAT11 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.12 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.13 Simply search by “cystocele” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 11 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 12 The HSTAT URL is http://hstat.nlm.nih.gov/. 13 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. 9
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Coffee Break: Tutorials for Biologists14 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.15 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.16 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
•
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 16 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 14 15
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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 cystocele 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 cystocele. 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 cystocele. 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 “cystocele”:
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Bladder Cancer http://www.nlm.nih.gov/medlineplus/bladdercancer.html Bladder Diseases http://www.nlm.nih.gov/medlineplus/bladderdiseases.html Kidney Diseases http://www.nlm.nih.gov/medlineplus/kidneydiseases.html Pelvic Support Problems http://www.nlm.nih.gov/medlineplus/pelvicsupportproblems.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on cystocele. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
Pelvic Support Problems Source: Washington, DC: American College of Obstetricians and Gynecologists (ACOG). 1991. 4 p. Contact: Available from ACOG Distribution Center. P.O. Box 4500, Kearneysville, WV 25430-4500. (800) 782-2264 or (304) 725-8410, ext. 350. Fax (800) 525-5562. Website: www.acog.com. PRICE: $15.00 for 50 copies. Summary: This brochure acquaints readers with various forms of female pelvic support problems, as well as their causes, symptoms, and treatment. The brochure begins by describing the pelvic organs and the three types of support that hold those organs in place: layers of connecting tissue called fascia, thickening of the fascia called ligaments, and a group of muscles that lie on either side and around the openings of the urethra, vagina, and anus. The main causes of pelvic support defects are childbirth and aging. The symptoms of pelvic support problems depend on which organs are involved and may include a feeling of pelvic heaviness or fullness; discomfort or aching pain in the pelvic area; a pulling or aching sensation in the lower abdomen, groin, or lower back; or leakage of urine. The brochure then describes the main types of pelvic support problems, including cystocele, uterine prolapse, enterocele, rectocele, and vaginal vault prolapse. The next section describes diagnostic tests used to confirm pelvic support problems. The final section describes treatment options, including Kegel exercises, surgical repair, and the use of devices (pessaries). The brochure concludes with a brief glossary of terms. Simple, anatomical line drawings illustrate the brochure. 6 figures.
Patient Resources
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Surgery for Stress Urinary Incontinence Source: San Bruno, CA: StayWell Company. 1998. 15 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. PRICE: $1.35 per copy; plus shipping and handling. Order number 11121. Summary: This patient education booklet reviews the surgical treatment for stress urinary incontinence (SUI). SUI is the problem of leaking urine when there is physical stress (pressure) put on the bladder; this can happen when the patient lifts something heavy, exercises, coughs, sneezes, or laughs, or gets up from a bed or chair. The booklet reviews the anatomy of the pelvis, then discusses preoperative care and preparation, the abdominal surgical procedure, the vaginal surgical procedures, the sling surgical procedure, other problems that may need repair, postoperative recovery in the hospital, and continued recovery at home. The booklet describes in clear, nontechnical language what the patient can expect to happen at each stage of the surgery, including before and after the actual procedure. The booklet lists the risks and possible complications of surgery for SUI, which can include infection; bleeding; the risks of anesthesia; damage to nerves, muscles, or nearby pelvic structures; and blood clots. The booklet reviews other problems that may need repair, including cystocele, uterine prolapse, rectocele, and vaginal vault prolapse. Each surgical procedure is illustrated with simple line drawings. One sidebar lists the postoperative problems that would require a call to the physician. The booklet is illustrated with full color line drawings. 30 figures.
•
How to Use a Pessary Source: American Family Physician. 61(9): 2729. May 1, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This patient education handout explains the use of the pessary, a plastic device that fits into the vagina to help support a woman's uterus, vagina, bladder, or rectum. Although many physicians are unfamiliar with the pessary, it remains an effective tool in the management of a number of gynecologic problems. The handout reviews the practical use of the pessary, which is most commonly used in the management of prolapse of the uterus (in which the uterus droops or falls down into the vagina), for pelvic support defects such as cystocele and rectocele, and in the treatment of stress urinary incontinence (SUI). There are a number of different types of pessaries and the physician will choose the most appropriate type. Followup care will include an immediate postplacement visit to the physician (a few days after the pessary is placed) and then a checkup every few months. Most pessaries can be worn for many days to weeks at a time before they have to be taken out and cleaned with ordinary soap and water. The pessary can fall out of the vagina if the woman strains or lifts something; if this happens regularly, the pessary is most likely too small and the woman should be refitted. Complications can be minimized with simple vaginal hygiene and regular followup visits. Patients are encouraged to contact their physicians if they experience any discomfort with the pessary or experience any trouble urinating or having a bowel movement.
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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 cystocele. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
•
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 cystocele. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with cystocele. 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 cystocele. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at
Patient Resources
41
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 “cystocele” (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 “cystocele”. 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 “cystocele” (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 “cystocele” (or a synonym) into the search box, and click “Submit Query.”
43
APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.17
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
17
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Cystocele
libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)18: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
•
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/
18
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries
45
•
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/
46
Cystocele
•
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
•
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
•
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
•
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
•
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
•
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
•
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
•
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
•
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
•
Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
•
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
•
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
•
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
•
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
•
Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
•
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
•
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
•
National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
•
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
Finding Medical Libraries
47
•
Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
•
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
•
New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
•
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
•
New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
•
New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
•
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
•
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
•
Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
•
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
•
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
•
Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
•
Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
•
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
•
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
•
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
•
Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
•
Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
48
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•
South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
•
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
•
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
•
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
49
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
•
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
51
CYSTOCELE 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] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]
Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anogenital: Pertaining to the anus and external genitals. [EU] Anomalies: Birth defects; abnormalities. [NIH] Antibiosis: A property of microorganisms which enables one microorganism to kill, injure, or inhibit the growth of a different microorganism. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU]
52
Cystocele
Anus: The opening of the rectum to the outside of the body. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Autosuggestion: Suggestion coming from the subject himself. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bladder Calculi: Calculi of the urinary bladder; also known as vesical calculi or bladder stones, and cystoliths. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brace: Any form of splint or appliance used to support the limbs or trunk. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] 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] 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] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Checkup: A general physical examination. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Circumcision: Excision of the prepuce or part of it. [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]
Dictionary 53
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] 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] Colloidal: Of the nature of a colloid. [EU] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Constrict: Tighten; narrow. [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] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH]
54
Cystocele
Cyst: A sac or capsule filled with fluid. [NIH] Cystectomy: Used for excision of the urinary bladder. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dissection: Cutting up of an organism for study. [NIH] Diverticula: Plural form of diverticulum. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Duct: A tube through which body fluids pass. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Enterocele: A hernia in the intestine. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences,
Dictionary 55
or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Estrogen: One of the two female sex hormones. [NIH] 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]
Fetal Weight: The weight of the fetus in utero, which is usually estimated by various formulas based on measurements made during prenatal ultrasonography. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fine-needle aspiration: The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Genital: Pertaining to the genitalia. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH]
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Glomeruli: Plural of glomerulus. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] 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] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]
Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]
Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hysterectomy: Excision of the uterus. [NIH] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Dictionary 57
Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lesion: An area of abnormal tissue change. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] 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] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy
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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] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] 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] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [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] Needle biopsy: The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration. [NIH] Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]
Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Orchiectomy: The surgical removal of one or both testicles. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH]
Dictionary 59
Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [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] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penile Prosthesis: Rigid, semi-rigid, or inflatable cylindric hydraulic devices, with either combined or separate reservoir and pumping systems, implanted for the surgical treatment of organic impotence. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] 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] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pneumonia: Inflammation of the lungs. [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] 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] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] 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
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convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Preoperative: Preceding an operation. [EU] Prepuce: A covering fold of skin; often used alone to designate the preputium penis. [EU] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]
Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protective Clothing: Clothing designed to protect the individual against possible exposure to known hazards. [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] 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] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]
Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH]
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Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Retractor: An instrument designed for pulling aside tissues to improve exposure at operation; an instrument for drawing back the edge of a wound. [NIH] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Seminal vesicles: Glands that help produce semen. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Skin graft: Skin that is moved from one part of the body to another. [NIH] Skin test: A test for an immune response to a compound by placing it on or under the skin. [NIH]
Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Speculum: An instrument used to widen an opening of the body to make it easier to look inside. [NIH] Sperm: The fecundating fluid of the male. [NIH]
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Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Systemic: Affecting the entire body. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] 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] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH]
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Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral resection: Surgery performed with a special instrument inserted through the urethra. Also called TUR. [NIH] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [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] 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] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary urgency: Inability to delay urination. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urologist: A doctor who specializes in diseases of the urinary organs in females and the urinary and sex organs in males. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterine Prolapse: Downward displacement of the uterus. It is classified in various degrees: in the first degree the cervix is within the vaginal orifice; in the second degree the cervix is
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outside the orifice; in the third degree the entire uterus is outside the orifice. [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] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vas Deferens: The excretory duct of the testes that carries spermatozoa. It rises from the scrotum and joins the seminal vesicles to form the ejaculatory duct. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasectomy: An operation to cut or tie off the two tubes that carry sperm out of the testicles. [NIH]
Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Vesicovaginal Fistula: An abnormal communication between the bladder and the vagina. [NIH]
Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]
65
INDEX A Abdomen, 18, 38, 51, 52, 56, 57, 59, 62 Abdominal, 6, 14, 18, 19, 22, 39, 51, 54, 59, 62 Adverse Effect, 4, 51, 61 Aerosol, 51, 62 Algorithms, 51, 52 Alpha Particles, 51, 60 Alternative medicine, 26, 51 Anal, 51, 55 Anatomical, 11, 38, 51 Anesthesia, 20, 21, 39, 51 Ankle, 51, 64 Anogenital, 5, 51 Anomalies, 22, 51 Antibiosis, 21, 51 Antibody, 51, 56 Antigen, 51, 56 Anus, 5, 38, 51, 52, 61 Arteries, 52, 53, 58 Autosuggestion, 52, 56 B Back Pain, 18, 52 Bewilderment, 52, 53 Biopsy, 52 Biotechnology, 7, 26, 33, 52 Bladder, 4, 5, 6, 8, 10, 11, 12, 13, 19, 20, 21, 22, 23, 27, 38, 39, 52, 54, 56, 60, 61, 62, 63, 64 Bladder Calculi, 12, 52 Blood vessel, 52, 60, 61, 64 Body Mass Index, 52, 59 Bowel, 5, 39, 51, 52, 57, 62 Bowel Movement, 5, 39, 52, 62 Brace, 18, 52 C Calculi, 52 Carbon Dioxide, 52, 55 Case report, 12, 52 Caudal, 52, 59 Cell, 52, 57, 58 Cervix, 52, 63 Checkup, 39, 52 Chronic, 52, 56, 62 Circumcision, 22, 52 Clinical trial, 7, 33, 52, 59 Cloning, 52, 53 Collagen, 4, 23, 53, 60
Colloidal, 53, 62 Computational Biology, 33, 53 Computed tomography, 9, 12, 53 Computerized axial tomography, 53 Computerized tomography, 53 Conception, 53, 55 Concomitant, 6, 10, 53 Confusion, 4, 53, 54 Connective Tissue, 53, 57 Constrict, 20, 53 Contraindications, ii, 53 Coronary, 53, 58 Coronary Thrombosis, 53, 58 Corpus, 53, 59 Cyst, 52, 54 Cystectomy, 22, 54 Cystitis, 22, 54 Cystoscopy, 22, 54 D Defecation, 5, 54 Dermal, 13, 54 Diagnostic procedure, 17, 26, 54 Diaphragm, 5, 54 Digestion, 52, 54, 57, 62 Digestive tract, 54, 61 Direct, iii, 54, 59, 61 Disorientation, 53, 54 Dissection, 22, 54 Diverticula, 4, 22, 54 Diverticulum, 6, 23, 54 Dorsal, 54, 59 Duct, 54, 62, 64 Dyspareunia, 22, 54 E Elastin, 53, 54 Electrons, 54, 60 Emulsion, 54, 55 Endoscopy, 21, 54 Enterocele, 5, 15, 27, 38, 54 Environmental Health, 32, 34, 54 Erectile, 55, 59 Estrogen, 5, 55 F Family Planning, 33, 55 Fat, 55, 59 Fatigue, 18, 55 Fetal Weight, 18, 55 Fetus, 18, 55, 60, 64
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Cystocele
Fine-needle aspiration, 55, 58 Fistula, 22, 55 Fixation, 14, 23, 55 Fovea, 55 G Gallbladder, 51, 55 Gas, 52, 55, 58, 62 Gastrin, 55, 56 Gene, 52, 55 Genital, 5, 20, 55, 63 Gland, 55, 57, 58, 59, 60 Glomeruli, 56, 60 Governing Board, 56, 59 Grade, 4, 6, 7, 11, 14, 15, 22, 56 Graft, 13, 56 Grafting, 56 Groin, 38, 56 H Hemorrhoids, 18, 56 Hernia, 4, 54, 56 Hormone, 5, 55, 56 Hydroxylysine, 53, 56 Hydroxyproline, 53, 56 Hysterectomy, 6, 15, 22, 56 I Iatrogenic, 5, 56 Immune response, 51, 56, 61 Implantation, 19, 53, 56 Impotence, 55, 56, 59 Incision, 56, 57, 60 Incontinence, 3, 4, 5, 6, 8, 10, 11, 13, 19, 20, 22, 23, 27, 39, 56, 62 Infarction, 53, 56, 58 Infection, 22, 39, 56, 57, 60, 62 Infertility, 57, 63 Interstitial, 22, 57 Intestine, 52, 54, 57 Intracellular, 56, 57 Intrinsic, 4, 57 Invasive, 57 Involuntary, 19, 57, 58, 61, 62 K Kb, 32, 57 Kidney Pelvis, 57, 63 Kidney stone, 22, 57 Kidney Transplantation, 21, 57 L Laparoscopy, 21, 57 Large Intestine, 54, 57, 61 Latent, 7, 57 Lesion, 11, 57, 63 Ligament, 14, 57, 60
Liver, 51, 54, 55, 57 Localized, 55, 56, 57, 63 Loop, 56, 57 Lumbar, 52, 57 Lymph, 57, 58 Lymph node, 57, 58 Lymphatic, 56, 57 M Magnetic Resonance Imaging, 5, 57 Medicament, 19, 58 MEDLINE, 33, 58 Mental, iv, 6, 32, 34, 53, 54, 55, 58, 60 MI, 49, 58 Microorganism, 51, 58 Molecular, 33, 35, 52, 53, 58 Musculature, 20, 58 Myocardium, 58 N Necrosis, 56, 58 Needle biopsy, 22, 55, 58 Nephrectomy, 21, 58 Nerve, 5, 51, 58 Nervous System, 58 Neutrons, 51, 58, 60 Nitrogen, 55, 58, 63 Nuclei, 51, 54, 58, 60 O Ophthalmology, 8, 55, 58 Orchiectomy, 22, 58 Outpatient, 4, 58 Overweight, 5, 59 P Pancreas, 51, 59 Patch, 14, 59 Pathologies, 19, 59 Patient Education, 38, 39, 44, 46, 49, 59 Patient Selection, 22, 59 Pelvic, 3, 4, 5, 6, 9, 10, 11, 13, 14, 19, 20, 22, 27, 38, 39, 59, 60 Pelvis, 21, 39, 51, 57, 59, 60, 64 Penile Prosthesis, 22, 59 Penis, 21, 59, 60 Perioperative, 6, 59 Phallic, 55, 59 Pharmacologic, 51, 59, 63 Physical Examination, 52, 59 Physiology, 27, 59 Pneumonia, 53, 59 Polypeptide, 53, 59 Posterior, 8, 19, 51, 52, 54, 59 Postoperative, 6, 11, 22, 39, 59 Postoperative Complications, 6, 59
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Practice Guidelines, 34, 59 Prenatal, 55, 60 Preoperative, 6, 39, 60 Prepuce, 52, 60 Prolapse, 4, 5, 8, 10, 15, 22, 27, 38, 39, 60 Proline, 53, 56, 60 Prostate, 21, 60, 63 Prostatectomy, 19, 22, 60 Prosthesis, 19, 27, 60 Protective Clothing, 4, 60 Protein S, 52, 60 Proteins, 51, 53, 58, 60, 63 Protons, 51, 60 Psychiatry, 55, 60 Psychogenic, 60, 63 Public Policy, 33, 60 Pyelonephritis, 9, 60 R Radiation, 19, 60, 64 Radioactive, 56, 60 Radiological, 9, 60 Radiology, 9, 60 Rectal, 5, 61 Rectum, 5, 39, 52, 54, 55, 56, 57, 60, 61 Recurrence, 11, 61 Refer, 1, 55, 58, 61 Remission, 61 Renal pelvis, 57, 61 Renovascular, 21, 61 Retractor, 4, 61 Retropubic, 60, 61 Risk factor, 5, 61 S Screening, 52, 61 Scrotum, 21, 61, 62, 64 Semen, 60, 61 Seminal vesicles, 61, 64 Shock, 61, 63 Side effect, 51, 61, 62 Skin graft, 61, 62 Skin test, 4, 61 Small intestine, 5, 56, 57, 61 Sneezing, 61, 62 Solvent, 15, 61 Specialist, 40, 61 Speculum, 4, 61 Sperm, 61, 62, 64 Spermatozoa, 61, 62, 64 Sphincter, 4, 19, 23, 62 Splint, 52, 62 Stenosis, 22, 62 Stents, 22, 62
Stomach, 51, 54, 55, 56, 61, 62 Stool, 56, 57, 62 Stress, 3, 4, 5, 6, 7, 8, 10, 11, 12, 13, 15, 18, 20, 22, 23, 27, 39, 62 Stress incontinence, 3, 5, 6, 7, 11, 12, 15, 20, 23, 27, 62 Stress urinary, 3, 4, 6, 8, 10, 11, 13, 23, 39, 62 Stricture, 22, 62 Subacute, 56, 62 Subclinical, 56, 62 Suspensions, 6, 62 Symphysis, 60, 62 Systemic, 56, 62 T Testicles, 58, 61, 62, 64 Thigh, 56, 62 Thoracic, 52, 54, 62 Thorax, 51, 57, 62 Tissue, 5, 38, 51, 52, 53, 55, 56, 57, 58, 59, 61, 62 Tomography, 62 Toxic, iv, 62, 63 Toxicology, 34, 63 Toxins, 51, 56, 63 Transfection, 52, 63 Transurethral, 4, 60, 63 Transurethral resection, 60, 63 Transurethral Resection of Prostate, 60, 63 Trauma, 21, 58, 63 Tryptophan, 53, 63 U Ulcer, 63, 64 Ultrasonography, 12, 55, 63 Ureter, 21, 57, 61, 63 Urethra, 4, 6, 19, 20, 21, 27, 38, 59, 60, 63 Urinary, 4, 5, 6, 19, 20, 21, 22, 23, 39, 52, 54, 56, 60, 61, 62, 63 Urinary Retention, 4, 63 Urinary tract, 63 Urinary urgency, 4, 63 Urinate, 63 Urine, 4, 19, 38, 39, 52, 56, 57, 61, 62, 63 Urodynamic, 4, 7, 15, 63 Urogenital, 5, 63 Urologist, 4, 63 Urology, 4, 6, 7, 8, 10, 11, 12, 13, 14, 15, 19, 21, 63 Uterine Prolapse, 5, 9, 27, 38, 39, 63 Uterus, 5, 39, 52, 53, 56, 63, 64 V Vagina, 4, 5, 9, 19, 20, 27, 38, 39, 52, 64
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Cystocele
Vaginal, 4, 5, 6, 7, 8, 13, 14, 15, 19, 20, 22, 38, 39, 63, 64 Varicose, 18, 64 Varicose vein, 18, 64 Vas Deferens, 21, 64 Vascular, 56, 64 Vasectomy, 22, 64 Vein, 64
Venous, 56, 60, 64 Vesicovaginal Fistula, 6, 22, 64 Veterinary Medicine, 33, 64 Volition, 57, 64 W Womb, 64 X X-ray, 53, 60, 64