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

RECTAL BLEEDING 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., 1960Rectal Bleeding: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84604-9 1. Rectal Bleeding-Popular works. I. Title.

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

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

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on rectal bleeding. 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 RECTAL BLEEDING .................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Rectal Bleeding............................................................................ 13 E-Journals: PubMed Central ....................................................................................................... 16 The National Library of Medicine: PubMed ................................................................................ 16 CHAPTER 2. DISSERTATIONS ON RECTAL BLEEDING...................................................................... 55 Overview...................................................................................................................................... 55 Dissertations on Rectal Bleeding ................................................................................................. 55 Keeping Current .......................................................................................................................... 55 CHAPTER 3. BOOKS ON RECTAL BLEEDING .................................................................................... 57 Overview...................................................................................................................................... 57 Book Summaries: Federal Agencies.............................................................................................. 57 Book Summaries: Online Booksellers........................................................................................... 58 Chapters on Rectal Bleeding ........................................................................................................ 58 CHAPTER 4. MULTIMEDIA ON RECTAL BLEEDING ......................................................................... 65 Overview...................................................................................................................................... 65 Video Recordings ......................................................................................................................... 65 CHAPTER 5. PERIODICALS AND NEWS ON RECTAL BLEEDING ...................................................... 67 Overview...................................................................................................................................... 67 News Services and Press Releases................................................................................................ 67 Newsletter Articles ...................................................................................................................... 69 Academic Periodicals covering Rectal Bleeding........................................................................... 70 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 73 Overview...................................................................................................................................... 73 NIH Guidelines............................................................................................................................ 73 NIH Databases............................................................................................................................. 75 Other Commercial Databases....................................................................................................... 77 APPENDIX B. PATIENT RESOURCES ................................................................................................. 79 Overview...................................................................................................................................... 79 Patient Guideline Sources............................................................................................................ 79 Finding Associations.................................................................................................................... 85 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 87 Overview...................................................................................................................................... 87 Preparation................................................................................................................................... 87 Finding a Local Medical Library.................................................................................................. 87 Medical Libraries in the U.S. and Canada ................................................................................... 87 ONLINE GLOSSARIES.................................................................................................................. 93 Online Dictionary Directories ..................................................................................................... 93 RECTAL BLEEDING DICTIONARY........................................................................................... 95 INDEX .............................................................................................................................................. 133

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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 rectal bleeding 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 rectal bleeding, 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 rectal bleeding, 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 rectal bleeding. 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 rectal bleeding, 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 rectal bleeding. 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 RECTAL BLEEDING Overview In this chapter, we will show you how to locate peer-reviewed references and studies on rectal bleeding.

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

Common Anorectal Conditions: Part I. Symptoms and Complaints Source: American Family Physician. 63(12): 2391-2398. June 15, 2001. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: Anorectal symptoms and complaints are common and may be caused by a wide spectrum of conditions. Although most conditions are benign and may be successfully treated by primary care practitioners, a high index of suspicion for colorectal cancer should be maintained, and all patients should be appropriately investigated. This article reviews the symptoms and complaints that patients may present to their primary care doctor. Patients may delay seeking medical advice because of embarrassment or fear of cancer. The authors note that inspection, palpation, and

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anoscopic examination using an Ive's slotted anoscope provide adequate initial assessment. Pruritus ani (anal itching) usually represents a self perpetuating itch scratch cycle and is uncommonly due to infection. The patient's history, as well as the physical examination, can distinguish anal pain due to hemorrhoids, fissure, abscess, cancer, or proctalgia fugax. The most frequent causes of rectal bleeding are hemorrhoids, fissures (abnormal openings from the rectum to other body cavities, organs, or to the skin), and polyps. Diagnoses associated with difficulty in passing stool can range from constipation to fecal incontinence (involuntary loss of stool). 4 figures. 3 tables. 7 references. •

Review of the Causes of Lower Gastrointestinal Tract Bleeding in Children Source: Gastroenterology Nursing. 24(2): 77-83. March-April 2001. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555. Summary: Bleeding may occur anywhere along the gastrointestinal (GI) tract, which covers a large surface area and is highly vascularized. Pediatric patients who present with blood in their stools (bowel movements) are a special challenge for the health care team. Seeing blood in the child's stools, the caregiver and child may become extremely anxious, fearing a devastating diagnosis. This article reviews the causes of lower GI tract bleeding in children. The differential diagnosis of this symptoms in infants and children includes numerous possibilities ranging from benign disorders, which require little or no treatment at all, to serious diseases that require immediate intervention. A complete history, including progression, duration, frequency, and severity of symptoms, is essential in assessing GI bleeding. Associated symptoms that help define the diagnosis include vomiting, diarrhea, constipation, abdominal pain, anorexia (lack of appetite), rash, joint pain or swelling, weight loss, fever, irritability, history of GI bleeding, or history of hematological or immunological disorders. Constipation with fissure (a tear in the anus) formation is the most common cause for rectal bleeding in toddlers and school age children. Infection is one of the more common causes of bleeding from the lower GI tract; infections can be due to Salmonella, Shigella, Campylobacter jejuni; Yersinia enterocolitica, Escherichia coli, Clostridium difficile, or Entamoeba histolytica. Other causes include swallowed blood, hemorrhoids, inflammatory bowel disease (IBD), intussusception (a portion of the bowel turns in on itself, creating an obstruction), polyps, lymphonodular hyperplasia, Meckel's diverticulum, allergic colitis, Henoch Schonlein purpura, hemolytic uremic syndrome (HUS), enterocolitis, child sexual abuse, and Munchausen syndrome by proxy.

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Gastrointestinal Bleeding in Infancy and Childhood Source: Gastroenterology Clinics of North America. 29(1): 37-66. March 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: Gastrointestinal (GI) bleeding is an alarming problem in children. Although many causes of GI bleeding are common to children and adults, the frequency of specific causes differs greatly, and some lesions, such as necrotizing enterocolitis or allergic colitis, are unique to children. This article reviews the spectrum of GI bleeding in infants and children. The author discusses the causes (etiology), diagnostic evaluation, and management, and highlights the differences with adult medicine. The more common causes of upper GI bleeding in children are ulcer and gastritis, esophagitis, and varices (enlarged veins or arteries). A detailed history and careful

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physical examination accompanied by limited laboratory studies may identify the underlying cause and predict the severity of gastrointestinal hemorrhage. Endoscopy is the preferred diagnostic procedure because it is sensitive and specific and, for some lesions, provides the means for immediate treatment. Medical therapy (drugs) is similar for adults and children, differing mostly in the dosage of medications. One table lists pediatric doses for medications commonly used in upper gastrointestinal bleeding. Endoscopic therapy may be used in children with an actively bleeding focal lesion or with a lesion at high risk of rebleeding. Surgery is reserved for bleeding that is uncontrollable by less invasive interventions. The latter part of the article reviews lower GI bleeding, noting that age is an important factor in diagnosis of etiology (cause). Colonoscopy is the preferred diagnostic modality for rectal bleeding. The article concludes with a brief description of small bowel hemorrhage, usually due to Meckel's diverticulum (a congenital anomaly), duplications of the bowel, or idiopathic necrotizing enteritis. 4 figures. 3 tables. 212 references. •

Coping with Chronic Disorders in Children Source: Digestive Health and Nutrition. p. 8, 32. July-August 1999. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. Email: [email protected]. Summary: Living with a chronic disorder is difficult at any age, but helping a child cope with a diagnosis of potentially lifelong management can be particularly challenging. This article offers strategies for coping with chronic disorders in children. The author uses the case of a small boy (age 3) diagnosed with ulcerative colitis. This is an inflammatory bowel disorder (IBD) that features inflammation of the rectum and colon which keeps water from being absorbed into the bloodstream and results in diarrhea. Other common symptoms of UC include abdominal cramps and rectal bleeding. The author reports the child's improvement after diagnosis and the parents' relief at having a healthy child who was accepting his daily regimen of medications. However, after the initial transition time, the parents began to worry about the causes of the boy's disease and his future, including social activities such as spending the night with friends, attending regular schools, and having to explain the disease to a prospective spouse. The author follows the family through the boy's cycle of remission and recurrence and emphasizes the need to explore additional strategies for management. The parents realize that they must accept the child's condition before being able to teach the child how to cope with a chronic disease. 6 references.

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Hemorrhoids and More: Common Causes of Blood in the Stool Source: Digestive Health and Nutrition. 3(4): 24-26. July-August 2001. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. Email: [email protected]. Summary: Most rectal bleeding is caused by hemorrhoids, which usually can be simply and effectively treated. This article reviews the many other conditions, including some serious disorders, that can cause blood in the stool. The author reminds readers that bleeding from any part of the nearly 40 foot long digestive tract can cause blood in the stool. Accurate and timely diagnostic tests are important to determine the cause of any bleeding. Bleeding higher up in the gut, from the esophagus or stomach, can result in stools with a black, tarry appearance. Bleeding from the lower end, such as the colon, or

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in large amounts, can appear as pure blood, blood clots, or as blood mixed with or streaking the stool. Another kind of blood, occult or hidden blood, may not be visible at all. A number of prescription and over the counter (OTC) medications can cause bleeding in the stomach and small intestine. The blood thinning drug warfarin also can induce bleeding in the intestine, as can some antibiotics. Other causes of bleeding can include ulcers, gastritis (inflammation of the stomach lining), ulcerative colitis, Crohn's disease, polyps (small growths inside the intestine), diverticular disease, abnormalities in the blood vessels (vascular anomalies), anal fissures (tears) and fistulas (abnormal openings between the anal canal and other organs, such as the bladder), and abscesses (pockets of infection. The author reiterates the importance of timely diagnosis, including a thorough patient history and evaluation of symptoms. Diagnostic tests can include blood tests, digital rectal examination, endoscopy, colonoscopy, sigmoidoscopy, fecal occult blood test, barium x rays, angiography (x rays of blood vessels), and nuclear scanning. Treatment depends on the source and extent of the bleeding. •

Inflammatory Bowel Disease in Pediatric and Adolescent Patients Source: Gastroenterology Clinics of North America. 28(2): 445-458. June 1999. Contact: Available from W.B. Saunders. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Once considered rare in pediatric practice, chronic inflammatory bowel disease (IBD) is now being recognized with increasing frequency in children of all ages. This article reviews IBD in pediatric and adolescent patients. In addition to the usual gastrointestinal symptoms of diarrhea, abdominal pain, weight loss, anemia, joint symptoms, and rectal bleeding, children may exhibit prominent extraintestinal manifestations such as growth failure and delayed puberty. Other problems unique to pediatrics include the lack of controlled clinical trials and the lack of medications available for and tested in children, as well as the psychological issues that occur in children and adolescents with IBD. The authors stress that these unique problems necessitate a different medical approach than is used for adult onset IBD. A critical factor in the successful management of this disease is the willingness of the patient to cooperate with the multidisciplinary care team. Parents and patients must be educated and supported to treat these disorders effectively. 1 table. 61 references. (AA-M).

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Polyposis Syndromes: Pediatric Implications Source: Gastrointestinal Endoscopy Clinics of North America. 11(4): 659-682. October 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Polyposis syndromes have been managed in the past by geneticists and adult gastroenterologists, but now increasingly fall into the practice of the pediatric gastroenterologist. Gastrointestinal polyps in children most commonly present with rectal bleeding, but of more concern, may have potential for malignant change. This article reviews the polyposis syndromes, their malignant potential, and their management algorithms. Topics include histopathologic classification of gastrointestinal polyps, clinical management, juvenile polyp, juvenile polyposis syndrome, PeutzJeghers syndrome (PJS), familial adenomatous polyposis, desmoid disease, other polyposis syndrome, and the role of the polyposis registries. The author also discusses the genetics of these syndromes and future advances. Children and adolescents with a polyposis syndrome are faced with the immediate complications of the polyps, such as

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intussusception or bleeding, plus the extraintestinal manifestations and the long-term risk of malignancy. Because the conditions are rare, an individual clinician may only see a child with polyposis every few years. The approach to care of these families should be multidisciplinary, involving a polyposis registry, a pediatric gastroenterologist, colorectal surgeon, pathologist, geneticist, and specialist nurses, all of whom should be familiar with the varied presentations and problems faced by these patients. 11 figures. 2 tables. 84 references. •

Inflammatory Bowel Disease: Origins, Presentation, and Course Source: Postgraduate Medicine. 103(5): 77-80, 83-84. May 1998. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: The exact cause of inflammatory bowel disease (IBD) remains unknown, but its destructive nature is clearly recognized. This article, the first of two on IBD, summarizes the pathogenesis and epidemiology of ulcerative colitis (UC) and Crohn's disease. Ways to distinguish between these two facets of IBD, both clinically and pathologically, are explained, as are disorders that may mimic IBD. The incidence and prevalence of IBD vary greatly with geographic location and ethnic background. The greatest risk factor is a family history of IBD and immunopathologic alterations culminating in IBD have only recently been described. UC is by definition confined to the colonic mucosa. Inflammation virtually always involves the rectum and is continuous and confluent to its proximal margin. The upper gastrointestinal tract and small bowel are not significantly involved; such involvement suggests Crohn's disease. Common presenting signs of UC include rectal bleeding, diarrhea, abdominal pain, and tenesmus. Crohn's disease is characterized by transmural inflammation. Any part of the gastrointestinal tract can be inflamed, but certain locations are more commonly involved than others. Transmural inflammation can lead to complications not often seen with UC, such as stricture formation, obstruction, fistulas, and abscesses. IBD can have hepatobiliary, rheumatologic, dermatologic, and ocular complications as well. 4 tables. 32 references. (AA-M).

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Radiation Proctitis Source: Practical Gastroenterology. 15(1): 15-21. January 1991. Summary: This article discusses radiation proctitis and includes a review of the effects of X-rays on tissue and the evolution of symptomatic intestinal injury, and concludes with an outline of the clinical manifestations and treatment of this disorder. Specific topics include the incidence of radiation proctitis, the effects of ionizing radiation on tissue, additional factors affecting cell survival, acute radiation injury, vascular changes, radiation pathology and the development of symptoms, the clinical presentation and diagnostic evaluation of this condition, rectal bleeding, and future improvements in therapy. The author concludes that the current therapy for advanced radiation injury to the intestine and rectum is generally not satisfactory. 2 figures. 1 table. 18 references.

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Coping with the Pain and Annoyance of Hemorrhoids Source: Digestive Health and Nutrition. p. 20-23. January-February 2000. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. Email: [email protected].

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Summary: This article helps readers understand and cope with hemorrhoids. The author describes how to distinguish between types of hemorrhoids, how to recognize the possible symptoms, and what treatment options are available. Following is a description of typical hemorrhoidal bleeding (bright red blood on the toilet tissue or in the toilet water); readers are encouraged to consult with a health care provider for even relatively minor rectal bleeding. Hemorrhoids are then defined in terms of their location. Internal hemorrhoids arise from blood vessels that lie up to 2 inches inside the anus, and external hemorrhoids form under the anal skin. Internal hemorrhoids, which are not usually seen or felt unless they protrude downward outside the anus, can cause other symptoms, including a feeling of fullness in the rectum (particularly after passing stool) or deep itching (pruritus). The author explores possible reasons why some people develop hemorrhoids, including certain working conditions (such as lots of sitting), weak muscles within the bowels, low fiber diets (which can result in straining with defecation), and pregnancy. Diagnostic tests can rule out other possible causes of rectal bleeding, including anal fissure, Crohn's disease or ulcerative colitis (inflammatory bowel diseases), Meckel's diverticulum, and cancer or noncancerous polyps in the bowel. Treatment options are reviewed, from lifestyle and dietary changes to topical therapy, to surgical treatments (rubber band ligation, laser treatment, and sclerosing injections). •

Mesalamine Capsules for Treatment of Active Ulcerative Colitis: Results of a Controlled Trial Source: American Journal of Gastroenterology. 88(8): 1188-1197. August 1993. Summary: This article reports on a study that was undertaken to determine the efficacy of a capsule formulation of mesalamine in 374 patients with mild to moderately active ulcerative colitis. Patients, stratified to pancolitis or left sided disease, received either placebo or mesalamine at 1, 2, or 4 grams daily for 8 weeks. Efficacy was assessed using clinical improvement (physician global assessment, sigmiodoscopic index, biopsy score, trips to the toilet, and clinical symptoms including abdominal pain, urgency, stool consistency, and rectal bleeding) and induction of remission (more stringent criteria for physician global assessment, sigmoidosocpic index, and biopsy score). For physician global assessment of treatment benefit, 79 percent and 84 percent of patients on the 2 g and 4 g dose of mesalamine, respectively, received treatment benefit, compared with 54 percent on placebo. For the physician global assessment of treatment success, both the 2 g and 4 g doses of mesalamine were superior to placebo (57 percent and 59 percent of patients, respectively, compared to 36 percent on placebo). Significant improvement compared to placebo was also observed at 2 g and 4 g for the four clinical symptoms and trips to the toilet. Oral mesalamine capsules were significantly superior to placebo for inducing remission, with 29 percent of patients at 2 g and 29 percent at 4 g achieving remission by physician global assessment, compared with 12 percent on placebo. Treatment response was not affected by extent of disease or prior steroid or sulfasalazine therapy. These data suggest that controlled release mesalamine capsules are a safe and effective monotherapy in doses of 2 to 4 grams daily for treating mild to moderatively active ulcerative colitis, as well as for inducing remission. 3 figures. 7 tables. 35 references.

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Case Study: Antibiotic-Induced Acute Diarrhea Source: Physician Assistant. 24(11): 56-58. November 2000. Contact: Available from Springhouse Corporation. Physician Assistant, P.O. Box 908, Springhouse, PA 19477. (215) 646-8700. Fax (215) 646-4399.

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Summary: This article reports the case of a 57 year old woman who presented to the emergency department with a 4 day history of abdominal cramps, nausea, and 2 to 3 episodes of watery diarrhea per day. She denied fever, vomiting, or bright red rectal bleeding. Her medical history was significant for seasonal allergic rhinitis, sinusitis, and depression. The differential diagnosis in this case included acute gastroenteritis, nonspecific abdominal pain, infectious diarrhea, giardiasis, Crohn's disease, ulcerative colitis, and antibiotic associated colitis (AAC). Because the clinical suspicion was high for AAC, the patient was given the diagnosis of presumptive Clostridium difficile enterocolitis and the cefpodoxime (a drug she was taking for the sinus infection) was stopped. She was started on metronidazole (Flagyl) 500 milligrams 3 times daily for 10 days and placed on a banana, applesauce, rice, and toast (BRAT) diet. At a family practice follow up appointment 2 days later, the patient was feeling much better. Laboratory studies showed presence of C. difficule toxins. The article describes this patient's need for a second course of drug therapy before complete resolution of the problem. The discussion section notes that antibiotic precipitated diarrhea is fairly common and may occur during the course of treatment or for several weeks after termination of the therapy. The first step for treating this disorder is discontinuing the probably offending antibiotics and starting treatment empirically with Flagyl or oral vancomycin. Antispasmodics are not recommended as they may worse the infectious process by prolonging contact between the organism and the intestinal mucosa. If the symptoms persist despite appropriate therapy, consultation with an infectious disease specialist is indicated. 3 references. •

Nutrition Management of Crohn's Disease Source: Today's Dietitian. 1(5): 36-39. May 1999. Contact: Available from Great Valley Publishing Company, Inc. 1288 Valley Forge Road, P.O. Box 2224, Suite 51, Valley Forge, PA 19482-2224. (610) 917-9300. Fax (610) 917-9186. Summary: This article reviews for dietitians the nutritional management of Crohn's disease (CD), one of the two diseases that comprise inflammatory bowel disease (IBD). Crohn's disease is characterized by diverse symptoms that remit and recur; CD typically features diarrhea, weight loss, and abdominal pain. Other symptoms can include rectal bleeding, fever, dermatologic and ocular (eye) irritation and inflammation, anemia resulting from blood loss, and delayed development and stunted growth in children. CD is diagnosed through a comprehensive medical history (including a history of food tolerances and intolerances), an assessment of symptoms, a thorough physical examination, and blood and stool testing. Although nutrition interventions cannot cure CD, medical nutrition therapy (MNT) strives to decrease or ease symptoms, to enhance drug effects, and to replenish nutrient deficiencies caused both by symptoms and by medications. The author reviews four areas that contribute to malnutrition in CD: gastrointestinal nutrient losses such as those that result from diarrhea, fistula and inflammation; poor intake in the presence of nausea, pain, bloating, and taste disturbances; malabsorption resulting from the use of medications, inflammation, and small bowel damage or removal; and increased nutrient needs due to infection or fever. Nutrition support is used as a primary source of nutrition or as an adjunct to oral feeding. Enteral feedings may be continuous, intermittent, or nocturnal. Elemental formulas are advanced as inflammation and ulceration resolve. Total parenteral nutrition (TPN, which totally bypasses the GI tract) is necessary when complete bowel rest is mandated and in patients with short bowel syndrome. TPN is initiated to supply all nutrient needs and the patient then adapts back to enteral or oral feeding as bowel problems resolve. The author concludes that differences in the presentation of CD, in

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responses to therapy, and in food tolerances result in a challenge to the dietitian working with this patient population. 1 figure. •

Controlling the Symptoms of Crohn's Disease Source: Digestive Health and Nutrition. 3(2): 24-29. March-April 2001. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (301) 654-2055, ext. 650. Website: www.dhnonline.org. Summary: This article reviews the current treatment strategies used to control the symptoms of Crohn's disease, a type of inflammatory bowel disease (IBD). Crohn's disease (CD) can cause inflammation anywhere in the digestive tract, including the mouth, but it usually occurs in the lower part of the small intestine (the ileum) or in the large intestine (colon). The specific cause of chronic inflammation in CD remains unknown, although it is likely to be a response to interactions between the environment, genetics, and the body's immune response. The most common symptoms of CD are diarrhea, abdominal pain, rectal bleeding, weight loss, and fever. The most frequent complications are intestinal blockage, ulcers in the intestinal wall, and fistulas. Malnutrition is another serious complication related to CD; people with CD may have poor appetites because of chronic pain, or they may avoid eating because they fear they will experience diarrhea and abdominal pain. A cure for CD has not yet been found, but treatments can be prescribed to control inflammation and allow the intestinal lining to heal, to relieve symptoms and manage complications, to reduce the need for surgery, and to correct nutritional deficiencies. Commonly prescribed drugs fall into five categories: aminosalicylates, antibiotics, corticosteroids, immunomodulatory drugs, and biologic therapy. When drug therapy fails to control CD, surgery is often necessary to correct complications such as intestinal obstruction or fistulas, and it may help relieve symptoms. The article concludes by briefly mentioning the important role of support groups in helping patients with CD cope with their chronic illness. Appended to the article is a list of additional resources, primarily websites.

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Anal Fissure: Unclear Causes But Promising New Treatments Source: JAAPA. Journal of the American Academy of Physician Assistants. 13(2): 45-47, 51-52, 55-56, 59. February 2000. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This article reviews the medical problem of anal fissure, focusing on patient care management. An anal fissure is a painful linear ulcer involving the epithelium of the anal canal. Many patients experience painful, bright red rectal bleeding, and the typical presenting complaint is a hemorrhoid. The author reviews the anatomy and physiology of the anal canal; the pathogenesis, presentation, and diagnosis of acute and chronic anal fissure; and the treatment options for this condition. An acute anal fissure, whose etiology is often clear, can usually be cured with conservative measures. The etiology of chronic anal ulcer is, however, under debate; hypotheses include anatomic arrangement, ischemia of the anoderm, and high anal resting pressures. The current treatment of choice for a chronic anal ulcer is lateral internal sphincterotomy. This irreversible surgical procedures carries a risk of flatus (gas) and stool incontinence. Several new and safe treatment options are now used, with varying success; the author discusses these options and patient followup, focusing on the care typically provided by

Studies 11

a physician's assistant. Appended to the article is a posttest with which readers can qualify for continuing medical education (CME) credit. 3 figures. 2 tables. 25 references. •

Pediatric Colonoscopy Source: Practical Gastroenterology. 21(3): 7-8, 13-14, 19-20, 25-27. March 1997. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, one in a series on pediatric endoscopy, considers the role of pediatric colonoscopy. Colonoscopy is now routinely performed in children with the use of intravenous conscious sedation or general anesthesia. The indications for pediatric colonoscopy differ from those for colonoscopy in adults. Rectal bleeding, protracted diarrhea, suspected polyps, and inflammatory bowel disease are the most common indications for colonoscopy in children. Colonoscopy is not useful in the evaluation of children with constipation and isolated recurrent abdominal pain. The technique of colonoscopy is modified for children, with emphasis on minimal loop formation and greater patient comfort during the procedure. Intubation of the terminal ileum is a standard part of the pediatric colonoscopy, and it is important for the diagnosis of Crohn's disease. Children require close monitoring for respiratory depression during colonoscopy. Resuscitation equipment of an appropriate size and pediatric dosages of medications should be available during endoscopic procedures. 8 figures. 18 references. (AA).

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Indications for Colonoscopy in Children Reviewed at Meeting Source: IBD Chronicle. 1(1): 11-12. May 1993. Contact: Available from Medical Information Services P.O. Box 1384, Ansonia Station, New York, NY 10023. Summary: This newsletter article reports on conferences and research related to inflammatory bowel disease (IBD). The article describes a session on pediatric endoscopy that reviewed the indications for colonoscopy in infants and children. Topics include the contraindications for colonoscopy; the use of colonoscopy in diagnosing lower gastrointestinal bleeding, rectal bleeding, chronic ulcerative colitis, and colonic polyposis; surveillance colonoscopy; the endoscopic management of the difficult polyp in children; equipment and supplies; the importance of adequate sedation; and colonoscopic findings in ulcerative colitis and in Crohn's disease.

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Radiology Source: Current Opinion in Gastroenterology. 6(1): 50-53. February 1990. Summary: This review of current activities in the field of gastroenterologic radiology covers radiological errors in the investigation of rectal bleeding; the barium enema in rectal carcinoma; lymphoid follicles and small polyps; magnetic resonance imaging for recurrent rectal cancer; ultrasonography in appendicitis; and the diagnosis and management of intussusception. 15 annotated references.

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Ulcerative Colitis: A Rational Approach to Management Source: Consultant. 41(4): 541-548. April 1, 2001. Contact: Available from Cliggott Publishing Company. 330 Boston Post Road, Darien, CT 06820-4027. (203) 661-0600.

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Summary: Ulcerative colitis (UC), a type of inflammatory bowel disease can manifest as proctitis or proctosigmoiditis, left sided colitoss, or pancolitis. This article offers a rational approach to the management of patients with UC. Frequent low volume bowel movements, urgency, rectal bleeding, and tenesmus (ineffective spasms of the rectum) alone suggest proctitis. Prostration, fever, tachycardia (racing heartbeat), dehydration, and complications of blood loss (which may or may not be accompanied by symptoms of proctitis) suggest more severe disease or more extensive bowel involvement. For patients with mild to moderate disease, mesalamine is recommended to induce and maintain remission. Systemic corticosteroids can induce remission in patients with moderate to severe disease but are not useful for maintenance therapy. Azathioprine or 6 mercaptopurine can be used to wean patients with moderate to severe colitis from corticosteroids and to maintain remission. If severe colitis does not respond to corticosteroids, immunosuppressive therapy or colectomy may be needed. Other indications for surgery include development of acute complications related to disease activity and chronic complications, such as dysplasia, carcinoma, recurrent hemorrhage, or growth retardation in children. Annual surveillance colonoscopy with biopsy is recommended for patients with pancolitis and left sided colitis. •

Review Article: Potential Therapeutic Applications and Mechanisms of Action of Heparin in Inflammatory Bowel Disease Source: Alimentary Pharmacology and Therapeutics. 14(11): 1403-1409. November 2000. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: Unfractioned heparin was recently reported to be beneficial in the treatment of inflammatory bowel disease (IBD). This article reviews the potential therapeutic applications and mechanisms of action of heparin in IBD. The available uncontrolled data show that the drug may be effective in steroid resistant ulcerative colitis (UC) with a percent of complete clinical remission of over 70 percent, after an average of 4 to 6 weeks of therapy. The administration of unfractioned heparin is not currently justified by the very limited available data. The worsening of rectal bleeding is infrequent in treated UC patients and only rarely does it require blood transfusion or a colectomy (removal of part of the colon). Low molecular weight heparin was used in a single trial in patients with steroid refractory UC, with results similar to those observed with unfractioned heparin. Since a prothrombotic state has been described in IBD, and microvascular intestinal occlusion (blockage of the smallest blood vessels in the intestine) seems to play a role in the pathogenesis of IBD, it is reasonable that part of the beneficial effects of unfractioned heparin in IBD may result from its anticoagulant properties. However, beyond its well known anticoagulant activity, unfractioned heparin also exhibits a broad spectrum of immunomodulating and anti inflammatory properties, by inhibiting the recruitment of neutrophils and reducing pro inflammatory cytokines. Moreover, heparin can restore the high affinity receptor binding of basic fibroblast growth factor; this would aid healing of the ulcerated mucosa. The authors conclude that unfractioned heparin may represent a safe therapeutic option for severe, steroid resistant UC, although randomized, controlled trials are needed to confirm this data. 1 figure. 2 tables. 71 references.

Studies 13

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

Project Title: BACTERIAL INFLAMMATION

MODULATION

OF

GASTROINTESTINAL

Principal Investigator & Institution: Czinn, Steven J.; Professor; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002 Summary: Inflammatory bowel disease is a general term used to describe a group of chronic inflammatory disorders of the gastrointestinal tract. The two major clinical entities are ulcerative colitis and Crohn's disease. The two major clinical entities are ulcerative colitis and Crohn's disease. Clinically ulcerative colitis is confined to the large intestine, whereas Crohn's disease may affect any part of the gastrointestinal tract. The Crohn'S & Colitis Foundation of America estimates that about two million Americans suffer from inflammatory bowel disease, 300,000 of them in the pediatric age group. Despite traditional medical therapy, inflammatory bowel disease in children results in significant morbidity such as chronic abdominal pain, rectal bleeding, anemia, weight loss and growth stunt. While active investigation has yet to discover what causes inflammatory bowel disease, it is believed than an inappropriate host immune response to antigens (bacteria or flood) normally found in the gastrointestinal tract results in a state of chronic inflammation. It has been difficult to investigate the relationship between luminal bacteria and immune dysregulation due to the lack of a colitis model induced by a single well-defined organism. Infection of the normally abiotic mouse stomach with Helicobacter and Lactobacillus species provides an excellent model for the investigation of bacteria-associated chronic inflammation of the gastrointestinal mucosa. We have developed several murine models in which various bacterial species, that are either normally non pathogenic or are only mildly pathogenic, can induce a state of chronic mucosal inflammation. The inflammatory response can be generated either by deleting or adding various immunoregulatory cytokines, or by systemically immunizing mice prior to infection. Of particular importance is the observation that the mucosal inflammation is maintained even when organisms are no longer detectable by microbiological and molecular techniques. Using these models we will test the central 2

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

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hypotheses that chronic gastrointestinal inflammation results from an aberrant immune response to antigenic stimulus, consisting of normal gastrointestinal bacteria. We propose to investigate the relationship between mucosal bacteria and immune regulation in the early, intermediate and late stages of chronic mucosal inflammation using our unique models of gastric Helicobacter and Lactobacillus infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL STUDIES: DOSE DISTRIBUTIONS AND OUTCOME ANALYSIS Principal Investigator & Institution: Leibel, Steven A.; Sloan-Kettering Institute for Cancer Res New York, Ny 10021 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The overall goals of RP1 are to use advanced techniques of IMRT to improve local control and to reduce the morbidity associated with the radiotherapy of carcinomas of the prostate and nasopharynx. Having demonstrated in prostate cancer a safe escalation of dose to 86.4 Gy, the first aim of RP1a is to address the important question of whether androgen deprivation will obviate the need for higher doses or whether androgen deprivation is unnecessary when higher dose levels can be administered. A randomized Phase III trial will be conducted, comparing the outcomes of 86.4 Gy IMRT alone with the combination of adjuvant androgen deprivation and 75.6 Gy IMRT, in either unfavorable risk or intermediate risk patients with Gleason scores of 8-10. We hypothesize that 86.4 Gy will improve local control and decrease the rate of distant metastasises to the same extent as 75.6 Gy and androgen deprivation therapy and that the quality of life of patients treated with radiotherapy alone will be superior to that of those receiving adjuvant androgen deprivation. The second aim is to conduct a Phase I dose-escalation study in stages IIIVB nasopharynx carcinoma using the 'dose painting' capability of IMRT to deliver a simultaneous, fieldwithin-a-field boost to regions of gross disease. Thirty fractions of 2.34 Gy to 70.2 Gy, and then 2.5 Gy to 75 Gy, will be tested. Much improvement is needed in the local outcome for advanced nasopharynx cancer, and preliminary results from our pilot study indicate that local tumor control may be improved with IMRT. We will ultimately test whether an improvement in local control by IMRT may result in a survival benefit. RP1b will investigate the influence of dose distributions, target and normal organ volumes irradiated, and anatomic location on outcome. Data from the dose-escalation and Phase III prostate trials will be used to assess the influence of volumes of rectal wall at the various doses on late rectal bleeding. We will study the dependence of biopsy outcome on risk group and dose distributions, and use data from high-dose patients to test the hypothesis that the inhomogeneities in their PTV/rectum overlap do not prevent improvement in outcome. Data from the lung studies in RP2 will be used to assess the influence of volume and location of irradiated lung on pneumonitis and provide limits for the safe treatment of NSCLC. Our initial study in nasopharynx aims to provide limits on the target inhomogeneity that will prevent significant loss of local control. These limits will determine the maximum degree of cochlea sparing for each patient. The study results will also generate the dose response of cochlea hearing loss and provide a rational basis for the minimization of both local failure and hearing loss. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 15

•

Project Title: CORE--CLINICAL PHYSICS Principal Investigator & Institution: Chui, Chen-Shou; Sloan-Kettering Institute for Cancer Res New York, Ny 10021 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The tasks of the Clinical Core are to a) provide treatment plans, quality assurance and monitoring of treatment delivery for patients treated in the Research Projects (RP), b)gather setup uncertainty data for head and neck patients, c) implement specialized treatment methods to enhance tumor localization and reduce the effects of treatment uncertainty developed in the research projects, and d) work with the Computer/Dosimetry Core and RPs to implement improvements to the treatment planning software. Intensity modulated radiotherapy (IMRT) plans will be designed for the treatment of prostate, nasopharynx and non-small cell lung tumors. For prostate tumors, plans will be created for patients treated with either 86.4 Gy IMRT or 75.6 Gy IMRT plus adjuvant androgen deprivation. The feasibility of image-guided "dose-painting" using IMRT in prostate cancer will also be evaluated using the image registration and delivered dose calculation methods developed in RP 3. This study will establish the limitations of IMRT to deliver 91.8 Gy to suspected tumor-bearing regions within the prostate. Patients with non-small cell lung tumors will be entered into a dose escalation study and will receive radiation alone or concurrent radiation and chemotherapy. They will be planned and treated with respiratory gated IMRT. Tumor localization will be improved with the use of respiration-gated PET/CT images. Plans will be designed using CT images from the portion of the respiratory cycle showing minimum tumor motion, selected from spiral CT images correlated with respiration. Fifty patients will be treated using megavoltage cone-beam CT imaging (MVCBI) to visualize tumor position during treatment. The IMRT plans for these patients will be designed with explicit consideration of the dose delivered during MVCBI. Patients with nasopharynx cancer will be entered into a Phase I dose escalation study, receiving either 70.2 or 75 Gy using osepainting and IMRT. Plans will deliver a non-uniform dose distribution concurrently treating sites of gross disease to 2.34 or 2.5 Gy per fraction and electively irradiated regions to 1.8 Gy per fraction. MR and PET images will be used to improve target and normal tissue localization. Techniques will be developed using enhanced inverse planning tools designed by the Computer Core to minimize salivary gland and cochlear doses. Setup uncertainty will be measured and incorporated into dose calculations facilitating an analysis of delivered dose to the tumor and normal tissues. Improvements in the inverse planning system will include biophysical models from RP 1b, i.e. improved normal tissue complication probability calculations for rectal bleeding, tumor control probability for nasopharynx tumors, and dose response data for sensorineural hearing loss, etc., applied to plan design as they become available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INFANTS WITH RECTAL BLEEDING--DEFINING ALLERGIC COLITIS & ROLE OF EOSINOPHILS Principal Investigator & Institution: Schwimmer, Jeffrey B.; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 452293039 Timing: Fiscal Year 2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

Rectal bleeding and colorectal cancer in general practice: diagnostic study. by Wauters H, Van Casteren V, Buntinx F.; 2000 Oct 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27509

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

44-year-old man with rectal bleeding. Author(s): Lehman G, Wellman H, Lappas J, Warfel K. Source: Indiana Med. 1985 February; 78(2): 127-33. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3871806

•

A case of rectal bleeding in infancy. Author(s): Leighton DM, Benghanem T, Montagne JP, Gruner M. Source: Australasian Radiology. 1990 February; 34(1): 89-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2357199

3 4

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

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

Studies 17

•

A case of spontaneous rupture of the colon with haemoperitoneum and rectal bleeding. Author(s): Christeas N, Georgoulis B, Hadzigiannakis E. Source: The British Journal of Surgery. 1969 April; 56(4): 310-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4952483

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A comparative study of double contrast barium enema and colonoscopy for evaluation of rectal bleeding in children. Author(s): Aggarwal V, Mittal SK, Kumar N, Chowdhury V. Source: Trop Gastroenterol. 1995 April-June; 16(2): 132-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8644363

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A current approach to rectal bleeding. Author(s): Levinson SL, Powell DW, Callahan WT, Jones JD, Kinard HB 3rd, Jackson AL, Lapis JL, Drossman DA. Source: Journal of Clinical Gastroenterology. 1981; 3 Suppl 1: 9-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6976985

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A randomized prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia. Author(s): Jensen DM, Machicado GA, Cheng S, Jensen ME, Jutabha R. Source: Gastrointestinal Endoscopy. 1997 January; 45(1): 20-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9013165

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A rare rectal tumor presenting with encopresis and rectal bleeding in a three-year-old girl: case report and review of the literature. Author(s): Michail S, Broxon E, Mezoff A, Preud'homme D, Hitch D. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 October; 35(4): 580-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12394388

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A retrospective study on the management of rectal bleeding. Author(s): Krishnan J, Berce MJ, Sweeney J, Hoffmann DC. Source: The Australian and New Zealand Journal of Surgery. 1987 September; 57(9): 6358. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3500706

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A solitary jejunal vascular abnormality: a source of massive rectal bleeding. Author(s): Saunders MP. Source: Postgraduate Medical Journal. 1991 July; 67(789): 683-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1924060

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•

Abdominal pain and rectal bleeding as a complication of biliary stent migration in a liver transplant recipient. Author(s): Yoshida EM, Steinbrecher UP. Source: Gastrointestinal Endoscopy. 1998 May; 47(5): 418-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9609442

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Absent portal vein presenting as rectal bleeding: a case report. Author(s): Lee JS, Yeong KY, Soo KC. Source: Journal of the Royal College of Surgeons of Edinburgh. 1994 April; 39(2): 118-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7520066

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Acute massive rectal bleeding as a presenting sign of Crohn disease. Author(s): Smith-Behn J, Banez A, Brown T, Simon R, Lin P. Source: N Y State J Med. 1988 October; 88(10): 545-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3265996

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Allergic colitis with rectal bleeding in an exclusively breast-fed neonate. Author(s): Perisic VN, Filipovic D, Kokai G. Source: Acta Paediatr Scand. 1988 January; 77(1): 163-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3259362

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Amebiasis presenting as rectal bleeding without diarrhea in childhood. Author(s): Jammal MA, Cox K, Ruebner B. Source: Journal of Pediatric Gastroenterology and Nutrition. 1985 April; 4(2): 294-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3872933

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Amoebic rectal bleeding in children. Author(s): Kalani BP, Sogani KC. Source: Am J Proctol. 1975 April; 26(2): 67-70. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1078941

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An unusual case of endometriosis causing rectal bleeding. Author(s): Andreyev HJ, Meyrick-Thomas J, Pathmanathan S, Macfarlane BJ. Source: Endoscopy. 1999 September; 31(7): S53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10533747

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An unusual cause of rectal bleeding in a patient with cystic fibrosis. Author(s): Treepongkaruna S, Hardikar W, Chow CW, Smith AL, Oliver MR. Source: Journal of Gastroenterology and Hepatology. 1999 March; 14(3): 281-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10197500

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Anal “epistaxis”: exteriorization of rectal bleeding during colonoscopy. Author(s): Delpre G, Niv Y. Source: Digestive Diseases and Sciences. 1995 October; 40(10): 2293. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7587803

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Anal verge and low rectal bleeding. A diagnostic problem. Author(s): Jaques PF, Fitch DD. Source: Journal of Clinical Gastroenterology. 1986 February; 8(1): 38-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3486208

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Analysis of the colonoscopic findings in patients with rectal bleeding according to the pattern of their presenting symptoms. Author(s): Church JM. Source: Diseases of the Colon and Rectum. 1991 May; 34(5): 391-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2022144

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Aneurysm of the superior hemorrhoidal artery: an unusual cause of massive rectal bleeding. Author(s): Pond GD, Ovitt TW, Witte CL, Farrell K. Source: J Can Assoc Radiol. 1977 June; 28(2): 146-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=300737

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Angiodysplasia of the colon: a cause of rectal bleeding. Author(s): Athanasoulis CA, Galdabini JJ, Waltman AC, Novelline RA, Greenfield AJ, Ezpeleta ML. Source: Cardiovasc Radiol. 1977-78; 1(1): 3-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=311247

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Angiodysplasia--an uncommon cause of colonic bleeding: colonoscopic evaluation of 1,050 patients with rectal bleeding and anaemia. Author(s): Danesh BJ, Spiliadis C, Williams CB, Zambartas CM. Source: International Journal of Colorectal Disease. 1987 November; 2(4): 218-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3500991

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Angiolymphoid hyperplasia with eosinophilia in the colon: a novel cause of rectal bleeding. Author(s): Berney DM, Griffiths MP, Brown CL. Source: Journal of Clinical Pathology. 1997 July; 50(7): 611-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9306946

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Ano-rectal bleeding. Author(s): Thomson JP. Source: Nurs Times. 1979 January 25; 75(4): 142-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=253285

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Ano-rectal bleeding. Author(s): Fuller JH. Source: The Practitioner. 1984 September; 228(1395): 825-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6332313

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Ano-rectal bleeding: a study of causes and investigative yields. Author(s): Williams JT, Thomson JP. Source: The Practitioner. 1977 September; 219(1311): 327-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=303765

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Aortocolic fistula: a rare cause of profuse rectal bleeding. Author(s): Kassum D, Kim S, Shojania AM, Kirkpatrick JR. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 1983 May; 26(3): 293-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6850443

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Apoptotic epithelial cells in biopsy specimens from infants with streaked rectal bleeding. Author(s): Kumagai H, Masuda T, Maisawa S, Chida S. Source: Journal of Pediatric Gastroenterology and Nutrition. 2001 April; 32(4): 428-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11396808

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Appendiceal intussusception: an unusual cause of painless rectal bleeding. Author(s): Brewer RJ, Wangensteen SL. Source: The American Surgeon. 1974 May; 40(5): 319-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4544976

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Argon plasma coagulation for rectal bleeding after prostate brachytherapy. Author(s): Smith S, Wallner K, Dominitz JA, Han B, True L, Sutlief S, Billingsley K. Source: International Journal of Radiation Oncology, Biology, Physics. 2001 November 1; 51(3): 636-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11597803

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Benign rectal ulceration of unknown origin. An unusual cause of rectal bleeding. Author(s): Howard ER, Whimster WF. Source: Archives of Disease in Childhood. 1976 February; 51(2): 156-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1083214

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Bilateral foot drop, weight loss and rectal bleeding as an acute presentation of Crohn's disease. Author(s): Gariballa SE, Gunasekera NP. Source: Postgraduate Medical Journal. 1994 October; 70(828): 762-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7831180

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Case for diagnosis. Rectal bleeding. Author(s): Johnson FB. Source: Military Medicine. 1981 October; 146(10): 723, 732. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6795541

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Catastrophic rectal bleeding from a ruptured splenic artery aneurysm. Author(s): Ek ET, Moulton CA, Mackay S. Source: Anz Journal of Surgery. 2003 May; 73(5): 361-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12752301

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Causes of ano-rectal bleeding. Author(s): Dehn T, McGinn FP. Source: Postgraduate Medical Journal. 1982 February; 58(676): 92-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6980405

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Causes of rectal bleeding in children. Author(s): Lawrence WW, Wright JL. Source: Pediatrics in Review / American Academy of Pediatrics. 2001 November; 22(11): 394-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11691950

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Cavernous haemangioma of the rectum: an uncommon cause of rectal bleeding. Author(s): Mathai V, Vyas FL, Jesudason SR. Source: Trop Gastroenterol. 2003 January-March; 24(1): 42-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12974218

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Challenge of chronic radiation-induced rectal bleeding. Author(s): Chapuis P. Source: Anz Journal of Surgery. 2001 April; 71(4): 200-1. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11355724

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Characteristics of neonates with isolated rectal bleeding. Author(s): Maayan-Metzger A, Ghanem N, Mazkereth R, Kuint J. Source: Archives of Disease in Childhood. Fetal and Neonatal Edition. 2004 January; 89(1): F68-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14711861

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Choriocarcinoma presenting with massive rectal bleeding. Author(s): Knobel J. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1973 November 10; 47(44): 2120. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4543519

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Chronic arthropathy and rectal bleeding in a long-term haemodialysis patient. Author(s): Zingraff J, Droz D, Touam M, Voisin MC, Drueke T. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 1995 November; 10(11): 2153-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8643191

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Chronic rectal bleeding after high-dose conformal treatment of prostate cancer warrants modification of existing morbidity scales. Author(s): Hanlon AL, Schultheiss TE, Hunt MA, Movsas B, Peter RS, Hanks GE. Source: International Journal of Radiation Oncology, Biology, Physics. 1997 April 1; 38(1): 59-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9212005

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Clinical course of rectal bleeding following I-125 prostate brachytherapy. Author(s): Hu K, Wallner K. Source: International Journal of Radiation Oncology, Biology, Physics. 1998 May 1; 41(2): 263-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9607339

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Clinical observations on diverticulosis-diverticulitis of the appendix. Rectal bleeding in association with symptoms of acute appendicitis suggests diagnosis. Author(s): Tamvakopoulos SK. Source: R I Med J. 1969 August; 52(8): 443-4 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4979423

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Colonic fistulization with rectal bleeding: a rare complication in acute necrotizing pancreatitis. Author(s): Aletras H, Eleftheriadis E. Source: World Journal of Surgery. 1989 November-December; 13(6): 823. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2623893

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Colonic lipoma presenting with recurrent rectal bleeding. Author(s): Kochhar R, Malik AK, Nagi B, Mehta SK, Wig JD. Source: Br J Clin Pract. 1990 August; 44(8): 324-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2206838

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Colonic lymphoma as a cause of massive rectal bleeding in a cardiac transplant recipient. Author(s): Stylianos S, Chen MH, Treat MR, LoGerfo P, Rose EA. Source: The Journal of Cardiovascular Surgery. 1990 May-June; 31(3): 315-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2370264

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Colonic tuberculosis presenting with massive rectal bleeding. Author(s): Pozniak AL, Dalton-Clark HJ, Ralphs DN. Source: Tubercle. 1985 December; 66(4): 295-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3878613

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Colonic varices. Unusual cause of rectal bleeding. Author(s): Pickens CA, Tedesco FJ. Source: The American Journal of Gastroenterology. 1980 January; 73(1): 73-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6966468

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Colonic varices: an often unrecognized cause of rectal bleeding. Author(s): Slee GR, Wagner SM, McCullough FS. Source: Gastrointestinal Endoscopy. 1985 April; 31(2): 107-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3873376

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Colonoscopic diagnosis and management of rectal bleeding. Author(s): Shinya H, Cwern M, Wolf G. Source: The Surgical Clinics of North America. 1982 October; 62(5): 897-903. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6981860

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Colonoscopic evaluation of rectal bleeding in young adults. Author(s): Acosta JA, Fournier TK, Knutson CO, Ragland JJ. Source: The American Surgeon. 1994 November; 60(11): 903-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7978692

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Colonoscopic evaluation of rectal bleeding: a study of 304 patients. Author(s): Tedesco FJ, Waye JD, Raskin JB, Morris SJ, Greenwald RA. Source: Annals of Internal Medicine. 1978 December; 89(6): 907-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=309745

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Colonoscopic findings in patients with hemorrhoids, rectal bleeding and normal rectoscopy. Author(s): Bat L, Pines A, Rabau M, Niv Y, Shemesh E. Source: Isr J Med Sci. 1985 February; 21(2): 139-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3872288

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Colonoscopy after Golytely preparation in acute rectal bleeding. Author(s): Caos A, Benner KG, Manier J, McCarthy DM, Blessing LD, Katon RM, Gogel HK. Source: Journal of Clinical Gastroenterology. 1986 February; 8(1): 46-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3486210

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Colonoscopy for intermittent rectal bleeding: impact on patient management. Author(s): Graham DJ, Pritchard TJ, Bloom AD. Source: The Journal of Surgical Research. 1993 February; 54(2): 136-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8479171

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Colonoscopy for investigation of unexplained rectal bleeding in a tropical country. Author(s): Bhargava DK, Rai RR, Chopra P. Source: Gastroenterol Jpn. 1990 December; 25(6): 781-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2279640

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Colonoscopy for rectal bleeding in childhood. Author(s): Holgersen LO, Mossberg SM, Miller RE. Source: Journal of Pediatric Surgery. 1978 February; 13(1): 83-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=305476

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Colonoscopy for unexplained rectal bleeding. Author(s): Fried MB. Source: British Medical Journal. 1979 March 17; 1(6165): 753. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=312123

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Colonoscopy for unexplained rectal bleeding. Author(s): Swarbrick ET, Fevre DI, Hunt RH, Thomas BM, Williams CB. Source: British Medical Journal. 1978 December 16; 2(6153): 1685-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=310702

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Colonoscopy in acute rectal bleeding. Author(s): Forde KA. Source: Gastrointestinal Endoscopy. 1981 November; 27(4): 219-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6975735

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Colonoscopy in acute rectal bleeding. Author(s): Forde KA. Source: Compr Ther. 1985 December; 11(12): 26-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3878265

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Colonoscopy in patients aged 80 years or older and its contribution to the evaluation of rectal bleeding. Author(s): Bat L, Pines A, Shemesh E, Levo Y, Zeeli D, Scapa E, Rosenblum Y. Source: Postgraduate Medical Journal. 1992 May; 68(799): 355-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1630980

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Colonoscopy in rectal bleeding. Author(s): Waye JD. Source: S Afr J Surg. 1976 September; 14(3): 143-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1087049

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Colonoscopy in the diagnosis of unexplained rectal bleeding. Author(s): Brand EJ, Sullivan BH Jr, Sivak MV Jr, Rankin GB. Source: Annals of Surgery. 1980 July; 192(1): 111-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7406555

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Colonoscopy in the diagnosis of unexplained rectal bleeding. Author(s): Knoepp LF Jr, McCulloch JH. Source: Diseases of the Colon and Rectum. 1978 November-December; 21(8): 590-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=310757

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Colonscopy for investigation of unexplained rectal bleeding. Author(s): Teague RH, Thornton JR, Manning AP, Salmon PR, Read AE. Source: Lancet. 1978 June 24; 1(8078): 1350-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=78109

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Colorectal cancer and polyps in patients aged 40 years and over who consult a GP with rectal bleeding. Author(s): Norrelund N, Norrelund H. Source: Family Practice. 1996 April; 13(2): 160-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8732328

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Colorectal polyps: an important cause of rectal bleeding. Author(s): Perisic VN. Source: Archives of Disease in Childhood. 1987 February; 62(2): 188-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3493736

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Comparison of predictive value for colorectal cancer in subjects with and without rectal bleeding. Author(s): Nakama H, Kayano T, Katsuura T, Kamigaito T, Shimada S, Nishikawa N, Yoshii S, Kamijo N. Source: Hepatogastroenterology. 1999 May-June; 46(27): 1730-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10430332

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Conformal irradiation of the prostate: estimating long-term rectal bleeding risk using dose-volume histograms. Author(s): Hartford AC, Niemierko A, Adams JA, Urie MM, Shipley WU. Source: International Journal of Radiation Oncology, Biology, Physics. 1996 October 1; 36(3): 721-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8948358

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Correlations between dose-surface histograms and the incidence of long-term rectal bleeding following conformal or conventional radiotherapy treatment of prostate cancer. Author(s): Fenwick JD, Khoo VS, Nahum AE, Sanchez-Nieto B, Dearnaley DP. Source: International Journal of Radiation Oncology, Biology, Physics. 2001 February 1; 49(2): 473-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11173143

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Crohn ileitis and massive rectal bleeding. Author(s): Schneider R. Source: N Y State J Med. 1988 October; 88(10): 519-20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3265995

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Cyclical rectal bleeding in colorectal endometriosis. Author(s): Levitt MD, Hodby KJ, van Merwyk AJ, Glancy RJ. Source: The Australian and New Zealand Journal of Surgery. 1989 December; 59(12): 941-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2597100

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Cytomegalovirus ileitis presenting as massive rectal bleeding in infancy. Author(s): Kawimbe B, Bem C, Patil PS, Bharucha H. Source: Archives of Disease in Childhood. 1991 July; 66(7): 883-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1650544

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Defining the clinical problem of massive rectal bleeding. Author(s): Heald RJ. Source: Diseases of the Colon and Rectum. 1974 July-August; 17(4): 432-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4211903

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Defining the role of fiberoptic sigmoidoscopy in the investigation of patients presenting with bright red rectal bleeding. Author(s): Van Rosendaal GM, Sutherland LR, Verhoef MJ, Bailey RJ, Blustein PK, Lalor EA, Thomson AB, Meddings JB. Source: The American Journal of Gastroenterology. 2000 May; 95(5): 1184-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10811325

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Delay in consulting a medical practitioner about rectal bleeding. Author(s): Byles JE, Redman S, Hennrikus D, Sanson-Fisher RW, Dickinson J. Source: Journal of Epidemiology and Community Health. 1992 June; 46(3): 241-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1645079

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Diagnosing rectal bleeding. Author(s): McConnell EA. Source: Nursing. 1991 August; 21(8): 102-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1870765

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Diagnostic yield of colorectal neoplasia with colonoscopy for abdominal pain, change in bowel habits, and rectal bleeding. Author(s): Neugut AI, Garbowski GC, Waye JD, Forde KA, Treat MR, Tsai JL, Lee WC. Source: The American Journal of Gastroenterology. 1993 August; 88(8): 1179-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8338084

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Diverticular disease and minor rectal bleeding. Author(s): Kewenter J, Hellzen-Ingemarsson A, Kewenter G, Olsson U. Source: Scandinavian Journal of Gastroenterology. 1985 October; 20(8): 922-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3878575

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Diverticular disease of the colon. A frequent cause of massive rectal bleeding. Author(s): Behringer GE, Albright NL. Source: American Journal of Surgery. 1973 April; 125(4): 419-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4540320

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Diverticular rectal duplication with heterotopic gastric mucosa in a child: a rare cause of rectal bleeding. Author(s): Kumar R, Shun A, Arbuckle S, Gaskin K. Source: Journal of Paediatrics and Child Health. 2000 April; 36(2): 191-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10760025

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Do patients assess rectal bleeding accurately? Author(s): Ann Intern Med. 2002 Jan 15;136(2):I30 Source: Anz Journal of Surgery. 2001 November; 71(11): 650-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11928734

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Does isolated rectal bleeding suggest colorectal cancer? Author(s): Douek M, Wickramasinghe M, Clifton MA. Source: Lancet. 1999 July 31; 354(9176): 393. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10437872

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Dose/volume relationship of late rectal bleeding after external beam radiotherapy for localized prostate cancer: absolute or relative rectal volume? Author(s): Kupelian PA, Reddy CA, Carlson TP, Willoughby TR. Source: Cancer Journal (Sudbury, Mass.). 2002 January-February; 8(1): 62-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11895204

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Duodenocolic fistula causing rectal bleeding. Author(s): Balaji V, Clark J, Klimach OE. Source: Journal of the Royal Society of Medicine. 1998 September; 91(9): 494-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9849526

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Dyschromatopsia (number 97) and rectal bleeding. Author(s): Stiff GJ, Haray PN, Foster ME. Source: Bmj (Clinical Research Ed.). 1996 September 7; 313(7057): 594. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8806249

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Early detection of colorectal cancer. Preliminary report on the prospective value of a combined screening method for occult rectal bleeding. Author(s): Otto S, Czalbert JH, Papp I, Eckhardt S. Source: Oncology. 1990; 47(3): 209-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2342763

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Ectopic gastric mucosa in rectum: a rare cause of rectal bleeding in children. Author(s): Menchaca Marines MC, Posselt HG, Waag KL. Source: Journal of Pediatric Gastroenterology and Nutrition. 1988 March-April; 7(2): 293-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2832586

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Ectopic pregnancy presenting as intermittent rectal bleeding and anemia. A case report. Author(s): de Boer CN. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1986 October; 24(5): 379-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2880773

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Ectopic prostatic tissue of the anal canal presenting with rectal bleeding: report of a case. Author(s): Tekin K, Sungurtekin U, Aytekin FO, Calli N, Erdem E, Ozden A, Yalcin N. Source: Diseases of the Colon and Rectum. 2002 July; 45(7): 979-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12130891

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Embolization of superior haemorrhoidal artery in the management of life-threatening rectal bleeding. Author(s): Derodra JK, Reidy JF, Jourdan MH. Source: The British Journal of Surgery. 1992 July; 79(7): 704-5. Erratum In: Br J Surg 1992 October; 79(10): 1108. Br J Surg 1993 March; 80(3): 396. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1643492

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Endoscopic treatment of massive rectal bleeding following prostate needle biopsy. Author(s): Strate LL, O'Leary MP, Carr-Locke DL. Source: Endoscopy. 2001 November; 33(11): 981-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11668408

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Endoscopic v radiological techniques for rectal bleeding. Author(s): Charnley RM. Source: Gut. 1989 April; 30(4): 558-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2785476

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Etopic pregnancy causing massive rectal bleeding. Author(s): Patterson SP, Frankum CE, Sexton H. Source: Southern Medical Journal. 1978 November; 71(11): 1449-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=309659

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Evans' syndrome in Castleman's disease: unusual presentation with rectal bleeding from angiodysplasia of cecum. Author(s): Rothstein H, Pfefferman R, Kusminski G, Hurwitz N, Berrebi A. Source: Isr J Med Sci. 1992 November; 28(11): 807-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1468898

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Factors associated with the frequency of stool examination: effect on incidence of reported rectal bleeding. Author(s): Kang JY, Rink E, Sundaram KK, Hartley I. Source: European Journal of Gastroenterology & Hepatology. 2003 May; 15(5): 531-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12702911

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Fatal rectal bleeding due to tuberculosis of the cecum. Author(s): Goudarzi HA, Mason LB. Source: Jama : the Journal of the American Medical Association. 1982 February 5; 247(5): 667-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6976444

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Five hundred consecutive sigmoidoscopies for frank rectal bleeding: an analysis. Author(s): Udezue NO. Source: Trop Doct. 1989 April; 19(2): 72-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2786657

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Focal rectal capillaritis: microscopic polyangiitis presenting as painless rectal bleeding. Author(s): Komanduri S, Jakate S, Keshavarzian A. Source: Journal of Clinical Gastroenterology. 2002 August; 35(2): 157-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12172362

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Frank rectal bleeding: a prospective study of causes in patients over the age of 40. Author(s): Cheung PS, Wong SK, Boey J, Lai CK. Source: Postgraduate Medical Journal. 1988 May; 64(751): 364-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3143995

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Gastric duplication presenting rectal bleeding. A clinical case supporting McLedtchie's theory. Author(s): da Costa JM, Mariz CM, de Sousa JA, Gonzaga RA, de Sousa RM, dos Santos NT. Source: Arquivos De Gastroenterologia. 1993 April-September; 30(2-3): 62-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8147736

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Gastric heterotopic mucosa in the rectum with Helicobacter pylori-like organisms: a rare cause of rectal bleeding. Author(s): Kestemberg A, Marino G, de Lima E, Garcia FT, Carrascal E, Arredondo JL. Source: International Journal of Colorectal Disease. 1993 March; 8(1): 9-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8492046

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Gastroenterology: a hypothetical case of rectal bleeding; incorporating a management self-test. Author(s): Kaufman B, Rogers AI. Source: Postgraduate Medicine. 1976 September; 60(9): 233-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1085446

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Hemangioma of the cecum: an overlooked cause of rectal bleeding. Author(s): Andiran F, Tanyel FC. Source: Journal of Pediatric Gastroenterology and Nutrition. 2000 March; 30(3): 330-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10749422

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Hematuria and rectal bleeding in the child with Klippel and Trenaunay syndrome. Author(s): Servelle M, Bastin R, Loygue J, Montagnani A, Bacour F, Soulie J, Andrieux JB. Source: Annals of Surgery. 1976 April; 183(4): 418-28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=178278

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Hematuria, rectal bleeding and pelvic phleboliths in children with the KlippelTrenaunay syndrome. Author(s): Azouz EM. Source: Pediatric Radiology. 1983; 13(2): 82-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6304604

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Heterotopic gastric mucosa of the rectum. A rare cause of rectal bleeding. Author(s): Jordan FT, Mazzeo RJ, Soiderer MH. Source: Archives of Surgery (Chicago, Ill. : 1960). 1983 July; 118(7): 878-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6602605

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Histopathology and microbiology of isolated rectal bleeding in neonates: the socalled 'ecchymotic colitis'. Author(s): Canioni D, Pauliat S, Gaillard JL, Mougenot JF, Bompard Y, Berche P, Schmitz J, Brousse N. Source: Histopathology. 1997 May; 30(5): 472-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9181369

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History of visible rectal bleeding in a primary care population. Initial assessment and 10-year follow-up. Author(s): Helfand M, Marton KI, Zimmer-Gembeck MJ, Sox HC Jr. Source: Jama : the Journal of the American Medical Association. 1997 January 1; 277(1): 44-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8980209

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How do general practitioners manage rectal bleeding? Author(s): Sladden MJ, Thomson AN. Source: Aust Fam Physician. 1998 January-February; 27(1-2): 78-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9503712

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How important is rectal bleeding in the diagnosis of bowel cancer and polyps? Author(s): Goulston KJ, Cook I, Dent OF. Source: Lancet. 1986 August 2; 2(8501): 261-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2874287

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Human immunodeficiency virus infection in Mexico City. Rectal bleeding and anal warts as risk factors among men reporting sex with men. Author(s): Coplan PM, Gortmaker S, Hernandez-Avila M, Spiegelman D, Uribe-Zuniga P, Mueller NE. Source: American Journal of Epidemiology. 1996 November 1; 144(9): 817-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8890660

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Impact of modern diagnostic methods on the management of active rectal bleeding. Ten year experience. Author(s): Colacchio TA, Forde KA, Patsos TJ, Nunez D. Source: American Journal of Surgery. 1982 May; 143(5): 607-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6979266

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Importance of unreported rectal bleeding. Author(s): Chambliss L, Hale W. Source: The Journal of Family Practice. 1997 April; 44(4): 341-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9108827

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Incidence and causes of rectal bleeding in general practice as detected by colonoscopy. Author(s): Metcalf JV, Smith J, Jones R, Record CO. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1996 March; 46(404): 161-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8731622

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Infra-diaphragmatic total anomalous pulmonary venous drainage presenting with rectal bleeding. Author(s): Elias-Jones AC, Cordner SV. Source: Archives of Disease in Childhood. 1983 August; 58(8): 637-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6604501

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Initial evaluation of rectal bleeding in young persons: a cost-effectiveness analysis. Author(s): Lewis JD, Brown A, Localio AR, Schwartz JS. Source: Annals of Internal Medicine. 2002 January 15; 136(2): 99-110. Summary for Patients In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11790061

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Intermittent unexplained rectal bleeding in childhood. Author(s): Bhargava DK, Chawla Y. Source: Indian J Pediatr. 1983 May-June; 50(404): 329-32. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6607886

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Interstitial pregnancy complicated by rectal bleeding. Author(s): Warshal DP, Fultz PJ, Dawson AE, Del Priore G, DuBeshter B. Source: American Journal of Obstetrics and Gynecology. 1996 November; 175(5): 1373-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8942518

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Intraoperative endoscopic localization of jejunal angiodysplasia as a source of massive rectal bleeding. Author(s): Steele JT, Cardwell RJ, Wagner SM, Merrick HW. Source: Surgical Endoscopy. 1989; 3(1): 56-9; Discussion 59-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2785296

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Intussusception of the appendix: another poorly recognized cause of rectal bleeding. Author(s): Gupta P, Chwals W, Guandalini S. Source: Journal of Pediatric Gastroenterology and Nutrition. 2000 March; 30(3): 320-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10749420

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Investigating chronic, bright red, rectal bleeding. Author(s): Mehanna D, Platell C. Source: Anz Journal of Surgery. 2002 December; 72(12): 923-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12485238

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Investigating chronic, bright red, rectal bleeding. Author(s): Mehanna D, Platell C. Source: Anz Journal of Surgery. 2001 December; 71(12): 720-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11906386

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Investigating rectal bleeding: red faced or reliable? Author(s): Macrae F. Source: Anz Journal of Surgery. 2001 December; 71(12): 699-700. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11906379

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Investigation of rectal bleeding. Author(s): Kang JY. Source: Singapore Med J. 1991 October; 32(5): 327-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1788576

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Investigation of rectal bleeding. Author(s): Raine PA. Source: Archives of Disease in Childhood. 1991 March; 66(3): 279-80. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2024999

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Investigation of rectal bleeding. Author(s): Friedman E. Source: Lancet. 1989 March 4; 1(8636): 492. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2563855

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Isolated aneurysm of internal iliac artery; Producing rectal bleeding. Author(s): Baron HC. Source: N Y State J Med. 1979 November; 79(12): 1884-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=316121

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Knowledge of cancer symptoms among patients attending one-stop breast and rectal bleeding clinics. Author(s): Pullyblank AM, Cawthorn SJ, Dixon AR. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2002 August; 28(5): 511-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12217303

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Laser therapy for severe radiation-induced rectal bleeding. Author(s): Ahlquist DA, Gostout CJ, Viggiano TR, Pemberton JH. Source: Mayo Clinic Proceedings. 1986 December; 61(12): 927-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3490606

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Late rectal bleeding after conformal radiotherapy of prostate cancer. II. Volume effects and dose-volume histograms. Author(s): Jackson A, Skwarchuk MW, Zelefsky MJ, Cowen DM, Venkatraman ES, Levegrun S, Burman CM, Kutcher GJ, Fuks Z, Liebel SA, Ling CC. Source: International Journal of Radiation Oncology, Biology, Physics. 2001 March 1; 49(3): 685-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11172950

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Late rectal bleeding following combined X-ray and proton high dose irradiation for patients with stages T3-T4 prostate carcinoma. Author(s): Benk VA, Adams JA, Shipley WU, Urie MM, McManus PL, Efird JT, Willett CG, Goitein M. Source: International Journal of Radiation Oncology, Biology, Physics. 1993 June 15; 26(3): 551-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8514551

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Letter: Rectal bleeding and indomethacin suppositories. Author(s): Levy N, Gaspar E. Source: Lancet. 1975 March 8; 1(7906): 577. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=47052

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Letter: Rectal bleeding in children. Author(s): Gorlick G. Source: The New England Journal of Medicine. 1974 July 4; 291(1): 49. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4545550

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Letter: Vascular colonic lesions causing rectal bleeding in Bantus. Author(s): Barss P. Source: The New England Journal of Medicine. 1974 November 7; 291(19): 1035. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4547247

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Limitations of combined flexible sigmoidoscopy and double contrast barium enema in patients with rectal bleeding. Author(s): Hixson LJ, Sampliner RE, Chernin M, Amberg J, Kogan F. Source: European Journal of Radiology. 1989 November; 9(4): 254-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2591391

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Limitations of combined flexible sigmoidoscopy and double-contrast barium enema in patients with rectal bleeding. Author(s): Gelfand DW, Ott DJ. Source: European Journal of Radiology. 1990 November-December; 11(3): 230-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2088329

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Live abdominal pregnancy presenting as massive rectal bleeding. Author(s): Bornman PC, Collins JS, Abrahamson MJ, Gilinsky NH. Source: Postgraduate Medical Journal. 1985 August; 61(718): 759-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3875846

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Logical clinical decisions in the investigation and management of non-urgent rectal bleeding. Author(s): Newstead GL. Source: Gastroenterol Jpn. 1991 July; 26 Suppl 3: 107-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1884941

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Managing GI disorders of aging: noncardiac chest pain and rectal bleeding. Author(s): Brandt LJ. Source: Geriatrics. 1986 July; 41(7): 20-4, 27, 30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3087821

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Massive rectal bleeding due to colonic tuberculosis. Author(s): Waghmare BG, Holay MP, Das RN, Kher A. Source: J Assoc Physicians India. 1988 June; 36(6): 392-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3263363

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Massive rectal bleeding due to ileal tuberculosis. Author(s): Watanabe T, Kudo M, Kayaba M, Shirane H, Tomita S, Orino A, Todo A, Chiba T. Source: Journal of Gastroenterology. 1999 August; 34(4): 525-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10452689

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Massive rectal bleeding due to ileocaecal tuberculosis (conservative approach) Author(s): Hiran S, Pande TK, Kumar S, Rao VV, Shah H, Pani S, Vishwanathan KA. Source: Postgraduate Medical Journal. 1994 January; 70(819): 55-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8140028

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Massive rectal bleeding due to intestinal tuberculosis. Author(s): Verma P, Kapur BM. Source: The American Journal of Gastroenterology. 1979 February; 71(2): 217-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=312011

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Massive rectal bleeding due to jejunal and colonic tuberculosis. Author(s): Joshi MA, Balsarkar D, Abhyankar A, Pereira DG, Avasare N, Pradhan C, Subramanyan P, Changlani TT, Deshmukh HL, Shirahatti RG, Biswas B. Source: Trop Gastroenterol. 1998 October-December; 19(4): 168-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10228447

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Massive rectal bleeding following faecal impaction. Author(s): Sutton R, Blake JR. Source: The British Journal of Surgery. 1984 August; 71(8): 631. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6611190

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Massive rectal bleeding following transrectal ultrasound-guided prostate biopsy. Author(s): Brullet E, Guevara MC, Campo R, Falco J, Puig J, Prera A, Prats J, Del Rosario J. Source: Endoscopy. 2000 October; 32(10): 792-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11068840

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Massive rectal bleeding from a Dieulafoy lesion in the rectum: successful endoscopic clipping. Author(s): Nomura S, Kawahara M, Yamasaki K, Nakanishi Y, Kaminishi M. Source: Endoscopy. 2002 March; 34(3): 237. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11870576

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Massive rectal bleeding from a Dieulafoy's type ulcer of the rectum: a review of this unusual disease. Author(s): Franko E, Chardavoyne R, Wise L. Source: The American Journal of Gastroenterology. 1991 October; 86(10): 1545-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1928055

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Massive rectal bleeding from an ulceration in a jejunal diverticulum. Author(s): Chow LW, Ong CL, Png DJ. Source: Journal of Clinical Gastroenterology. 1993 July; 17(1): 85-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8409307

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Massive rectal bleeding from colonic fistula in pancreatitis. Author(s): Poole GV Jr, Wallenhaupt SL. Source: Archives of Surgery (Chicago, Ill. : 1960). 1984 June; 119(6): 732-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6732482

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Massive rectal bleeding from colonic tuberculosis. Author(s): Monkemuller KE, Lewis JB Jr. Source: The American Journal of Gastroenterology. 1996 July; 91(7): 1439-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8678011

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Massive rectal bleeding from jejunal diverticula. Author(s): Wilcox RD, Shatney CH. Source: Surg Gynecol Obstet. 1987 November; 165(5): 425-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3118488

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Massive rectal bleeding in a malingering patient. Author(s): Seijffers MJ, Welner A. Source: Diseases of the Colon and Rectum. 1969 September-October; 12(5): 347-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5307257

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Massive rectal bleeding in Crohn's colitis. Author(s): Ciccarelli O, Coley GM. Source: Conn Med. 1986 May; 50(5): 301-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3486743

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Massive rectal bleeding in pregnancy: a case report. Author(s): Byrne DJ, Mills J. Source: Journal of the Royal College of Surgeons of Edinburgh. 1995 December; 40(6): 396. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8583446

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Massive rectal bleeding in the adult. Author(s): Kirkpatrick JR. Source: Diseases of the Colon and Rectum. 1969 July-August; 12(4): 248-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5306633

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Massive rectal bleeding of colonic origin: localization of the bleeding site. Author(s): Hagihara PF, Sachatello CR, Mattingly SS, Ram M, Griffen WO Jr. Source: Surgery. 1982 October; 92(4): 589-97. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6981864

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Minor rectal bleeding. Treatment guidelines for infants and children. Author(s): O'Holleran TP, O'Holleran LW, Mirza M. Source: J Kans Med Soc. 1982 May; 83(5): 231-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6980247

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Multiple microaneurysms of the superior hemorrhoidal artery: unusual recurrent massive rectal bleeding: report of a case. Author(s): Baig MK, Lewis M, Stebbing JF, Marks CG. Source: Diseases of the Colon and Rectum. 2003 July; 46(7): 978-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12847377

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Necrotizing enterocolitis and milk protein intolerance. Causes of rectal bleeding in a term infant. Author(s): Eggertsen SC, Pereira PK. Source: The Journal of Family Practice. 1989 February; 28(2): 219-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2783727

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Necrotizing enterocolitis: an unusual cause of rectal bleeding in a term infant. Author(s): Turner LM, Miller RF. Source: Annals of Emergency Medicine. 1986 June; 15(6): 742-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3706869

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'One-stop' rectal bleeding clinics without routine flexible sigmoidoscopy are unsafe. Author(s): Toomey P, Asimakopoulos G, Zbar A, Kmiot W. Source: Annals of the Royal College of Surgeons of England. 1998 March; 80(2): 131-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9623380

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Operative angiography in the management of massive rectal bleeding. Author(s): Sabanathan S, Nag SB. Source: Journal of the Royal College of Surgeons of Edinburgh. 1984 March; 29(2): 96-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6429326

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Operative angiography in the management of massive rectal bleeding. Author(s): Harvey MH, Neoptolemos JP, Watkin EM. Source: Journal of the Royal College of Surgeons of Edinburgh. 1984 September; 29(5): 329. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6334158

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Peroperative colonoscopy in massive rectal bleeding. Author(s): Batch AJ, Pickard RG, De Lacey G. Source: The British Journal of Surgery. 1981 January; 68(1): 64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6970057

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Portal vein thrombosis associated with rectal bleeding: non-invasive diagnosis and follow up by ultrasound. Author(s): Agrez M, Enno A, Puvaneswary M. Source: The Australian and New Zealand Journal of Surgery. 1994 September; 64(9): 6436. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8085984

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Predictive value of rectal bleeding for distal colonic neoplastic lesions in a screened population. Author(s): Ferraris R, Senore C, Fracchia M, Sciallero S, Bonelli L, Atkin WS, Segnan N; SCORE Working Group, Italy. Source: European Journal of Cancer (Oxford, England : 1990). 2004 January; 40(2): 24552. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14728939

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Predictive value of rectal bleeding in screening for rectal and sigmoid polyps. Author(s): Chapuis PH, Goulston KJ, Dent OF, Tait AD. Source: British Medical Journal (Clinical Research Ed.). 1985 May 25; 290(6481): 1546-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3924158

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Predictive value of signs and symptoms for colorectal cancer in patients with rectal bleeding in general practice. Author(s): Fijten GH, Starmans R, Muris JW, Schouten HJ, Blijham GH, Knottnerus JA. Source: Family Practice. 1995 September; 12(3): 279-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8536830

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Preoperative diagnosis of rectal bleeding in an adult using a radioisotope scan. Author(s): Randolph RP, Kovalcik PJ, Mullen JT. Source: Southern Medical Journal. 1977 June; 70(6): 680-685. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=301663

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Primary Kaposi's sarcoma of the ileum presenting as massive rectal bleeding. Author(s): Neff R, Kremer S, Voutsinas L, Waxman M, Mitty W Jr. Source: The American Journal of Gastroenterology. 1987 March; 82(3): 276-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3493686

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Primary nonspecific ileal ulceration as a cause of massive rectal bleeding. Author(s): Sunaryo FP, Boyle JT, Ziegler MM, Heyman S. Source: Pediatrics. 1981 August; 68(2): 247-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6973746

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Primary rectal lymphoma staged by magnetic resonance imaging: case report of an unusual cause of rectal bleeding. Author(s): Church J, Bodie B, Jagelman DG, Buonocore E. Source: Cleve Clin Q. 1984 Summer; 51(2): 477-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6331917

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Problems in family practice. Rectal bleeding. Author(s): Graham J. Source: The Journal of Family Practice. 1978 July; 7(1): 169-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=307591

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Profuse rectal bleeding--an unusual cause. Author(s): Keane TE, Tait P, Tanner AR, Peel AL. Source: Diseases of the Colon and Rectum. 1988 December; 31(12): 989-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3265097

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Prolonged rectal bleeding associated with hemorrhoids: the diagnostic contribution of colonoscopy. Author(s): Pines A, Shemesh E, Bat L. Source: Southern Medical Journal. 1987 March; 80(3): 313-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3493539

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Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding. Author(s): Irvine EJ, O'Connor J, Frost RA, Shorvon P, Somers S, Stevenson GW, Hunt RH. Source: Gut. 1988 September; 29(9): 1188-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3273756

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Prostatic carcinoma: rectal bleeding after radiation therapy. Author(s): Kagan AR, Steckel RJ, Nussbaum H, O'Connell TX. Source: Ajr. American Journal of Roentgenology. 1981 June; 136(6): 1207-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6786037

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Quality of life in patients undergoing treatment for chronic radiation-induced rectal bleeding. Author(s): Guest M, Smith JJ, Davies AH. Source: The British Journal of Surgery. 1999 January; 86(1): 135-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10027379

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Quality of life in patients undergoing treatment for chronic radiation-induced rectal bleeding. Author(s): Dent OF, Galt E, Chapuis PH, Yuile P, Sinclair G, Bokey EL. Source: The British Journal of Surgery. 1998 September; 85(9): 1251-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9752870

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Radiology in investigation of rectal bleeding. Author(s): Bartram CI. Source: Diseases of the Colon and Rectum. 1980 July-August; 23(5): 318-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6967396

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Rectal bleeding after conformal 3D treatment of prostate cancer: time to occurrence, response to treatment and duration of morbidity. Author(s): Teshima T, Hanks GE, Hanlon AL, Peter RS, Schultheiss TE. Source: International Journal of Radiation Oncology, Biology, Physics. 1997 August 1; 39(1): 77-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9300742

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Rectal bleeding after radiation therapy for prostate cancer: endoscopic evaluation. Author(s): Moore EM, Magrino TJ, Johnstone PA. Source: Radiology. 2000 October; 217(1): 215-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11012447

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Rectal bleeding and colorectal cancer in general practice: diagnostic study. Author(s): Wauters H, Van Casteren V, Buntinx F. Source: Bmj (Clinical Research Ed.). 2000 October 21; 321(7267): 998-9. Erratum In: Bmj. 2001 February 24; 322(7284): 488. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11039968

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Rectal bleeding and colorectal cancer. Inclusion criteria of study need clarification. Author(s): Fahey T, Montgomery A, Schroeder K. Source: Bmj (Clinical Research Ed.). 2001 March 10; 322(7286): 610; Author Reply 611. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11269248

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Rectal bleeding and colorectal cancer. Results of study were incorrectly interpreted. Author(s): Leung WC. Source: Bmj (Clinical Research Ed.). 2001 March 10; 322(7286): 610; Author Reply 611. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11269249

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Rectal bleeding and high alkaline phosphatase. Author(s): Finster JL. Source: Hosp Pract (Off Ed). 1985 October 30; 20(10A): 27. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3932376

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Rectal bleeding and its management after irradiation for uterine cervical cancer. Author(s): Chun M, Kang S, Kil HJ, Oh YT, Sohn JH, Ryu HS. Source: International Journal of Radiation Oncology, Biology, Physics. 2004 January 1; 58(1): 98-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14697426

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Rectal bleeding and polyps. Author(s): Latt TT, Nicholl R, Domizio P, Walker-Smith JA, Williams CB. Source: Archives of Disease in Childhood. 1993 July; 69(1): 144-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8024299

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Rectal bleeding as the first clinical symptom of renal cell carcinoma. Author(s): Roumen RM, Corten RL, Meijer JW. Source: Neth J Surg. 1989 October; 41(5): 117. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2586811

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Rectal bleeding as the presenting sympton of acute pancreatitis. Author(s): Sahebjami H, Gillespie L, Ferris PJ, Danovitch SH. Source: The American Journal of Gastroenterology. 1970 October; 54(4): 388-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5312280

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Rectal bleeding associated with chronic pancreatitis. Author(s): Seiler C, Fielding G, Blumgart LH, Triller J, Schultheiss HR. Source: Hpb Surg. 1991; 3(3): 199-203. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2043517

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Rectal bleeding caused by Campylobacter jejuni in a neonate. Author(s): Reina J, Borrell N, Fiol M. Source: The Pediatric Infectious Disease Journal. 1992 June; 11(6): 500-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1608692

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Rectal bleeding caused by rupture of an aneurysm of the iliac artery into the rectum. Author(s): Wahlgren CM, Wahlberg E. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(1): 59-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12022374

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Rectal bleeding complicating radiofrequency-induced thermal destruction of the endometrium. Author(s): Loffeld RJ. Source: American Journal of Obstetrics and Gynecology. 1995 June; 172(6): 1951. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7778664

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Rectal bleeding due to amebic colitis diagnosed by multiple endoscopic biopsies: report of two cases. Author(s): Rozen P, Baratz M, Rattan J. Source: Diseases of the Colon and Rectum. 1981 March-April; 24(2): 127-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6971211

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Rectal bleeding due to diversion colitis. Author(s): Ona FV, Boger JN. Source: The American Journal of Gastroenterology. 1985 January; 80(1): 40-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3871305

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Rectal bleeding due to enemas. Author(s): Caos A, Flood B, Morrell M. Source: The American Journal of Gastroenterology. 1989 January; 84(1): 87. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2783529

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Rectal bleeding due to nonspecific colitis in premature infants. Author(s): Giacoia GP, Williams GP. Source: Southern Medical Journal. 1995 July; 88(7): 789-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7597492

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Rectal bleeding due to Oesophagostomum brumpti: report of a case. Author(s): Leoutsakos B, Agnadi N, Kolisiatis S. Source: Diseases of the Colon and Rectum. 1977 October; 20(7): 632-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=303170

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Rectal bleeding due to Trihuris trichiura. Author(s): Fisher RM, Cremin BJ. Source: The British Journal of Radiology. 1970 March; 43(507): 214-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5309320

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Rectal bleeding from a mucous fistula secondary to a Dieulafoy's lesion. Author(s): Abdelmalek MF, Pockaj BA, Leighton JA. Source: Journal of Clinical Gastroenterology. 1997 June; 24(4): 259-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9252854

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Rectal bleeding from gastric tissue in the rectum. Author(s): Sugarman GI, Weitzman JJ, Isaacs H Jr, Beck DB. Source: Lancet. 1970 January 31; 1(7640): 251. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4189064

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Rectal bleeding in a 4-month-old boy. Author(s): Dutro JA, Santanello SA, Unger F, Goodwin CD. Source: Jama : the Journal of the American Medical Association. 1986 October 24-31; 256(16): 2239-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3020266

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Rectal bleeding in a baby of three months. Author(s): Rossiter EJ, Waterhouse AR, Sarkis RR. Source: Aust Paediatr J. 1982 June; 18(2): 132-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6982704

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Rectal bleeding in a patient with exstrophy of the bladder. Author(s): Sloan JW Jr, Burns JR, Witten DM, Kheir SM. Source: The Journal of Urology. 1983 May; 129(5): 1027-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6602223

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Rectal bleeding in a patient with portal hypertension. Author(s): Sinha UK, Raha SK, Wilkins WE. Source: Postgraduate Medical Journal. 2001 October; 77(912): 665, 677. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11571382

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Rectal bleeding in a preterm infant as a symptom of allergic colitis. Author(s): Swart JF, Ultee K. Source: European Journal of Pediatrics. 2003 January; 162(1): 55-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12607535

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Rectal bleeding in children. Author(s): Kalani BP, Sogani KC. Source: Indian Pediatrics. 1977 November; 14(11): 895-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=306969

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Rectal bleeding in children. Author(s): Rittershofer CR. Source: Postgraduate Medicine. 1966 April; 39(4): 431-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5295492

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Rectal bleeding in Crohn's disease of colon. Author(s): Bandler M. Source: N Y State J Med. 1972 June 15; 72(12): 1585-91. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4537631

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Rectal bleeding in general practice patients. Author(s): Sladden MJ, Thomson AN, Lombard CJ. Source: Aust Fam Physician. 1999 July; 28(7): 750-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10431442

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Rectal bleeding in infancy and childhood. Author(s): Talukder BC. Source: J Indian Med Assoc. 1974 April 1; 62(7): 240-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4547290

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Rectal bleeding in infancy and childhood: a review of 100 cases. Author(s): Dalal SJ, Dabhoi-wala NF. Source: Indian Pediatrics. 1967 January; 4(1): 37-49. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5298515

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Rectal bleeding in patients less than 50 years of age. Author(s): Korkis AM, McDougall CJ. Source: Digestive Diseases and Sciences. 1995 July; 40(7): 1520-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7628276

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Rectal bleeding in Prader-Willi syndrome. Author(s): Bhargava SA, Putnam PE, Kocoshis SA, Rowe M, Hanchett JM. Source: Pediatrics. 1996 February; 97(2): 265-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8584392

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Rectal bleeding in the first month of life. Author(s): Levene MI. Source: Postgraduate Medical Journal. 1979 January; 55(639): 22-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=311920

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Rectal bleeding in the pediatric emergency department. Author(s): Teach SJ, Fleisher GR. Source: Annals of Emergency Medicine. 1994 June; 23(6): 1252-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8198299

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Rectal bleeding induced by Dipyridamole. Author(s): Bayer I, Kyzer S, Creter D, Lewinski UH. Source: Diseases of the Colon and Rectum. 1986 February; 29(2): 123-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3484697

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Rectal bleeding secondary to fecal disimpaction: angiographic diagnosis and treatment. Author(s): Naderi MJ, Bookstein JJ. Source: Radiology. 1978 February; 126(2): 387-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=304584

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Rectal bleeding with special reference to cancer of the large intestine. Author(s): Aylett SO. Source: British Medical Journal. 1968 July 13; 3(610): 103-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5301998

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Rectal bleeding, abdominal pain, and fever. Author(s): Przytulski BS, Lotfi M, Hood C, Adelman HM. Source: Hosp Pract (Off Ed). 2000 July 15; 35(7): 21-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10916502

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Rectal bleeding. Author(s): Hartley GC. Source: Aust Fam Physician. 2000 September; 29(9): 829-33. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11008384

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Rectal bleeding. Author(s): Davies P, Button C, Foster M. Source: Nurs Times. 1998 April 22-28; 94(16): 46-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9625963

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Rectal bleeding. Author(s): Jonides L. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 1992 November-December; 6(6): 377, 390. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1491323

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Rectal bleeding. Author(s): Killingback M. Source: The Australian and New Zealand Journal of Surgery. 1982 December; 52(6): 5479. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6984647

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Rectal bleeding. Author(s): Hunt RH. Source: Clin Gastroenterol. 1978 September; 7(3): 719-40. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=361310

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Rectal bleeding. Author(s): Moody FG. Source: The New England Journal of Medicine. 1974 April 11; 290(15): 839-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4594163

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Rectal bleeding. Author(s): Pope D. Source: The Practitioner. 1988 March 8; 232(1444): 260-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3263632

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Rectal bleeding. Author(s): Majumdar P. Source: J Indian Med Assoc. 1972 March 16; 58(6): 207-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4537340

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Rectal bleeding. Author(s): Minkowitz S, Mellins HZ. Source: Minn Med. 1965 December; 48(12): 1673-80. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5295200

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Rectal bleeding. An unusual long-term complication of neonatal necrotizing enterocolitis of the newborn. Author(s): Halac E, Grinblat DA, Vilarrodona HA, Indiveri DR, Gonzalez-Pratt S, del Valle Martinez M. Source: Clinical Pediatrics. 1984 September; 23(9): 522-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6331941

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Rectal bleeding. Do other symptoms aid in diagnosis? Author(s): Mant A, Bokey EL, Chapuis PH, Killingback M, Hughes W, Koorey SG, Cook I, Goulston KJ, Dent OF. Source: Diseases of the Colon and Rectum. 1989 March; 32(3): 191-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2784096

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Rectal bleeding. Patient delay in presentation. Author(s): Dent OF, Goulston KJ, Tennant CC, Langeluddecke P, Mant A, Chapuis PH, Ward M, Bokey EL. Source: Diseases of the Colon and Rectum. 1990 October; 33(10): 851-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2209274

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Rectal bleeding: a rare complication of abdominal pregnancy. Author(s): Saravanane C, Robinson Smile S, Chandra SS, Habeebullah S. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1997 February; 37(1): 124-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9157838

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Rectal bleeding: history is key. Author(s): Schroeder K. Source: The Practitioner. 2002 September; 246(1638): 604-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12233172

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Rectal bleeding: is it always an indication for colonoscopy? Author(s): Bond JH. Source: The American Journal of Gastroenterology. 2002 February; 97(2): 223-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11866253

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Rectal bleeding: prevalence and consultation behaviour. Author(s): Crosland A, Jones R. Source: Bmj (Clinical Research Ed.). 1995 August 19; 311(7003): 486-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7647645

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Rectal bleeding: when and how to investigate. Author(s): Goulston K, Dent O. Source: Aust Fam Physician. 1987 April; 16(4): 379, 382. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3496076

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Rectal bleeding: when is it right to refer? Author(s): Thompson M, Prytherch D. Source: The Practitioner. 1996 March; 240(1560): 198-200. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8710736

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Rectal peptic ulceration--a rare cause of rectal bleeding. Report of a case. Author(s): Testart J, Maupas JL, Metayer J, Peillon C. Source: Diseases of the Colon and Rectum. 1988 October; 31(10): 803-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3048936

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Rectosigmoidoscopic findings during isolated rectal bleeding in the neonate. Author(s): Dupont C, Badoual J, Le Luyer B, Le Bourgeois C, Barbet JP, Voyer M. Source: Journal of Pediatric Gastroenterology and Nutrition. 1987 March-April; 6(2): 257-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3501006

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Rectourethral fistula and massive rectal bleeding from iodine-125 prostate brachytherapy: a case report. Author(s): Cherr GS, Hall C, Pineau BC, Waters GS. Source: The American Surgeon. 2001 February; 67(2): 131-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11243535

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Recurrent rectal bleeding from portal hypertensive colopathy in a patient with hemorrhoids. Author(s): Ohta M, Hashizume M, Kishihara F, Kawanaka H, Tanoue K, Sugimachi K. Source: The American Journal of Gastroenterology. 1995 September; 90(9): 1531-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7661188

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Relationships between a sign of rectal bleeding and the results of an immunochemical occult blood test, and colorectal cancer. Author(s): Nakama H, Zhang B, Abdul Fattah AS, Kamijo N, Fukazawa K. Source: European Journal of Cancer Prevention : the Official Journal of the European Cancer Prevention Organisation (Ecp). 2000 October; 9(5): 325-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11075885

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Relationships between DVHs and late rectal bleeding after radiotherapy for prostate cancer: analysis of a large group of patients pooled from three institutions. Author(s): Fiorino C, Cozzarini C, Vavassori V, Sanguineti G, Bianchi C, Cattaneo GM, Foppiano F, Magli A, Piazzolla A. Source: Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology. 2002 July; 64(1): 1-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12208568

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Residual staples as a possible cause of recurrent rectal bleeding after stapled haemorrhoidectomy. Author(s): Quah HM, Hadi HI, Hay DJ, Maw A. Source: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2003 March; 5(2): 196. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12780915

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Retained stool as a guide to the site of severe rectal bleeding. Author(s): Quint KM, Banks PA. Source: Journal of Clinical Gastroenterology. 1986 February; 8(1): 43-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3486209

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'Reversible vascular occlusion of the colon' causing rectal bleeding. Author(s): Bentlif PS, Eichhorn RD. Source: Am J Proctol. 1967 August; 18(4): 311-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5299619

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Ruptured interstitial pregnancy causing massive rectal bleeding. Author(s): Bigg RL, Jarolim C, Kram DD, Bessinger HE. Source: Archives of Surgery (Chicago, Ill. : 1960). 1965 December; 91(6): 1021-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5294637

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Schistosomal rectal polyp--an unusual cause of rectal bleeding. Author(s): Delgado J, Delgado B, Sztarkier I, Baer A, Depsames R. Source: Isr Med Assoc J. 2004 February; 6(2): 114-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14986472

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Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking. Author(s): Talley NJ, Jones M. Source: The American Journal of Gastroenterology. 1998 November; 93(11): 2179-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9820393

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Severe rectal bleeding due to leech bite. Author(s): Raj SM, Radzi M, Tee MH. Source: The American Journal of Gastroenterology. 2000 June; 95(6): 1607. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10894623

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Severe rectal bleeding due to Salmonella paratyphi B. Author(s): Spence JA, Mogere R, Palmer TJ, Rowe PH. Source: British Medical Journal (Clinical Research Ed.). 1987 June 20; 294(6587): 1589. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3113542

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Severe rectal bleeding from an intramural hematoma of the sigmoid. Author(s): Schiller M, Morse TS, Frye TR. Source: Pediatrics. 1971 July; 48(1): 146-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5561868

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Shome et al: The differential diagnosis for painless rectal bleeding. Author(s): Thylan S, Perper MM. Source: The American Journal of Gastroenterology. 1996 June; 91(6): 1280-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8651199

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Sigmoidoscopy, colonoscopy, and radiology in the evaluation of children with rectal bleeding. Author(s): Cucchiara S, Guandalini S, Staiano A, Devizia B, Capano G, Romaniello G, Poggi V, Tamburrini O, Settimi A, de Ritis G. Source: Journal of Pediatric Gastroenterology and Nutrition. 1983 November; 2(4): 66771. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6606026

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Significance of rectal bleeding in diverticular disease in patients at St. Mark's Hospital. Author(s): Penfold JC. Source: The British Journal of Surgery. 1973 July; 60(7): 557-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4541502

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Simplified management of post-prostate biopsy rectal bleeding. Author(s): Maatman TJ, Bigham D, Stirling B. Source: Urology. 2002 September; 60(3): 508. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12350498

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Solitary rectal ulcer: an unusual cause of rectal bleeding in children. Author(s): Eigenmann PA, Le Coultre C, Cox J, Dederding JP, Belli DC. Source: European Journal of Pediatrics. 1992 September; 151(9): 658-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1396926

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Spirochaetosis: a remediable cause of diarrhoea and rectal bleeding? Author(s): Tomkins DS, Cooke EM, Macdonald RC, Abbott CR. Source: British Medical Journal (Clinical Research Ed.). 1982 January 2; 284(6308): 52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6797642

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Spirochaetosis: a remediable cause of diarrhoea and rectal bleeding? Author(s): Douglas JG, Crucioli V. Source: British Medical Journal (Clinical Research Ed.). 1981 November 21; 283(6303): 1362. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6797542

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Study of the efficacy of diagnostic tests in rectal bleeding. Author(s): Quinlan JA Jr, Becker AH Jr, Go HT. Source: Md State Med J. 1980 November; 29(11): 70-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6970312

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The development of a treatment protocol for patients with chronic radiation-induced rectal bleeding. Author(s): Chapuis P, Dent O, Bokey E, Galt E, Zelas P, Nicholls M, Yuile P, Mameghan H. Source: The Australian and New Zealand Journal of Surgery. 1996 October; 66(10): 6805. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8855923

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The impact of colonoscopy on the early detection of colonic neoplasms in patients with rectal bleeding. Author(s): Guillem JG, Forde KA, Treat MR, Neugut AI, Bodian CA. Source: Annals of Surgery. 1987 November; 206(5): 606-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3499877

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The incidence and causes of rectal bleeding. Author(s): Edwards A, Stott N. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1996 October; 46(411): 625. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8945806

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The incidence and outcome of rectal bleeding in general practice. Author(s): Fijten GH, Muris JW, Starmans R, Knottnerus JA, Blijham GH, Krebber TF. Source: Family Practice. 1993 September; 10(3): 283-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8282152

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The incidence of rectal bleeding following three-dimensional conformal radiotherapy of prostatic cancer. Author(s): Kurtman C. Source: International Urology and Nephrology. 2001; 33(2): 375-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12092660

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The management of rectal bleeding. Author(s): Jones R, Farthing M, Barnes J, Leicester R. Source: Br J Clin Pract. 1993 May-June; 47(3): 155-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8347443

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The Peutz-Jeghers syndrome: a rare cause of rectal bleeding in a child. Author(s): Linder LH, Roberson SH, Levy JL Jr. Source: The American Surgeon. 1971 May; 37(5): 276-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5576597

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The radiographic significance of undocumented rectal bleeding. Author(s): Shaw R, Rosenblum SR, Desautels JE. Source: J Can Assoc Radiol. 1972 September; 23(3): 224-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4628503

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Torrential rectal bleeding. An unusual presentation of colonic carcinoma. Author(s): Tesar PJ, Judson RT. Source: The Medical Journal of Australia. 1983 March 19; 1(6): 280-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6600812

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Tranexamic acid and rectal bleeding. Author(s): McElligott E, Quigley C, Hanks GW. Source: Lancet. 1991 February 16; 337(8738): 431. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1671453

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Unexplained rectal bleeding. Author(s): Williams CB, Hussein AT. Source: The Practitioner. 1980 April; 224(1342): 379-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6968900

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Unusual cause of massive rectal bleeding. Author(s): Wig JD, Kohli PK, Kaushik SP, Talwar BL, Bushwarmath SR, Dutta TK. Source: Indian Journal of Cancer. 1980 December; 17(4): 276-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6971799

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Use of endoscopic band ligation in the treatment of ongoing rectal bleeding. Author(s): Vandervoort J, Montes H, Soetikno RM, Ukomadu C, Carr-Locke DL. Source: Gastrointestinal Endoscopy. 1999 March; 49(3 Pt 1): 392-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10049429

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Use of multidetector-row computed tomographic colonography before flexible sigmoidoscopy in the investigation of rectal bleeding. Author(s): Taylor SA, Halligan S, Vance M, Windsor A, Atkin W, Bartram CI. Source: The British Journal of Surgery. 2003 September; 90(9): 1163-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12945088

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Warfarin-induced rectal bleeding as clue to colon cancer. Author(s): Carey RJ. Source: Lancet. 1984 March 3; 1(8375): 505-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6142220

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Yield of colonoscopy for nonacute rectal bleeding. Author(s): Sawhney MS, Nelson DB. Source: Gastroenterology. 2002 December; 123(6): 2151-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12454874

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Yield of colonoscopy in patients with nonacute rectal bleeding: a multicenter database study of 1766 patients. Author(s): Mulcahy HE, Patel RS, Postic G, Eloubeidi MA, Vaughan JA, Wallace M, Barkun A, Jowell PS, Leung J, Libby E, Nickl N, Schutz S, Cotton PB. Source: The American Journal of Gastroenterology. 2002 February; 97(2): 328-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11866269

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CHAPTER 2. DISSERTATIONS ON RECTAL BLEEDING Overview In this chapter, we will give you a bibliography on recent dissertations relating to rectal bleeding. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “rectal bleeding” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on rectal bleeding, we have not necessarily excluded non-medical dissertations in this bibliography.

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

Colonoscopy for Evaluation of Unexplained Rectal Bleeding in Young Adults by Graham, Erin Marie; MS from D'Youville College, 2003, 117 pages http://wwwlib.umi.com/dissertations/fullcit/1415314

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

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CHAPTER 3. BOOKS ON RECTAL BLEEDING Overview This chapter provides bibliographic book references relating to rectal bleeding. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on rectal bleeding 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 “rectal bleeding” (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 rectal bleeding: •

PDR for Herbal Medicines. 1st ed Source: Montvale, NJ: Medical Economics Company. 1998. 1244 p. Contact: Available from Medical Economics Publishing Inc. P.O. Box 10689, Des Moines, IA 50336. (800) 922-0937. Fax (515) 284-6714. Website: www.medecbookstore.com. PRICE: $59.99. ISBN: 1563632926. Summary: Most of today's herbal remedies exhibit varying degrees of therapeutic value. Some, such as ginkgo, valerian, and saw palmetto, seem genuinely useful, while others, such as ephedra, tansy, and nightshade, can actually be dangerous. As the use of unfamiliar botanicals spreads, the need to steer patients toward the few truly useful preparations and warn them away from ineffective, dangerous alternatives is becoming an increasingly significant priority. This volume, from the publishers of Physicians Desk Reference, brings together the findings of the German Regulatory Authority's herbal

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watchdog agency (commonly caused Commission E). This agency conducted an intensive assessment of the peer-reviewed literature on some 300 common botanicals, weighing the quality of the clinical evidence and identifying the uses for which the herb can reasonably be considered effective. This reference book contains profiles of over 600 medicinal herbs. Each entry contains up to 9 standard sections: name(s), description, actions and pharmacology, indications and usage, contraindications, precautions and adverse reactions, overdosage, dosage, and literature. The entries have also been indexed by scientific and common name, indications, therapeutic category, and side effects. To assist in identification, the reference book includes a section of full-color plates of the plants included. The book concludes with a glossary of the specialized botanical nomenclature and other unfamiliar terminology, a list of poison control centers, and a list of drug information centers. Some of the herbs are listed for use for abdominal cramps or distress, acid indigestion, appetite stimulation, rectal bleeding, various bowel disorders, stomach cancer, cholelithiasis (gallstones), colic, colitis, constipation, dehydration, diarrhea, digestive disorders, dysentery, enteritis, anal fissure, flatulence (intestinal gas), gastritis, gastroenteritis, gastrointestinal disorders, gout, helminthiasis, hemorrhage, hemorrhoids, hepatitis, hypercholesterolemia, jaundice, liver and gall bladder complaints, liver disorders, malaria, nausea, abdominal pain, and vomiting.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “rectal bleeding” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “rectal bleeding” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “rectal bleeding” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Rectal Bleeding, a Danger Signal? by G. Fijten (Editor); ISBN: 9051702248; http://www.amazon.com/exec/obidos/ASIN/9051702248/icongroupinterna

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

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Behcet's Disease Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 655-658. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: Behcet's disease is an inflammatory disorder of unknown cause that can affect multiple organ systems, including the gastrointestinal (GI) tract. This chapter on Behcet's disease is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). Although the cause of Behcet's disease is not know, genetic and environmental factors appear to influence the expression of the disease. Approximately 10 to 25 percent of patients with Behcet's disease develop GI involvement. Gastrointestinal Behcet's disease is important because patients who have it often are acutely ill, have a worse prognosis than patients without GI involvement, and usually require chronic therapy. With regard to the timing, GI involvement may be evident when Behcet's disease is first diagnosed or, more typically, may emerge a year or more later. Distinguishing Behcet's disease from inflammatory bowel disease, especially Crohn's disease, often is difficult and sometimes is impossible. Both disorders share many extraintestinal features, including inflammation of the mucous membranes, skin, eye, and joints. The most frequently noted symptoms of Behcet's disease of the bowel are abdominal pain, anorexia (lack of appetite), rectal bleeding, vomiting, and diarrhea. From a therapeutic standpoint, distinguishing GI Behcet's disease from IBD is not crucial, because the medical treatments are similar. Prednisone is the cornerstone of therapy for any severe inflammation in Behcet's disease; immunomodulators are also commonly used, particularly for chronic treatment. 3 tables. 13 references.

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Diagnosing Inflammatory Bowel Disease Source: in Zonderman, J. and Vender, R.S. Understanding Crohn Disease and Ulcerative Colitis. Jackson, MS: University Press of Mississippi. 2000. p. 3-22. Contact: Available from University Press of Mississippi. 3825 Ridgewood Road, Jackson, MS 39211-6492. (601) 432-6205. Fax (601) 432-6217. E-mail: [email protected]. PRICE: $28.00 plus shipping and handling. ISBN: 1578062039. Summary: Crohn's disease and ulcerative colitis, together known as inflammatory bowel disease (IBD), are chronic illnesses of unknown origin. This chapter on diagnosing IBD is from a book that provides timely information about how to obtain and maintain the highest quality of life possible while living with IBD. The authors offer a patient's perspective on coping with IBD. They caution that the diagnosis of IBD may be made quickly or may take a relatively long time, depending on the symptoms people have when they first visit a doctor because of distress. IBD is most commonly diagnosed in two age groups: young adulthood (ages 15 to 30 years), and middle age (ages 50 to 65 years). Prompt diagnosis and treatment of IBD is important; these are chronic, lifelong conditions that demand medical vigilance. In addition, those in their fifties are entering the age at which colorectal cancer becomes more prevalent; it is important that individuals be evaluated by a physician who can distinguish colitis from cancer. The chapter discusses the three classic symptoms that a doctor considers when assessing whether an individual has IBD: persistent or recurrent diarrhea (with or without rectal

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bleeding), pain, and fever. The authors review the laboratory tests and other diagnostic procedures that may be used, including sigmoidoscopy, colonoscopy, barium enema, and upper gastrointestinal (GI) x ray. The authors also describe the nine varieties (subtypes) of IBD: ulcerative proctitis, proctosigmoiditis, left sided colitis, pancolitis, gastroduodenal Crohn disease, jejunoileitis, ileitis, ileocolitis, and granulomatous colitis. 5 figures. •

Diverticulitis and Diverticular Hemorrhage Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume One. Philadelphia, PA: Current Medicine. 1999. p. 727-732. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Diverticulosis signifies the presence of diverticula, or pouches, in the colon. Diverticulitis implies infection caused by perforation of a diverticulum. This chapter on diverticulitis and diverticular hemorrhage is from a lengthy gastroenterology textbook that focuses on issues of patient care. Diverticula are usually discovered accidentally when a patient undergoes a barium enema or colonoscopy for unrelated colon symptoms or for cancer surveillance. A few patients experience complications, such as perforation, causing a local infection or abscess, or bleeding from an arteriole in the diverticulum. The authors review the clinical picture, diagnosis, and management of diverticulitis and diverticular bleeding. Uncomplicated disease causes no symptoms, but many persons have coincident irritable bowel syndrome (IBS) symptoms, which include abdominal pain and altered bowel habits. The patient with acute diverticulitis usually experiences left lower quadrant abdominal pain, malaise, fever, nausea, and vomiting. Hospital care includes intravenous fluids and antibiotics, medications for adequate pain control, and close observation for complications. Hemorrhage from colonic diverticula is a major cause of rectal bleeding in the elderly. Initial management requires resuscitation and assessment of blood loss. Most diverticular bleeding stops spontaneously, and only 25 percent of cases recur. 1 figure. 7 tables. 29 references.

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Refractory Distal Colitis Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 81-85. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: Patients with refractory distal colitis suffer unrelenting or episodic symptoms of colonic inflammation despite maintenance therapy. This chapter on refractory distal colitis is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). Evaluation of the patient is approached in terms of the symptoms that disrupt their lives and the extent and severity of mucosal inflammation. Although these two issues are integrally related with a positive therapeutic response improving both, optimal management addresses each individually. Refractory colitis is a term with numerous possible interpretations: failure to respond to conventional therapy, partial therapeutic response, extension of the

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disease, persistent symptoms despite apparent mucosal healing, or control of disease only with doses of medication that induce toxicity. The principal persistent symptoms are rectal bleeding, pain, tenesmus, constipation, increased number of stools, nocturnal diarrhea, fecal incontinence, perineal pain, and systemic symptoms such as fatigue and fever. Management options include mesalamine, glucocorticoids, mercaptopurine and azathioprine, methotrexate, nicotine, metronidazole, heparin, and cyclosporine, as well as surgical intervention. The author concludes by noting that a few patients with left sided UC are disabled by their symptoms and do not respond to medical therapy (drugs); in this select group of patients, surgery is a reasonable approach with less health risk than long term glucocorticoid therapy. •

Behavioral Pain Management Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 587-591. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on behavioral pain management is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). In addition to symptoms of diarrhea, rectal bleeding, and weight loss, abdominal pain is described by more than 75 percent of patients with inflammatory bowel disease. Although psychological characteristics have not been shown to cause inflammatory bowel disease, patients having this disorder have been found to be more hypochondriacal, depressed, anxious, obsessive-compulsive, and nonassertive than normal control populations in many studies, even though there are some exceptions. In addition, patients with IBD have been reported by some investigators as being similar to patients diagnosed with psychosomatic disorders such as spastic colitis on measures of anxiety, neurotic tendencies, or affective disorders. These findings have led to the conclusion that the interaction between emotional stress and psychological characteristics can affect the onset or exacerbation of symptoms associated with IBD. As a consequence, behaviorally based treatments useful in the management of chronic pain arising from other disorders can be applied in the treatment of pain associated with IBD. The author offers guidelines for recognizing patients with a chronic pain syndrome, summarizes the important facets of the physician-patient relationship, and outlines specific behavioral pain management for IBD, including stress management, somatic anxiety, biofeedback, relaxation training, behavior therapy, and family therapy; the use of narcotic analgesic (pain killing) medications is also mentioned. The chapter concludes with a case report that illustrates the successful treatment of chronic pain in a patient with IBD. 13 references.

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Other Colitides Source: in Kirsner, J.B., ed. Inflammatory Bowel Disease. 5th ed. Saint Louis, MO: W.B. Saunders Company. 1999. p. 410-423. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 11830 Westline Industrial Drive, Saint Louis, MO 63146-9988. (800) 545-2522. Fax (800) 568-5136. E-mail: [email protected]. Website: www.wbsaunders.com. PRICE: $145.00 plus shipping and handling. ISBN: 0721676162.

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Summary: This chapter on other colitides in inflammatory bowel disease (IBD) is from a comprehensive textbook that describes all the latest scientific and clinical advances in the field of IBD, including etiology and pathogenesis, evaluation and classification, medical and surgical therapies, and patient care management. The other colitides include collagenous and lymphocytic colitis, and infectious colitis, including colitis due to bacteria (such as Clostridium difficile or Escherichia coli), mycobacteria (tuberculosis, Salmonella, Shigella, or Yersinia), viral infection (including cytomegalovirus or HIV), protozoa (including crytosporidium), other parasites, and fungal infection (including with candida and aspergillus). In each section the author discusses symptoms, diagnosis, associations with other gastrointestinal diseases, and treatment options. The author notes that the mimicry of ulcerative colitis and Crohn's disease by other forms of colitis and by many bacterial, viral, and protozoan infections reflects the well known limitation of the intestine's clinical and morphologic responsiveness to disease. This restriction emphasizes the importance of the careful evaluation of all patients with intestinal symptoms (diarrhea, rectal bleeding, and associated symptoms), not only to recognize treatable (curable) diseases but also to identify clues as to the nature and treatment of IBD. 4 figures. 8 tables. 101 references. •

Your Digestive System Source: in Larson, D.E., ed. Mayo Clinic Family Health Book. 2nd ed. New York, NY: William Morrow and Company, Inc. 1996. p. 737-824. Contact: Available from Mayo Clinic. 200 First Street, S.W., Rochester, MN 55905. (800) 291-1128 or (507) 284-2511. Fax (507) 284-0161. Website: www.mayo.edu. PRICE: $39.95 plus shipping and handling. ISBN: 0688144780. Summary: This chapter on the digestive system is from a family health guide published by the Mayo Clinic. The lengthy chapter features nine sections: the digestive system at work, esophageal problems, stomach problems, disorders of the small and large intestines, anorectal disorders, liver disease, gallbladder and bile duct disorders, pancreatic diseases, and hernias. Within each section, multiple entries each begin with a review of signs and symptoms of the problem. This is followed by a description of the disease and a discussion on how the physician might make a diagnosis. The authors often include reviews of the real or potential seriousness of the problem. Each section then discusses treatment options, including medications or surgery, and, when appropriate, self help strategies. Topics covered include heartburn, hiatal hernia, hiccups, swallowing problems, gastrostomy, esophageal stricture, foreign bodies, esophageal tumors, esophageal varices, esophageal rupture, indigestion, peptic ulcer, Zollinger Ellison syndrome, gastritis, drug induced stomach problems, gastrointestinal tract bleeding, stomach tumors, stomach dilation, Menetrier disease, eosinophilic gastroenteritis, infections of the gastrointestinal tract, antibiotic associated diarrhea, malabsorption problems, acute appendicitis, Meckel diverticulum, intussusception, protein losing enteropathy, primarily (idiopathic) intestinal pseudo-obstruction, carcinoid syndrome, Crohn's disease, ulcerative colitis, colostomy and ileostomy, tumors of the small intestine, ileo anal anastomosis, diverticulosis and diverticulitis, irritable bowel syndrome, chronic constipation, dietary fiber, laxative abuse, intestinal gas, fecal impaction, colon polyps, colonoscopy, colon cancer, megacolon, peritonitis, familial Mediterranean fever, intestinal obstruction, vascular problems of the bowel, hemorrhoids, anal itch, anal fissures and fistulas, rectal bleeding, anorectal abscess, anal pain, proctitis, fecal incontinence, acute viral hepatitis, alcoholic (and other drug related) hepatitis, chronic hepatitis, cirrhosis, liver biopsy, liver tumors, liver abscess, liver transplantation, gallstones, bile duct obstruction, choledochal cysts, acute and chronic

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pancreatitis, malignant pancreatic tumors, congenital pancreatic abnormalities, inguinal hernia, and other abdominal hernias. The chapter features line drawings, black and white photographs, and sidebars for additional information. •

Digestive System Source: in Hagan, P.T., ed. Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems. New York, NY: Kensington Publishers. 1999. p. 56-67. Contact: Available from Mayo Clinic. 200 First Street, S.W., Rochester, MN 55905. (800) 291-1128 or (507) 284-2511. Fax (507) 284-0161. Website: www.mayo.edu. PRICE: $16.95 plus shipping and handling. ISBN: 0962786578. Summary: This chapter on the digestive tract is from a self care handbook on everyday health problems. Published by the Mayo Clinic, this handbook offers readers a guide to symptoms, diagnosis, and treatment (particularly self care strategies and tips for handling these problems in children) for common problems. The chapter begins with a brief overview of the anatomy and physiology of the digestive system. Following are discussions of abdominal pain, colic, constipation, diarrhea, excessive gas and gas pains, gallstones, gastritis (burning or sour stomach), hemorrhoids and rectal bleeding, hernias, indigestion and heartburn, irritable bowel syndrome (IBS), nausea and vomiting, and ulcers. Sidebars cover appendicitis, excessive use of laxatives, and a new dual drug treatment for peptic ulcers. The chapter concludes with the address and telephone number for the National Digestive Diseases Information Clearinghouse (NDDIC) for further information. The book is focused on how to prevent illness, how to detect illness before it becomes a serious, costly problem, and how to avoid unnecessary trips to the clinic or emergency room. 7 figures.

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CHAPTER 4. MULTIMEDIA ON RECTAL BLEEDING Overview In this chapter, we show you how to keep current on multimedia sources of information on rectal bleeding. 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 rectal bleeding is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “rectal bleeding” 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 “rectal bleeding” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on rectal bleeding: •

Bottom Line on Hemorrhoids Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1996. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. PRICE: $19.95 plus shipping and handling; bulk copies available. Order number 051997A. Summary: Straining when going to the bathroom, constipation, prolonged sitting, and infection can all contribute to hemorrhoids, defined as enlarged veins around the anus. This videotape is one in a series of health promotion programs called 'Picture of Health,' produced by the University of Wisconsin. In this program, moderated by Mary Lee and featuring gastroenterologist John Wyman, the common symptoms, diagnosis, and management of hemorrhoids are covered. Dr. Wyman explains the difference between internal and external hemorrhoids (merely an anatomical distinction), and prolapsed

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hemorrhoids, which are enlarged internal hemorrhoids that drop (prolapse) outside the anus. Symptoms include pain and bleeding; pain because of blood clots and bleeding due to trauma to the thin walled veins in that area. The causes of hemorrhoids include straining during defecation, pregnancy, prolonged sitting, constipation, childbirth, and obesity. Dr. Wyman recommends that anyone over the age of 40 who experiences rectal bleeding should consult a physician; younger people who experience recurrent bleeding should also see their physician (to rule out inflammatory bowel disease). Treatment options for hemorrhoids include changes in habits, such as not straining, not wiping vigorously, softening the stool with dietary changes (usually the addition of dietary fiber), and not prolonging sitting on the toilet. Surgery is used for external hemorrhoids, to remove the veins and tributaries; for internal hemorrhoids, rubber band ligation is very effective. The program also explores the problem of perianal dermatitis, including its risk factors and treatment options (which focus on keeping the area clean and dry, and not using over the counter creams that are petroleum based). The program reiterates the importance of having any rectal bleeding investigated by one's health care provider. The program concludes by referring viewers to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). •

Ulcerative Colitis: The Disease and Enema Therapy Source: Marietta, GA: Solvay Pharmaceuticals, Inc. 1996. (videocassette). Contact: Available from Solvay Pharmaceuticals, Inc. 901 Sawyer Road, Marietta, GA 30062. (800) 354-0026. PRICE: Single copy free. Summary: This videotape program provides information and reassurance for people recently diagnosed with ulcerative colitis (UC). The program notes that UC can have a great impact on a person's life, but that following the prescribed treatment can help relieve symptoms and return a sense of normalcy. The narrator reviews the possible causes of UC, including genetic, infectious, and autoimmune theories, noting that UC is not contagious or caused by stress or food sensitivity. UC is most often found in the developing world, and people are usually diagnosed in their teens or twenties. The program then features brief interviews with six women who describe how they felt when they first received the diagnosis. Reactions ranged from fear and anxiety to relief that they finally had a name for their symptoms. The narrator then lists the common symptoms of UC: diarrhea, rectal bleeding, bloody stool, loss of appetite, anemia, abdominal pain, weight loss, fever, and gas (flatulence). Less common symptoms can include joint pain, skin lesions, and eye inflammation. The program then features a man and two women talking about symptoms, particularly urgency and frequency, and the impact of these symptoms on their lifestyles. The narrator notes that there are rectal agents, oral medications, antibiotics, and combination therapies, but that the video will focus on enema therapy. The program then interviews three patients who use Rowasa (mesalamine in a rectal suspension enema form). The patients talk about enema therapy and the improved quality of life they have found using this form of the drug. The program then uses line drawings to demonstrate how to give oneself an enema. The medication should be given when the patient can stay prone for 30 minutes or, preferably, overnight. The program concludes by encouraging viewers to ask their health care provider to answer any questions they may have. The address and tollfree telephone number (800-343-3637) of the Crohn's and Colitis Foundation of America are also provided.

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CHAPTER 5. PERIODICALS AND NEWS ON RECTAL BLEEDING Overview In this chapter, we suggest a number of news sources and present various periodicals that cover rectal bleeding.

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

Most people fail to seek care for rectal bleeding Source: Reuters Health eLine Date: May 22, 2002

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•

Colonoscopy can be cost-effective for evaluating young patients with rectal bleeding Source: Reuters Medical News Date: January 16, 2002

•

Rectal bleeding in patients over age 60 years requires follow-up Source: Reuters Medical News Date: October 24, 2000

•

Colorectal cancer rare in patients presenting with isolated rectal bleeding Source: Reuters Medical News Date: August 02, 1999

•

All Cases Of Visible Rectal Bleeding Require Thorough Investigation Source: Reuters Medical News Date: January 03, 1997

•

Rectal Bleeding: An Independent Risk Factor For HIV Infection Source: Reuters Medical News Date: November 12, 1996

•

Color-Blind Men May Not Recognize Rectal Bleeding Source: Reuters Medical News Date: September 09, 1996 The NIH

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

Periodicals and News 69

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 “rectal bleeding” (or synonyms). If you know the name of a company that is relevant to rectal bleeding, 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 “rectal bleeding” (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 “rectal bleeding” (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 rectal bleeding: •

Facts and Fiction of Rectal Bleeding: What It Is and What It Isn't Source: Intestinal Fortitude. 4(4): 1-3. Spring 1994. Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Pittsburgh, PA 15219. (412) 261-5888. Summary: This newsletter article provides basic information on rectal bleeding. The author emphasizes that rectal bleeding is a common occurrence. Since it can be a sign of a serious problem in the gastrointestinal (GI) tract, it should always be evaluated by a health care provider. However, rectal bleeding can be caused by hemorrhoids and other less serious illnesses. The author reviews some typical sources of blood in the stool, including hemorrhoids, fissures, benign growths or polyps of the colon, and tumors or cancer. The appearance of GI bleeding varies based on where the blood is originating from and how severe it is. If bleeding is coming from the anus, rectum, or distal colon, there will be bright red blood coating the stool or mixed with the stool. The stool may be mixed with dark red blood if the bleeding is higher up in the colon or at the far end of the small intestine. The author differentiates between acute massive bleeding (which requires immediate medical attention) and chronic slow bleeding (which may result in anemia). The article concludes with a discussion of the various diagnostic tests used to determine the cause of rectal bleeding. Examinations that should be done for rectal bleeding are digital examination anoscopy, sigmoidoscopy, and possible colonoscopy for the lower GI tract. A barium enema may also be needed. For possible causes in the upper GI tract, esophagogastroduodenoscopy, upper GI barium studies, and small

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bowel barium studies may be indicated. Testing of the stool may be the first step to determine the presence of blood. (AA-M).

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

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APPENDICES

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

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute7: •

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

•

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

•

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

•

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

•

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

•

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

7

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

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

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

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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/

•

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

•

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

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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 75

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:9 •

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

•

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

•

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

•

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

•

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

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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

•

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

•

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

8 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 9 See http://www.nlm.nih.gov/databases/databases.html.

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•

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

•

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

The NLM Gateway10 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “rectal bleeding” (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 3403 17 988 11 130 4549

HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.14 Simply search by “rectal bleeding” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

10

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

11

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14

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

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

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Coffee Break: Tutorials for Biologists15 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.16 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.17 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

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

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

•

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

15 Adapted 16

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

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 17 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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

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Anal and Rectal Diseases http://www.nlm.nih.gov/medlineplus/analandrectaldiseases.html Colonic Polyps http://www.nlm.nih.gov/medlineplus/colonicpolyps.html Colorectal Cancer http://www.nlm.nih.gov/medlineplus/colorectalcancer.html Crohn's Disease http://www.nlm.nih.gov/medlineplus/crohnsdisease.html Hemorrhoids http://www.nlm.nih.gov/medlineplus/hemorrhoids.html Ulcerative Colitis http://www.nlm.nih.gov/medlineplus/ulcerativecolitis.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 National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “rectal bleeding” (or synonyms). The following was recently posted: •

AACE medical guidelines for clinical practice for the diagnosis and treatment of hyperandrogenic disorders Source: American Association of Clinical Endocrinologists - Medical Specialty Society; 2001 Mar-April; 15 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2847&nbr=2073&a mp;string=rectal+AND+bleeding

•

ACR Appropriateness Criteriatm for locally unresectable rectal cancer Source: American College of Radiology - Medical Specialty Society; 1998 (revised 2002); 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3559&nbr=2785&a mp;string=rectal+AND+bleeding

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•

Acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health-care facilities Source: Consortium for Spinal Cord Medicine - Private Nonprofit Organization; 1997 February (updated 2001 Jul); 29 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2964&nbr=2190&a mp;string=rectal+AND+bleeding

•

ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery Source: American Society of Health-System Pharmacists - Professional Association; 1999 September 15; 50 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2182&nbr=1408&a mp;string=rectal+AND+bleeding

•

Chemotherapy and biotherapy: guidelines and recommendations for practice Source: Oncology Nursing Society - Professional Association; 2001; 226 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3209&nbr=2435&a mp;string=rectal+AND+bleeding

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Colorectal cancer screening Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1995 May (revised 2002 Jun); 45 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3406&nbr=2632&a mp;string=rectal+AND+bleeding

•

Diagnosis and management of epilepsy in adults. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2003 April; 49 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3737&nbr=2963&a mp;string=rectal+AND+bleeding

•

Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy. Parts I and II Source: American Urological Association, Inc. - Medical Specialty Society; 2001 April; 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2920&nbr=2146&a mp;string=rectal+AND+bleeding

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Human papillomavirus infection. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 5 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3240&nbr=2466&a mp;string=rectal+AND+bleeding

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Lung cancer. Palliative care Source: American College of Chest Physicians - Medical Specialty Society; 2003 January; 28 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3653&nbr=2879&a mp;string=rectal+AND+bleeding

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Management of chronic kidney disease and pre-ESRD in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 2000 November; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3099&nbr=2325&a mp;string=rectal+AND+bleeding

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Management of colorectal cancer. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2003 March; 47 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3724&nbr=2950&a mp;string=rectal+AND+bleeding

•

Management of ulcerative colitis Source: Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society; 2000 (revised 2001); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2967&nbr=2193&a mp;string=rectal+AND+bleeding

•

Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps Source: American College of Gastroenterology - Medical Specialty Society; 1993 (revised 2000); 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2624&nbr=1850&a mp;string=rectal+AND+bleeding

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•

Practice parameters for the prevention of venous thromboembolism Source: American Society of Colon and Rectal Surgeons - Medical Specialty Society; 2000 August; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2593&nbr=1819&a mp;string=rectal+AND+bleeding

•

Practice parameters for the treatment of sigmoid diverticulitis Source: American Society of Colon and Rectal Surgeons - Medical Specialty Society; 2000; 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2596&nbr=1822&a mp;string=rectal+AND+bleeding

•

Prostate cancer Source: National Committee on Cancer Care (Singapore) - National Government Agency [Non-U.S.]; 2000 May; 49 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2836&nbr=2062&a mp;string=rectal+AND+bleeding

•

Prostate specific antigen (PSA): best practice policy Source: American Urological Association, Inc. - Medical Specialty Society; 1999 December 21; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2181&nbr=1407&a mp;string=rectal+AND+bleeding

•

Screening for colorectal cancer: recommendations and rationale Source: United States Preventive Services Task Force - Independent Expert Panel; 1996 (revised 2002 Jul); 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3285&nbr=2511&a mp;string=rectal+AND+bleeding

•

Screening test to detect Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2002 October; 38 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3483&nbr=2709&a mp;string=rectal+AND+bleeding

•

Sexual assault and STDs. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3246&nbr=2472&a mp;string=rectal+AND+bleeding

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Special populations. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3231&nbr=2457&a mp;string=rectal+AND+bleeding

•

Surgical management of hemorrhoids Source: Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society; 1996 (revised 2000); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2171&nbr=1397&a mp;string=rectal+AND+bleeding

•

Surgical treatment of cancer of the colon or rectum Source: Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society; 1996 (revised 2000); 5 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2168&nbr=1394&a mp;string=rectal+AND+bleeding

•

Surgical treatment of diverticulitis Source: Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society; 1996 (revised 2000); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2169&nbr=1395&a mp;string=rectal+AND+bleeding 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 rectal bleeding. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

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

•

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

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•

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

•

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

•

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

•

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

•

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

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to rectal bleeding. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with rectal bleeding. 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 rectal bleeding. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “rectal bleeding” (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 “rectal bleeding”. Type the following hyperlink into

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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 “rectal bleeding” (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 “rectal bleeding” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.18

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

18

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)19: •

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

•

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

•

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

•

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

•

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

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

19

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

Finding Medical Libraries 89

•

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

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

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

•

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

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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/

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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

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

•

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

•

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

•

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

•

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

•

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

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•

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

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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

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

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

•

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

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

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

•

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

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

•

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 91

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

93

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

95

RECTAL BLEEDING DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Cramps: Abdominal pain due to spasmodic contractions of the bowel. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Ablate: In surgery, is to remove. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH]

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Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [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] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaemia: A reduction below normal in the number of erythrocytes per cu. mm., in the quantity of haemoglobin, or in the volume of packed red cells per 100 ml. of blood which occurs when the equilibrium between blood loss (through bleeding or destruction) and blood production is disturbed. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angiodysplasia: Degenerative, acquired lesions consisting of distorted, dilated, thin-walled vessels lined by vascular endothelium. This pathological state is seen especially in the gastrointestinal tract and is frequently a cause of upper and lower gastrointestinal hemorrhage in the elderly. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Anomalies: Birth defects; abnormalities. [NIH]

Dictionary 97

Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anoscopy: A test to look for fissures, fistulae, and hemorrhoids. The doctor uses a special instrument, called an anoscope, to look into the anus. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

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] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [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] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Archaea: One of the three domains of life (the others being bacteria and Eucarya), formerly called Archaebacteria under the taxon Bacteria, but now considered separate and distinct. They are characterized by: 1) the presence of characteristic tRNAs and ribosomal RNAs; 2) the absence of peptidoglycan cell walls; 3) the presence of ether-linked lipids built from branched-chain subunits; and 4) their occurrence in unusual habitats. While archaea resemble bacteria in morphology and genomic organization, they resemble eukarya in their method of genomic replication. The domain contains at least three kingdoms: crenarchaeota, euryarchaeota, and korarchaeota. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH]

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Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Arthropathy: Any joint disease. [EU] Aspergillus: A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family Trichocomaceae. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Autacoids: A chemically diverse group of substances produced by various tissues in the body that cause slow contraction of smooth muscle; they have other intense but varied pharmacologic activities. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autoimmune Hepatitis: A liver disease caused when the body's immune system destroys liver cells for no known reason. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Dysreflexia: That part of the nervous system concerned with the unconscious regulation of the living processes of the body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Barium enema: A procedure in which a liquid with barium in it is put into the rectum and colon by way of the anus. Barium is a silver-white metallic compound that helps to show the image of the lower gastrointestinal tract on an x-ray. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH]

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Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopsy specimen: Tissue removed from the body and examined under a microscope to determine whether disease is present. [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] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Regions: Anatomical areas of the body. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH]

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Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoid: A type of tumor usually found in the gastrointestinal system (most often in the appendix), and sometimes in the lungs or other sites. Carcinoid tumors are usually benign. [NIH]

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

Cardiac: Having to do with the heart. [NIH] 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] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Choledochal Cyst: A congenital cystic dilatation of the common bile duct; this condition may be asymptomatic, or cause vomiting, fever, jaundice, or pain in the right upper quadrant. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH]

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Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chondrocytes: Polymorphic cells that form cartilage. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colon Polyps: Small, fleshy, mushroom-shaped growths in the colon. [NIH] Colonic Neoplasms: Tumors or cancer of the colon. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of

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the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Common Bile Duct: The largest biliary duct. It is formed by the junction of the cystic duct and the hepatic duct. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomographic colonography: CTC. A procedure in which a detailed picture of the colon is created by an x-ray machine linked to a computer. Also called computed tomography (CT) scan or computerized axial tomography (CAT) scan of the colon. [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] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] 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] Conscious Sedation: An alternative to general anesthesia in patients for whom general anesthesia is refused or considered inadvisable. It involves the administering of an antianxiety drug (minor tranquilizer) and an analgesic or local anesthetic. This renders the patient free of anxiety and pain while allowing the patient to remain in verbal contact with the physician or dentist. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [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] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH]

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Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [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] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermatitis: Any inflammation of 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] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach,

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liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Digital rectal examination: DRE. An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulosis: A condition marked by small sacs or pouches (diverticula) in the walls of an organ such as the stomach or colon. These sacs can become inflamed and cause a condition called diverticulitis, which may be a risk factor for certain types of cancer. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU]

Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH]

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Electrolytes: Substances that break up into ions (electrically charged particles) when they are dissolved in body fluids or water. Some examples are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells, and the movement of wastes out of cells. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation of the intestinal mucosa of the small and large bowel. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophilia: Abnormal increase in eosinophils in the blood, tissues or organs. [NIH] Eosinophilic: A condition found primarily in grinding workers caused by a reaction of the pulmonary tissue, in particular the eosinophilic cells, to dust that has entered the lung. [NIH] Eosinophilic Gastroenteritis: Infection and swelling of the lining of the stomach, small intestine, or large intestine. The infection is caused by white blood cells (eosinophils). [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a

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slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epistaxis: Bleeding from the nose. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Stricture: A narrowing of the esophagus often caused by acid flowing back from the stomach. This condition may require surgery. [NIH] Esophageal Varices: Stretched veins in the esophagus that occur when the liver is not working properly. If the veins burst, the bleeding can cause death. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagogastroduodenoscopy: Exam of the upper digestive tract using an endoscope. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Family Health: The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also, the impact of family organization or disorganization on the health status of its members. [NIH]

Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH]

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Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Family Therapy: A form of group psychotherapy. It involves treatment of more than one member of the family simultaneously in the same session. [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]

Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Fecal occult blood test: A test to check for blood in stool. (Fecal refers to stool; occult means hidden.) [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibroblast Growth Factor: Peptide isolated from the pituitary gland and from the brain. It is a potent mitogen which stimulates growth of a variety of mesodermal cells including chondrocytes, granulosa, and endothelial cells. The peptide may be active in wound healing and animal limb regeneration. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fine-needle aspiration: The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Follicles: Shafts through which hair grows. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body

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through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal Hemorrhage: Bleeding in the gastrointestinal tract. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic

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(drugs). [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Granulomatous Colitis: Another name for Crohn's disease of the colon. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haemodialysis: The removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane, e.g., by means of a haemodialyzer. [EU] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Hay Fever: A seasonal variety of allergic rhinitis, marked by acute conjunctivitis with lacrimation and itching, regarded as an allergic condition triggered by specific allergens. [NIH]

Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helminthiasis: Infestation with parasitic worms of the helminth class. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level

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may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatitis, Chronic: A collective term for a clinical and pathological syndrome which has several causes and is characterized by varying degrees of hepatocellular necrosis and inflammation. Specific forms of chronic hepatitis include autoimmune hepatitis, chronic hepatitis B, chronic hepatitis C, chronic hepatitis D, indeterminate chronic viral hepatitis, cryptogenic chronic hepatitis, and drug-related chronic hepatitis. [NIH] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Causes heartburn from stomach acid flowing back up through the 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] Host: Any animal that receives a transplanted graft. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to

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an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypoxic: Having too little oxygen. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileitis: Inflammation of the ileum. [EU] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH] Iliac Artery: Either of two large arteries originating from the abdominal aorta; they supply blood to the pelvis, abdominal wall and legs. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Indomethacin: A non-steroidal anti-inflammatory agent (NSAID) that inhibits the enzyme cyclooxygenase necessary for the formation of prostaglandins and other autacoids. It also inhibits the motility of polymorphonuclear leukocytes. [NIH]

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Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant, Newborn: An infant during the first month after birth. [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]

Infectious Diarrhea: Diarrhea caused by infection from bacteria, viruses, or parasites. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Information Centers: Facilities for collecting and organizing information. They may be specialized by subject field, type of source material, persons served, location, or type of services. [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestinal Pseudo-Obstruction: Obstruction of the intestines that is functional, not mechanical. [NIH]

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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] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH]

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Kinetic: Pertaining to or producing motion. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [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] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipoma: A benign tumor composed of fat cells. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [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] Lubricants: Oily or slippery substances. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocytic: Referring to lymphocytes, a type of white blood cell. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH]

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Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Maintenance therapy: Treatment that is given to help a primary (original) treatment keep working. Maintenance therapy is often given to help keep cancer in remission. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malingering: Simulation of symptoms of illness or injury with intent to deceive in order to obtain a goal, e.g., a claim of physical illness to avoid jury duty. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megacolon: Pathological enlargement of the colon. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU]

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Mercaptopurine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mitosporic Fungi: A large and heterogenous group of fungi whose common characteristic is the absence of a sexual state. Many of the pathogenic fungi in humans belong to this group. [NIH]

Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH]

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Mucociliary: Pertaining to or affecting the mucus membrane and hairs (including eyelashes, nose hair, .): mucociliary clearing: the clearance of mucus by ciliary movement ( particularly in the respiratory system). [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasopharynx: The nasal part of the pharynx, lying above the level of the soft palate. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrotizing Enterocolitis: A condition in which part of the tissue in the intestines is destroyed. Occurs mainly in under-weight newborn babies. A temporary ileostomy may be necessary. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needle biopsy: The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] 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] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurotic: 1. Pertaining to or characterized by neurosis. 2. A person affected with a neurosis. [EU]

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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] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occult Blood: Chemical, spectroscopic, or microscopic detection of extremely small amounts of blood. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] Overdosage: 1. The administration of an excessive dose. 2. The condition resulting from an excessive dose. [EU] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be

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associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]

Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parenteral Nutrition: The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). [NIH] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope. [NIH] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH] Pediatric Gastroenterologist: A doctor who treats children with digestive diseases. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or

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substance. [EU] Perianal: Located around the anus. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pneumonia: Inflammation of the lungs. [NIH] Pneumonitis: A disease caused by inhaling a wide variety of substances such as dusts and molds. Also called "farmer's disease". [NIH] Poison Control Centers: Facilities which provide information concerning poisons and treatment of poisoning in emergencies. [NIH]

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Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyp: A growth that protrudes from a mucous membrane. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Portal Hypertension: High blood pressure in the portal vein. This vein carries blood into the liver. Portal hypertension is caused by a blood clot. This is a common complication of cirrhosis. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Presumptive: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Proctalgia Fugax: Intense pain in the rectum that occasionally happens at night. Caused by muscle spasms around the anus. [NIH] Proctitis: Inflammation of the rectum. [EU] Proctosigmoiditis: Irritation of the rectum and the sigmoid colon. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed

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over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] 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] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoal: Having to do with the simplest organisms in the animal kingdom. Protozoa are single-cell organisms, such as ameba, and are different from bacteria, which are not members of the animal kingdom. Some protozoa can be seen without a microscope. [NIH] Protozoan: 1. Any individual of the protozoa; protozoon. 2. Of or pertaining to the protozoa; protozoal. [EU] Protozoan Infections: Infections with unicellular organisms of the subkingdom Protozoa. [NIH]

Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney. [NIH] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Policy: A course or method of action selected, usually by a government, from among

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alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH]

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Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] 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 cell carcinoma: A type of kidney cancer. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour

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vision. Called also retinal, and retinene1. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Ristocetin: An antibiotic mixture of two components, A and B, obtained from Nocardia lurida (or the same substance produced by any other means). It is no longer used clinically because of its toxicity. It causes platelet agglutination and blood coagulation and is used to assay those functions in vitro. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [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] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] 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.

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[NIH]

Short Bowel Syndrome: A malabsorption syndrome resulting from extensive operative resection of small bowel. [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] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Sinusitis: An inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sonogram: A computer picture of areas inside the body created by bouncing sound waves off organs and other tissues. Also called ultrasonogram or ultrasound. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with

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heightened deep tendon reflexes. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincters: Any annular muscle closing an orifice. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splenic Artery: The largest branch of the celiac trunk with distribution to the spleen, pancreas, stomach and greater omentum. [NIH] Splenic Vein: Vein formed by the union (at the hilus of the spleen) of several small veins from the stomach, pancreas, spleen and mesentery. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stool test: A test to check for hidden blood in the bowel movement. [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 management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH]

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Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [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] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU] Thermal: Pertaining to or characterized by heat. [EU] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH]

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Time Management: Planning and control of time to improve efficiency and effectiveness. [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] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] 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] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transrectal ultrasound: A procedure used to examine the prostate. An instrument is inserted into the rectum, and sound waves bounce off the prostate. These sound waves create echoes, which a computer uses to create a picture called a sonogram. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Unresectable: Unable to be surgically removed. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products

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of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. [NIH] Varices: Stretched veins such as those that form in the esophagus from cirrhosis. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Hepatitis: Hepatitis caused by a virus. Five different viruses (A, B, C, D, and E) most commonly cause this form of hepatitis. Other rare viruses may also cause hepatitis. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and

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kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Wound Healing: Restoration of integrity to traumatized tissue. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH]

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INDEX A Abdominal Cramps, 5, 9, 58, 95 Abdominal Pain, 4, 6, 7, 8, 9, 10, 11, 13, 27, 46, 58, 59, 60, 61, 63, 66, 95, 108, 115, 120, 129 Aberrant, 14, 95 Ablate, 95, 104 Abscess, 4, 60, 62, 95 Acrylonitrile, 95, 125 Acute renal, 95, 110 Adaptability, 95, 100 Adjuvant, 14, 15, 95, 108 Adolescence, 95, 119 Adverse Effect, 95, 126 Affinity, 12, 95, 126 Age Groups, 59, 95 Aged, 80 and Over, 95 Agonist, 95, 118 Algorithms, 6, 95, 99 Alimentary, 12, 82, 84, 96, 103, 119 Alkaline, 42, 96, 98 Alkaline Phosphatase, 42, 96 Alkaloid, 96, 116, 118 Allergic Rhinitis, 9, 96, 109 Alpha Particles, 96, 123 Alternative medicine, 68, 96 Amebiasis, 18, 96, 116 Ampulla, 96, 105 Anaemia, 19, 96 Anaesthesia, 96, 112 Anal, 4, 6, 8, 10, 19, 29, 32, 58, 62, 80, 96, 107 Anal Fissure, 6, 8, 10, 58, 62, 96 Analgesic, 61, 96, 102, 116 Anastomosis, 62, 96 Anatomical, 65, 96, 99, 111 Anemia, 6, 9, 13, 29, 66, 69, 96, 115 Anesthesia, 11, 96, 102 Aneurysm, 19, 21, 34, 43, 96 Angiodysplasia, 19, 29, 33, 96 Angiography, 6, 39, 96 Anomalies, 6, 96 Anorectal, 3, 62, 97 Anorexia, 4, 59, 97, 108, 130 Anoscopy, 69, 97 Antibacterial, 97, 127, 130 Antibiotic, 8, 9, 62, 97, 125, 127

Antibody, 95, 97, 103, 109, 111, 112, 113, 116, 123, 127, 131 Anticoagulant, 12, 97, 131 Antigen, 83, 95, 97, 111, 112 Anti-infective, 97, 113 Anti-inflammatory, 97, 108, 111 Antimetabolite, 97, 116 Antimicrobial, 81, 97 Antineoplastic, 97, 116 Anus, 4, 8, 65, 69, 96, 97, 98, 99, 101, 105, 107, 110, 112, 120, 121, 124 Anxiety, 61, 66, 97, 102 Aorta, 97, 111 Appendicitis, 11, 22, 62, 63, 97 Archaea, 97, 116 Arteries, 4, 97, 99, 103, 111, 116, 117 Arterioles, 97, 99 Artery, 19, 29, 38, 96, 98, 99, 103, 105, 123 Arthropathy, 22, 98 Aspergillus, 62, 98 Asymptomatic, 81, 96, 98, 100, 118 Atrial, 98, 131 Atrial Fibrillation, 98, 131 Autacoids, 98, 111 Autodigestion, 98, 118 Autoimmune Hepatitis, 98, 110 Autonomic, 81, 98 Autonomic Dysreflexia, 81, 98 B Bacteria, 13, 62, 97, 98, 104, 105, 106, 107, 108, 112, 116, 122, 127, 130 Bacterium, 98, 110 Barium, 6, 11, 17, 35, 41, 60, 69, 98 Barium enema, 11, 17, 35, 41, 60, 69, 98 Base, 98, 113, 130 Behavior Therapy, 61, 98 Benign, 3, 4, 20, 69, 98, 100, 114, 117, 123, 131 Bile, 62, 98, 99, 107, 111, 113, 114, 127 Bile Acids, 98, 127 Bile Acids and Salts, 98 Bile duct, 62, 99, 107, 111 Bile Pigments, 99, 113 Biliary, 18, 99, 102, 118 Biliary Tract, 99, 118 Bilirubin, 99, 107, 110 Biopsy, 8, 12, 14, 20, 37, 52, 62, 99 Biopsy specimen, 20, 99

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Biotechnology, 16, 68, 75, 99 Bladder, 6, 44, 58, 99, 111, 112, 122, 130 Bloating, 9, 99, 111, 115 Blood pressure, 99, 110, 116, 121, 126 Blood transfusion, 12, 99 Blood vessel, 6, 8, 12, 96, 99, 105, 110, 113, 120, 127, 128, 130 Body Fluids, 99, 104, 105, 118, 126 Body Regions, 99, 101 Bone Marrow, 99, 103, 114, 128 Bowel Movement, 4, 12, 99, 103, 127 Brachytherapy, 20, 22, 49, 99, 112, 113, 123, 131 Branch, 91, 99, 108, 119, 127 Breakdown, 99, 103, 107 C Calculi, 99, 109 Capsules, 8, 99, 108 Carbon Dioxide, 100, 124 Carcinogen, 100, 116 Carcinogenic, 100, 127 Carcinoid, 62, 100 Carcinoma, 11, 12, 14, 35, 41, 53, 100 Cardiac, 23, 98, 100, 108, 117, 124, 127 Case report, 17, 18, 29, 38, 40, 49, 61, 100, 101 Cecum, 29, 30, 31, 100, 114 Cell, 7, 15, 95, 97, 98, 99, 100, 101, 103, 105, 113, 116, 117, 120, 122, 124, 128, 130, 131 Cell Division, 98, 100, 120 Cell Respiration, 100, 124 Cell Survival, 7, 100 Cellulose, 100, 120 Cerebral, 100, 106, 107, 115, 126 Cerebral Cortex, 100, 106, 107 Cerebral Palsy, 100, 126 Cervical, 42, 100 Cervix, 100 Chemotherapy, 15, 81, 100 Chest Pain, 36, 100 Choledochal Cyst, 62, 100 Cholelithiasis, 58, 100 Cholesterol, 98, 100, 107, 110, 127 Cholinergic, 101, 118 Chondrocytes, 101, 107 Chromatin, 101, 106, 118 Chronic Disease, 5, 101 Cirrhosis, 62, 101, 121, 130 Clinical study, 101, 102 Clinical trial, 13, 75, 101, 103, 122, 123 Cloning, 99, 101 Coagulation, 20, 101, 125, 131

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Cochlea, 14, 101, 112 Cochlear, 15, 101 Cognitive restructuring, 101, 127 Colectomy, 12, 101 Colic, 58, 63, 101 Colitis, 4, 8, 9, 11, 12, 13, 18, 31, 38, 43, 44, 45, 58, 59, 60, 61, 62, 66, 80, 101 Colon Polyps, 62, 101 Colonic Neoplasms, 52, 101 Colonoscopy, 5, 6, 11, 12, 17, 19, 24, 25, 27, 32, 39, 41, 48, 51, 52, 54, 55, 60, 62, 68, 69, 101 Colorectal, 3, 7, 16, 19, 25, 26, 27, 28, 30, 40, 42, 50, 59, 68, 80, 81, 82, 83, 101 Colorectal Cancer, 3, 16, 26, 28, 40, 42, 50, 59, 80, 82, 83, 101 Colostomy, 62, 102 Common Bile Duct, 100, 102 Complete remission, 102, 124 Computational Biology, 75, 102 Computed tomographic colonography, 54, 102 Computed tomography, 102 Cone, 15, 102, 128 Connective Tissue, 99, 102, 107, 108, 114, 125 Conscious Sedation, 11, 102 Consciousness, 96, 102, 104, 124 Constipation, 4, 11, 58, 61, 62, 63, 65, 102, 120 Constriction, 102, 113 Consultation, 9, 49, 102 Consumption, 102, 108, 118 Contraindications, ii, 11, 58, 102 Contrast medium, 96, 102 Controlled clinical trial, 6, 102 Conventional therapy, 60, 102, 103 Conventional treatment, 102, 103 Coronary, 103, 116, 117 Coronary Thrombosis, 103, 116, 117 Corticosteroids, 10, 12, 103, 108 Cyclosporine, 61, 103 Cytokines, 12, 13, 103 Cytomegalovirus, 26, 62, 103 Cytoplasm, 103, 106, 118 Cytotoxic, 103, 123 D Defecation, 8, 66, 103 Degenerative, 96, 103, 110 Dehydration, 12, 58, 103 Deprivation, 14, 15, 103 Dermatitis, 66, 103

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Diagnostic procedure, 5, 60, 68, 103 Diaphragm, 103, 110 Diarrhea, 4, 5, 6, 7, 8, 9, 10, 11, 18, 58, 59, 61, 62, 63, 66, 96, 103, 112, 115 Diarrhoea, 52, 103, 108 Dietary Fiber, 62, 66, 103 Dietitian, 9, 10, 103 Digestion, 96, 98, 99, 103, 104, 111, 113, 114, 119, 127 Digestive system, 62, 63, 103, 108 Digestive tract, 5, 10, 63, 104, 106, 126 Digital rectal examination, 6, 104 Dilatation, 96, 100, 104, 121 Dilation, 62, 104 Diploid, 104, 120 Direct, iii, 104, 108, 124 Dissociation, 95, 104, 113 Distal, 39, 60, 69, 104, 122 Diverticula, 37, 60, 104 Diverticulitis, 22, 60, 62, 83, 84, 104 Diverticulosis, 22, 60, 62, 104 Diverticulum, 4, 5, 8, 37, 60, 62, 104 Duct, 62, 96, 102, 104, 125, 127 Duodenum, 98, 104, 105, 108, 119, 127 Dyes, 104, 118 Dysentery, 58, 96, 104 Dyspepsia, 104, 111 Dysplasia, 12, 104 E Efficacy, 8, 52, 104 Electrocoagulation, 17, 101, 104 Electrolytes, 98, 105 Emboli, 29, 105, 131 Embolism, 105, 123, 131 Embolization, 29, 105, 131 Embryo, 105, 112 Encopresis, 17, 105 Endemic, 105, 115 Endometrial, 105 Endometriosis, 18, 26, 105 Endometrium, 43, 105 Endoscope, 105, 106 Endoscopic, 5, 11, 17, 29, 33, 37, 42, 43, 54, 101, 105, 126 Endoscopy, 5, 6, 11, 17, 18, 23, 24, 29, 33, 37, 54, 105 Endothelial cell, 105, 107 Endothelium, 96, 105 Enema, 41, 66, 105 Enteritis, 5, 58, 105 Enterocolitis, 4, 9, 38, 39, 105 Environmental Health, 74, 76, 105

Enzyme, 96, 105, 111, 116, 119, 124, 131 Eosinophilia, 19, 105 Eosinophilic, 62, 105 Eosinophilic Gastroenteritis, 62, 105 Eosinophils, 105, 114 Epidermal, 106, 131 Epidermis, 106, 123 Epistaxis, 19, 106 Epithelial, 20, 106, 110 Epithelial Cells, 20, 106, 110 Epithelium, 10, 105, 106, 108, 119 Equipment and Supplies, 11, 106 Erythrocytes, 96, 99, 106, 124 Escalation, 14, 15, 106 Esophageal, 62, 106 Esophageal Stricture, 62, 106 Esophageal Varices, 62, 106 Esophagitis, 4, 106 Esophagogastroduodenoscopy, 69, 106 Esophagus, 5, 103, 104, 106, 108, 109, 119, 120, 127, 130 Evacuation, 102, 106, 114, 123 Evoke, 106, 127 Exhaustion, 106, 115 Expiration, 106, 124 External-beam radiation, 106, 113, 123, 131 Extravasation, 106, 109 F Faecal, 36, 103, 106 Family Health, 62, 106 Family Planning, 75, 106 Family Practice, 9, 25, 32, 38, 40, 53, 107 Family Therapy, 61, 107 Fat, 98, 99, 105, 107, 114 Fatigue, 61, 107 Fecal Incontinence, 4, 61, 62, 107, 111 Fecal occult blood test, 6, 107 Feces, 102, 105, 106, 107, 127 Fibrin, 107, 120 Fibroblast Growth Factor, 12, 107 Fibrosis, 18, 107 Fine-needle aspiration, 107, 117 Fissure, 4, 10, 107 Fistula, 9, 20, 28, 37, 44, 49, 107, 108 Flatulence, 58, 66, 107 Flatus, 10, 107, 108 Fold, 107, 116, 118 Follicles, 11, 107 Fungi, 107, 116 G Gallbladder, 62, 95, 99, 104, 107, 108

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Gallstones, 58, 62, 63, 98, 100, 107 Gamma Rays, 107, 123 Gas, 10, 58, 62, 63, 66, 100, 107, 111, 115 Gastric, 14, 27, 28, 30, 31, 44, 98, 108, 109, 119 Gastric Juices, 108, 119 Gastric Mucosa, 27, 28, 31, 108 Gastritis, 4, 6, 58, 62, 63, 108 Gastroduodenal, 60, 108 Gastroenteritis, 9, 58, 108 Gastroenterologist, 7, 65, 108 Gastrointestinal Hemorrhage, 5, 96, 108 Gastrointestinal tract, 7, 13, 62, 96, 98, 107, 108, 127 Gastrostomy, 62, 108 Gelatin, 108, 128 Gene, 99, 108 General practitioner, 32, 108 Genetics, 6, 10, 108 Giardiasis, 9, 108, 116 Gland, 15, 108, 114, 118, 120, 122, 127, 128 Glucocorticoid, 61, 108 Glucuronic Acid, 109, 110 Gonadal, 109, 127 Gout, 58, 109 Governing Board, 109, 121 Graft, 109, 110 Granulomatous Colitis, 60, 109 Groin, 109, 112 Growth, 6, 9, 12, 13, 95, 97, 100, 107, 109, 115, 117, 120, 121, 128 H Haemodialysis, 22, 109 Haploid, 109, 120 Haptens, 95, 109 Hay Fever, 96, 109 Health Promotion, 65, 109 Health Status, 106, 109 Heartbeat, 12, 109 Heartburn, 62, 63, 109, 110, 111 Helminthiasis, 58, 109 Hematoma, 51, 109 Hematuria, 31, 81, 109 Hemoglobin, 96, 106, 109 Hemolytic, 4, 110 Hemorrhage, 5, 12, 58, 60, 104, 110, 123 Hemorrhoid, 10, 110 Heparin, 12, 61, 110 Hepatitis, 58, 62, 110, 130 Hepatitis, Chronic, 62, 110 Hepatocellular, 110 Hepatocytes, 110

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Heredity, 108, 110 Heterogeneity, 95, 110 Hiatal Hernia, 62, 110 Hormone, 103, 110, 113, 121, 128 Host, 13, 110, 130 Hyperbilirubinemia, 110, 113 Hypercholesterolemia, 58, 110 Hyperplasia, 4, 19, 110 Hypertension, 110, 121, 130 Hypertrophy, 110 Hyperuricemia, 109, 111 Hypoxic, 111, 116 I Id, 80, 81, 82, 83, 84, 90, 92, 111 Idiopathic, 5, 62, 111 Ileal, 36, 40, 111 Ileitis, 26, 60, 111 Ileostomy, 62, 111, 117 Ileum, 10, 11, 40, 100, 111 Iliac Artery, 34, 43, 111 Immune response, 10, 13, 95, 97, 109, 111, 130 Immune system, 98, 111, 114, 130, 131 Immunodeficiency, 32, 111 Immunologic, 111, 123 Immunology, 95, 111 Immunosuppressant, 111, 116 Immunosuppressive, 12, 108, 111 Immunosuppressive therapy, 12, 111 Impaction, 36, 62, 111 Impairment, 111, 112 Implant radiation, 111, 112, 113, 123, 131 In vivo, 110, 111 Incision, 101, 111, 113 Incontinence, 10, 105, 111 Indicative, 58, 111, 119, 130 Indigestion, 58, 62, 63, 111 Indomethacin, 35, 111 Induction, 8, 112 Infancy, 4, 16, 26, 45, 112 Infant, Newborn, 95, 112 Infarction, 112 Infection, 4, 6, 9, 13, 32, 60, 62, 65, 68, 82, 96, 103, 105, 108, 111, 112, 114, 128, 129, 131 Infectious Diarrhea, 9, 112 Inflammatory bowel disease, 4, 6, 7, 8, 9, 10, 11, 12, 13, 59, 60, 61, 62, 66, 112 Information Centers, 58, 112 Inguinal, 63, 112 Inguinal Hernia, 63, 112 Inner ear, 112, 130

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Intermittent, 9, 24, 29, 33, 112 Internal Medicine, 23, 33, 108, 112 Internal radiation, 112, 113, 123, 131 Interstitial, 33, 50, 99, 112, 113, 131 Intestinal, 7, 9, 10, 12, 36, 58, 62, 69, 105, 112, 115 Intestinal Mucosa, 9, 105, 112 Intestinal Obstruction, 10, 62, 112 Intestinal Pseudo-Obstruction, 62, 112 Intestine, 6, 7, 12, 62, 98, 99, 102, 105, 113, 114 Intracellular, 112, 113 Intramuscular, 113, 119 Intravenous, 11, 60, 113, 119 Intrinsic, 95, 113 Intussusception, 4, 7, 11, 20, 33, 62, 113 Invasive, 5, 39, 113, 115 Involuntary, 4, 107, 113, 117 Iodine, 49, 113 Ionization, 113 Ionizing, 7, 96, 113, 123 Irradiation, 26, 35, 42, 113, 131 Irritants, 104, 113 Ischemia, 10, 113 J Jaundice, 58, 100, 110, 113 Joint, 4, 6, 66, 98, 113, 128 K Kb, 74, 113 Kidney Disease, 66, 74, 82, 113 Kinetic, 113, 114 L Labyrinth, 101, 112, 114, 130 Large Intestine, 10, 13, 46, 62, 100, 101, 104, 105, 113, 114, 124, 126 Laxative, 62, 114 Leukocytes, 99, 103, 105, 111, 114, 118 Library Services, 90, 114 Ligament, 114, 122 Ligation, 8, 54, 66, 114 Lipoma, 22, 114 Liver, 18, 58, 62, 95, 98, 99, 101, 103, 104, 106, 107, 108, 109, 110, 114, 121 Liver Transplantation, 62, 114 Localization, 15, 33, 38, 114 Localized, 28, 95, 109, 112, 114, 120, 129 Locomotion, 114, 120 Loop, 11, 111, 114 Lubricants, 114, 120 Lymph, 100, 105, 114 Lymph node, 100, 114 Lymphatic, 105, 112, 114, 127

Lymphocyte, 97, 114 Lymphocytic, 62, 114 Lymphoid, 11, 103, 114 Lymphoma, 23, 40, 114 M Magnetic Resonance Imaging, 11, 40, 115 Maintenance therapy, 12, 60, 115 Malabsorption, 9, 62, 115, 126 Malabsorption syndrome, 115, 126 Malaise, 60, 115 Malaria, 58, 115 Malaria, Falciparum, 115 Malaria, Vivax, 115 Malignancy, 7, 115, 119 Malignant, 6, 63, 97, 115, 117, 123, 125 Malingering, 38, 115 Malnutrition, 9, 10, 115 Manifest, 12, 115 Medical Records, 115, 125 Medicament, 115, 128 MEDLINE, 75, 115 Megacolon, 62, 115 Membrane, 96, 105, 109, 115, 117, 119, 121 Memory, 97, 115 Mental, iv, 13, 74, 76, 100, 104, 107, 115, 122, 130 Mercaptopurine, 12, 61, 116 Mesenteric, 116, 121 Metabolic disorder, 109, 116 Methotrexate, 61, 116 Metronidazole, 9, 61, 116 MI, 46, 93, 116 Microbe, 116, 129 Microbiological, 13, 116 Microbiology, 31, 116 Migration, 18, 116 Mitosporic Fungi, 98, 116 Modification, 22, 116, 123 Molecular, 12, 13, 75, 77, 99, 102, 110, 116, 125 Molecule, 97, 98, 104, 116, 123, 124 Monitor, 116, 118 Monoclonal, 113, 116, 123, 131 Monotherapy, 8, 116 Morphine, 116, 117 Motility, 111, 116 Motion Sickness, 116, 117 Mucociliary, 117, 126 Mucosa, 7, 12, 13, 30, 108, 117 Mucus, 104, 117, 129 Mydriatic, 104, 117 Myocardial infarction, 103, 116, 117, 131

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Myocardium, 116, 117 N Narcosis, 117 Narcotic, 61, 116, 117 Nasopharynx, 14, 15, 117 Nausea, 9, 58, 60, 63, 108, 111, 117, 130 Necrotizing Enterocolitis, 4, 48, 117 Need, 3, 5, 9, 10, 14, 42, 57, 58, 65, 69, 85, 117 Needle biopsy, 29, 107, 117 Neonatal, 21, 48, 117 Neoplasia, 27, 117 Neoplasm, 117, 125 Neoplastic, 39, 114, 117 Nephropathy, 113, 117 Nerve, 96, 117, 127 Nervous System, 98, 116, 117, 128 Neurons, 117, 118, 128 Neurosis, 117 Neurotic, 61, 117, 130 Neutrons, 96, 113, 118, 123 Neutrophils, 12, 114, 118 Nicotine, 61, 118 Nuclear, 6, 107, 118 Nuclei, 96, 115, 118, 122 Nucleus, 101, 103, 105, 107, 118, 122 Nursing Care, 118, 119 Nutritional Support, 108, 118 O Occult, 6, 28, 50, 107, 118 Occult Blood, 50, 118 Ocular, 7, 9, 118 Omentum, 118, 127 Overdosage, 58, 118 Oxygen Consumption, 118, 124 P Palate, 117, 118 Palpation, 3, 118 Pancreas, 95, 104, 108, 118, 127 Pancreatic, 62, 118 Pancreatitis, 22, 37, 43, 63, 118 Papillomavirus, 82, 119 Paralysis, 119, 126 Paranasal Sinuses, 119, 126 Parasitic, 104, 109, 119 Parenteral, 9, 119 Parenteral Nutrition, 9, 119 Partial remission, 119, 124 Pathogenesis, 7, 10, 12, 62, 119 Pathologic, 99, 103, 110, 119 Pathologist, 7, 119 Patient Care Management, 10, 62, 119

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Pediatric Gastroenterologist, 6, 119 Pediatrics, 6, 21, 40, 45, 46, 48, 51, 52, 119 Pelvic, 31, 105, 119, 122 Pelvis, 111, 119, 130 Pepsin, 119 Peptic, 49, 62, 63, 119 Peptic Ulcer, 49, 62, 63, 119 Peptide, 107, 119, 122 Perception, 102, 119 Perforation, 60, 119 Perianal, 66, 120 Perineal, 61, 120 Perineum, 120 Peritoneum, 118, 120 Peritonitis, 62, 120 Petroleum, 66, 120 Pharmacologic, 96, 98, 120, 129 Pharynx, 117, 120 Photocoagulation, 101, 120 Physical Examination, 4, 5, 9, 120 Physiologic, 95, 120, 124 Physiology, 10, 63, 108, 120 Pilot study, 14, 120 Pituitary Gland, 107, 120 Plants, 58, 96, 100, 120, 125, 129 Plasma, 20, 108, 109, 120, 125 Platinum, 114, 120 Pneumonia, 102, 120 Pneumonitis, 14, 120 Poison Control Centers, 58, 120 Poisoning, 108, 117, 120, 121 Polyp, 6, 11, 50, 82, 121 Polyposis, 6, 11, 102, 121 Polysaccharide, 97, 100, 121 Portal Hypertension, 45, 121 Portal Vein, 18, 121 Posterior, 96, 118, 121 Practice Guidelines, 76, 80, 121 Presumptive, 9, 121 Prevalence, 7, 49, 51, 121 Probe, 17, 121 Proctalgia Fugax, 4, 121 Proctitis, 7, 12, 60, 62, 121 Proctosigmoiditis, 12, 60, 121 Progesterone, 121, 127 Progression, 4, 121 Progressive, 101, 106, 109, 121 Prolapse, 66, 121 Prone, 66, 121 Prophylaxis, 81, 121, 131 Prospective study, 17, 30, 121 Prostaglandins, 111, 122

139

Prostaglandins A, 111, 122 Prostate, 14, 15, 20, 22, 26, 28, 29, 34, 35, 37, 41, 42, 49, 50, 52, 83, 122, 129 Protein S, 99, 122 Proteins, 97, 101, 103, 116, 119, 120, 122, 125, 129 Protocol, 52, 122 Protons, 96, 113, 122, 123 Protozoa, 62, 104, 116, 122 Protozoal, 122 Protozoan, 62, 108, 115, 122, 129 Protozoan Infections, 62, 122 Proximal, 7, 104, 122 Proxy, 4, 122 Pruritus, 4, 8, 122, 130 Psychotherapy, 107, 122, 123 Puberty, 6, 122 Public Policy, 75, 122 Pulmonary, 32, 99, 102, 105, 123, 131 Pulmonary Embolism, 123, 131 Pupil, 104, 117, 123 Purgative, 114, 123 Purpura, 4, 123 Q Quality of Life, 14, 59, 66, 123 R Race, 116, 123 Radiation, 7, 15, 17, 20, 21, 22, 26, 34, 35, 41, 42, 52, 106, 107, 112, 113, 116, 123, 131 Radiation therapy, 41, 42, 106, 112, 113, 123, 131 Radioactive, 111, 112, 113, 118, 123, 131 Radioimmunotherapy, 123 Radioisotope, 40, 123 Radiolabeled, 113, 123, 131 Radiological, 11, 29, 123 Radiology, 11, 16, 31, 35, 41, 42, 44, 46, 50, 51, 80, 123 Radiotherapy, 14, 15, 26, 28, 34, 50, 53, 99, 113, 123, 131 Randomized, 12, 14, 17, 104, 123 Reassurance, 66, 123 Receptor, 12, 97, 102, 124 Rectal, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 58, 59, 60, 61, 62, 63, 66, 67, 68, 69, 80, 81, 82, 83, 84, 124 Recur, 9, 60, 124

Recurrence, 5, 124 Red blood cells, 106, 110, 124, 125 Reductase, 116, 124 Refer, 1, 49, 107, 114, 118, 123, 124 Refraction, 124, 127 Refractory, 12, 60, 104, 124 Regeneration, 107, 124 Regimen, 5, 104, 124 Registries, 6, 124 Regurgitation, 109, 124 Remission, 5, 8, 12, 115, 124 Renal cell carcinoma, 42, 124 Resection, 124, 126 Respiration, 15, 100, 116, 124 Restoration, 124, 131 Resuscitation, 11, 60, 124 Retinal, 102, 124 Retrospective, 17, 125 Retrospective study, 17, 125 Rigidity, 120, 125 Risk factor, 7, 32, 51, 66, 104, 121, 125 Risk patient, 14, 125 Ristocetin, 125, 130 Rubber, 8, 66, 95, 125 S Saliva, 125 Salivary, 15, 103, 125 Salivary glands, 103, 125 Saponins, 125, 127 Sarcoma, 40, 125 Screening, 28, 40, 81, 83, 101, 125 Sedative, 125, 130 Self Care, 63, 125 Semen, 122, 125 Serum, 120, 125 Sex Characteristics, 95, 122, 125 Shock, 125, 129 Short Bowel Syndrome, 9, 126 Side effect, 58, 95, 111, 126, 129 Sigmoid, 40, 51, 83, 121, 126 Sigmoid Colon, 121, 126 Sigmoidoscopy, 6, 27, 35, 39, 41, 51, 54, 60, 69, 126 Signs and Symptoms, 40, 62, 124, 126, 130 Sinusitis, 9, 126 Skeleton, 113, 126 Small intestine, 6, 10, 62, 69, 100, 104, 105, 108, 110, 111, 112, 113, 126 Social Environment, 123, 126 Social Support, 126, 127 Sodium, 105, 109, 126 Soma, 126

Rectal bleeding

Somatic, 61, 95, 126 Sonogram, 126, 129 Sound wave, 126, 129 Spasmodic, 95, 126 Spastic, 61, 126 Spasticity, 126 Specialist, 7, 9, 85, 104, 127 Species, 13, 98, 108, 115, 116, 119, 123, 127, 128, 130 Specificity, 95, 127 Spectroscopic, 118, 127 Spectrum, 3, 4, 12, 127 Sphincters, 107, 127 Spinal cord, 81, 100, 117, 127 Spleen, 103, 114, 127 Splenic Artery, 21, 127 Splenic Vein, 121, 127 Stenosis, 127, 128 Stent, 18, 127 Steroid, 8, 12, 98, 125, 127 Stimulus, 14, 127 Stomach, 5, 13, 58, 62, 63, 95, 98, 103, 104, 105, 106, 108, 110, 117, 118, 119, 120, 126, 127 Stool, 4, 5, 8, 9, 10, 30, 50, 66, 69, 101, 107, 111, 114, 127, 128 Stool test, 9, 127 Stress, 6, 61, 66, 108, 117, 125, 127 Stress management, 61, 127 Stricture, 7, 127, 128 Stromal, 105, 128 Stupor, 117, 128 Styrene, 125, 128 Subacute, 112, 126, 128 Subclinical, 112, 128 Subcutaneous, 119, 128 Subspecies, 127, 128 Support group, 10, 128 Suppositories, 35, 108, 128 Symphysis, 122, 128 Symptomatic, 7, 118, 128 Synaptic, 118, 128 Synaptic Transmission, 118, 128 Systemic, 12, 61, 97, 99, 112, 113, 123, 128, 131 T Tachycardia, 12, 128 Telangiectasia, 17, 128 Tenesmus, 7, 12, 61, 104, 128 Thermal, 43, 104, 118, 128 Thromboembolism, 83, 128 Thrombosis, 39, 122, 128

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Thyroid, 113, 128 Time Management, 127, 129 Tomography, 102, 129 Topical, 8, 129 Toxic, iv, 118, 128, 129, 130 Toxicity, 61, 125, 129 Toxicology, 76, 129 Toxins, 9, 97, 109, 112, 123, 129 Transfection, 99, 129 Transfusion, 129 Transrectal ultrasound, 37, 129 Trauma, 66, 106, 119, 129 Trees, 125, 129 Trichomoniasis, 116, 129 Tunica, 117, 129 U Ulcer, 4, 10, 37, 52, 129 Ulceration, 9, 20, 37, 40, 119, 129 Ulcerative colitis, 5, 6, 7, 8, 9, 11, 12, 13, 59, 60, 61, 62, 66, 82, 112, 129 Ultrasonography, 11, 129 Unconscious, 98, 111, 129 Unresectable, 80, 129 Uraemia, 119, 129 Urethra, 122, 130 Uric, 109, 111, 130 Urinary, 99, 111, 130 Urine, 99, 109, 111, 130 Uterus, 100, 105, 121, 130 V Vaccine, 95, 122, 130 Valerian, 57, 130 Vancomycin, 9, 130 Varices, 4, 23, 130 Vascular, 6, 7, 17, 35, 50, 62, 96, 105, 112, 130 Vasculitis, 119, 130 Vein, 39, 96, 113, 118, 121, 127, 130 Venous, 32, 83, 122, 130, 131 Venous Thrombosis, 130, 131 Venules, 99, 130 Vertebrae, 127, 130 Vestibule, 101, 112, 130 Veterinary Medicine, 75, 130 Viral, 62, 110, 130, 131 Viral Hepatitis, 62, 110, 130 Virulence, 129, 130 Virus, 32, 130 Vitro, 110, 111, 125, 131 Volition, 113, 131 W Warfarin, 6, 54, 131

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Warts, 32, 131 White blood cell, 97, 105, 114, 117, 131 Wound Healing, 107, 131

X X-ray, 7, 35, 98, 102, 107, 113, 118, 123, 131 X-ray therapy, 113, 131

Rectal bleeding

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Rectal bleeding

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