ECTOPIC
PREGNANCY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Ectopic Pregnancy: 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: 0-597-83902-6 1. Ectopic Pregnancy-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on ectopic pregnancy. 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 ECTOPIC PREGNANCY .............................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Ectopic Pregnancy ........................................................................ 4 E-Journals: PubMed Central ....................................................................................................... 28 The National Library of Medicine: PubMed ................................................................................ 29 CHAPTER 2. NUTRITION AND ECTOPIC PREGNANCY .................................................................... 73 Overview...................................................................................................................................... 73 Finding Nutrition Studies on Ectopic Pregnancy ....................................................................... 73 Federal Resources on Nutrition ................................................................................................... 78 Additional Web Resources ........................................................................................................... 79 CHAPTER 3. ALTERNATIVE MEDICINE AND ECTOPIC PREGNANCY .............................................. 81 Overview...................................................................................................................................... 81 National Center for Complementary and Alternative Medicine.................................................. 81 Additional Web Resources ........................................................................................................... 85 General References ....................................................................................................................... 86 CHAPTER 4. PATENTS ON ECTOPIC PREGNANCY ........................................................................... 87 Overview...................................................................................................................................... 87 Patents on Ectopic Pregnancy ..................................................................................................... 87 Patent Applications on Ectopic Pregnancy.................................................................................. 90 Keeping Current .......................................................................................................................... 91 CHAPTER 5. BOOKS ON ECTOPIC PREGNANCY............................................................................... 93 Overview...................................................................................................................................... 93 Book Summaries: Federal Agencies.............................................................................................. 93 Book Summaries: Online Booksellers........................................................................................... 95 The National Library of Medicine Book Index ............................................................................. 96 Chapters on Ectopic Pregnancy ................................................................................................... 97 CHAPTER 6. MULTIMEDIA ON ECTOPIC PREGNANCY .................................................................... 99 Overview...................................................................................................................................... 99 Bibliography: Multimedia on Ectopic Pregnancy ........................................................................ 99 CHAPTER 7. PERIODICALS AND NEWS ON ECTOPIC PREGNANCY ............................................... 101 Overview.................................................................................................................................... 101 News Services and Press Releases.............................................................................................. 101 Newsletters on Ectopic Pregnancy ............................................................................................ 105 Academic Periodicals covering Ectopic Pregnancy.................................................................... 106 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................. 107 Overview.................................................................................................................................... 107 U.S. Pharmacopeia..................................................................................................................... 107 Commercial Databases ............................................................................................................... 108 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 111 Overview.................................................................................................................................... 111 NIH Guidelines.......................................................................................................................... 111 NIH Databases........................................................................................................................... 113 Other Commercial Databases..................................................................................................... 116 APPENDIX B. PATIENT RESOURCES ............................................................................................... 117 Overview.................................................................................................................................... 117 Patient Guideline Sources.......................................................................................................... 117 Finding Associations.................................................................................................................. 123 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 125 Overview.................................................................................................................................... 125
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Preparation................................................................................................................................. 125 Finding a Local Medical Library................................................................................................ 125 Medical Libraries in the U.S. and Canada ................................................................................. 125 ONLINE GLOSSARIES................................................................................................................ 131 Online Dictionary Directories ................................................................................................... 134 ECTOPIC PREGNANCY DICTIONARY .................................................................................. 135 INDEX .............................................................................................................................................. 177
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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 ectopic pregnancy 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 ectopic pregnancy, 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 ectopic pregnancy, 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 ectopic pregnancy. 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 ectopic pregnancy, 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 ectopic pregnancy. 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 ECTOPIC PREGNANCY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on ectopic pregnancy.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and ectopic pregnancy, 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 “ectopic pregnancy” (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: •
Primary Care Diagnosis of Acute Abdominal Pain Source: Nurse Practitioner. 21(12): 19-20, 23-26, 28-30, 35-41. December 1996. Contact: Available from Nurse Practitioner. P.O. Box 5053, Brentwood, TN 37024-9739. (800) 490-6580. Fax (615) 377-0525. Summary: The abdomen, as the largest cavity in the body, holds both fixed and relatively mobile organs, which when either diseased, traumatized, malfunctioning, or infected may present a wide and diverse range of signs and symptoms. This article reviews the surface anatomy of the abdomen, approach to the patient with abdominal pain, and history taking and physical examination. Adjunctive studies, which might help to reduce the differential diagnosis, are mentioned. The goal of the article is to help
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the reader formulate an accurate diagnosis in a timely manner via a complete and well focused physical examination. Intra-abdominal causes of abdominal pain include peritonitis, bowel obstruction, and vascular disorders. Extra-abdominal sources of abdominal pain include the thorax, pelvis, and the abdominal wall. Some metabolic and neurogenic sources of abdominal pain are examined. Life threatening causes of abdominal pain include ectopic pregnancy, acute myocardial infarction, abdominal aortic aneurysm, splenic rupture, and obstructed bowel. The author's discussion of these entities concentrates on the initial presentation of the patient, typical progression of symptoms, and appropriate initial treatment as well as referral. The process of ruling out emergent abdominal pain is also examined. The article concludes with a posttest with which readers can qualify for three ANCC (American Nurses Credentialing Center) continuing education contact hours. 8 tables. 18 references. (AA-M).
Federally Funded Research on Ectopic Pregnancy The U.S. Government supports a variety of research studies relating to ectopic pregnancy. 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 ectopic pregnancy. 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 ectopic pregnancy. The following is typical of the type of information found when searching the CRISP database for ectopic pregnancy: •
Project Title: ANTIMICROBIALS AGAINST CHLAMYDIA AND GC INFECTION: IN VITRO STUDIES Principal Investigator & Institution: Cooper, Morris D.; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2001 Summary: Microbial pathogens which invade the genital mucosa have specific mechanisms which involve adherence, invasion, intracellular survival and exit as a means of production of pathogenicity. C. trachomatis is the most common sexually transmitted bacterial pathogen in this country causing about 4.5 million cases of chlamydia in men, women, and children. The majority of chlamydial infections in women are asymptomatic, sequealae of untreated infections are an important part of the pathogenesis of the disease. Infections due to N. gonorrhoeae, like those of C. trachomatis, remain a major cause of STDs. Further, they remain a major cause of pelvic inflammatory disease, tubal infertility, ectopic pregnancy and chronic pelvic pain in the United States. Epidemiologic data provide strong evidence that gonococcal infections
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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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facilitate the transmission of other STDs and studies have begun to elucidate the specific mechanisms through which this facilitation occurs(). In 1996, there were greater than 325,000 cases of gonorrhea reported in the United States. However, this rate has continued to decline since 1975 but still remains a significant cause of disease. Although adequate antimicrobial therapy exists for this infection rates are high (17 percent/100,000 population) and antimicrobial resistance is significant (29 percent of all isolates collected in 1996 were resistant to penicillin, tetracycline or both). Therefore, alternate methods of controlling the infection remains a high priority. Toward this end, we are aggressively pursuing antimicrobials which have potential as topical microbicides. Therefore, there is a critical need to find a microbicide that would interact with these pathogens either prior to or at the point of interaction with cells of the genital mucosa. We have decided to study a variety of chemical agents including detergents, bile salts and other compounds to determine their antichlamydial and antigonococcal activity in both in vitro assays using cell cultures and the human fallopian tube organ culture model. This proposal will address several questions which are central to the determination of useful microbicidal agents which will interrupt the interaction between the chlamydial elementary body and/or gonococci and receptors on the host cell surface. The specific aims of this proposal are: (1) To expand the human primary cell culture systems to evaluate in vitro the efficacy and cytotoxicity of potential topical antimicrobials to prevent infection of the genital mucosa by Chlamydia trachomatis and/or Neisseria gonorrhoeae. (2) Define the mechanism(s) by which select noncytotoxic candidate topical antimicrobials inhibit C. trachomatis and/or N. gonorrhoeae and (3) Isolate the HS glycosaminoglycans (GAGs) from human genital tract cells and organ cultures and identify fractions important for C. trachomatis adherence to cells. These studies should allow a detailed study of antimicrobials which will allow their potential as topical microbicides to be exploited. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ASSESSING THE VARIABILITY IN TIME TO TREATMENT IN SURGER Principal Investigator & Institution: Chassin, Mark R.; Health Policy; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 29-SEP-2002 Summary: Many factors influence patients' decisions to seek medical care when they experience symptoms of illness. Different factors influence the ability of patients to enter the health care system once they decide they wish to. Yet a different set of considerations affect the provision of timely and effective care. For a number of surgical conditions, delays in providing definitive care are especially likely to increase the frequency of serious adverse outcomes, including death, immediate complications, and long-term disability. For these delay-sensitive conditions, we currently understand very little about the relationship between time to treatment and outcomes, which components of this total time are the most important determinants of outcome, and which components may be modifiable. Past work has focused on conditions such as myocardial infarction and trauma and has emphasized particular segments of time (e.g., time from injury to hospital; time from onset of chest pain to emergency room door). None has articulated a conceptual framework that encompasses the full range of factors that might influence delays. These include patient factors (knowledge, beliefs, and coping strategies), physician factors (knowledge, diagnostic acumen), hospital factors (availability of diagnostic tests and operating rooms), and health system factors (health insurance, utilization management, gatekeeping). We propose to study three delay-
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sensitive conditions: appendicitis, ectopic pregnancy, and intestinal obstruction. In phase 1, we will review medical records retrospectively to establish the relationship between overall time to treatment and health outcomes and to examine variability in different components of this time. Multivariate analysis will permit us to examine the effect of time to treatment after adjustment for age and comorbid conditions. In phase 2, we will gather data concurrently from patients and their physicians, as well as from medical records, to assess the full range of patient, physician, and health system factors contributing to variability in time to treatment. These analyses will substantially improve our understanding of the relationship between time to treatment and health outcomes. Studying three conditions will permit some initial observations about how unique or generalizable these relationships are in different clinical settings. These data may also lead to hypotheses about which factors associated with delays might be modifiable, leading to the design of specific interventions to reduce delays and improve outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CELLULAR TRAFFICKING TO INFLAMED FEMALE GENITAL MUCOSA Principal Investigator & Institution: Kelly, Kathleen A.; Assistant Professor; Pathology and Laboratory Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: Pelvic inflammatory disease, tubal infertility and ectopic pregnancy typically emerge in females after a chronic infection with Chlamydia trachomatis or Neisseria gonorrhoeae. Due to the insidious nature of chlamydial infections, efforts have been put forth to develop a vaccine that would enhance the clearance of organisms, avoid chronic infections, and in turn, eliminate reproductive disability. Based on the theory of a common mucosal immune system, lymphocyte recruitment to the genital mucosa is predicted to occur when lymphocytes are activated at distant mucosal surfaces. Studies of Chlamydia genital infection in the mouse have shown that T cells are required for protection and effector T cells are found in the genital mucosa following immunization at other mucosal sites. Currently, the degree of T cell migration to the genital mucosa following antigen delivery at other mucosal surfaces is unknown in humans. In this proposal, we will test the hypothesis that T cells activated at other mucosal surfaces can be recruited to the genital mucosa during an inflammatory process. Since T cells are not commonly recruited to the genital mucosa, we will study females infected with C. trachomatis or N. gonorrhoeae as a model to test this hypothesis. The specific aims of this proposal are to: 1) Develop a method to identify T cells that home to the genital mucosa in vivo using individuals with a sexually transmitted disease (STD). 2) Determine if immunization by a distant mucosal route promotes T cell trafficking to the genital mucosa. We will define the homing receptor expression pattern (gut mucosal, other mucosal, non-mucosal) on endocervical T cells and IFNgamma+ peripheral blood cells from STD infected volunteers using flow cytometric techniques. We will also determine which adhesion molecules are induced within the female genital mucosa during STD infection by utilizing an in vitro fallopian tube culture of living tissue followed by immunohistological staining. The candidate homing receptor: adhesion molecule pairs will be tested in a genital mucosa adhesion assay. The frequency of genital mucosa homing T cells and mature dendritic cells will be monitored in volunteers following immunization with Salmonella typhi vaccine via different routes.
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These studies will contribute to the design of STD vaccines that would provide lasting immunity in the female genital mucosa. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CHEMOKINE REGULATION OF MUCOSAL IMMUNITY AGAINST GENITAL CHLAMYDIAL INFECTION Principal Investigator & Institution: Ananaba, Godwin A.; Spelman College 350 Spelman Ln Sw Atlanta, Ga 30314 Timing: Fiscal Year 2001 Summary: Genital infection by the obligate intracellular bacterium, Chlamydia trachomatis, is the most common bacterial sexually transmitted disease (STD) in the United States, with four million annual cases that cost $2.18 billion. In women the infection can lead to serious complications, including pelvic inflammatory disease, ectopic pregnancy and infertility. Many of the infections are asymptomatic and irreversible complications may be the first symptoms. The obvious concern that Chlamydia poses a potential threat to human reproduction, well-being and national budgets has intensified research on intervention and prevention strategies, of which a vaccine is a high priority. Anti-chlamydial vaccine research include the use of animal models for studying the pathogenesis and immunobiology of the disease, and defining antigens and immune effectors mediating immunity. These studies have shown that T cell- mediated immune responses, involving the induction and recruitment of T helper type 1 (Th1) cells into the genital mucosa is crucial for chlamydial immunity. Such factors would likely influence the genital mucosal expression and regulation of chemokines released by injected epithelial cells, chemokine receptors on recruited leukocytes, adhesion molecules involved in genital mucosal lymphoepithelial interactions, and local cytokine secretion. The focus of this proposal is to use novel in vitro and in vivo models of chlamydial infection and molecular and biochemical techniques to investigate the recruitment and maintenance of immune effectors in the genital mucosa following an infection. Specific studies will: (a) identify the chemokines elaborated by infected epithelial cells, for recruiting Th1 cells into the genital tract; and (b) identify certain adhesion molecules that are up-regulated after chlamydial infection and play a role in the retention of effectors in the genital tract. The results from this study will contribute to a better understanding of the regulatory mechanisms of effector recruitment and retention in the genital mucosa during chlamydial infection, which may lead to the designing of rational strategies to enhance the efficacy and long-term protective immunity of a chlamydial vaccine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CHLAMYDIA TRACHOMATIS ENVELOPE COMPONENTS AND VIRULENCE Principal Investigator & Institution: Raulston, Jane E.; Pathology; East Tennessee State University Box 70565 Johnson City, Tn 37601 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2004 Summary: (provided by applicant): Chlamydia trachomatis is the leading bacterial agent of sexually transmitted infections in the United States and a major culprit in urethritis, cervicitis, endometritis, salpingitis, pelvic inflammatory disease, infertility and ectopic pregnancy. The highest chlamydial infection rates are observed in young people between 15 and 34 years of age. Throughout these peak reproductive years, the endometrial epithelial cell layer lining the uterine cavity is subject to constant changes in
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levels of micronutrients such as iron, due to hormonal cycling during menstruation. Endometrial epithelial cells are natural target host cells for infection by chlamydiae. The availability of iron is well-known to have a tremendous influence on the production of bacterial antigens, envelope components and virulence factors; these effects are particularly prominent for obligate intracellular pathogens such as chlamydiae. In other pathogens, virulence factors produced in response to low concentrations of iron elicit tissue damage in the host. Certain bacterial iron-regulated proteins are also immunotherapeutic targets for vaccine design. In these studies, the mechanism for regulation of chlamydial iron-responsive proteins and antigens will be examined in Specific Aim 1. Specific Aims 2 and 3 will (i) determine the identities of chlamydial ironregulated proteins, and (ii) quantitatively assess transcription of the genes encoding these components under iron-deficient growth conditions, respectively. In Specific Aim 4, an envelope transport system will be examined to determine whether or not it functions as a major iron-uptake pathway for the chlamydiae. The long-term objectives for these studies are to develop a better understanding of mechanisms for the destructive tissue pathology observed in chlamydial infections and to provide new insights on specific chlamydial proteins and antigens that could be tested for their immunotherapeutic potential. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CHLAMYDIAL IMMUNITY AND PATHOGENESIS Principal Investigator & Institution: Stephens, Richard S.; Professor; None; University of California Berkeley Berkeley, Ca 94720 Timing: Fiscal Year 2001; Project Start 01-APR-1997; Project End 31-MAR-2003 Summary: (Adapted from the applicant's abstract): Chlamydia trachomatis is a common and important cause of sexually transmitted infection, and the most damaging diseases are salpingitis and epididymitis, that may result in infertility, chronic pelvic pain and ectopic pregnancy. The focus of this proposal is the characterization of immune responses to chlamydial infection that are related to immunity or pathogenesis. Immunity to C. trachomatis is poorly understood, although animal models and human trachoma vaccine trials have demonstrated important roles for both antibody and cellmediated mechanisms. The hypothesis is that antigen-specific humoral and cellmediated immune responses associated with immunity and resolution of infection can be identified using in vitro neutralization and cytotoxicity assays. Moreover, it is proposed that inflammatory pathogenic responses originate by proinflammatory cytokines produced from infected epithelial cells and amplified by antigen-specific immune responses. Over 15 serovariants of C. trachomatis have been described and serovar-specific antigens are associated with protective immunity. The major outer membrane protein (MOMP) of chlamydiae contains the serovar-specific antigen. However, this antigenically complex molecule also contains subspecies- and speciesspecific antigens. The MOMP is the target of antibody-mediated neutralization. The specific aims are the characterization of antibody-mediated neutralization of extracellular organisms, dissection and optimization of target MOMP epitopes, cellmediated immune responses that recognize and lyse chlamydia-infected cells, and innate cellular immunopathogenic responses to chlamydial infection. The broad, longterm objective of this application is a basic understanding of innate and immune mechanisms associated with immune protection and disease and it is expected that this will have applications for developing a biological strategies for prevention of infection or disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: COOPERATIVE MULTICENTER REPRODUCTIVE MEDICINE NETWORK Principal Investigator & Institution: Carson, Sandra; Professor; Obstetrics and Gynecology; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: Technologic advancements allowing the early, nonsurgical diagnosis of ectopic pregnancy prompted the initiation of medical therapy for ectopic pregnancy. The medical regimens became popularized without efficacy assessment or rigid criteria for the limitations of usage. In May, 1999 the Reproductive Medicine Network initiated a pilot protocol to 1) compare the efficacy of single dose methotrexate and multiple dose methotrexate in the treatment of ectopic pregnancy and 2) determine the limitations of usage for each protocol. The Principal Investigator of this application is the principal author of the prospective randomized trial for this project, a project well suited for the multicenter network because of its importance to public health and its need for a large number of subjects due to the expected small differences in efficacy. As a Reproductive Medicine Network member for 10 years, the Principal Investigator and Co-Investigator have had a major role in the two completed network studies. We contributed 225 subjects or 24 percent of the total, to the project, "Randomized Treatment of Unexplained Infertility", with 32 percent of the resultant pregnancies.' A comparable number were recruited for the "Evaluation of Semen Parameters in Fertile Males". Our institution is especially well positioned to contribute to the newest initiated networkwide study, "The Evaluation of the Luteal Phase in Fertile and Infertile Women" because the faculty at Baylor is responsible for 3 hospitals (1 public; 2 private) in the nation's largest concentration of health care facilities-the Texas Medical Center. In part, for this reason, the ectopic pilot study initiated only 6 weeks ago, is already 40 percent completed and ahead of the recruitment schedule. In addition, one of the largest male reproductive units (Dr. Larry Lipshultz) complements our 3 Reproductive Endocrinologists, 2 Reproductive Geneticists, and 4 Gynecologists. Our experience in the Reproductive Medical Network has enabled us to collaborate with the other clinical centers and data collection center in designing prospective clinical trials to test hypothesis relevant to clinical medicine. We acknowledge and accept first hand the loss of autonomy necessary to represent the collective wisdom of the several institutions participating in a multicenter effort. However, the gains are substantial to the scientific community -and long awaited in our field in particular. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: COOPERATIVE MULTICENTER REPRODUCTIVE MEDICINE NETWORK Principal Investigator & Institution: Coutifaris, Christos; Associate Professor and Director; Obstetrics and Gynecology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: Through this application, the University of Pennsylvania seeks to continue its participation in the network of clinical reproductive medicine units (RMU). The University has established strength in clinical and basic research in infertility, endocrinology and reproductive biology. High volume clinical programs in the surgical and medical treatment of female and male infertility have been in place for over three decades. Laboratories dedicated to reproductive medicine (assisted reproductive technologies, andrology, and reproductive endocrinology) and an NIH-supported
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Clinical Research Center enhance the clinical and research programs. The participating faculty brings expertise in gynecology, andrology, psychiatry, clinical epidemiology and biostatistics, clinical chemistry and computer and information technology. The proposed administrative structure for the RMU includes a Principal Investigator, Christos Coutifaris, M.D., Ph.D., Director of the Division of Reproductive Endocrinology and Infertility, who will be assisted by two co- principal investigators Luigi Mastroianni, Jr., M.D., previous director of the division and original P.I. of the Penn RMU and Kurt Barnhart, M.D., M.S.C.E., director of the division's clinical research unit. In addition, an Executive Committee will oversee the progress and functions of the RMU. During the previous period of funding, the first two clinical trials were completed and the initial analysis of the superovulation/intrauterine insemination (SO/IUI) protocol was published in the New England Journal of Medicine. Analyses of the fertile male study results and those of a number of ancillary studies stemming from the SO/IUI trial are currently being performed. If funding is extended, the University of Pennsylvania RMU will continue to recruit patients for the endometrial biopsy study (Penn's "concept protocol" in the previous submission) recently approved as a Network-wide protocol and will participate in any new studies decided upon by the steering committee and NICHD. It is anticipated that two additional years will be required for completion of the endometrial biopsy study. It is also anticipated that the protocol for the use of Methotrexate for treatment of ectopic pregnancy will be implemented in all RMN sites. With the recent establishment of a clinical research unit within the Division, which has dedicated space, equipment and personnel, the Penn RMU is in the unique position to undertake and successfully participate in multiple concurrent clinical trials. It is our expectation that as the Reproductive Medicine Network has now matured, multiple protocols will successfully be implemented. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CYTOKINE NETWORK IN CHLAMYDIAL DISEASE Principal Investigator & Institution: Darville, Toni; Professor; Pediatrics; University of Arkansas Med Scis Ltl Rock 4301 W Markham St Little Rock, Ar 72205 Timing: Fiscal Year 2001; Project Start 15-APR-1999; Project End 31-MAR-2004 Summary: (Adapted from the Applicant's Abstract): In women, the manifestations of C. trachomatis infection range from asymptomatic cervicitis to pelvic inflammatory disease, infertility, and ectopic pregnancy. Variations in outcomes suggest humans exhibit heterogeneity in host susceptibility to chlamydial disease. A genetic influence on disease susceptibility is supported by epidemiological studies in humans, and in animal models of experimental infection. The candidate has confirmed that true differences exist among three genetically defined strains of mice as regards resolution of chlamydial genital tract infection and the development of pathological sequelae. Despite these differences, extensive data reveal their acquired immune responses to be similar - CD4+ T cells of the Th 1 phenotype are critical to recovery from chlamydial infection. In contrast, comparisons of responses active during the first week of infection reveal significant differences in early cellular and cytokine response mediators. This proposal involves using the inherent differences present in these strains of mice as a tool for examining cytokine regulatory pathways important in chlamydial disease pathogenesis. The significance of the different patterns of cytokine responses determined among the three strains will be further explored with mice genetically deficient in specific cytokine mediators. Specific aims of the proposal include: 1) confirmation of the role of TNFalpha and of neutrophils in early control of chlamydial infection and determination of their role in the development of chronic pathology; 2) delineation of the contribution of
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other proinflammatory cytokines (interleukin-1 and interleukin-6) and of select chemokines to host defense and immunopathology; 3) determination if different kinetics of the downregulatory cytokines, TGF-beta and interleukin-10, influence the course and outcome of chlamydial genital tract infection. A determination of cytokine response patterns that promote tissue damage from those that result in benign resolution of infection is an important goal as regards the development of a safe and effective chlamydial vaccine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DOUCHING AND REPRODUCTIVE TRACT INFECTIONS Principal Investigator & Institution: Funkhouser, Ellen M.; Epidemiology & Interntl Health; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Douching is a common practice among American women, especially in the South, among Black women, and among women who are less educated. Douching has been associated with many adverse health events including pelvic inflammatory disease and ectopic pregnancy, and to a much less well established degree, sexually transmitted diseases (STDs). The proposed project is a cross-sectional study of reproductive tract infections and douching practices in Jefferson County, AL. Women attending the County STD clinic and 2 County Family Planning Clinics will be interviewed prior to examination regarding douching practices and history of sexual activities, pregnancies, contraceptive practices, and STDs. Presence of infections and pH of vaginal secretions will be ascertained from appropriate tests. Cases will be women presenting with syphilis, gonorrhea, trichomonas, chlamydia , or bacterial vaginosis. Over a 29 month period 4,370 women, 1,400 from the STD clinic and 2,970 from the Family Planning Clinics, will be interviewed. This should provide about 935 STD cases, 577 cases of bacterial vaginosis without an STD, and 2,858 women with no infections. Douching practices among women with and without a reproductive tract infections will be compared. Logistic regression analysis will be used to assess the following: 1) whether douching is associated with increased risks of STDs or bacterial vaginosis; 2) whether douching is associated with vaginal pH; 3) whether there is a dose-response relationship regarding frequency of douching; and 4) whether the risk differs according to preparation used. We believe the similarities in socioeconomic status of women attending the clinics will be substantial making douching practices potentially one of the most distinguishing characteristics of women with and without an infection. Furthermore, the findings will be readily generalizable to a population that historically and currently has some of the highest STD rates in the nation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DOUCHING, VAGINAL MICROBIOLOGY, AND PID Principal Investigator & Institution: Ness, Roberta B.; Professor and Chair; Epidemiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 01-DEC-1998; Project End 30-NOV-2003 Summary: Pelvic inflammatory disease is a major or cause of reproductive morbidity worldwide. Its sequelae include tubal infertility, chronic pelvic pain, recurrent PID and ectopic pregnancy. Douching is a common and possibly modifiable potential risk factor for PID, but a handful of previous studies examining this association are retrospective and conflicting. At the same time, compelling data suggest that douching may alter the
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vaginal microenvironment, thereby predisposing to bacterial vaginosis and perhaps, resultant PID, but this has not been fully tested. We propose to conduct a large, multicenter, prospective cohort study to examine the independent association between douching and PID and to study the effect of douching on vaginal microbiology. We will enroll 1800 women at high risk for acquiring sexually transmitted infections. Half will be women who report douching consistently at least once per month over the past six months; half will be women who report never douching in the past six months. Enrolled women will be evaluated at baseline by interview for behavioral characteristics related to douching and STD risk and by lower genital tract microbiology for N. gonorrhoea, C. trachomatis, bacterial vaginosis, and concentrations of lactobacillus, anaerobes and facultative bacteria. During 3-4.5 years of follow-up, serial interviews will be completed and self-obtained vaginal swabs assessed for lactobacilli and other vaginal bacteria. The primary outcome of PID (symptomatic endometritis), will be compared between the douching and non-douching groups. We will also compare the following: 1) gonococcal or chlamydial cervicitis at baseline, 2) bacterial vaginosis and semi-quantitative lactobacilli concentration at baseline, 3) change during follow-up in the concentration of lactobacilli (hydrogen-peroxide producing and non-producing), as well as anaerobic and facultative bacteria. Given the paucity of information regarding the relationship between douching and reproductive outcomes, the proposed study is imperative in order to direct future public health recommendations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ECTOPIC TRANSPLANTATION OF INVASIVE TROPHOBLAST Principal Investigator & Institution: Adams, Alison P.; J a Baker Inst for Animal Hlth; Cornell University Ithaca Office of Sponsored Programs Ithaca, Ny 14853 Timing: Fiscal Year 2001; Project Start 15-JUL-2001 Summary: This proposal is based upon the hypothesis that the trophoblast has the capacity to regulate maternal immune responses during pregnancy, independent of the hormonal status of the mother or the site of implantation. A system for transplanting equine invasive trophoblast cells to ectopic sites has been developed as a means to assess the maternal immune responses to the developing conceptus. Preliminary studies demonstrate that transplanted trophoblast: 1) differentiate and function in sites other than the uterus, 2) evoke strong cellular and humoral immune responses by the recipient, 3) downregulate MHC class I antigens as they do after invading the uterus in normal pregnancy, and 4) survive for 28 days or longer after transplantation. Based on the trophoblast transplant model, this proposal would address the following questions: 1) Are the humoral and cellular immune responses to invasive trophoblast altered in a non-uterine mucosal site (vulvar mucosa) when compared to those which occur 1n normal pregnancy? Immune responses to trophoblast transplants would be compared to those induced by normal pregnancy or by skin allografting using the following assays: lymphocyte microcytotoxicity assay to determine the cytotoxic antibody titer, duration, and onset, Western blot technique to identify the molecular target(s) of the antibody response, ELISA capture assay to determine antibody isotypes, quantitative RT-PCR assay to identify cytokine profiles, and cytotoxic lymphocyte (CTL) assay to assess cellular immune functions. 2) What mechanisms do invasive trophoblast cells employ to regulate maternal immune responses? Molecular assays would be used to determine if invasive trophoblast cells control immune effector function by synthesizing immunosuppressive factors, such as indoleamine 2,3- dioxygenase (IDO) and FasL. Quantitative and in situ RT-PCR assays would be performed on allogeneic and MHC class I compatible trophoblast transplants to determine the presence and temporal
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expression of these transcripts. The proposed study should provide important insights into the relative roles of the trophoblast, the uterine site, and the pregnant state in influencing fetal evasion of maternal immune responses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ED STAFFING AND PATIENT OUTCOMES Principal Investigator & Institution: Bickell, Nina A.; Health Policy; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: (PROVIDED BY APPLICANT): Society depends on accessible, responsive emergency medical care. Overcrowding and understaffing in Emergency Departments (ED) are serious issues and may adversely affect the health and safety of individuals in need of timely care. Despite emergency departments' critical "front-line" role, little is known about optimal physician and nurse staffing of Emergency Departments and their effects on patients' care and health outcomes for common urgent conditions. We propose to assess the relationship of Emergency Department physician and nurse staffing on time to treatment and patients' health outcomes for 3 delay sensitive conditions: appendicitis, ectopic pregnancy and intestinal obstruction. We will build on an ongoing AHRQ-funded project, "Assessing the Variability in Time to Treatment in Surgery." That study is collecting detailed information about symptom onset time, exam times, times of diagnosis and treatment, clinical characteristics and the course of care for patients with appendicitis, ectopic pregnancy and intestinal obstruction (N=409). In the proposed study, we will obtain data on emergency department physician and nurse staffing, patient census, and patients' level of nursing acuity from the emergency department's computer tracking software and other hospital data systems. The specific aims of this study are: 1. To explore and quantify the relationship between ED staffing and patient risk of adverse health outcomes. 2. To explore and quantify the relationship between ED staffing and different components of time to treatment. 3. To explore the relationship between the level of acuity of illness in the ED and different components of time to treatment. We will use multivariate analysis to examine the relationship of key ED physician and nurse staffing with time between patients' arrival to the ED and: 1) first emergency department examination; 2) diagnosis; 3) treatment; and with 4) rates of rupture for patients seen in the emergency department with the 3 delay sensitive conditions. These analyses will provide important information about the association of key emergency department staffing on patients' receipt of timely care and the health consequences of our current emergency delivery system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: FUNCTION OF OPA AND LOS IN GONOCOCCAL PATHOGENESIS Principal Investigator & Institution: Stein, Daniel C.; Professor; Cell Biology & Molecular Gen; University of Maryland College Pk Campus College Park, Md 20742 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2004 Summary: (provided by applicant): Neisseria gonorrhoeae causes about 600,000 new infections each year in the United States, with health-care costs approaching 2 billion dollars/year. The costs and human suffering are amplified by the fact that concomitant gonococcal infections appear to facilitate HIV transmission. Gonococci preferentially infect the human urogenital tract, and its ability to enter and transcytose this mucosal surface is a chief cause of pelvic inflammatory disease, tubal infertility, ectopic pregnancy, and chronic pelvic pain. Various surface components, i.e.,
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lipooligosaccharide (LOS) and opacity proteins (Opa), are important in mediating these diseases. Most studies have used tissue culture models to study the role of individual surface components in the pathogenic process, even though it is likely that multiple components are needed and/or are able to act synergistically. The fact that this pathogen manipulates its outer membrane suggests that such modifications are important in pathogenesis. Nothing is known about possible interactions between the surface molecules, because to date, we have lacked bacterial strains that have invariant, defined surfaces. This has prevented us from developing a comprehensive understanding of the pathogenesis of gonococcal disease. The objective of this proposal is to understand how gonococcal opacity proteins and Iipooligosaccharides interact in the pathogenic process. The central hypothesis of the proposed research is that different variants of these surface antigens are important for the various stages of infection and/or symptom elicitation. We intend to test our hypotheses by pursuing three specific aims: We will determine how various surface structures interact in the invasion process, we will identify which receptors are responsible for binding specific LOS molecules and we will define the signal transduction pathways that are activated in host celIs that are initiated by gonococcal adherence and/or invasion. The proposed research addresses the fundamental problem of how LOS and Opa interact in the disease process. We will define how LOS and Opa variation contribute to disease pathogenesis. The impact on human health is expected to be significant, because the new knowledge will likely make possible new approaches to the prevention and treatment of gonorrhea. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GLYCOPROTEIN HORMONE FOLDING Principal Investigator & Institution: Moyle, William R.; Associate Professor; Ob, Gyn and Reproductive Scis; Univ of Med/Dent Nj-R W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, Nj 08854 Timing: Fiscal Year 2001; Project Start 15-FEB-2000; Project End 31-JAN-2005 Summary: Reproduction and thyroid function are controlled by the glycoprotein hormones, heterodimeric proteins composed of an alpha-subunit common to all and a hormone-specific beta-subunit. These subunits are structurally similar and the heterodimer is stabilized by a portion of the beta-subunit that is wrapped around the alpha-subunit and latched by a disulfide to the beta-subunit core. While this arrangement has obvious implications for the stabilities of these proteins, it raises questions as to how they are synthesized. Some studies in vivo suggest the subunits might combine before the seatbelt is latched. However, it is clear that subunit combination in vitro occurs efficiently even when the seatbelt remains latched. Glycoprotein hormone synthesis remains poorly understood in spite of its potential importance as a source of hCG metabolites observed during ectopic pregnancy, Down's syndrome, and even some cancers. Here we describe studies designed to learn how hCG is folded and assembled in vivo and to determine how the subunits combine in vitro. During the latter studies we will test a novel model of subunit combination that explains how one part of the alpha-subunit can pass through the small opening created by attachment of the beta-subunit seatbelt to the subunit core. The following specific aims are planned. In Aim 1 we will identify parts of the beta-subunit that influence its rate of folding in transfected CHO cells. These studies rely on the technique of homolog scanning and will employ analogs created by combining parts of the alpha- and betasubunits and by combining parts of the hCG and hFSH beta-subunits. In Aim 2 we will determine if subunit combination occurs before or after the seatbelt is latched in cells and learn if this process is influenced by the alpha-subunit. These studies will employ
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an antibody that can separate heterodimers in which the seatbelt is latched from those in which it yet to form. In Aim 3 we will determine the mechanism of subunit combination in vitro, a process that occurs while the seatbelt latch remains closed. These studies will involve measurements of the distance between the seatbelt and other parts of the free beta-subunit. They will also involve careful measurement of the rates of association and dissociation of subunit analogs, some of which lack seatbelts or contain seatbelts that are unable to be latched. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GONADAL AND ENDOMETRIAL FUNCTION IN HUMAN REPRODUCTION Principal Investigator & Institution: Giudice, Linda C.; Professor; Gynecology and Obstetrics; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 07-APR-1997; Project End 31-MAR-2007 Summary: Our currently funded NIH U-54 SCCPRR Center has provided the foundation for a rich, interactive environment for the pursuit of and training in reproductive biology and medicine at Stanford University. It consists of an integrated group of investigators in the Department of Gynecology and Obstetrics and for this competitive renewal adds an investigator in Developmental Biology and In Situ Hybridization Core, and Bioinformatics Core). The projects are designed to investigate molecular mechanisms governing reproductive processes in the ovary, endometrium, and testis, and to benefit specifically from interactions among investigators and cores. The central endometrium, and testing, and to benefit specifically from interactions among investigators and cores. The central theme of the Center is gonadal and endometrial function in reproduction, with a focus on the human, thereby enhancing the long-term goal of translational research to clinical reproductive disorders, including infertility and poor pregnancy outcome. Projects by Hsuehi and Conti interact, as they focus on early ovarian follicle development and on the role of mechanisms governing meiosis in the female gonad, respectively. Project by Giudice investigates auto/paracrine mechanisms in human implantation, primarily involving the IGF system. It interacts extensive with Project by Conti from the perspective of signaling mechanisms and Project by Fuller due to new findings in human endometrium of the Drosophila homologs important in cell-cell interactions. In this renewal, we will welcome a new project (Fuller) that focuses on early events in meiosis in the male gonad, using the Drosophila model. It interacts with Project by Hsuehi, Conti and Giudice. The pilot project (Tazuke) focuses on early germ cell development in the male gonad using the Drosophila model with a translation to the human. It interacts will allow projects. The enter is highly enriched by the University environment with seminars, courses, conferences, and core facilities. Issues of female infertility and fertility are critical to the national agenda to improve women's health care. Male factors also contribute significantly to reproductive failure, and understanding their pathogenesis and treatment is very important. Our Center's goal is to investigate basic cellular and physiologic processes involve din normal reproductive function, laying the foundation to understand abnormal follicle failure, male infertility, miscarriage and ectopic pregnancy. Advances in the enter are anticipated to lead to new diagnostic and therapeutic modalities for reproductive disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GONOCOCCAL INFECTION AND GENE EXPRESSION IN FEMALE MICE Principal Investigator & Institution: Jerse, Ann E.; Associate Professor; Henry M. Jackson Fdn for the Adv Mil/Med Rockville, Md 20852 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2004 Summary: (Adapted from the applicant's abstract): Neisseria gonorrhoeae has a serious impact on women=s health due to the frequency with which this pathogen infects the upper reproductive tract, and the resultant serious complications (e.g., chronic pelvic pain, involuntary infertility and ectopic pregnancy). Current models for studying gonococcal pathogenesis are limited in their ability to sufficiently mimic the intricate balance of host factors in the female reproductive tract. Therefore, the long-term objectives of this proposal are to further develop a female mouse model of gonorrhea for studying the adaptation of N. gonorrhoeae to the host in terms of phase and antigenic variation of surface molecules and gene expression in vivo. The specific aims designed to achieve this objective are to: i. further characterize experimental infection of estradioltreated mice for use as a research tool for studying specific aspects of gonococcal genital tract infection; ii. identify the host factor(s) that play a role in the selection for gonococcal opacity (Opa) protein expression during experimental infection and to test the capacity of an Opa-specific immune response to drive antigenic variation of Opa phenotype in vivo; iii. identify gonococcal genes that are induced during experimental murine infection using reporter gene fusions. The proposed experiments designed to address these aims are: i.) the susceptibility of estradiol- treated outbred (SLC:ddY) and inbred (BALB/6) mice to N. gonorrhoeae will be characterized with regard to duration of infection and degree of inflammation. Upper reproductive tract infection will be assessed in terms of bacterial interactions with the murine endometrium; ii.) host factors that select for Opa-positive gonococci in vivo will be studied by monitoring Opa protein expression in neutrophil-depleted mice, complement-deficient mice and inbred mice that uniformly do not produce inflammation in response to infection. The PI will compare the Opa phenotype of vaginal isolates from unimmunized mice and from mice immunized with a single purified Opa protein antigenic variant to determine if an Opaspecific immune response decreases the number of gonococci expressing the homologous Opa protein in vivo; iii.) expression of a gonococcal catalase-reporter gene fusion will be measured during murine infection and in neutrophil adherence assays to study the regulation of gonococcal catalase in response to inflammation. A transcriptional gene fusion bank using the green fluorescent reporter gene will be constructed and screened for promoters that are expressed during experimental murine infection; genes identified under these conditions will be cloned for further study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HOST FACTORS IN SUSCEPTIBILITY TO CHLAMYDIAL DISEASE Principal Investigator & Institution: Ramsey, Kyle H.; Microbiology; Midwestern University 555 31St St Downers Grove, Il 60515 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2007 Summary: (provided by the applicant): Chlamydia trachomatis infections are the most commonly reported transmissible diseases in the U.S. Diagnosis, treatment, and sequelae of chlamydial disease cost billions of dollars each year in the U.S. alone. The infection is often asymptomatic in women. Variations in the host immune response are likely to blame for adverse outcomes because not all persons who become infected will suffer the long-term consequences of the disease. In those who progress to disease, the
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affected tissues are significantly altered in their structure and function by a process that ultimately results in scarring and blockage of the fallopian tubes. This results in tubal factor infertility and risk of ectopic pregnancy. Our hypothesis is that those who sustain this outcome have dysregulation of factors which are responsible for the repair of the extracellular matrix. To address hypothesis, we will use a mouse model of chlamydial disease where inbred strains exist which have been characterized as resistant or susceptible as indicated by the outcomes of tubal damage and infertility. In approach, we will first extensively compare and contrast these strains with regard to their ability to modify and repair the extracellular matrix of the urogenital tract in vivo and in vitro. Subsequently, we will define the role of matrix metalloproteinases (MMPs) in the outcome of chlamydial disease through in vivo studies where the enzymes are inhibited pharmacologically or cytokines that influence their activity and production are neutralized. We will then define a role of specific metalloproteinases to the disease process through the use of mice with deletions in genes that encode the enzymes. Lastly, the contribution of specific inflammatory cells to the modulation of extracellular matrix in chlamydial disease will be defined by the production of bone marrow chimeras between susceptible and resistant strains of mice and subsequent depletions of leukocyte populations. In summary, it is the intent of this proposal to define host factors that are responsible for adverse chlamydial disease outcome. The information derived will assist in the development of therapies which could ameliorate the chlamydial disease process; noninvasive diagnostic indicators of progressive scarring and abnormal physiological outcome; development of prognostic indicators of those at high risk for chlamydial disease; and, further advances in design of a safe and effective chlamydial vaccine through avoidance of adverse outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMMUNITY TO CHLAMYDIAL GENITAL INFECTION Principal Investigator & Institution: Morrison, Richard P.; Professor; Microbiology; Montana State University (Bozeman) Bozeman, Mt 59717 Timing: Fiscal Year 2001; Project Start 01-JUN-1996; Project End 31-AUG-2005 Summary: (Adapted from the Applicant's Abstract): Chlamydia trachomatis is possibly the most common sexually transmitted bacterial pathogen in the world. In the United States, 4 million new cases of C, trachomatis urogenital tract infection occur each year, and it is estimated that the cost of treating those infections approaches $4 billion annually. Urogenital infections caused by C. trachomatis result in a number of diverse clinical conditions. Infections in women range from acute self-limiting infections to more serious infections that result in pelvic inflammatory disease, infertility and ectopic pregnancy. Considerable progress has been made in the past few years to significantly broaden our understanding of immune responses that develop during the course of chlamydial infection. However, our understanding of effector mechanisms that limit chlamydial infection and prevent reinfection is insufficient. The investigator's recent data suggest that both CD4+ T cells and B cells (antibody) contribute to adaptive immunity to chlamydial genital tract infection. Thus the overall goal of this project is to use the murine model of C. trachomatis genital tract infection to study the relationship between CD4+ T cells and antibody in adaptive immunity to infection. That goal will be realized through the studies described in 4 specific aims: 1) To determine the ability of immune B cells and antibody to reconstitute protective immunity in CD4-depleted B cell deficient mice; 2) To determine if the lack of mature B cells in B cell gene knockout mice affects the development of chlamydial-specific memory T cell responses; 3) To determine the effect of simultaneous immune cell depletions on acquired immunity; and
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4) To evaluate the inhibitory effects of antibodies and lymphocytes on chlamydial growth in vitro (antibody dependent cellular cytotoxicity). These studies will broaden our understanding of how the host resists chlamydial infection, and may provide new insights into the formulation and administration of an effective vaccine to control the spread of chlamydial infections or prevent the serious sequelae of disease pathogenesis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMMUNOPATHOLOGY OF TUBAL INFERTILITY Principal Investigator & Institution: De La Maza, Luis M.; Professor; Pathology; University of California Irvine Irvine, Ca 926977600 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JAN-2008 Summary: (provided by applicant): Chlamydia trachomatis is one of the most common pathogens involved in sexually transmitted diseases. In most instances, particularly in women, the infection is asymptomatic and thus, therapeutic measures cannot be initiated. Even in symptomatic cases, unless adequate therapy is implemented in a timely fashion, the patient may end up suffering from long term sequelae including chronic abdominal pain, ectopic pregnancy and infertility. In this proposal we want to test the hypothesis that a vaccine consisting of the C. trachomatis major outer membrane protein (MOMP) will be able to induce protection in mice against a genital challenge with the C. trachomatis mouse pneumonitis (MoPn) biovar. To achieve this goal we want to utilize a MOMP preparation extracted from native organisms that following purification, has been refolded. Adjuvants, that can be utilized in humans, including CpG, ISCOM, Montanide and DNA plasmids will be tested in mice for their ability to enhance the immunogenicity of the MOMP. In addition, in an effort to optimize a protective immune response, we will test different routes of vaccination. In the immunized animals we will be assessing the parameters that are critical for protection using different approaches. We will first compare the immune response in protected and control groups of three different strains of mice, and will attempt to identify epitopes of the MOMP recognized by B and T cells. Another group of immunocompetent animals will be first immunized with MOMP and subsequently, will be treated with antibodies to block CD4+ and CD8+ T cells and B cells before they are challenged. In addition, we will transfer CD4+ and CD8+ T cells and B cells and antibodies from immunized mice to naive animals before they are challenged. Also, we will use anti-ML-12 and anti-IL-4 antibodies to characterize the role that Th1 and Th2 cells have in protection. Furthermore, to identify the cytokines involved in the eradication of Chlamydia, MOMP-immunized mice will be treated with anti-IFN-g and anti-TNF-a antibodies before they are challenged. In conclusion, our goals are to establish an immunization protocol, utilizing a purified and folded MOMP preparation, that can protect mice against a genital challenge, and to characterize the immune components induced by the folded MOMP that are critical for protection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INDUCTION OF PROTECTIVE IMMUNITY AGAINST CHLAMYDIA Principal Investigator & Institution: Eko, Francis O.; Professor; Microbiology, Biochemistry & Immunology; Morehouse School of Medicine Atlanta, Ga 30310 Timing: Fiscal Year 2001; Project Start 01-SEP-1996; Project End 30-JUN-2006 Summary: (provided by the applicant): Genital infection by the obligate intracellular pathogen, Chlamydia trachomatis, is the most common bacterial sexually transmitted disease (STD) in the United States, with four million reported annual cases that cost over
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$2 billion. Of major pathophysiological significance is the propensity for cervical infection in women to spread into the upper genital tract, provoking serious complications such as pelvic inflammatory disease, fallopian tube scarring, ectopic pregnancy and infertility. Also, the frequently asymptomatic infections do cause severe irreversible complications to be the first evidence of an infection. There are concerns that genital chlamydial disease, like certain other STDs, such as AIDS and gonococcal disease, may pose a serious threat to human reproduction, well-being and healthcare costs. Current control and prevention strategies target frequent screening for early detection and treatment, and development of vaccines as the priority. The search for a chlamydial vaccine has led to extensive research to define the crucial immune effectors in anti-chlamydial immunity, identify antigens that elicit protective immunity, and design effective methods of vaccine delivery. Our research has been focused on identifying the relevant immune parameters in chlamydial immunity and elucidating the mechanism(s) of intraepithelial inhibition of chlamydiae. Our findings and reports by others have culminated in a new paradigm for designing vaccines against Chlamydia based on the induction of local mucosal TH1 response. The major challenge at this stage is to select an appropriate immunogen(s) and design an effective delivery system, to induce high levels of local genital mucosal Th1 response to maintain long-term immunity. Accordingly, this proposal uses immunological, genetic engineering, molecular, cellular and biochemical techniques to investigate the central hypothesis that protective anti-chlamydial immunity will be established if immunogenic chlamydial antigen(s) are effectively delivered to induce high frequency of specific Th1 cells in the genital mucosa. Specific studies planned will use genetically engineered and wild type mice to: (a) investigate the efficacy of genetically designed recombinant multi-subunit vaccines composed of mucosal bacterial ghosts co-expressing multiple membrane proteins of C. trachomatis; (b) assess the therapeutic benefits of an immunotherapeutic cellular vaccine based on IL-lO gene-suppressed dendritic cells presenting antigens for inducing high frequency of specific Th1 response, as an alternative therapeutic vaccine for C. trachomatis; (c) identify the major mucosal inductive sites, antigen-presenting cells and other accessory cells crucial for Th1 activation; and (d) define the molecular and cellular elements regulating Th1 activation, trafficking and recruitment into the genital mucosa following effective cellular and subunit vaccination against C. trachomatis. Results from these studies will likely lead to the development of a reliable vaccine regimen against Chlamydia, which should have major implications for the genital, ocular, and lung infections and their complications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INPATIENT VS OUTPATIENT THERAPY FOR ACUTE PELVIC INFLAMMATORY DISEASE Principal Investigator & Institution: Holley, Robert L.; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001 Summary: Pelvic inflamatory disease (PID) affects women in the United States in nearepidemic proportions. Nearly 11% of American women of reproductive age reported that they received treatment for PID in 1988. The costs associated with PID and its sequelae are enormous. Annual U.S. expenditures for the acute treatment of PID have been estimated at between $700 million and $2 billion annually; indirect costs may amount to an additional $1 billion per year. Inpatient treatment is over 10 times more expensive than outpatient treatment. The primary aim of thi study is to test the effectiveness and cost-effectiveness of outpatient vs. inpatient treatment for PID in
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preventing involuntary infertility. Additional long-term outcomes to be compared are repeat episodes of PID, ectopic pregnancy, functional decline due to chronic pelvic pain, frequency of health service use, the occurrence of indirect costs associated with PIDrelated illness, and patient-reported quality of life. This study is a randomized clinical trial involving adult female patients. During a 5-year period, 1,380 women will be enrolled from 6 clinical sites. A total of 1,200 women in seven clinical sites will be randomized in equal numbers into one of two treatment groups: inpatient or outpatient. Non-investigational antibiotics consisting of Cefoxitin and Doxycycline will be used in both groups, with a total treatment course of 14 days. Follow-up for each patient encompasses a period of 60 months. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INPATIENT VS OUTPATIENT THERAPY FOR ACUTE PELVIC INFLAMMATORY DISEASE Principal Investigator & Institution: Hemsell, David L.; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2001 Summary: Acute PID affects over 1 million American women a year. The highrisk group for this infection is primarily younger women and adolescents. PID may result in significant sequelae such as involuntary infertility, ectopic pregnancy, and chronic pelvic pain. Costs for the acute treatment of women have been estimated to be between $750 million and $2 billion dollars annually, and treatment for the complications of this infection may at least double these healthcare costs.The purpose of this masked, prospective, randomized, 5-center, open clinical trial is to compare inpatient versus outpatient Centers for disease Control- recommended combination antimicrobial treatment for women with the same degree of acute pelvic inflammatory disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: NEW FUNCTIONAL MODELS FOR BIOMEDICAL DATA Principal Investigator & Institution: Guo, Wensheng; Assistant Professor; Biostatistics and Epidemiology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 01-JAN-2000; Project End 31-DEC-2003 Summary: (Adapted from the Applicant's Abstract): Functional data are common in cancer studies and other biomedical research, such as biomarkers measured over time in cancer experiments and other clinical trials, growth curves, hormone profiles, circadian rhythms in biological signals and drug activities. Although much work has been done on functional models for independent data, extensions to incorporate complex designs and correlations are still very preliminary. The first specific aim of this application is to develop general functional models using smoothing splines that can incorporate complex designs and allow flexible nonparametric between-curve random effects. Another long-existing problem for functional models is the heavy computational demand. Except in very simple cases, most of the current estimation procedures need to invert large dimensional matrices. This prevents applications to large data sets. In this application, we will develop O(N) sequential estimation procedures for general functional models by modifications of the Kalman filtering and fixed interval smoothing. Serial measurements have become a natural part of patient monitoring and medical diagnosis. In monitoring and predicting a patient-specific outcome based on laboratory tests or other biomarkers, we can obtain more accurate predictions by
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borrowing the strength from the existing patient population profiles over time. In medical diagnosis, we can gain efficiency by using the up-to-date cumulative information and compare the individual profile with the existing group profiles. In this application, we will develop dynamic patient monitoring and diagnostic methods, in which flexible functional models will be used to model both the population and individual profiles. With the proposed sequential estimation procedures, these methods can be efficiently calculated and implemented in a real time setting, which leads to rapid medical interventions. Most current statistical inference procedures rely on the distributional assumptions, such as the normality assumption. When the distribution is multimodal, it is often difficult to make parametric assumptions, and therefore nonparametric density estimation methods are needed. In this application, we will develop general density models and their associated inference procedures, and apply these methods to accessible biomedical data sets. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ORAL METHOTREXATE FOR PRIMARY ECTOPIC PREGNANCY THERAPY Principal Investigator & Institution: Creinin, Mitchell B.; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001 Summary: The specific aims of this study are to establish the potential efficacy and side effect profiles of methotrexate 50 mg orally for the medical treatment of extrauterine pregnancy. This trial is based on the hypothesis that methotrexate 50 mg orally will be 90% effective (approximately equal to methotrexate 50 mg/m2 intramuscularly) for the medical treatment of ectopic pregnancy. Since the oral regimen has never been evaluated as primary treatment, it is necessary to perform a pilot study as an initial investigation of its safety and efficacy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PATHOGENESIS OF PERSISTENT CHLAMYDIAL STDS Principal Investigator & Institution: Dean, Deborah A.; Assistant Professor of Medicine; Children's Hospital & Res Ctr at Oakland Research Center at Oakland Oakland, Ca 94609 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-DEC-2007 Summary: (provided by applicant): Chlamydia trachomatis(CT) is the leading cause of sexually transmitted diseases (STD) in the developed world. CT infections and their sequelae of pelvic inflammatory disease, ectopic pregnancy, and infertility are responsible for approximately 80% of the estimated $2.5 billion annual cost of these infections in the United States. Further, up to 50% of women become reinfected and are at increased risk for these sequelae. Many reinfections reflect persistence that likely plays an important role in pathogenesis. The major outer membrane protein is considered to be the immunodominant protein of CT. However, the discovery of open reading frames predicted to encode a nine-member polymorphic membrane protein (Prop) gene (pmp) family in the recently published genome sequence of CT serovar D suggest that these Props may also be important in chlamydial biology. Further, CT contains a partial tryptophan biosynthesis operon (trpR, trpA, trpB) not found in a CT mouse strain (MoPn) or other species of Chlamydia. Tryptophan is essential for chlamydial replication, and tryptophan depletion in vitro results in chlamydial persistence. Our hypothesis is that the prop and tryptophan genes may undergo
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selection that results in differential expression or activity of these proteins that: 1) consequently determine active or persistent infection; and 2) are significantly involved in pathogenesis as an outcome of persistence or outcome of other factors. By analyzing the genetic profile of prototype and serial recurrent and persistent CT STD patient strains and by correlating these data with epidemiologic and clinical findings, we hope to identify the genes, genetic/protein variation and evolution of this variation in the organism, and how these are linked to persistence and pathogenesis. Thus, this grant will answer broad questions about the genetic and protein basis for persistence and for pathogenesis, and provide important research tools including a Database and DNA microarray that will be of long-term benefit to investigators in the field of Chlamydia. The Specific Aims for this grant are to: 1) Sequence the nine pmps, and trpR, trpA, and trpB genes for the 19 prototype serovars of CT and create a DNA microarray for these genes and ompA to differentiate strains of CT, and for use in Aim 2; and 2) Identify polymorphisms in and protein expression of the nine props, specific tryptophan operon genes, and other constitutively expressed genes among serial cervical samples from patients with persistent versus non-persistent CT STDs; correlate the genetic and protein expression profiles of these serial samples with epidemiologic and clinical findings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PATHOGENESIS OF TUBAL FACTOR INFERTILITY Principal Investigator & Institution: Ault, Kevin A.; Obstetrics and Gynecology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-JUL-2002 Summary: Tubal factor infertility is a common gynecological problem, responsible for 15-30 percent of all infertility. Most cases of tubal factor infertility are caused by Chlamydia trachomatis. Chlamydia is the most common sexually transmitted disease in the United States. Upper genital tract infections with Chlamydia are often asymptomatic or subclinical but can result in fallopian tube damage. These obligate intracellular microorganisms elude host defenses causing a persistent indolent infection. While multiple epidemiological studies have shown a link between Chlamydia and infertility, the underlying immunology and pathogenesis is poorly understood. Recent research has shown that an antibody response to the chlamydial 60-kilodalton heat shock protein (hsp 60) is associated with tubal factor infertility. Another 10-kilodalton heat shock protein (hsp 10) has been recently described. Our initial studies would indicate that infertile women also have antibodies to this chlamydial antigen. The central hypothesis of this research plan is that an altered immune response to chlamydial heat shock proteins is responsible for tubal factor infertility. The specific aims for this project are 1) to determine lymphocyte responses to hsp 10 and hsp 60 in women with tubal factor infertility and 2) to study expression of hsp 10 and hsp 60 in an in vitro model of fallopian tube infection. This research plan is part of a NICHD Mentored Clinical Scientist Development Award. The candidate for this award, Dr. Kevin Ault, is a clinically trained gynecologist. His interest in infectious diseases is the result of caring for women with tubal factor infertility. Other common gynecological diseases, such as ectopic pregnancy and pelvic inflammatory disease, have also been linked to infection with Chlamydia. By training gynecologists to apply fundamental techniques in immunology and microbiology to the problem of Chlamydia and infertility, we can have a better understanding of this common problem in women's health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PID EVALUATION AND CLINICAL HEALTH STUDY--PEACH Principal Investigator & Institution: Randall, Hugh W.; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2001 Summary: The primary aim of this study is to test the effectiveness and cost effectiveness of standard outpatient vs standard inpatient treatment for pelvic inflammatory disease (PID) in preventing involuntary infertility. The investigators will also determine effects on: time to clinical improvement, microbiologic cure, patient satisfaction, endometrial clearing, treatment adherence, PID recurrence, ectopic pregnancy, diminished functionality, and quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PILOT--CHLAMYDIA SCREENING IN PRIMARY CARE SETTING Principal Investigator & Institution: Jumping Eagle, Sara; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2008 Summary: Minorities are disproportionately affected by most sexually transmitted diseases ($TDs). One STD, chlamydia, may result in pelvic inflammatory disease, infertility, ectopic pregnancy, urethdtis, and cervical cancer. Chlamydia infection also signals unprotected sex and is strongly associated with the spread of HIV. Rates of chlamydia infection among American Indians (AIs) nationally have increased 133% from 1997-2001 and chlamydia infection among AIs is 6 times more common than among the US White population. This epidemic of chlamydia infection is of great concern to AI communities not only because it increases the risk of HIV acquisition, but because of the associated potential for rapid transmission of HIV in the population. Although the number of AIs with HIV/AIDS is low, these concerns are not unfounded since Als have experienced a >10-fold increase in HIV/AIDS since 1990. Reducing STD rates requires understanding patterns of acquisition and transmission of chlamydia among both AI men and women. The female predominance in documented Chlamydia infection has been attributed to distinct but related factors: differential use of health services, in part because women have symptoms substantially more often than men, and challenges to effective partner tracing posed by economic, cultural, and geographic constraints. However, effective partner tracing is a criticalcomponent in reducing the burden of chlamydia since it contributes substantially to reducing its prevalence in the population. In this project, we propose to 1) implement a chlamydia screening program for all males, ages 14-35, who present for care at an IHS facility in a Northern Plains reservation; the data from a bdef questionnaire and the test results will be used to estimate the burden of chlamydia infection by age, gender, presence of symptoms, and clinical history, and to determine infection reduction achieved with universal screening; 2) assess the completeness and yield of partner tracing; and 3) examine rates of reinfection using a test-of-cure strategy. We also will blend these epidemiological data with qualitative data gathered from key informants and focus groups about our brief questionnaire and the partner notification process. Our confidential study database will track demographic data, symptoms, partner follow-up, number of partners, laboratory tests results (re-infection status), and treatment. To accomplish these aims, we have brought together an interdisciplinary team of highly respected, experienced, researchers and clinicians. This project promises to provide the information needed to develop the recommendations for community- and clinic-based strategies to improve screening, partner tracing, and treatment.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INFERTILITY
POOR
OBSTETRIC
AND
PEDIATRIC
OUTCOMES
AFTER
Principal Investigator & Institution: Croughan-Minihane, Mary; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001 Summary: The primary aim of this retrospective cohort study is to determine whether naturally and treatment-achieved pregnancies among infertility patients (infertile pregnancy cohort) are at higher risk for adverse outcomes as compared to naturally conceived pregnancies achieved by fertile women (fertile pregnancy cohort) and where these differences persist after controlling for maternal and infant factors such as maternal age, parity, and gestational age. The infertile pregnancy cohort (n=5160) will be comprised of 3 groups of women: (1) infertile women who conceived between 1/1/94-1/1/97 as a result of infertility treatments; (2) fertile women who conceived as a result of infertility treatment undertaken as a result of male factor infertility; and (3) infertile women who conceived naturally after presenting for infertility treatment. The fertile pregnancy cohort (n=5160) is the non-exposed comparison group composed of women frequency matched on date of conception and maternal age who do not have a history of infertility and who conceived naturally. The outcomes of interest include pregnancy complications (e.g., IUGR, placental complications, and pre-eclampsia), labor and delivery complications (e.g., operative delivery and still birth), neonatal complications (e.g., death, cerebral palsy, and mental retardation). We expect to have over 90% power to detect statistically significant differences been the infertile and fertile pregnancy cohorts in nearly all of these outcomes. Infertility, prenatal, L&D, and pediatric medical records will be reviewed and a maternal interview conducted to gather complete information on infertility and reproductive history, health status and outcomes, and care providers. The relationships will be analyzed using path analysis, considering differences in risk according to fertility status, infertility etiology, infertility treatments received, and other maternal characteristics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RISK FACTORS AS PREDICTORS OF ECTOPIC PREGNANCY Principal Investigator & Institution: Barnhart, Kurt T.; Assistant Professor; Obstetrics and Gynecology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 01-MAY-1999; Project End 30-APR-2004 Summary: Ectopic pregnancy (EP) is the leading pregnancy - related cause of death in the first trimester of pregnancy and a major contributor to maternal morbidity. As the tubal pregnancy progresses, it erodes into blood vessels and can cause massive intraabdominal bleeding. There are limitations in the strategies currently employed to diagnose EP. Even with the use of diagnostic algorithms that systematically evaluate all women at risk for an EP, only 50 percent of women with an EP can be diagnosed upon presentation to an Emergency Department (ED). Diagnosis in the remaining 50 percent represents a clinical conundrum and can take up to 6 weeks. If the diagnosis of EP is delayed, the abnormal gestation will continue to grow in the fallopian tube with potential rupture resulting in greater risks of morbidity, and mortality. Moreover, an EP of large size is not amenable to medical therapy, may require major surgery (laparotomy) instead of laparoscopy and can cause greater damage to fallopian tube (and greater impairment of fertility), even if treated before rupture. The aims of this
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proposal focus on this clinically relevant subpopulation of women at risk for an EP butwhose diagnosis cannot be confirmed during their initial presentation to the ED, and is thus delayed. The University of Pennsylvania Medical Center has used a systematic, validated, protocol to diagnose pregnant women who are at risk for EP since 1989. An existing electronic database chronicles the clinical course and contains the results of the diagnostic tests used to definitively diagnose women at risk for EP but not diagnosed upon presentation to the ED. We plan to use the information in this database to: 1) identify factors predictive of EP in this subgroup of pregnant women and derive a clinical prediction rule to help identify those at highest risk for EP in an attempt to shorten the time needed for diagnosis. And 2) to evaluate the serial betahcg determinations to assess the clinical utility defining deviations from the curves characteristic of a viable intrauterine pregnancy (IUP) or spontaneous miscarriage (SAB) to diagnose an EP. For these aims, we will use a retrospective cohort study design of greater than 2100 subjects. We also plan to perform a prospective cohort study, in the same study population to: 3) evaluate the utility of novel strong predictors of EP including the endometrial stripe thickness and chlamydia serology, independently, and in context with the derived prediction rule. And 4) to validate our derived prediction rule using a prospectively collected sample of women at high risk of EP. Finally, we plan for the first time, 5) to investigate if the different clinical situations in which a woman with EP are diagnosed represent differences in the natural history of EP. This proposal represents a unique opportunity to use large amounts of existing data, combined with the efficient prospective collection of data, to understand and improve upon important limitations in our ability to diagnose a reproductive disorder with important public health consequences. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STDS AND THE PATHOGENESIS OF SUBCLINICAL PID Principal Investigator & Institution: Sweet, Richard L.; Professor and Chair; MageeWomen's Hospital of Upmc 300 Halket St Pittsburgh, Pa 15213 Timing: Fiscal Year 2001; Project Start 01-MAY-1998; Project End 30-APR-2003 Summary: Unrecognized pelvic inflammatory disease (PID) may be a major factor in the pathogenesis of tubal factor infertility. This is supported by the presence of serologic evidence of prior sexually transmitted diseases (STD's) in a large proportion of women with tubal factor infertility, yet most of these women do not recall a history of STD's or PID. In addition, many women with lower genital tract infection associated with STD's (gonorrhea, chlamydia, bacterial vaginosis) have histologic evidence of endometritis even though they do not have symptoms of PID. Our hypothesis is that unrecognized PID due to STD's is associated with tubal obstruction. We propose to test this hypothesis in a cohort of 1500 women aged 15-30 with lower genital tract STD associated infection. A group of 200 women with acute symptomatic PID will be evaluated for comparison. Specimens will be obtained from the vagina and cervix for microbiologic analysis and measurement of defensins (neutrophil granule products). An endometrial biopsy will be obtained for histologic and microbiologic analysis. The primary outcome of this study is tubal impatency, therefore all women will undergo a hysterosalpingogram 12 weeks from enrollment. Other outcomes include infertility and ectopic pregnancy formation, which will be determined using regular telephone contact for at least one year to determine the rate of adverse reproductive sequelae. The frequency of tubal impatency will be compared between women with acute symptomatic PID, women with unrecognized PID, and uninfected women. The risk of unrecognized PID will be compared between women testing positive for an STD and uninfected women. As the
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diagnostic accuracy for the diagnosis of PID is currently suboptimal, risk factors for unrecognized PID will be established, a clinical prediction model will be devised, and defensins from the lower genital tract will be evaluated as less-invasive markers of PID. The microbiology and histology of unrecognized PID will be compared to these findings in acute PID, in an effort to understand the pathogenesis of PID. Information obtained from this study will: i) determine the role of unrecognized PID in subsequent tubal damage ii) establish risk factors and predictors of PID iii)improve the understanding of the pathogenesis of PID. Earlier detection of unrecognized PID will enable more timely treatment, with the intent on reducing the rate of tubal impatency and resultant adverse reproductive sequelae. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TRANSLATING CHLAMYDIA SCREENING GUIDELINES INTO PRACTICE Principal Investigator & Institution: Thompson, Robert S.; Group Health Cooperative of Puget Sound 200 15Th Ave E Seattle, Wa 98112 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 30-JUN-2003 Summary: Sexually transmitted Chlamydia trachomatis infections in women, often asymptomatic, have serious consequences if left untreated. However, studies from Group Health Cooperative (GHC) have shown the impact can be decreased (i.e., a 56 percent decrease in PID) if at-risk women receive screening and treatment. Over the last two years, GHC has developed an evidence-based chlamydia screening guideline to initiate translation of the evidence into practice. Objective: To evaluate the effectiveness of several multifaceted strategies for guideline implementation. Site: Thirty staff model outpatient clinics at GHC. Methods: This is a randomized trial of guideline implementation strategies carried out at the provider and patient levels. Using a 2x2 factorial design, we will compare standard guideline implementation to three other strategies: one with only provider-specific components, one with only patient-specific components and one with both provider- and patient-specific components. Providerspecific strategies (with randomization occurring at the clinic level) include the use of opinion leaders, measurement and feedback, and prompts placed in Pap test kits. The patient- specific strategy (with randomization of individual enrollees) consists of a prompt placed in the chart of 14-20 year-old females as a paper-based test to establish the case for a future computerized automated prompt system. Outcomes: Outcomes will be measured at baseline and post-implementation. The primary outcome is the rate of appropriate chlamydia screening among 14- 25 year-old females. Other primary outcomes are 1) the rate of chlamydia screening as defined by a new HEDIS measure; 2) changes in provider knowledge, attitudes/beliefs, self-efficacy, practices, and perceived barriers and supports; 3) the cost per woman appropriately screened and the marginal cost-effectiveness of each intervention arm. Secondary outcomes include changes in the rates of positive chlamydia tests, PID and ectopic pregnancy. Major study benefits: To our knowledge this will be the first study to evaluate conceptually-based guideline implementation strategies in a defined HMO clinical population. In order to further enhance generalizability, we will test selected implementation strategies in a networkmodel managed care setting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TRANSMISSIBILITY OF GC AND CT DIAGNOSED USING NAAT Principal Investigator & Institution: Rogers, Susan M.; Senior Scientist; Research Triangle Institute Box 12194, 3040 Cornwallis Rd Research Triangle Park, Nc 27709
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Timing: Fiscal Year 2001; Project Start 27-SEP-2001; Project End 28-FEB-2005 Summary: (provided by applicant) Infections with Neisseria gonorrhoeae (GC) and Chiamydia trachornatis (Ct) are known to facilitate HIV transmission. It is estimated, for example, that the presence of untreated chiamydial infection increases the likelihood per contact of HIV transmission by a relative risk of 3 about6. These STDs have other important health consequences, including pelvic inflammatory disease, perinatal complications, and subsequent risks of infertility and ectopic pregnancy in women. The development of nucleic acid amplification tests (NAAT) that can be used with urine specimens has permitted a new paradigm for epidemiological research on these STDs. Urine specimens for STD detection can easily be obtained in population surveys and public health programs to enable generalizations about the prevalence of symptomatic and asymptomatic infections in the population at large and among hard to reach at-risk populations. Results of these studies are disturbing. In one major U.S. city, for example, it is estimated that 8.3 percent of adults ages 18-35 has an untreated GC or Ct infection. Most of these infections were diagnosed among adults who report no recent symptoms and who do not present the classic STD behavioral risk profile. These results could indicate a large and hidden epidemic of asymptomatic infections that are unlikely to be detected and treated without vigorous public health interventions. However, it is also possible that NAAT testing is identifying clinically inconsequential infections because of the assay's ability to detect extremely low levels of viable organisms (i.e., below the infectious inoculum) or amplifiable DNA (or RNA) from residual pathogens (i.e., nonviable organisms) of past infections that are well on their way to being cleared. We propose to explore this issue by testing a sample of 8,000 adults, ages 18-35, attending the Johns Hopkins Adult Emergency Department. Subjects testing positive for GC or Ct will be re-evaluated using traditional diagnostic tests for these infections and be treated. Recent sexual partners of infected subjects and a random subsample of partners from uninfected subjects will also be contacted and tested. The proposed research will allow us to: (1) determine whether the probabilities of infection transmission are equivalent for GC and Ct infections detectable only by NAAT versus infections detectable by traditional testing procedures; (2) determine whether asymptomatic infections have an equivalent probability of transmission as symptomatic infections; (3) determine whether infections that can only be detected by NAAT testing have the same clinical consequences as infections that are detectable by traditional assays; and (4) examine the correlates of infections detected by NAAT versus traditional diagnostic tests. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: VIRULENCE FACTORS OF CHLAMYDIAE Principal Investigator & Institution: Wyrick, Priscilla B.; Professor; Microbiology; East Tennessee State University Box 70565 Johnson City, Tn 37601 Timing: Fiscal Year 2001; Project Start 01-APR-1995; Project End 31-MAR-2005 Summary: Chlamydia trachomatis serovars D-K are the most common cause, in the USA and worldwide, of bacterially-acquired sexually transmitted diseases and their sequelae, including prostatitis, epididymitis, pelvic inflammatory disease, ectopic pregnancy and sterility. Chlamydial diseases are insidious and they constitute significant primary, secondary and tertiary health concerns in which women bear a special burden because of their increased risk of adverse reproductive consequences. The goal of this laboratory for 25 years has been to try to understand the basic biology of chlamydial growth in its host epithelial cell in order to understand the infectious process and to permit dissection of the cellular and molecular consequences of persistent infection, since the majority of chlamydial tubal disease appears to result from chronic subclinical, persistent infection.
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This proposal is a continuation of on-going efforts to understand the crucial attachment/entry steps, the signals in chlamydiae-infected epithelial cells which trigger neutrophil chemotaxis--since a prolonged inflammatory response to persistent chlamydial antigens is believed to be responsible for the damage and sequelae, and hormone modulation of entry and signaling of neutrophils. In Aim 1, the chlamydial envelope-associated hsp70 and its co- chaperonins GrpE and DnaJ will be incorporated into liposomes, along with known and suspected adhesins, to define the role of hsp70 in entry and, in Aim 2, help identify the receptor which functions with newly identified, estrogen-responsive receptor accessory proteins. Also in Aim 2, the swine C. trachomatis S45 isolate- swine genital tissue model of infection will be developed to dissect hormone modulation of entry and neutrophil signaling (Aim 3). In Aim 3, a comparison will be made of chlamydial and chemokine signals triggering neutrophil chemotaxis to polarized HeLa cells normally and persistently infected with noninvasive, asymptomatic serovar E versus invasive, symptomatic serovar L2. Finally, in Aim 4, cryo-electron microscopy and density gradients will be used to show that chlamydial antigen secretion and trafficking can occur via vesicles pinched off from the chlamydial inclusion. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “ectopic pregnancy” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for ectopic pregnancy in the PubMed Central database: •
Ectopic pregnancy rates with day 3 versus day 5 embryo transfer: a retrospective analysis. by Milki AA, Jun SH.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=270025
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Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis. by Egger M, Low N, Smith GD, Lindblom B, Herrmann B.; 1998 Jun 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28575
3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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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 ectopic pregnancy, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “ectopic pregnancy” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for ectopic pregnancy (hyperlinks lead to article summaries): •
A casemix cost comparison of 2 treatments for ectopic pregnancy. Author(s): Lowe PJ, Mamers PM, Sturrock TV, Healy D. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1998 August; 38(3): 333-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9761168&dopt=Abstract
•
A cervical ectopic pregnancy managed by medical treatment and angiographic embolization. Author(s): Wong YH, Liang EY, Ng TK, Lau KY. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1999 November; 39(4): 493-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10687773&dopt=Abstract
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A comparative case-controlled study of laparoscopic vs laparotomy management of ectopic pregnancy: an evaluation of reproductive performance after radical vs conservative treatment of tubal ectopic pregnancy. Author(s): Tahseen S, Wyldes M. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 March; 23(2): 189-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745569&dopt=Abstract
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A comparison of laparoscopic surgery and laparotomy in the treatment of ectopic pregnancy. Author(s): Xiang XD, Tang YQ, Mao JF. Source: Singapore Med J. 1999 February; 40(2): 88-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10414165&dopt=Abstract
6
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A new laparoscopic approach for the treatment of interstitial ectopic pregnancy. Author(s): Rahimi MA. Source: The Journal of the American Association of Gynecologic Laparoscopists. 1999 May; 6(2): 205-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10226134&dopt=Abstract
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A population-based analytical approach to assessing patterns, determinants, and outcomes of health care with application to ectopic pregnancy. Author(s): Coste J, Bouyer J, Fernandez H, Pouly JL, Job-Spira N. Source: Medical Care. 2000 July; 38(7): 739-49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10901357&dopt=Abstract
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A six-year audit of the management of ectopic pregnancy. Author(s): Cooray H, Harilall M, Farquhar CM. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 November; 42(5): 538-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12495104&dopt=Abstract
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A technique to reduce the chance of persistent ectopic pregnancy. Author(s): Pun TC, Ling FW. Source: The Journal of the American Association of Gynecologic Laparoscopists. 1999 November; 6(4): 522-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10610211&dopt=Abstract
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Acute urinary retention due to ectopic pregnancy. Author(s): David PR, Gianotti AJ, Garmel GM. Source: The American Journal of Emergency Medicine. 1999 January; 17(1): 44-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9928698&dopt=Abstract
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Adnexal ring sign and hemoperitoneum caused by hemorrhagic ovarian cyst: pitfall in the sonographic diagnosis of ectopic pregnancy. Author(s): Hertzberg BS, Kliewer MA, Bowie JD. Source: Ajr. American Journal of Roentgenology. 1999 November; 173(5): 1301-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10541109&dopt=Abstract
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Ambulatory diagnosis and medical management of ectopic pregnancy in a public teaching hospital serving indigent women. Author(s): Nelson AL, Adams Y, Nelson LE, Lahue AK. Source: American Journal of Obstetrics and Gynecology. 2003 June; 188(6): 1541-7; Discussion 1547-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12824991&dopt=Abstract
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An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy. Author(s): Sowter MC, Farquhar CM, Gudex G. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 February; 108(2): 204-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11236121&dopt=Abstract
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An exceptionally rare ectopic pregnancy. Author(s): Reid F, Steel M. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 February; 110(2): 222-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12618173&dopt=Abstract
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An update on the medical treatment of ectopic pregnancy. Author(s): Barnhart K, Esposito M, Coutifaris C. Source: Obstetrics and Gynecology Clinics of North America. 2000 September; 27(3): 653-67, Viii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10958010&dopt=Abstract
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Antibodies to Chlamydia trachomatis in patients presenting with ectopic pregnancy at Groote Schuur Hospital. Author(s): Tregoning SK, Ballard RC, Andersson PB, Fehler HG, van der Spuy ZM. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 2000 July; 90(7): 727-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10985137&dopt=Abstract
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Are gestational age and endometrial thickness alternatives for serum human chorionic gonadotropin as criteria for the diagnosis of ectopic pregnancy? Author(s): Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, van der Veen F, Hemrika DJ, Bossuyt PM. Source: Fertility and Sterility. 1999 October; 72(4): 643-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10521102&dopt=Abstract
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Arteriovenous malformation of mesosalpinx associated with a 'vanishing' ectopic pregnancy: diagnosis with three-dimensional color power angiography. Author(s): Shih JC, Shyu MK, Cheng WF, Lee CN, Jou HJ, Wang RM, Hsieh FJ. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 1999 January; 13(1): 63-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10201089&dopt=Abstract
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Aspiration and microscopy in the diagnosis of ectopic pregnancy. Author(s): Lipscomb GH, Gildner K, Shulman LP, Eltorky M, McCord ML, Ling FW. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1998 November; 63(2): 153-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9856321&dopt=Abstract
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Assessment of uterine circulation in ectopic pregnancy by transvaginal color Doppler. Author(s): Szabo I, Csabay L, Belics Z, Fekete T, Papp Z. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003 February 10; 106(2): 203-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12551793&dopt=Abstract
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Autotransfusion for ruptured ectopic pregnancy. Author(s): Selo-Ojeme DO, Onwude JL, Onwudiegwu U. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2003 February; 80(2): 103-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566181&dopt=Abstract
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Background factors and management of ectopic pregnancy in Sweden. Changes over a decade. Author(s): Thorburn J, Friberg B, Schubert W, Wassen AC, Lindblom B. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1987; 66(7): 597-602. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3326392&dopt=Abstract
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Background factors of ectopic pregnancy. I. Frequency distribution in a case-control study. Author(s): Thorburn J, Berntsson C, Philipson M, Lindblom B. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1986 December; 23(5-6): 321-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3803684&dopt=Abstract
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Background factors of ectopic pregnancy. II. Risk estimation by means of a logistic model. Author(s): Thorburn J, Philipson M, Lindblom B. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1986 December; 23(5-6): 333-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3803685&dopt=Abstract
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Bacteriologic findings with ectopic pregnancy. Author(s): Berenson A, Hammill H, Martens M, Faro S. Source: J Reprod Med. 1991 February; 36(2): 118-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2010893&dopt=Abstract
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Bcl-2 expression as a novel immunohistochemical marker for ruptured tubal ectopic pregnancy. Author(s): Kucera E, Konig F, Tangl S, Grosschmidt K, Kainz C, Sliutz G. Source: Human Reproduction (Oxford, England). 2001 June; 16(6): 1286-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11387307&dopt=Abstract
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Bedside application of an ultrasensitive urine test for HCG in patients with suspected ectopic pregnancy. Author(s): Buck RH, Pather N, Moodley J, Joubert SM, Norman RJ. Source: Annals of Clinical Biochemistry. 1987 May; 24 ( Pt 3): 268-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3606011&dopt=Abstract
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Beta HCG levels after conservative treatment of ectopic pregnancy: is a plateau normal? Author(s): Thompson GR, O'Shea RT, Harding A. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1994 February; 34(1): 96-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7519843&dopt=Abstract
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Beta-hCG-negative ectopic pregnancy in the right tube. Author(s): Tews G, Ebner T, Yaman C. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2001 August; 8(3): 338-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11509770&dopt=Abstract
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Beta-human chorionic gonadotropin levels and the likelihood of ectopic pregnancy in emergency department patients with abdominal pain or vaginal bleeding. Author(s): Kohn MA, Kerr K, Malkevich D, O'Neil N, Kerr MJ, Kaplan BC. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 2003 February; 10(2): 119-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12574008&dopt=Abstract
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Bilateral ectopic pregnancy after transfer of two embryos. Author(s): Klipstein S, Oskowitz SP. Source: Fertility and Sterility. 2000 November; 74(5): 887-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11056227&dopt=Abstract
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Bilateral ectopic pregnancy. Author(s): Longombe AO. Source: Trop Doct. 1989 October; 19(4): 191. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2815319&dopt=Abstract
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Bilateral ectopic pregnancy. A case report. Author(s): Abramovici D, Morfesis FA, Ally S, Bathija NR. Source: J Ky Med Assoc. 1995 July; 93(7): 295. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7636398&dopt=Abstract
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Bilateral ectopic pregnancy: a case report. Author(s): Gernaat HB. Source: Trop Doct. 1989 April; 19(2): 76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2734842&dopt=Abstract
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Bilateral ectopic pregnancy: a case report. Author(s): Gwinn RB. Source: The Journal of Family Practice. 1987 October; 25(4): 397-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3655679&dopt=Abstract
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Bilateral hematosalpinx in a case of ectopic pregnancy: a clinical dilemma. Author(s): Sindos M, Wang TF, Pisal N, Eben F, Singer A. Source: American Journal of Obstetrics and Gynecology. 2003 September; 189(3): 892-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14526340&dopt=Abstract
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Bilateral tubal ectopic pregnancy after in vitro fertilization and embryo transfer. Author(s): Chang JC, Lin YC, Sun TT. Source: J in Vitro Fert Embryo Transf. 1991 October; 8(5): 292-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1757745&dopt=Abstract
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Bilateral tubal ectopic pregnancy: a tale of caution. Author(s): Ryan MT, Saldana B. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 2000 October; 7(10): 1160-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11015251&dopt=Abstract
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Bilateral tubal ectopic pregnancy: diagnostic pitfalls. Author(s): De Graaf FL, Demetroulis C. Source: Br J Clin Pract. 1997 January-February; 51(1): 56-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9158276&dopt=Abstract
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Bilateral ureteric obstruction: an unusual late complication of ruptured ectopic pregnancy. Author(s): Cumming JA. Source: British Journal of Urology. 1988 August; 62(2): 182-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3408891&dopt=Abstract
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Blood or urine measurement of human chorionic gonadotropin for detection of ectopic pregnancy? A comparative study of quantitative and qualitative methods in both fluids. Author(s): Norman RJ, Buck RH, Rom L, Joubert SM. Source: Obstetrics and Gynecology. 1988 March; 71(3 Pt 1): 315-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3347413&dopt=Abstract
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Case report: atypical ectopic pregnancy and culdocentesis. Still a valuable emergency medicine procedure. Author(s): Herd AM, Sokal J. Source: Can Fam Physician. 2001 October; 47: 2057-8, 2061. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11723600&dopt=Abstract
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Cervical ectopic pregnancy with placenta percreta and bladder wall invasion. Author(s): Jaswal TS, Singh S, Nanda S, Sangwan K, Chauhan M, Marwah N. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 October; 81(10): 991-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12366495&dopt=Abstract
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Cervical ectopic pregnancy: a case report and literature review. Author(s): Gun M, Mavrogiorgis M. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002 March; 19(3): 297-301. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896956&dopt=Abstract
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Cervical fluid oncofetal fibronectin as a predictor of early ectopic pregnancy. Is it affected by blood contamination? Author(s): Shimoya K, Hashimoto K, Shimizu T, Koyama M, Azuma C, Murata Y. Source: J Reprod Med. 2002 August; 47(8): 640-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12216430&dopt=Abstract
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Chlamydia trachomatis and ectopic pregnancy: retrospective analysis of salpingectomy specimens, endometrial biopsies, and cervical smears. Author(s): Lan J, van den Brule AJ, Hemrika DJ, Risse EK, Walboomers JM, Schipper ME, Meijer CJ. Source: Journal of Clinical Pathology. 1995 September; 48(9): 815-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7490313&dopt=Abstract
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Chlamydial serology among patients with tubal factor infertility and ectopic pregnancy in Alexandria, Egypt. Author(s): Mehanna MT, Rizk MA, Eweiss NY, Ramadan M, Zaki SA, Sadek A, Chow JM, Schachter J. Source: Sexually Transmitted Diseases. 1995 September-October; 22(5): 317-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7502187&dopt=Abstract
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Chromosomal abnormalities and ectopic pregnancy? New directions for aetiological research. Author(s): Job-Spira N, Coste J, Bouyer J, Tharaux-Deneux C, Fernandez H. Source: Human Reproduction (Oxford, England). 1996 February; 11(2): 239-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8671200&dopt=Abstract
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Chronic ectopic pregnancy after clinically successful methotrexate treatment of ectopic pregnancy. Author(s): Dunn RC, Taskin O. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1995 December; 51(3): 247-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8745091&dopt=Abstract
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Clinic: critically appraised topics. Ectopic pregnancy evaluating first-line diagnostic tools. Author(s): Onega T. Source: Jaapa. 2001 August; 14(8): 21-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11556059&dopt=Abstract
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Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment. Author(s): Olofsson JI, Poromaa IS, Ottander U, Kjellberg L, Damber MG. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 August; 80(8): 744-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11531618&dopt=Abstract
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Clinical presentation of ectopic pregnancy in Transkei, South Africa. Author(s): Amoko DH, Buga GA. Source: East Afr Med J. 1995 December; 72(12): 770-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8689974&dopt=Abstract
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Color doppler in the diagnosis of ectopic pregnancy in the emergency department: is there anything beyond a mass and fluid? Author(s): Blaivas M. Source: The Journal of Emergency Medicine. 2002 May; 22(4): 379-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113849&dopt=Abstract
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Commentary on “Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy”. Kadar N, DeVore G, Romero R. Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy. Obstet Gynecol 1981;58:156-61. Author(s): Pitkin RM. Source: Obstetrics and Gynecology. 2003 October; 102(4): 672. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14550993&dopt=Abstract
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Concurrent appendicitis and ectopic pregnancy. A case report. Author(s): Riggs JC, Schiavello HJ, Fixler R. Source: J Reprod Med. 2002 June; 47(6): 510-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12092024&dopt=Abstract
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Conservative treatment of ectopic pregnancy in a caesarean section scar. Author(s): Chuang J, Seow KM, Cheng WC, Tsai YL, Hwang JL. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 September; 110(9): 869-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511972&dopt=Abstract
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Conservative treatment of ectopic pregnancy in a cesarean section scar with methotrexate: a case report. Author(s): Nawroth F, Foth D, Wilhelm L, Schmidt T, Warm M, Romer T. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 November; 99(1): 135-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11604205&dopt=Abstract
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Contraception and the risk of ectopic pregnancy: a meta-analysis. Author(s): Mol BW, Ankum WM, Bossuyt PM, Van der Veen F. Source: Contraception. 1995 December; 52(6): 337-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8749596&dopt=Abstract
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Contralateral corpus luteum in ectopic pregnancy: what does it tell us about ovum pickup? Author(s): Ziel HK, Paulson RJ. Source: Fertility and Sterility. 2002 April; 77(4): 850-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11937149&dopt=Abstract
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Control for tubal disease before ascribing ectopic pregnancy to hormone imbalance. Author(s): Speirs A. Source: Human Reproduction (Oxford, England). 1996 February; 11(2): 235-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8671197&dopt=Abstract
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Cytogenetic study employing chorionic villi in ectopic pregnancy. Author(s): Han SS, Yang YH. Source: Yonsei Medical Journal. 1995 November; 36(5): 438-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8546002&dopt=Abstract
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Declining incidence of ectopic pregnancy in a UK city health district between 1990 and 1999. Author(s): Irvine LM, Setchell ME. Source: Human Reproduction (Oxford, England). 2001 October; 16(10): 2230-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11574521&dopt=Abstract
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Derivation of a clinical prediction model for the emergency department diagnosis of ectopic pregnancy. Author(s): Buckley RG, King KJ, Disney JD, Ambroz PK, Gorman JD, Klausen JH. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 1998 October; 5(10): 951-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9862584&dopt=Abstract
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Detection of chlamydial antigenic material in ovarian, prostatic, ectopic pregnancy and semen samples of culture-negative subjects. Author(s): Toth M, Patton DL, Campbell LA, Carretta EI, Mouradian J, Toth A, Shevchuk M, Baergen R, Ledger W. Source: American Journal of Reproductive Immunology (New York, N.Y. : 1989). 2000 April; 43(4): 218-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10836251&dopt=Abstract
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Diagnosing ectopic pregnancy. Author(s): Hendry JN. Source: Can Fam Physician. 2001 December; 47: 2457-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11785274&dopt=Abstract
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Diagnosing ectopic pregnancy: decision analysis comparing six strategies. Author(s): Gracia CR, Barnhart KT. Source: Obstetrics and Gynecology. 2001 March; 97(3): 464-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11239658&dopt=Abstract
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Diagnosing suspected ectopic pregnancy. Can we offer completely non-surgical management for ectopic pregnancy? Author(s): Sau AK, Sau M. Source: Bmj (Clinical Research Ed.). 2001 March 31; 322(7289): 793-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11282876&dopt=Abstract
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Diagnosing suspected ectopic pregnancy. Hcg monitoring and transvaginal ultrasound lead the way. Author(s): Ankum WM. Source: Bmj (Clinical Research Ed.). 2000 November 18; 321(7271): 1235-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11082067&dopt=Abstract
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Diagnosing suspected ectopic pregnancy. Patients with falling concentrations of beta human chorionic gonadotrophin should be seen regularly. Author(s): Irvine LM. Source: Bmj (Clinical Research Ed.). 2001 March 31; 322(7289): 794. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11282878&dopt=Abstract
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Diagnosis and treatment of heterotopic pregnancy compared with ectopic pregnancy. Author(s): Soriano D, Shrim A, Seidman DS, Goldenberg M, Mashiach S, Oelsner G. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 August; 9(3): 352-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12101334&dopt=Abstract
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Diagnosis of acute and persistent ectopic pregnancy. Author(s): Graczykowski JW, Seifer DB. Source: Clinical Obstetrics and Gynecology. 1999 March; 42(1): 9-22; Quiz 55-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10073295&dopt=Abstract
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Diagnosis of ectopic pregnancy after in vitro fertilization and embryo transfer. Author(s): Mol BW, van der Veen F, Hajenius PJ, Engelsbel S, Ankum WM, Hogerzeil HV, Hemrika DJ, Bossuyt PM. Source: Fertility and Sterility. 1997 December; 68(6): 1027-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9418692&dopt=Abstract
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Diagnosis of ectopic pregnancy. Author(s): Kory LA. Source: Ajr. American Journal of Roentgenology. 2000 October; 175(4): 1185-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11000190&dopt=Abstract
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Diagnosis of ectopic pregnancy. Author(s): Brennan DF. Source: J Fla Med Assoc. 1997 December-1998 January; 84(9): 549-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9505475&dopt=Abstract
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Diagnosis of ectopic pregnancy. Author(s): Barnhart K, Coutifaris C. Source: Annals of Emergency Medicine. 1997 February; 29(2): 295-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9018199&dopt=Abstract
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Diagnosis of ectopic pregnancy--why we need a protocol. Author(s): Koh GH, Yeo GS. Source: Singapore Med J. 1997 September; 38(9): 369-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9407760&dopt=Abstract
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Diagnosis of ruptured ectopic pregnancy by bedside ultrasonography. Author(s): Popat RU, Adams CP. Source: The Journal of Emergency Medicine. 2002 May; 22(4): 409-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113854&dopt=Abstract
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Diagnostic curettage in the evaluation of ectopic pregnancy. Author(s): McCollum JS. Source: American Family Physician. 2001 January 15; 63(2): 220, 222, 225. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11201690&dopt=Abstract
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Differentiating tubal abortion from viable ectopic pregnancy with serum CA-125 and beta-human chorionic gonadotropin determinations. Author(s): Predanic M. Source: Fertility and Sterility. 2000 March; 73(3): 522-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10689006&dopt=Abstract
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Direct cost of single dose methotrexate for unruptured ectopic pregnancy. Prospective comparison with laparoscopy. Author(s): Lecuru F, Robin F, Chasset S, Leonard F, Guitti S, Taurelle R. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2000 January; 88(1): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10659909&dopt=Abstract
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Doppler findings in chronic ectopic pregnancy: case report. Author(s): Abramov Y, Nadjari M, Shushan A, Prus D, Anteby SO. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 1997 May; 9(5): 344-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9201879&dopt=Abstract
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Early diagnosed intramural ectopic pregnancy associated with adenomyosis: report of an unusual case. Author(s): Karakok M, Balat O, Sari I, Kocer NE, Erdogan R. Source: Clin Exp Obstet Gynecol. 2002; 29(3): 217-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519047&dopt=Abstract
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Ectopic pregnancy after tubal sterilization. Author(s): Engin Y, Ustun Y, Gungor M, Ortac F. Source: J Pak Med Assoc. 2002 September; 52(9): 428-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12532581&dopt=Abstract
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Ectopic pregnancy and emergency care: ethical and legal issues. Author(s): Dickens BM, Faundes A, Cook RJ. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2003 July; 82(1): 121-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12834958&dopt=Abstract
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Ectopic pregnancy and laparoscopy: review of 1197 patients treated by salpingectomy or salpingotomy. Author(s): Maymon R, Shulman A, Halperin R, Michell A, Bukovsky I. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1995 September; 62(1): 61-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7493711&dopt=Abstract
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Ectopic pregnancy associated with tubal schistosomiasis. Author(s): Eogan M, O'Malley A, Flavin R, Gillan J, McKenna P, Coulter-Smith S. Source: Ir Med J. 2002 September; 95(8): 250. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405506&dopt=Abstract
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Ectopic pregnancy in African developing countries. Author(s): Goyaux N, Leke R, Keita N, Thonneau P. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 April; 82(4): 305-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716313&dopt=Abstract
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Ectopic pregnancy in the levonorgestrel releasing intrauterinesystem (LNG-IUS) user: atypical presentation. Author(s): Abu JI, Wandless GM, Emembolu JO. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 September; 22(5): 567-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521443&dopt=Abstract
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Ectopic pregnancy revisited in Benin City, Nigeria: analysis of 152 cases. Author(s): Gharoro EP, Igbafe AA. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 December; 81(12): 1139-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519110&dopt=Abstract
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Ectopic pregnancy risk when contraception fails. A review. Author(s): Furlong LA. Source: J Reprod Med. 2002 November; 47(11): 881-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12497674&dopt=Abstract
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Ectopic pregnancy with a translocated Mirena intrauterine system. Author(s): Kwong FN, Rai H, Mayne C. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2002 April; 28(2): 95-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12396781&dopt=Abstract
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Ectopic pregnancy without therapy despite previous failure with in vitro fertilization and a male partner with an extremely low hypoosmotic swelling test score: case report. Author(s): Check ML, Check JH. Source: Clin Exp Obstet Gynecol. 2002; 29(3): 189-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519040&dopt=Abstract
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Ectopic pregnancy. Author(s): Duchatel FC. Source: Current Opinion in Obstetrics & Gynecology. 1995 December; 7(6): 472-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8620082&dopt=Abstract
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Ectopic pregnancy. Author(s): Della-Giustina D, Denny M. Source: Emergency Medicine Clinics of North America. 2003 August; 21(3): 565-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962347&dopt=Abstract
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Ectopic pregnancy: a nursing approach to excess risk among minority women. Author(s): Bernstein J. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1995 November-December; 24(9): 803-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8583270&dopt=Abstract
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Ectopic pregnancy: ultrasonographic diagnosis and interpretive pitfalls. Author(s): Hertzberg BS, Kliewer MA. Source: Southern Medical Journal. 1995 December; 88(12): 1191-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7502109&dopt=Abstract
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Ectopic pregnancy--Part I: Clinical and laboratory diagnosis. Author(s): Brennan DF. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 1995 December; 2(12): 1081-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8597920&dopt=Abstract
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Ectopic pregnancy--Part II: Diagnostic procedures and imaging. Author(s): Brennan DF. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 1995 December; 2(12): 1090-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8597921&dopt=Abstract
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Effect of transvaginal sonography on the use of invasive procedures for evaluating patients with a clinical diagnosis of ectopic pregnancy. Author(s): Atri M, Valenti DA, Bret PM, Gillett P. Source: Journal of Clinical Ultrasound : Jcu. 2003 January; 31(1): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12478646&dopt=Abstract
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Emergency contraception and risk of ectopic pregnancy: is there need for extra vigilance? Author(s): Vinson DR. Source: Annals of Emergency Medicine. 2003 August; 42(2): 306-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899155&dopt=Abstract
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Evaluation of serum creatine kinase levels in ectopic pregnancy. Author(s): Qasim SM, Trias A, Sachdev R, Kemmann E. Source: Fertility and Sterility. 1996 February; 65(2): 443-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8566277&dopt=Abstract
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Factors determining fertility after conservative or radical surgical treatment for ectopic pregnancy. Author(s): dela Cruz A, Cumming DC. Source: Fertility and Sterility. 1997 November; 68(5): 871-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9389818&dopt=Abstract
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Factors influencing reproductive performance following previous ectopic pregnancy. Author(s): Sobande AA. Source: Saudi Med J. 2000 December; 21(12): 1130-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11360085&dopt=Abstract
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Factors that may predispose to rupture of tubal ectopic pregnancy. Author(s): Roussos D, Panidis D, Matalliotakis I, Mavromatidis G, Neonaki M, Mamopoulos M, Koumantakis E. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2000 March; 89(1): 15-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10733018&dopt=Abstract
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Failure of creatine kinase to predict ectopic pregnancy. Author(s): Korhonen J, Alfthan H, Stenman UH, Ylostalo P. Source: Fertility and Sterility. 1996 May; 65(5): 922-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8612849&dopt=Abstract
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Failure of tubal closure following laser salpingostomy for ampullary tubal ectopic pregnancy. Author(s): Cropp CS, Cowell PD, Rock JA. Source: Fertility and Sterility. 1987 November; 48(5): 887-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2444466&dopt=Abstract
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False-negative laparoscopy: a pitfall in the diagnosis of early ectopic pregnancy. Author(s): Edozien LC, Pandiarajan T, Ali SW. Source: Br J Clin Pract. 1995 November-December; 49(6): 326-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8554960&dopt=Abstract
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Fertility after ectopic pregnancy in an African population. Author(s): Ogunniyi SO, Faleyimu BL. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1989 November; 30(3): 245-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2575051&dopt=Abstract
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Fertility after ectopic pregnancy in relation to background factors and surgical treatment. Author(s): Thorburn J, Philipson M, Lindblom B. Source: Fertility and Sterility. 1988 April; 49(4): 595-601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3350155&dopt=Abstract
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Fertility after ectopic pregnancy. Author(s): Ory SJ, Nnadi E, Herrmann R, O'Brien PS, Melton LJ 3rd. Source: Fertility and Sterility. 1993 August; 60(2): 231-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8339816&dopt=Abstract
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Fertility after ectopic pregnancy. Author(s): Mitchell DE, McSwain HF, Peterson HB. Source: American Journal of Obstetrics and Gynecology. 1989 September; 161(3): 576-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2782338&dopt=Abstract
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Fertility after ectopic pregnancy. Author(s): Querleu D, Boutteville C. Source: Fertility and Sterility. 1989 June; 51(6): 1069-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2721725&dopt=Abstract
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Fertility after ectopic pregnancy. Effects of surgery and expectant management. Author(s): Strobelt N, Mariani E, Ferrari L, Trio D, Tiezzi A, Ghidini A. Source: J Reprod Med. 2000 October; 45(10): 803-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11077627&dopt=Abstract
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Fertility after ectopic pregnancy: first results of a population-based cohort study in france. Author(s): Job-Spira N, Bouyer J, Pouly JL, Germain E, Coste J, Aublet-Cuvelier B, Fernandez H. Source: Human Reproduction (Oxford, England). 1996 January; 11(1): 99-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8671168&dopt=Abstract
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Fertility after nonsurgical treatment of ectopic pregnancy. Author(s): Carp HJ, Oelsner G, Serr DM, Mashiach S. Source: J Reprod Med. 1986 February; 31(2): 119-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2937917&dopt=Abstract
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Fertility after organ-preserving surgery of ectopic pregnancy: results of a multicenter study. Author(s): Korell M, Albrich W, Hepp H. Source: Fertility and Sterility. 1997 August; 68(2): 220-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9240246&dopt=Abstract
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Fertility following ectopic pregnancy with special reference to previous use of an intra-uterine contraceptive device (IUCD). Author(s): Sandvei R, Ulstein M, Wollen AL. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1987; 66(2): 131-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3618137&dopt=Abstract
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Fertility following laparoscopic removal of rudimentary horn with an ectopic pregnancy. Author(s): Adolph AJ, Gilliland GB. Source: J Obstet Gynaecol Can. 2002 July; 24(7): 575-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12196850&dopt=Abstract
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Fertility outcome after conservative surgical treatment of ectopic pregnancy evaluated in a randomized trial. Author(s): Lundorff P, Thorburn J, Lindblom B. Source: Fertility and Sterility. 1992 May; 57(5): 998-1002. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1572493&dopt=Abstract
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Fertility outcome after ectopic pregnancy and use of an intrauterine device at the time of the index ectopic pregnancy. Author(s): Bernoux A, Job-Spira N, Germain E, Coste J, Bouyer J. Source: Human Reproduction (Oxford, England). 2000 May; 15(5): 1173-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10783373&dopt=Abstract
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Flow cytometric DNA in ectopic pregnancy. Author(s): Aine R, Karikoski-Leo R, Heinonen PK. Source: Journal of Clinical Pathology. 1990 November; 43(11): 963. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2262574&dopt=Abstract
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Gamete intrafallopian transfer (GIFT) complicated by bilateral ectopic pregnancy. Author(s): Olive DL, Taylor N, Cothran GE, Schenken RS. Source: Fertility and Sterility. 1988 April; 49(4): 719-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3280349&dopt=Abstract
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Gamete intrafallopian transfer in women who had ectopic pregnancy previously. Author(s): Guirgis RR, Craft IL. Source: Obstetrics and Gynecology. 1992 April; 79(4): 586-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1553182&dopt=Abstract
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Genital schistosomiasis presenting as suspected ectopic pregnancy in the Western Cape. Author(s): Schneider D, Steyn DW. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 2000 June; 90(6): 609. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10918890&dopt=Abstract
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Gestational choriocarcinoma in a tubal ectopic pregnancy. Author(s): Bakri YN, Amri A, Mulla J. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1992 January; 71(1): 67-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1315103&dopt=Abstract
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Gonadotropin-producing benign cystic teratoma simulating a ruptured ectopic pregnancy. Author(s): Pothula V, Matseoane S, Godfrey H. Source: Journal of the National Medical Association. 1994 March; 86(3): 221-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7514671&dopt=Abstract
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Gray-scale findings in ectopic pregnancy resembling molar pregnancy and missed abortion. Author(s): Kadar N, Romero R. Source: Journal of Clinical Ultrasound : Jcu. 1982 October; 10(8): 403-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6816822&dopt=Abstract
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hCG, progesterone, alpha-fetoprotein, and estradiol in the identification of ectopic pregnancy. Author(s): Masse J. Source: Obstetrics and Gynecology. 1993 August; 82(2): 317-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7687757&dopt=Abstract
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hCG, progesterone, alpha-fetoprotein, and estradiol in the identification of ectopic pregnancy. Author(s): Grosskinsky CM, Hage ML, Tyrey L, Christakos AC, Hughes CL. Source: Obstetrics and Gynecology. 1993 May; 81(5 ( Pt 1)): 705-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7682316&dopt=Abstract
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Hematosalpinx after methotrexate treatment of unruptured ectopic pregnancy. Author(s): Frishman GN, Seifer DB. Source: Fertility and Sterility. 1993 September; 60(3): 571-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8375544&dopt=Abstract
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Hemorrhagic shock from a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result. Author(s): Kalinski MA, Guss DA. Source: Annals of Emergency Medicine. 2002 July; 40(1): 102-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12085079&dopt=Abstract
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Heterotopic pregnancy of a ruptured ectopic pregnancy coexisting with a twin intrauterine pregnancy: a case report. Author(s): Zvandasara P. Source: Cent Afr J Med. 2001 February; 47(2): 44-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11957271&dopt=Abstract
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Heterotopic pregnancy: discovery of ectopic pregnancy after elective abortion. Author(s): DeFrancesch F, DiLeo L, Martinez J. Source: Southern Medical Journal. 1999 March; 92(3): 330-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10094279&dopt=Abstract
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High dose methotrexate infusion with leucovorin rescue for treatment of ectopic pregnancy. Author(s): Larson DM, Tipping SJ, Mulligan GM, Johnson KK, Becker J. Source: Wis Med J. 1995 December; 94(12): 664-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8571615&dopt=Abstract
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High progesterone levels and ciliary dysfunction--a possible cause of ectopic pregnancy. Author(s): Paltieli Y, Eibschitz I, Ziskind G, Ohel G, Silbermann M, Weichselbaum A. Source: Journal of Assisted Reproduction and Genetics. 2000 February; 17(2): 103-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10806589&dopt=Abstract
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History and physical examination to estimate the risk of ectopic pregnancy: validation of a clinical prediction model. Author(s): Buckley RG, King KJ, Disney JD, Gorman JD, Klausen JH. Source: Annals of Emergency Medicine. 1999 November; 34(5): 589-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10533005&dopt=Abstract
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Hospital referrals with possible ectopic pregnancy: prospective observational study. Author(s): Crocker A, Arulkumaran S, Hayman R. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 March; 23(2): 179-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745566&dopt=Abstract
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Hospital resources used for ectopic pregnancy treatment by laparoscopy and methotrexate. Author(s): Lecuru F, Camatte S, Viens-Bitker C, Chasset S, Leonard F, Taurelle R. Source: Jsls. 2001 April-June; 5(2): 117-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11394423&dopt=Abstract
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How effectively do copper intrauterine devices prevent ectopic pregnancy? Author(s): Skjeldestad FE. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1997 August; 76(7): 684-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9292645&dopt=Abstract
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Human chorionic gonadotropin level as a predictor of trophoblastic infiltration into the tubal wall in ectopic pregnancy: a blinded study. Author(s): Natale A, Candiani M, Merlo D, Izzo S, Gruft L, Busacca M. Source: Fertility and Sterility. 2003 April; 79(4): 981-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12749441&dopt=Abstract
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Human chorionic gonadotropin levels in the evaluation of ectopic pregnancy. Author(s): Laing FC, Brown DL. Source: Radiology. 1998 July; 208(1): 271-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9646827&dopt=Abstract
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Human chorionic gonadotropin patterns after a single dose of methotrexate for ectopic pregnancy. Author(s): Natale A, Busacca M, Candiani M, Gruft L, Izzo S, Felicetta I, Vignali M. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 January 10; 100(2): 227-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11750970&dopt=Abstract
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Hysteroscopic diagnosis of ectopic pregnancy. Author(s): Marpeau L, Larue L, Rhimi Z, Barau G, Pigne A, Barrat J. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1992 August 21; 46(1): 31-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1426498&dopt=Abstract
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Hysteroscopic management of cornual ectopic pregnancy. Author(s): Pal B, Akinfenwa O, Harrington K. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 September; 110(9): 879-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511976&dopt=Abstract
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Hysteroscopic management of cornual ectopic pregnancy. Author(s): Sanz LE, Verosko J. Source: Obstetrics and Gynecology. 2002 May; 99(5 Pt 2): 941-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11975968&dopt=Abstract
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Hysteroscopic resection of a cervical ectopic pregnancy. Author(s): Hardy TJ. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 August; 9(3): 370-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12101337&dopt=Abstract
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Hysteroscopic resection of a cervical ectopic pregnancy. Author(s): Ash S, Farrell SA. Source: Fertility and Sterility. 1996 November; 66(5): 842-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8893698&dopt=Abstract
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Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy. Author(s): Corsan GH, Karacan M, Qasim S, Bohrer MK, Ransom MX, Kemmann E. Source: Human Reproduction (Oxford, England). 1995 October; 10(10): 2719-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8567799&dopt=Abstract
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Implementation of probabilistic decision rules improves the predictive values of algorithms in the diagnostic management of ectopic pregnancy. Author(s): Mol BW, van Der Veen F, Bossuyt PM. Source: Human Reproduction (Oxford, England). 1999 November; 14(11): 2855-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10548636&dopt=Abstract
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Improved fertility following conservative surgical treatment of ectopic pregnancy. Author(s): Bangsgaard N, Lund CO, Ottesen B, Nilas L. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 August; 110(8): 765-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892689&dopt=Abstract
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Incidence and risk factors for ectopic pregnancy. Author(s): Pisarska MD, Carson SA. Source: Clinical Obstetrics and Gynecology. 1999 March; 42(1): 2-8; Quiz 55-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10073294&dopt=Abstract
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Incidence of ectopic pregnancy and sexually transmitted disease in the Canadian Central Arctic. Author(s): Orr PH, Brown R. Source: Int J Circumpolar Health. 1998; 57 Suppl 1: 127-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10093261&dopt=Abstract
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Increasing incidence of ectopic pregnancy: is it iatrogenic? Author(s): Ong S, Wingfield M. Source: Ir Med J. 1999 August; 92(5): 364-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10522077&dopt=Abstract
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Interstitial ectopic pregnancy--management with laparoscopically-guided local methotrexate infiltration. Author(s): Wilkinson C, Petrucco O, Pachulicz M, Furness M. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1998 November; 38(4): 434-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9890227&dopt=Abstract
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Interstitial pregnancy: a potential for misdiagnosis of ectopic pregnancy with emergency department ultrasonography. Author(s): DeWitt C, Abbott J. Source: Annals of Emergency Medicine. 2002 July; 40(1): 106-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12085080&dopt=Abstract
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Interventions for tubal ectopic pregnancy. Author(s): Hajenius PJ, Mol BW, Bossuyt PM, Ankum WM, Van Der Veen F. Source: Cochrane Database Syst Rev. 2000; (2): Cd000324. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796710&dopt=Abstract
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Intraoperative autologous blood transfusion for hemoperitoneum resulting from ectopic pregnancy or ovarian bleeding during laparoscopic surgery. Author(s): Yamada T, Okamoto Y, Kasamatsu H, Mori H. Source: Jsls. 2003 April-June; 7(2): 97-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856837&dopt=Abstract
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Intraoperative blood salvage and autotransfusion in the management of ruptured ectopic pregnancy: a review. Author(s): Selo-Ojeme DO. Source: East Afr Med J. 2001 September; 78(9): 465-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11921578&dopt=Abstract
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Intratubal methotrexate for prevention of persistent ectopic pregnancy after salpingotomy. Author(s): Kaya H, Babar Y, Ozmen S, Ozkaya O, Karci M, Aydin AR, Ozbasar D. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 November; 9(4): 464-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12386357&dopt=Abstract
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Intrauterine ectopic pregnancy. A case report. Author(s): Padovan P, Lauri F, Marchetti M. Source: Clin Exp Obstet Gynecol. 1998; 25(3): 79-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9856302&dopt=Abstract
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Intravascular contrast agent in the ultrasonography of ectopic pregnancy. Author(s): Orden MR, Gudmundsson S, Helin HL, Kirkinen P. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 1999 November; 14(5): 348-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10623995&dopt=Abstract
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Is a clinical prediction model accurate for predicting ectopic pregnancy? Author(s): Buckley R, King K, Disney J. Source: The Western Journal of Medicine. 2000 October; 173(4): 251. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11017987&dopt=Abstract
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Is perforation of the appendix a risk factor for tubal infertility and ectopic pregnancy? An appraisal of the evidence. Author(s): Urbach DR, Cohen MM. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 1999 April; 42(2): 101-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10223070&dopt=Abstract
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Is the male involved in the aetiology of ectopic pregnancy? Author(s): Warnes GM, Petrucco OM, Seamark RF, Lancaster PA. Source: Human Reproduction (Oxford, England). 1998 December; 13(12): 3505-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9886541&dopt=Abstract
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Is the rising incidence of ectopic pregnancy unexplained? Author(s): Ankum WM. Source: Human Reproduction (Oxford, England). 1996 February; 11(2): 238-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8671199&dopt=Abstract
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Isolated fluid in the cul-de-sac: how well does it predict ectopic pregnancy? Author(s): Dart R, McLean SA, Dart L. Source: The American Journal of Emergency Medicine. 2002 January; 20(1): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11781902&dopt=Abstract
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IUDs and ectopic pregnancy. Author(s): Sivin I. Source: Contraception. 1995 November; 52(5): 321-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8585891&dopt=Abstract
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Lack of sensitivity of endometrial thickness in predicting the presence of an ectopic pregnancy. Author(s): Mehta TS, Levine D, McArdle CR. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 1999 February; 18(2): 117-22; Quiz 123-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10206804&dopt=Abstract
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Laparoscopic management of a case of abdominal ectopic pregnancy. Author(s): Kwok A, Chia KK, Ford R, Lam A. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 August; 42(3): 300-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230069&dopt=Abstract
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Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar. Author(s): Lee CL, Wang CJ, Chao A, Yen CF, Soong YK. Source: Human Reproduction (Oxford, England). 1999 May; 14(5): 1234-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10325269&dopt=Abstract
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Laparoscopic management of ectopic pregnancy. Author(s): Ghosh S, Mann C, Khan K, Gupta JK. Source: Semin Laparosc Surg. 1999 June; 6(2): 68-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10459058&dopt=Abstract
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Laparoscopic management of ectopic pregnancy. Author(s): Grainger DA, Seifer DB. Source: Current Opinion in Obstetrics & Gynecology. 1995 August; 7(4): 277-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7578967&dopt=Abstract
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Laparoscopic management of ectopic pregnancy: a 5-year experience. Author(s): Mohamed H, Maiti S, Phillips G. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 July; 22(4): 411-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521467&dopt=Abstract
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Laparoscopic surgery in ectopic pregnancy. Author(s): Lundorff P. Source: Acta Obstetricia Et Gynecologica Scandinavica. Supplement. 1997; 164: 81-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9225646&dopt=Abstract
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Laparoscopic surgery with intraoperative autologous blood transfusion in patients with heavy hemoperitoneum due to ectopic pregnancy. Author(s): Yamada T, Kasamatsu H. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2000 May; 7(2): 255-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10806273&dopt=Abstract
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Laparoscopic surgical approach to ectopic pregnancy. Author(s): Vasile C, Litta P, Sacco G, Minante M. Source: Clin Exp Obstet Gynecol. 1999; 26(1): 35-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10490355&dopt=Abstract
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Laparoscopic treatment of ectopic pregnancy resulting from intrauterine transmigration. Author(s): Pasini A, Alfieri L, Belloni C. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 May; 108(5): 545-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11368145&dopt=Abstract
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Laparoscopic treatment of ectopic pregnancy. Author(s): Gray DT, Thorburn J, Lundorff P, Lindblom B. Source: Lancet. 1995 September 9; 346(8976): 706-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7658849&dopt=Abstract
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Laparoscopy with ultrasonographic guidance of intraamniotic methotrexate injection for ectopic pregnancy. A report of two cases. Author(s): Akira S, Ishihara T, Yamanaka A, Takeshita T, Kaseki H, Araki T. Source: J Reprod Med. 2000 October; 45(10): 844-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11077636&dopt=Abstract
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Laparotomy or laparoscopic surgery? Factors affecting the surgeons choice for the treatment of ectopic pregnancy. Author(s): Akhan SE, Baysal B. Source: Archives of Gynecology and Obstetrics. 2002 April; 266(2): 79-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12049300&dopt=Abstract
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Levels of vascular endothelial growth factor are elevated in patients with ectopic pregnancy: is this a novel marker? Author(s): Daniel Y, Geva E, Lerner-Geva L, Eshed-Englender T, Gamzu R, Lessing JB, Bar-Am A, Amit A. Source: Fertility and Sterility. 1999 December; 72(6): 1013-7. Erratum In: Fertil Steril 2000 May; 73(5): 1072. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10593373&dopt=Abstract
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Life-threatening neutropenia following methotrexate treatment of ectopic pregnancy: a report of two cases. Author(s): Isaacs JD Jr, McGehee RP, Cowan BD. Source: Obstetrics and Gynecology. 1996 October; 88(4 Pt 2): 694-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8841256&dopt=Abstract
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Local application of methotrexate for ectopic pregnancy with a percutaneous puncturing technique. Author(s): Mesogitis SA, Daskalakis GJ, Antsaklis AJ, Papantoniou NE, Papageorgiou JS, Michalas SK. Source: Gynecologic and Obstetric Investigation. 1998; 45(3): 154-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9565137&dopt=Abstract
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Local injection of methotrexate dissolved in saline versus methotrexate suspensions for the conservative treatment of ectopic pregnancy. Author(s): Fujishita A, Ishimaru T, Masuzaki H, Samejima T, Matsuwaki T, Chavez RO, Yamabe T. Source: Human Reproduction (Oxford, England). 1995 December; 10(12): 3280-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8822458&dopt=Abstract
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Longitudinal observations of human chorionic gonadotropin in serum following surgery for ectopic pregnancy. Author(s): Rempen A, Haubitz I. Source: Archives of Gynecology and Obstetrics. 1996; 258(4): 181-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8844135&dopt=Abstract
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Low-dose oral methotrexate with expectant management of ectopic pregnancy. Author(s): Korhonen J, Stenman UH, Ylostalo P. Source: Obstetrics and Gynecology. 1996 November; 88(5): 775-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8885912&dopt=Abstract
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Low-resistance endometrial arterial flow in the exclusion of ectopic pregnancy revisited. Author(s): Wherry KL, Dubinsky TJ, Waitches GM, Richardson ML, Reed S. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 2001 April; 20(4): 335-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11316311&dopt=Abstract
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Management of ectopic pregnancy at a military medical center. Author(s): Russell CS, Calhoun B. Source: Military Medicine. 2002 February; 167(2): 129-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11873534&dopt=Abstract
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Management of ectopic pregnancy in a Scottish teaching hospital: implications for training. Author(s): Davidson EJ, Nicholson SC. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 March; 22(2): 197-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521708&dopt=Abstract
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Management of separation pain after single-dose methotrexate therapy for ectopic pregnancy. Author(s): Lipscomb GH, Puckett KJ, Bran D, Ling FW. Source: Obstetrics and Gynecology. 1999 April; 93(4): 590-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10214839&dopt=Abstract
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Measurement of IgG antibodies to Chlamydia trachomatis by commercial enzyme immunoassays and immunofluorescence in sera from pregnant women and patients with infertility, pelvic inflammatory disease, ectopic pregnancy, and laboratory diagnosed Chlamydia psittaci/Chlamydia pneumoniae infection. Author(s): Jones CS, Maple PA, Andrews NJ, Paul ID, Caul EO. Source: Journal of Clinical Pathology. 2003 March; 56(3): 225-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610104&dopt=Abstract
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Measurement of intrauterine human decidua-associated protein 200 and diagnosis of ectopic pregnancy. Author(s): Halperin R, Hadas E, Bukovsky I, Schneider D. Source: Gynecologic and Obstetric Investigation. 1998; 45(4): 225-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9623785&dopt=Abstract
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Medical management of ectopic pregnancy. Author(s): Buster JE, Pisarska MD. Source: Clinical Obstetrics and Gynecology. 1999 March; 42(1): 23-30; Quiz 55-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10073296&dopt=Abstract
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Medical management of ectopic pregnancy. Author(s): Namnoum AB. Source: Clinical Obstetrics and Gynecology. 1998 June; 41(2): 382-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9646970&dopt=Abstract
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Medical management of interstitial ectopic pregnancy: a case report and literature review. Author(s): Fisch JD, Ortiz BH, Tazuke SI, Chitkara U, Giudice LC. Source: Human Reproduction (Oxford, England). 1998 July; 13(7): 1981-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9740461&dopt=Abstract
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Medical treatment of ectopic pregnancy using parental methotrexate. Author(s): Ekele BA. Source: West Afr J Med. 2001 July-September; 20(3): 181-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11922147&dopt=Abstract
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Medical vs. Surgical treatment of ectopic pregnancy. The University of New Mexico's six-year experience. Author(s): Lewis-Bliehall C, Rogers RG, Kammerer-Doak DN, Conway SC, Amaya C, Byrn F. Source: J Reprod Med. 2001 November; 46(11): 983-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11762155&dopt=Abstract
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Methotrexate administration for ectopic pregnancy in the emergency department--one hospital's protocol/competencies. Author(s): Miller JH, Griffin E. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 2003 June; 29(3): 240-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776079&dopt=Abstract
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Microlaparoscopy for an intact ectopic pregnancy and endometriosis with the use of a diode laser: case report. Author(s): Abrao MS, Ikeda F, Podgaec S, Pereira PP. Source: Human Reproduction (Oxford, England). 2000 June; 15(6): 1369-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10831571&dopt=Abstract
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Mifepristone and methotrexate: the combination for medical treatment of ectopic pregnancy. Author(s): Gazvani MR, Emery SJ. Source: American Journal of Obstetrics and Gynecology. 1999 June; 180(6 Pt 1): 1599-600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10368554&dopt=Abstract
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Mifepristone in treating ectopic pregnancy. Author(s): Zhang W, Wang L. Source: Chinese Medical Journal. 1999 April; 112(4): 376-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11593544&dopt=Abstract
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Misdiagnosis of an interstitial ectopic pregnancy after unilateral salpingectomy. Author(s): Yim S, Fung HY, To K. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1996 February; 36(1): 80-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8775259&dopt=Abstract
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Molar cornual ectopic pregnancy. Author(s): Zite NB, Lipscomb GH, Merrill K. Source: Obstetrics and Gynecology. 2002 May; 99(5 Pt 2): 891-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11975948&dopt=Abstract
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Moral absolutism and ectopic pregnancy. Author(s): Kaczor C. Source: The Journal of Medicine and Philosophy. 2001 February; 26(1): 61-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11262641&dopt=Abstract
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Mortality and morbidity associated with misdiagnosis of ectopic pregnancy in a defined Nigerian population. Author(s): Orji EO, Fasubaa OB, Adeyemi B, Dare FO, Onwudiegwu U, Ogunniyi SO. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 September; 22(5): 548-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521428&dopt=Abstract
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MR appearance of ruptured tubal ectopic pregnancy. Author(s): Kinoshita T, Ishii K, Higashiiwai H. Source: European Journal of Radiology. 1999 November; 32(2): 144-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10628424&dopt=Abstract
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MRI of early unruptured ectopic pregnancy: detection of gestational sac. Author(s): Nishino M, Hayakawa K, Kawamata K, Iwasaku K, Takasu K. Source: Journal of Computer Assisted Tomography. 2002 January-February; 26(1): 134-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11801918&dopt=Abstract
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New options for diagnosis and treatment of ectopic pregnancy. Author(s): Ory SJ. Source: Jama : the Journal of the American Medical Association. 1992 January 22-29; 267(4): 534-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1530874&dopt=Abstract
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New techniques in the diagnosis of ectopic pregnancy. Author(s): Taylor KJ, Meyer WR. Source: Obstetrics and Gynecology Clinics of North America. 1991 March; 18(1): 39-54. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1923256&dopt=Abstract
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Non-invasive management of patients with suspected ectopic pregnancy: a survey among Dutch gynaecologists. Author(s): Engelsbel S, Mol BW, Hajenius PJ, Ankum WM, van der Veen F, Hemrika DJ, Bossuyt PM. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 March; 95(1): 81-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11267725&dopt=Abstract
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Non-neoplastic ovarian cysts with ectopic pregnancy. Author(s): Harper SL, Tiltman AJ. Source: International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists. 1991; 10(4): 372-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1774108&dopt=Abstract
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Nonsurgical management of ectopic pregnancy associated with severe hyperstimulation syndrome. Author(s): Chotiner HC. Source: Obstetrics and Gynecology. 1985 November; 66(5): 740-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3932909&dopt=Abstract
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Nonsurgical management of ectopic pregnancy. Author(s): Rotmensch S, Jaffe R. Source: Fertility and Sterility. 1988 June; 49(6): 1091. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3371488&dopt=Abstract
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Nonsurgical management of unruptured ectopic pregnancy: an extended clinical trial. Author(s): Sauer MV, Gorrill MJ, Rodi IA, Yeko TR, Greenberg LH, Bustillo M, Gunning JE, Buster JE. Source: Fertility and Sterility. 1987 November; 48(5): 752-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2444463&dopt=Abstract
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Nonsurgical management of unruptured isthmic ectopic pregnancy: preliminary experience. Author(s): Sauer MV, Gorrill MJ, Rodi IA, Yeko TR, Greenberg LH, Gunning JE, Buster JE. Source: Int J Fertil. 1988 March-April; 33(2): 116-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2898448&dopt=Abstract
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Nonsurgical treatment of an ectopic pregnancy with methotrexate. Author(s): Weinman SA. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 1996 December; 22(6): 597-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9060326&dopt=Abstract
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Non-surgical treatment of ectopic pregnancy in the sole remaining tube. Author(s): Parrilla JJ, Abad L, Server J, Gimeno F, Martinez-Roman S, Balasch J. Source: Human Reproduction (Oxford, England). 1995 July; 10(7): 1866-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8583000&dopt=Abstract
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Nonsurgical treatment of ectopic pregnancy. Author(s): Lipscomb GH, Stovall TG, Ling FW. Source: The New England Journal of Medicine. 2000 November 2; 343(18): 1325-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11058678&dopt=Abstract
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Nonsurgical treatment of ectopic pregnancy. Author(s): Tulandi T. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1992 June; 38(2): 107-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1356840&dopt=Abstract
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Nonsurgical treatment of ectopic pregnancy. Author(s): Martin DC. Source: Fertility and Sterility. 1987 August; 48(2): 344-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2956131&dopt=Abstract
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Nonsurgical treatment of ectopic pregnancy. Author(s): Ory SJ. Source: Fertility and Sterility. 1986 November; 46(5): 767-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3780998&dopt=Abstract
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Non-surgical treatment of ectopic pregnancy. Author(s): Saunders NJ. Source: British Journal of Obstetrics and Gynaecology. 1990 November; 97(11): 972-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2252876&dopt=Abstract
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Non-surgical treatment of ectopic pregnancy. Author(s): Lindblom B, Enk L, Hahlin M, Kallfelt B, Lundorff P, Thorburn J. Source: Lancet. 1988 June 18; 1(8599): 1403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2898082&dopt=Abstract
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Nontubal ectopic pregnancy. Author(s): Bayless RB. Source: Clinical Obstetrics and Gynecology. 1987 March; 30(1): 191-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2438076&dopt=Abstract
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Nuclear magnetic resonance imaging of a patient with an ectopic pregnancy. Author(s): Roth G, Kleinstein J, Kuhnert A, Kunzel W. Source: Gynecologic and Obstetric Investigation. 1987; 23(2): 135-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3583093&dopt=Abstract
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Old ectopic pregnancy remnants with morphological features of placental site nodule occurring in fallopian tube and broad ligament. Author(s): Kouvidou C, Karayianni M, Liapi-Avgeri G, Toufexi H, Karaiossifidi H. Source: Pathology, Research and Practice. 2000; 196(5): 329-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10834390&dopt=Abstract
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Omental trophoblastic implants and hemoperitoneum after laparoscopic salpingostomy for ectopic pregnancy. A case report. Author(s): Pal L, Parkash V, Rutherford TJ. Source: J Reprod Med. 2003 January; 48(1): 57-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611098&dopt=Abstract
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Operative laparoscopy for management of ectopic pregnancy in patients with hypovolemic shock. Author(s): Soriano D, Yefet Y, Oelsner G, Goldenberg M, Mashiach S, Seidman DS. Source: The Journal of the American Association of Gynecologic Laparoscopists. 1997 May; 4(3): 363-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9154787&dopt=Abstract
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Operative laparoscopy for the treatment of ectopic pregnancy in a residency program. Author(s): Vu K, Gehlbach DL, Rosa C. Source: J Reprod Med. 1996 August; 41(8): 602-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8866389&dopt=Abstract
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Operative laparoscopy versus laparotomy for the management of ectopic pregnancy. Author(s): Zhu L, Wong F, Bai J. Source: Chinese Medical Journal. 2000 September; 113(9): 810-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11776076&dopt=Abstract
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Operative management of ectopic pregnancy: a cost analysis. Author(s): Foulk RA, Steiger RM. Source: American Journal of Obstetrics and Gynecology. 1996 July; 175(1): 90-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8694081&dopt=Abstract
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Oral methotrexate for treatment of ectopic pregnancy. Author(s): Lipscomb GH, Meyer NL, Flynn DE, Peterson M, Ling FW. Source: American Journal of Obstetrics and Gynecology. 2002 June; 186(6): 1192-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12066097&dopt=Abstract
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Outcome analysis of a protocol including bedside endovaginal sonography in patients at risk for ectopic pregnancy. Author(s): Mateer JR, Valley VT, Aiman EJ, Phelan MB, Thoma ME, Kefer MP. Source: Annals of Emergency Medicine. 1996 March; 27(3): 283-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8599484&dopt=Abstract
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Over-diagnosis of hydatidiform mole in early tubal ectopic pregnancy. Author(s): Burton JL, Lidbury EA, Gillespie AM, Tidy JA, Smith O, Lawry J, Hancock BW, Wells M. Source: Histopathology. 2001 May; 38(5): 409-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11422477&dopt=Abstract
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Past contraceptive method use and risk of ectopic pregnancy. Author(s): Parazzini F, Ferraroni M, Tozzi L, Benzi G, Rossi G, La Vecchia C. Source: Contraception. 1995 August; 52(2): 93-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8536453&dopt=Abstract
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Pelviscopic organ-preserving treatment of ectopic pregnancy using fibrin sealant. Author(s): Rudelstorfer B, Loidl K. Source: The Journal of the American Association of Gynecologic Laparoscopists. 1995 November; 3(1): 81-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9050620&dopt=Abstract
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Perforated appendicitis and ectopic pregnancy following in-vitro fertilization. Author(s): Akman MA, Katz E, Damewood MD, Ramzy AI, Garcia JE. Source: Human Reproduction (Oxford, England). 1995 December; 10(12): 3325-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8822469&dopt=Abstract
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Placental site trophoblastic tumor masquerading as an ovarian ectopic pregnancy. Author(s): Condous G, Thomas J, Okaro E, Bourne T. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2003 May; 21(5): 504-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768567&dopt=Abstract
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Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital. Author(s): Potter MB, Lepine LA, Jamieson DJ. Source: American Journal of Obstetrics and Gynecology. 2003 May; 188(5): 1192-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748475&dopt=Abstract
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Preoperative diagnosis of unilateral tubal twin ectopic pregnancy with one live twin. Author(s): Basama FM. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 May; 23(3): 313-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918472&dopt=Abstract
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Presumed diagnosis of ectopic pregnancy. Author(s): Lewis J. Source: Obstetrics and Gynecology. 2003 January; 101(1): 201; Author Reply 201-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12517668&dopt=Abstract
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Presumed diagnosis of ectopic pregnancy. Author(s): Sanjaghsaz H. Source: Obstetrics and Gynecology. 2003 January; 101(1): 200-1; Author Reply 201-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12517667&dopt=Abstract
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Previous cesarean delivery and the risk of ectopic pregnancy. Author(s): Kendrick JS, Tierney EF, Lawson HW, Strauss LT, Klein L, Atrash HK. Source: Obstetrics and Gynecology. 1996 February; 87(2): 297-301. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8559542&dopt=Abstract
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Progestogen-only emergency contraception and ectopic pregnancy. Author(s): Harrison-Woolrych M, Woolley J. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2003 January; 29(1): 5-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12626168&dopt=Abstract
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Quantitative B-hCG levels less than 1000 mIU/mL in patients with ectopic pregnancy: pelvic ultrasound still useful. Author(s): Counselman FL, Shaar GS, Heller RA, King DK. Source: The Journal of Emergency Medicine. 1998 September-October; 16(5): 699-703. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9752940&dopt=Abstract
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Quinacrine sterilization: an assessment of risks for ectopic pregnancy, birth defects and cancer. Author(s): Kessel E. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1998 June; 14(2): 81-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9820926&dopt=Abstract
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Reproductive potential after an ectopic pregnancy. Author(s): al-Nuaim L, Bamgboye EA, Chowdhury N, Adelusi B. Source: Fertility and Sterility. 1995 November; 64(5): 942-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7589638&dopt=Abstract
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Retroperitoneal subpancreatic ectopic pregnancy following in vitro fertilization in a patient with previous bilateral salpingectomy: how did it get there? Author(s): Dmowski WP, Rana N, Ding J, Wu WT. Source: Journal of Assisted Reproduction and Genetics. 2002 February; 19(2): 90-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11958512&dopt=Abstract
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Reversible alopecia after single-dose methotrexate treatment in a patient with ectopic pregnancy. Author(s): Trout S, Kemmann E. Source: Fertility and Sterility. 1995 October; 64(4): 866-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7672164&dopt=Abstract
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Risk factors for ectopic pregnancy after in vitro fertilization and embryo transfer. Author(s): Ribic-Pucelj M, Tomazevic T, Vogler A, Meden-Vrtovec H. Source: Journal of Assisted Reproduction and Genetics. 1995 October; 12(9): 594-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8580656&dopt=Abstract
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Risk factors for ectopic pregnancy: a comprehensive analysis based on a large casecontrol, population-based study in France. Author(s): Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, Job-Spira N. Source: American Journal of Epidemiology. 2003 February 1; 157(3): 185-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543617&dopt=Abstract
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Risk factors of ectopic pregnancy. Author(s): Bunyavejchevin S, Havanond P, Wisawasukmongchol W. Source: J Med Assoc Thai. 2003 June; 86 Suppl 2: S417-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930019&dopt=Abstract
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Role of chromosome abnormalities in ectopic pregnancy. Author(s): Coste J, Fernandez H, Joye N, Benifla J, Girard S, Marpeau L, Job-Spira N. Source: Fertility and Sterility. 2000 December; 74(6): 1259-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11119765&dopt=Abstract
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Role of previous ectopic pregnancy in altering the presentation of suspected ectopic pregnancy. Author(s): Spandorfer SD, Barnhart KT. Source: J Reprod Med. 2003 March; 48(3): 133-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698768&dopt=Abstract
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Ruptured ectopic pregnancy presenting with hyperglycaemia. Author(s): Bhattacharyya A, Tymms DJ. Source: Int J Clin Pract. 2000 July-August; 54(6): 409-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11092119&dopt=Abstract
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Ruptured tubal ectopic pregnancy associated with negative qualitative human chorionic gonadotrophin levels. Author(s): Goh JT, Sidhu MS. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2000 November; 40(4): 459-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11194437&dopt=Abstract
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Second trimester uterine atony imitating ectopic pregnancy: magnetic resonance diagnosis. Author(s): Wax JR, Tempany CM, Slowey MJ, Smith JF, Floyd RC. Source: Military Medicine. 1995 October; 160(10): 534-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7501205&dopt=Abstract
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Serum beta-hCG regression after laparoscopic salpingostomy in the treatment of ectopic pregnancy in Thai women. Author(s): Wisawasukmongchol W, Sophonsritsuk A, Bunyavejchevin S, Suwajanakorn S, Manotaya S. Source: J Med Assoc Thai. 2002 June; 85 Suppl 1: S441-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12188449&dopt=Abstract
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Serum concentrations of interleukin-2R (IL-2R), IL-6, IL-8, and tumor necrosis factor alpha in patients with ectopic pregnancy. Author(s): Soriano D, Hugol D, Quang NT, Darai E. Source: Fertility and Sterility. 2003 April; 79(4): 975-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12749440&dopt=Abstract
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Severe intraperitoneal hemorrhage in ectopic pregnancy. Author(s): Heinonen S, Penttinen J, Ryynanen M. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1996 February; 52(2): 189-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8855105&dopt=Abstract
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Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Author(s): Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Source: Human Reproduction (Oxford, England). 2002 December; 17(12): 3224-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456628&dopt=Abstract
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Smoking cessation or reduction in women attempting to conceive after ectopic pregnancy. Author(s): Bouyer J, Rouxel A, Job-Spira N. Source: European Journal of Epidemiology. 2001; 17(12): 1063-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12530763&dopt=Abstract
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Subclassification of indeterminate pelvic ultrasonography: prospective evaluation of the risk of ectopic pregnancy. Author(s): Dart RG, Burke G, Dart L. Source: Annals of Emergency Medicine. 2002 April; 39(4): 382-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11919524&dopt=Abstract
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Surgical treatment of ectopic pregnancy. Author(s): Mol BW, Bossuyt PM. Source: Lancet. 1995 September 2; 346(8975): 638-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7651025&dopt=Abstract
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Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States. Author(s): Zane SB, Kieke BA Jr, Kendrick JS, Bruce C. Source: Maternal and Child Health Journal. 2002 December; 6(4): 227-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12512764&dopt=Abstract
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Symptom-free women at increased risk of ectopic pregnancy: should we screen? Author(s): Mol BW, van der Veen F, Bossuyt PM. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 July; 81(7): 661-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190842&dopt=Abstract
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The hidden side of ectopic pregnancy: the hormonal factor. Author(s): Fernandez H, Bouyer J, Coste J, Job-Spira N. Source: Human Reproduction (Oxford, England). 1996 February; 11(2): 243-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8671201&dopt=Abstract
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The impact of ectopic pregnancy: a 16-year follow-up study. Author(s): Lasker JN, Toedter LJ. Source: Health Care for Women International. 2003 March; 24(3): 209-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12746012&dopt=Abstract
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The medical management of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens. Author(s): Barnhart KT, Gosman G, Ashby R, Sammel M. Source: Obstetrics and Gynecology. 2003 April; 101(4): 778-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12681886&dopt=Abstract
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The prediction of ectopic pregnancy after in-vitro fertilization and embryo transfer. Author(s): Marcus SF, Macnamee M, Brinsden P. Source: Human Reproduction (Oxford, England). 1995 August; 10(8): 2165-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8567860&dopt=Abstract
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The time has come for the medical management of ectopic pregnancy. Author(s): Schink JC. Source: Wis Med J. 1995 December; 94(12): 668-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8571616&dopt=Abstract
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Transvaginal intratubal methotrexate treatment of ectopic pregnancy. Report of 100 cases. Author(s): Darai E, Benifla JL, Naouri M, Pennehouat G, Guglielmina JN, Deval B, Filippini F, Crequat J, Madelenat P. Source: Human Reproduction (Oxford, England). 1996 February; 11(2): 420-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8671235&dopt=Abstract
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Treatment of ectopic pregnancy by local injection of hypertonic glucose: a randomized trial comparing administration guided by transvaginal ultrasound or laparoscopy. Author(s): Gjelland K, Hordnes K, Tjugum J, Augensen K, Bergsjo P. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1995 September; 74(8): 629-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7660770&dopt=Abstract
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Treatment of ectopic pregnancy with single-dose methotrexate in a patient with an intrauterine device. A case report. Author(s): Sites CK. Source: J Reprod Med. 1995 November; 40(11): 800-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8592317&dopt=Abstract
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Tubal ectopic pregnancy: a patho-physiological explanation involving endometriosis. Author(s): Hunter RH. Source: Human Reproduction (Oxford, England). 2002 July; 17(7): 1688-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12093825&dopt=Abstract
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Two-step diagnosis of bilateral ectopic pregnancy after in vitro fertilization. Author(s): Hugues J, Olszewska B, Dauvergne P, Bulwa S, Cedrin-Durnerin I. Source: Journal of Assisted Reproduction and Genetics. 1995 August; 12(7): 460-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8574077&dopt=Abstract
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Ultrasonographic examination by emergency physicians of patients at risk for ectopic pregnancy. Author(s): Mateer JR, Aiman EJ, Brown MH, Olson DW. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 1995 October; 2(10): 867-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8542485&dopt=Abstract
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Ultrasonography and ectopic pregnancy--a review. Author(s): Seffah JD. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2000 December; 71(3): 263-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11102620&dopt=Abstract
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Ultrasound availability in the evaluation of ectopic pregnancy in the ED: comparison of quality and cost-effectiveness with different approaches. Author(s): Durston WE, Carl ML, Guerra W, Eaton A, Ackerson LM. Source: The American Journal of Emergency Medicine. 2000 July; 18(4): 408-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10919529&dopt=Abstract
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Ultrasound-guided injection of ectopic pregnancy. Author(s): Natofsky JG, Lense J, Mayer JC, Yeko TR. Source: Clinical Obstetrics and Gynecology. 1999 March; 42(1): 39-47; Quiz 55-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10073298&dopt=Abstract
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Unsuspected chronic ectopic pregnancy in a patient with chronic pelvic pain. Author(s): Porpora MG, Alo PL, Cosmi EV. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1999 February; 64(2): 187-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10189032&dopt=Abstract
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Unusual localisation of an ectopic pregnancy. Author(s): Chiovschi S, Vasile M, Grigoras D, Cioata I, Lazar E, Ples M. Source: Clin Exp Obstet Gynecol. 1998; 25(4): 151-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9987577&dopt=Abstract
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Urine beta-core fragment, a potential screening test for ectopic pregnancy and spontaneous abortion. Author(s): Cole LA, Isozaki T, Jones EE. Source: Fetal Diagnosis and Therapy. 1997 November-December; 12(6): 336-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9475362&dopt=Abstract
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Use of hysterosalpingosonography for early diagnosis of ectopic pregnancy. Author(s): Robin F, Lecuru F, Bernard JP, Darles C, Taurelle R. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1998 August; 79(2): 217-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9720845&dopt=Abstract
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Usefulness of pipelle endometrial biopsy in the diagnosis of women at risk for ectopic pregnancy. Author(s): Barnhart KT, Gracia CR, Reindl B, Wheeler JE. Source: American Journal of Obstetrics and Gynecology. 2003 April; 188(4): 906-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12712084&dopt=Abstract
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Utility of a single beta HCG measurement to evaluate for absence of ectopic pregnancy. Author(s): Marill KA, Ingmire TE, Nelson BK. Source: The Journal of Emergency Medicine. 1999 May-June; 17(3): 419-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10338231&dopt=Abstract
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Vaginal douching and ectopic pregnancy. Author(s): Meyer L, Brouselle C, Soulat C, Gros I. Source: Jama : the Journal of the American Medical Association. 1991 May 22-29; 265(20): 2670-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2023343&dopt=Abstract
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Vaginal douching and the risk of ectopic pregnancy among black women. Author(s): Kendrick JS, Atrash HK, Strauss LT, Gargiullo PM, Ahn YW. Source: American Journal of Obstetrics and Gynecology. 1997 May; 176(5): 991-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9166157&dopt=Abstract
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Vaginal probe ultrasonography and ectopic pregnancy. Author(s): Goldstein SR. Source: American Journal of Obstetrics and Gynecology. 1990 September; 163(3): 1099100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2206060&dopt=Abstract
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Vaginal sonography in ectopic pregnancy. A prospective evaluation. Author(s): Rempen A. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 1988 July; 7(7): 381-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3043018&dopt=Abstract
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Vaginal ultrasonography in the diagnosis of ectopic pregnancy. Author(s): Frishman GN, Luciano AA. Source: American Journal of Obstetrics and Gynecology. 1990 June; 162(6): 1640-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2193522&dopt=Abstract
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Value of transvaginal sonography in the evaluation of live monochorionic diamniotic twin ectopic pregnancy. Author(s): Baksu A, Baksu B, Goker N. Source: Journal of Clinical Ultrasound : Jcu. 2002 November-December; 30(9): 570-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12404527&dopt=Abstract
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Vascular cell adhesion molecule-1 in normal, failed, and ectopic pregnancy. Author(s): Daniel Y, Geva E, Eshed-Englender T, Gamzu R, Lessing JB, Bar-Am A, Amit A. Source: American Journal of Reproductive Immunology (New York, N.Y. : 1989). 2000 February; 43(2): 92-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10735600&dopt=Abstract
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Vascular endothelial growth factor (VEGF) and discrimination between abnormal intrauterine and ectopic pregnancy. Author(s): Kucera-Sliutz E, Schiebel I, Konig F, Leodolter S, Sliutz G, Koelbl H. Source: Human Reproduction (Oxford, England). 2002 December; 17(12): 3231-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456629&dopt=Abstract
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Viability of Chlamydia trachomatis in fallopian tubes of patients with ectopic pregnancy. Author(s): Gerard HC, Branigan PJ, Balsara GR, Heath C, Minassian SS, Hudson AP. Source: Fertility and Sterility. 1998 November; 70(5): 945-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9806581&dopt=Abstract
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Vital signs fail to correlate with hemoperitoneum from ruptured ectopic pregnancy. Author(s): Hick JL, Rodgerson JD, Heegaard WG, Sterner S. Source: The American Journal of Emergency Medicine. 2001 October; 19(6): 488-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11593468&dopt=Abstract
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What is the optimal protocol for diagnosis of ectopic pregnancy? Author(s): Abrahamson L, Newton W. Source: The Journal of Family Practice. 2001 July; 50(7): 570. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11485699&dopt=Abstract
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What is the significance of the human chorionic gonadotropin value in ectopic pregnancy? Author(s): DiMarchi JM, Kosasa TS, Hale RW. Source: Obstetrics and Gynecology. 1989 December; 74(6): 851-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2586949&dopt=Abstract
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When to suspect ectopic pregnancy. Author(s): Trustem A. Source: Rn. 1991 August; 54(8): 22-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1866582&dopt=Abstract
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Where the pendulum of expectant management of ectopic pregnancy should rest? Author(s): Lurie S, Katz Z. Source: Gynecologic and Obstetric Investigation. 1996; 42(3): 145. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8938461&dopt=Abstract
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CHAPTER 2. NUTRITION AND ECTOPIC PREGNANCY Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and ectopic pregnancy.
Finding Nutrition Studies on Ectopic Pregnancy The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “ectopic pregnancy” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7
Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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The following information is typical of that found when using the “Full IBIDS Database” to search for “ectopic pregnancy” (or a synonym): •
A hypothesis on the increasing rates of ectopic pregnancy. Author(s): MRC Mammalian Development Unit, London, UK. Source: James, W H Paediatr-Perinat-Epidemiol. 1989 April; 3(2): 189-93; discussion 1934 0269-5022
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A rabbit model for the evaluation of minimal access treatment of ectopic pregnancy in humans, using intrachorionic injection and local hyperthermia. Author(s): Clinic Dr. Guth, Hamburg, Germany. Source: Popp, L W Gaetje, R Status, S Lierse, W Clin-Exp-Obstet-Gynecol. 1993; 20(4): 226-35 0390-6663
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Advancing conservative treatment of ectopic pregnancy--laparoscopic and “nonsurgical” management. Author(s): Department of Obstetrics and Gynaecology, University of Goteborg, Sweden. Source: Thorburn, J Ann-Med. 1992 February; 24(1): 43-7 0785-3890
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Cervical ectopic pregnancy: review of the literature and report of a case treated by single-dose methotrexate therapy. Author(s): Department of Gynecology and Obstetrics, Johns Hopkins University, Francis Scott Key Medical Center, Baltimore, Maryland 21224. Source: Yankowitz, J Leake, J Huggins, G Gazaway, P Gates, E Obstet-GynecolSurvolume 1990 July; 45(7): 405-14 0029-7828
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Cervical pregnancy. A case report. Author(s): Division of Maternal-Fetal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Source: Roussis, P Ball, R H Fleischer, A C Herbert, C M 3rd J-Reprod-Med. 1992 May; 37(5): 479-81 0024-7758
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Cervical pregnancy: two case reports. Author(s): Bridgeport Hospital, Bridgeport, USA. Source: Rosenman, Stephen Kleinman, Gary Conn-Med. 2002 February; 66(2): 71-2 00106178
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Chemotherapy for ectopic pregnancy. Author(s): Mayo Medical School, Rochester, Minnesota. Source: Ory, S J Obstet-Gynecol-Clin-North-Am. 1991 March; 18(1): 123-34 0889-8545
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Conservative management of ectopic pregnancy: prospective randomized clinical trial of methotrexate versus prostaglandin sulprostone by combined transvaginal and systemic administration. Author(s): Department of Obstetrics and Gynecology, Hopital Antoine Beclere, Clamart, France. Source: Fernandez, H Baton, C Lelaidier, C Frydman, R Fertil-Steril. 1991 April; 55(4): 746-50 0015-0282
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Conservative treatment of ectopic pregnancy and its effect on corpus luteum activity. Author(s): Department of Obstetrics and Gynecology B, Sapir Medical Center, Kfar Saba, Israel. Source: Shulman, A Maymon, R Zmira, N Lotan, M Holtzinger, M Bahary, C GynecolObstet-Invest. 1992; 33(3): 161-4 0378-7346
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Current trends in the treatment of ectopic pregnancy. Author(s): IIIrd Inst. of Obstetrics and Gynaecology, University La Sapienza, Rome, Italy.
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Source: Boni, T Pecorini, F Turco, C Matteo, P S Marzetti, L Clin-Exp-Obstet-Gynecol. 1995; 22(3): 198-201 0390-6663 •
Ectopic pregnancy treated with trichosanthin. Clinical analysis of 71 patients. Source: Lu, P X Jin, Y C Chin-Med-J-(Engl). 1989 May; 102(5): 365-7 0366-6999
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Ectopic pregnancy, the new gynecological epidemic disease: review of the modern work-up and the nonsurgical treatment option. Author(s): Department of Obstetrics & Gynecology B Sapir Medical Center, Kfar Saba, Israel. Source: Maymon, R Shulman, A Maymon, B B Bar Levy, F Lotan, M Bahary, C Int-JFertil. 1992 May-June; 37(3): 146-64 0020-725X
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Ectopic pregnancy: in vitro effects of prostaglandins on the oviduct and corpus luteum. Source: Hahlin, M Bokstrom, H Lindblom, B Fertil-Steril. 1987 June; 47(6): 935-40 00150282
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Intrauterine pregnancy after treatment of tubal pregnancy with local and systemic prostaglandins in a patient with a single oviduct. Author(s): Department of Obstetrics and Gynaecology, University of Graz, Austria. Source: Honigl, W Lang, P F Weiss, P A Winter, R Hum-Reprod. 1992 April; 7(4): 573-4 0268-1161
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Lack of resolution of ectopic pregnancy by intratubal injection of methotrexate. Author(s): University of Pittsburgh School of Medicine, Pennsylvania. Source: Mottla, G L Rulin, M C Guzick, D S Fertil-Steril. 1992 March; 57(3): 685-7 00150282
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Laparoscopic treatment of an interstitial pregnancy. Author(s): Providence Medical Center, Medford, Oregon, USA. Source: Laury, D J-Am-Assoc-Gynecol-Laparosc. 1995 February; 2(2): 219-21 1074-3804
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Local prostaglandin F2 alpha injection for termination of ectopic pregnancy. Source: Lindblom, B Hahlin, M Kallfelt, B Hamberger, L Lancet. 1987 April 4; 1(8536): 776-7 0140-6736
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Management of tubal pregnancy with methotrexate. Author(s): Department of Obstetrics and Gynaecology, Edith Wolfson Medical Center, Holon, Israel. Source: Zakut, H Sadan, O Katz, A Dreval, D Bernstein, D Br-J-Obstet-Gynaecol. 1989 June; 96(6): 725-8 0306-5456
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Medical and surgical treatment of ectopic pregnancy. Author(s): Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada. Source: Tulandi, T Curr-Opin-Obstet-Gynecol. 1994 April; 6(2): 149-52 1040-872X
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Medical management of cervical pregnancy--a report of two cases. Author(s): Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
[email protected] Source: Chew, S AnandakuMarch, C Singapore-Med-J. 2001 November; 42(11): 537-9 0037-5675
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Methotrexate therapy for persistent ectopic pregnancy after conservative laparoscopic management. Author(s): Department of Obstetrics and Gynecology, University of Massachusetts Medical Center, Worcester.
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Source: Rose, P G Cohen, S M Obstet-Gynecol. 1990 November; 76(5 Pt 2): 947-9 00297844 •
Methotrexate treatment of unruptured ectopic pregnancy: a report of 100 cases. Author(s): Department of Obstetrics and Gynecology, University of Tennessee, Memphis. Source: Stovall, T G Ling, F W Gray, L A Carson, S A Buster, J E Obstet-Gynecol. 1991 May; 77(5): 749-53 0029-7844
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Methotrexate versus hyperosomolar glucose in the treatment of extrauterine pregnancy. Author(s): Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Israel. Source: Sadan, O Ginath, S Debby, A Rotmensch, S Golan, A Zakut, H Glezerman, M Arch-Gynecol-Obstet. 2001 May; 265(2): 82-4 0932-0067
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Misdiagnosis of interstitial pregnancy followed by uterine cornual rupture during induced midtrimester abortion. Author(s): Department of Obstetrics and Gynecology, Hvidovre Hospital, University of Copenhagen, Denmark. Source: Petersen, K R Larsen, G K Norring, K Jensen, F R Acta-Obstet-Gynecol-Scand. 1992 May; 71(4): 316-8 0001-6349
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Non-neoplastic ovarian cysts with ectopic pregnancy. Author(s): Department of Anatomical Pathology, University of Cape Town, Republic of South Africa. Source: Harper, S L Tiltman, A J Int-J-Gynecol-Pathol. 1991; 10(4): 372-9 0277-1691
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Nonsurgical management of tubal pregnancy. Necessity in view of the changing clinical appearance. Author(s): Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel. Source: Pansky, M Golan, A Bukovsky, I Caspi, E Am-J-Obstet-Gynecol. 1991 March; 164(3): 888-95 0002-9378
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Nonsurgical treatment of ectopic pregnancy. Author(s): Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada. Source: Tulandi, T Int-J-Gynaecol-Obstet. 1992 June; 38(2): 107-13 0020-7292
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Outpatient chemotherapy of unruptured ectopic pregnancy. Author(s): Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38163. Source: Stovall, T G Ling, F W Buster, J E Fertil-Steril. 1989 March; 51(3): 435-8 0015-0282
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Ovarian pregnancy diagnosed in the third trimester: a case report. Author(s): Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical School, Japan. Source: Seki, H Kuromaki, K Takeda, S Kinoshita, K J-Obstet-Gynaecol-Res. 1997 December; 23(6): 543-6 1341-8076
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Prophylactic vasopressin during laparoscopic salpingotomy for ectopic pregnancy. Author(s): Atatepe sitesi B-2, Block no. 32, Sogutozu 06520 Ankara, Turkey. Source: Ugur, M Yesilyurt, H Soysal, S Gokmen, O J-Am-Assoc-Gynecol-Laparosc. 1996 May; 3(3): 365-8 1074-3804
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Prostaglandin injection for termination of tubal pregnancy: preliminary results. Author(s): I. Univ. Frauenklinik Wien, Vienna, Austria. Source: Husslein, P Fitz, R Pateisky, N Egarter, C Am-J-Perinatol. 1989 April; 6(2): 117-20 0735-1631
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Prostaglandin versus expectant management in early tubal pregnancy. Author(s): I. Univ. Frauenklinik, Vienna/Austria. Source: Egarter, C Kiss, H Husslein, P Prostaglandins-Leukot-Essent-Fatty-Acids. 1991 March; 42(3): 177-9 0952-3278
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Recurrent ectopic pregnancy following in-vitro fertilization. Author(s): Department of Obstetrics and Gynaecology, Christian-Albrechts-University, Kiel, FRG. Source: al Hussaini, T Mettler, L Hum-Reprod. 1992 November; 7(10): 1479-80 0268-1161
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Reproductive performance after local and systemic prostaglandin for ectopic pregnancy. Author(s): I. Department of Obstetrics and Gynecology, University of Vienna, Austria. Source: Egarter, C Kiss, H Vavra, N Husslein, P Arch-Gynecol-Obstet. 1992; 252(1): 45-8 0932-0067
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Retained trophoblast after conservative management of ectopic pregnancy. A report of two cases. Author(s): Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee 37232. Source: Hill, G A Cartwright, P S Herbert, C M 3rd J-Reprod-Med. 1990 April; 35(4): 4157 0024-7758
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Return of reproductive performance after expectant management and local treatment for ectopic pregnancy. Author(s): Department of Obstetrics and Gynaecology, Hopital Antoine Beclere, Clamart, France. Source: Fernandez, H Lelaidier, C Baton, C Bourget, P Frydman, R Hum-Reprod. 1991 November; 6(10): 1474-7 0268-1161
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Serial endovaginal sonography of ectopic pregnancies treated with methotrexate. Author(s): Department of Radiology, University of Tennessee, Memphis. Source: Brown, D L Felker, R E Stovall, T G Emerson, D S Ling, F W Obstet-Gynecol. 1991 March; 77(3): 406-9 0029-7844
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Serum progesterone and 17-hydroxyprogesterone in the diagnosis of ectopic pregnancies and the value of progesterone replacement in intrauterine pregnancies when serum progesterone levels are low. Author(s): Department of Obstetrics and Gynecology, Cooper Hospital/University Medical Center, Robert Wood Johnson Medical School, Camden, N.J. Source: Choe, J K Check, J H Nowroozi, K Benveniste, R Barnea, E R Gynecol-ObstetInvest. 1992; 34(3): 133-8 0378-7346
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Successful treatment of a live cervical pregnancy with methotrexate and folinic acid. A case report. Author(s): Department of Obstetrics and Gynecology, Michael Reese Hospital and Medical Center, Pritzker School of Medicine, University of Chicago, IL 60616. Source: Kaplan, B R Brandt, T Javaheri, G Scommegna, A J-Reprod-Med. 1989 October; 34(10): 853-6 0024-7758
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Systemic methotrexate treatment in early unruptured ectopic pregnancy. Author(s): II Institute of Ob/Gyn, University of Rome La Sapienze, Italy.
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Source: Scarpellini, F Boccadoro, R Scarpellini, L Clin-Exp-Obstet-Gynecol. 1997; 24(3): 141-3 0390-6663 •
The nonsurgical management of ectopic pregnancy. Source: Shapiro, B S Clin-Obstet-Gynecol. 1987 March; 30(1): 230-5 0009-9201
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Treatment of 53 cases of ectopic pregnancy with the agents for promoting blood circulation and removing blood stasis. Author(s): Beijing Obstetrical and Gynecological Hospital. Source: Wang, L J-Tradit-Chin-Med. 1996 June; 16(2): 83-7 0254-6272
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Treatment of ectopic pregnancy by means of prostaglandins. Author(s): 1. Department of Gynecology and Obstetrics, University of Vienna, Austria. Source: Egarter, C Husslein, P Prostaglandins-Leukot-Essent-Fatty-Acids. 1989 February; 35(2): 91-2 0952-3278
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Treatment of tubal pregnancy by laparoscope-guided injection of prostaglandin F2 alpha. Author(s): Department of Obstetrics and Gynecology, University of Goteborg, Sweden. Source: Lindblom, B Hahlin, M Lundorff, P Thorburn, J Fertil-Steril. 1990 September; 54(3): 404-8 0015-0282
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Treatment of unruptured ectopic pregnancy by needling of sac and injection of methotrexate or PG E2 under transvaginal sonography control. Report of 10 cases. Author(s): Institute of Sterility Treatment, Vienna, Austria. Source: Feichtinger, W Kemeter, P Arch-Gynecol-Obstet. 1989; 246(2): 85-9 0932-0067
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Tubal ectopic pregnancy after in vitro fertilization and embryo transfer: a role for proximal occlusion or salpingectomy after failed distal tubal surgery? Author(s): Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada. Source: Zouves, C Erenus, M Gomel, V Fertil-Steril. 1991 October; 56(4): 691-5 0015-0282
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Tubal physiologic consideration in ectopic pregnancy. Source: Pulkkinen, M O Talo, A Clin-Obstet-Gynecol. 1987 March; 30(1): 164-72 00099201
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Use of adhesion prevention barriers in ovarian surgery, tubalplasty, ectopic pregnancy, endometriosis, adhesiolysis, and myomectomy. Author(s): University of Southern California School of Medicine, Department of Obstetrics and Gynecology, Livingston Reproductive Biology Laboratory, Los Angeles 90033, USA. Source: diZerega, G S Curr-Opin-Obstet-Gynecol. 1996 June; 8(3): 230-7 1040-872X
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.healthnotes.com/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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CHAPTER 3. ALTERNATIVE MEDICINE AND ECTOPIC PREGNANCY Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to ectopic pregnancy. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to ectopic pregnancy and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “ectopic pregnancy” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to ectopic pregnancy: •
An indirect method of discovering primary traumatic experiences: two case examples. Author(s): Cheek DB. Source: Am J Clin Hypn. 1989 July; 32(1): 41-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2773821&dopt=Abstract
•
An unusual ectopic pregnancy operated on under acupuncture analgesia. Author(s): Patel K, Nene ML. Source: East Afr Med J. 1978 February; 55(2): 87-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=668611&dopt=Abstract
•
Analysis of maternal deaths in the Central Region of Malawi. Author(s): Bullough CH.
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Source: East Afr Med J. 1981 January; 58(1): 25-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7215271&dopt=Abstract •
Cervical ectopic pregnancy Author(s): Rahimi MA, Benny PS. Source: The Journal of the American Association of Gynecologic Laparoscopists. 1996 August; 3(4, Supplement): S41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9074219&dopt=Abstract
•
Channelling light and color. Author(s): Batz L. Source: Calif Nurse. 1984 December-1985 January; 80(10): 6-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6391618&dopt=Abstract
•
China: a new medicine born of tradition. Author(s): Wen W. Source: Unesco Cour. 1979 July; 7: 25-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12309932&dopt=Abstract
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Critical comparisons of alternative therapies for ectopic pregnancy! Author(s): Fernandez H, Lelaidier C. Source: Fertility and Sterility. 1993 January; 59(1): 246; Author Reply 246-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8466575&dopt=Abstract
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Critical comparisons of alternative therapies for ectopic pregnancy! Author(s): Pansky M, Golan A, Bukovsky I, Caspi E. Source: Fertility and Sterility. 1993 January; 59(1): 245-6; Author Reply 246-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8419218&dopt=Abstract
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Critical comparisons of alternative therapies for ectopic pregnancy! Author(s): Kooi S, Kock HC. Source: Fertility and Sterility. 1993 January; 59(1): 244-5; Author Reply 246-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8419217&dopt=Abstract
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Ectopic pregnancy treated with trichosanthin. Clinical analysis of 71 patients. Author(s): Lu PX, Jin YC. Source: Chinese Medical Journal. 1989 May; 102(5): 365-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2509159&dopt=Abstract
•
Enhanced magnetic resonance imaging in monitoring of conservative treatment of cervical pregnancy.
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Author(s): Takashima M, Yamasaki M, Fujita I, Ohashi M, Matsuo H, Mochizuki M, Kitagaki H, Kono M. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 1995 December; 21(6): 545-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8640463&dopt=Abstract •
Exsanguination in a Jehovah's Witness. Author(s): Harris TJ, Parikh NR, Rao YK, Oliver RH. Source: Anaesthesia. 1983 October; 38(10): 989-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6638445&dopt=Abstract
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Heterotopic pregnancy following ovulation stimulation with clomiphene: a report of three cases. Author(s): Ahove OI, Sotiloye OS. Source: West Afr J Med. 2000 January-March; 19(1): 77-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10821092&dopt=Abstract
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High dose methotrexate infusion with leucovorin rescue for treatment of ectopic pregnancy. Author(s): Larson DM, Tipping SJ, Mulligan GM, Johnson KK, Becker J. Source: Wis Med J. 1995 December; 94(12): 664-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8571615&dopt=Abstract
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Local etoposide injection for treatment of tubal pregnancy with cardiac activity. Author(s): Kusaka M, Tanaka T, Fujimoto S. Source: Int J Fertil Menopausal Stud. 1994 January-February; 39(1): 11-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7513224&dopt=Abstract
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My conscience, your money. Author(s): Post SG, Fleck L. Source: The Hastings Center Report. 1995 September-October; 25(5): 28; Discussion 28-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8530266&dopt=Abstract
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Observations on abortion in Zambia. Author(s): Castle MA, Likwa R, Whittaker M. Source: Stud Fam Plann. 1990 July-August; 21(4): 231-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2219228&dopt=Abstract
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Ovarian pregnancy diagnosed in the third trimester: a case report. Author(s): Seki H, Kuromaki K, Takeda S, Kinoshita K.
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Source: The Journal of Obstetrics and Gynaecology Research. 1997 December; 23(6): 5436. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9433046&dopt=Abstract •
Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. Author(s): Lumley J, Watson L, Watson M, Bower C. Source: Cochrane Database Syst Rev. 2001; (3): Cd001056. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11686974&dopt=Abstract
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Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. Author(s): Lumley J, Watson L, Watson M, Bower C. Source: Cochrane Database Syst Rev. 2000; (2): Cd001056. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796229&dopt=Abstract
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Preliminary report on maternal deaths in the Southern Highlands of Tanzania in 1983. Author(s): Price TG. Source: J Obstet Gynaecol East Cent Africa. 1984 September; 3(3): 103-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12283147&dopt=Abstract
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Secondary abdominal pregnancy in a Jehovah's Witness. Author(s): Shaw HA, Ezenwa E. Source: Southern Medical Journal. 2000 September; 93(9): 898-900. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11005351&dopt=Abstract
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Successful conservative treatment for advanced interstitial pregnancy. A case report. Author(s): Chen CL, Wang PH, Chiu LM, Yang ML, Hung JH. Source: J Reprod Med. 2002 May; 47(5): 424-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12063884&dopt=Abstract
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Successful treatment of cervical pregnancy with oral etoposide. Author(s): Segna RA, Mitchell DR, Misas JE. Source: Obstetrics and Gynecology. 1990 November; 76(5 Pt 2): 945-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1699185&dopt=Abstract
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The veracious etiology of ectopic pregnancy. Author(s): Lurie S, Rabinerson D, Shoham Z. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1998 January; 77(1): 120-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9492732&dopt=Abstract
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Treatment of 53 cases of ectopic pregnancy with the agents for promoting blood circulation and removing blood stasis. Author(s): Wang L. Source: J Tradit Chin Med. 1996 June; 16(2): 83-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9389129&dopt=Abstract
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Trichosanthin injection in tubal pregnancy. Author(s): Egarter C, Husslein P, Yeung HW. Source: Gynecologic and Obstetric Investigation. 1991; 31(2): 119-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1709895&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMDHealth: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to ectopic pregnancy; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
General Overview Appendicitis Source: Integrative Medicine Communications; www.drkoop.com
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Kidney Stones Source: Integrative Medicine Communications; www.drkoop.com Pelvic Inflammatory Disease Source: Integrative Medicine Communications; www.drkoop.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. PATENTS ON ECTOPIC PREGNANCY Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “ectopic pregnancy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on ectopic pregnancy, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Ectopic Pregnancy By performing a patent search focusing on ectopic pregnancy, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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The following is an example of the type of information that you can expect to obtain from a patent search on ectopic pregnancy: •
Cervical barrier shield for female vaginal douche Inventor(s): Dolisi; Frank (Old Brookville, NY) Assignee(s): American Maternity Products, Inc. (Old Brookville, NY) Patent Number: 6,113,580 Date filed: August 27, 1998 Abstract: The female vaginal douche with cervical shield is a unique device with a wide range of health implications. The device is unique because there is no existing device available that offers the ability to cleanse the vaginal mucosa without allowing a forceful flow of fluid, debris, and bacteria (both commensal and pathogenic), into the uterine cervix. At present, when vaginal douching takes place, there is no barrier in place to protect or shield the cervix from this potentially harmful practice. By combining the vaginal douche applicator with an attached cervical shield, access to the uterine cervix will be limited. The limitation theoretically prevents microorganisms from entering the upper female genital tract. Shielding the cervix during vaginal douching has the potential to prevent serious pelvic infections including pelvic inflammatory disease, tuboovarian abscess, endometritis, as well as female factor infertility and potentially life threatening ectopic pregnancy. It is also possible that other unwanted effects such as uncomfortable uterine cramps may be prevented as well. The female vaginal douche with a cervical barrier shield is applied as one unit, and can be either disposable or nondisposable. Once applied, the douche may be utilized in the typical fashion, but with possibly less complicated and unwanted side effects. Excerpt(s): The present invention relates to protective barriers for internal hygiene. Existing vaginal douches include hollow fluid flow applicators for dispensing fluid into a vagina. However, because of the proximity of the vagina to the cervix, leading to the uterus, there is the risk of trans-cervical contamination of the uterus with bacteria, contaminated fluid and/or debris. Serious health risks include infection, sterility, ectopic pregnancies and/or pelvic inflammatory disease. It is therefore an object of the present invention to provide a uterine cervical shield to a vaginal douche applicator. Web site: http://www.delphion.com/details?pn=US06113580__
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Ectopic pregnancy test Inventor(s): Senyei; Andrew E. (Santa Ana, CA), Teng; Nelson N. H. (Hillsborough, CA) Assignee(s): Adeza Biomedical Corporation (Sunnyvale, CA) Patent Number: 5,236,846 Date filed: July 18, 1991 Abstract: A method for determining ectopic pregnancy in pregnant persons comprises obtaining a test sample; and determining the absence of a fetal restricted antigen in the sample. The sample is obtained from the vaginal cavity in the vicinity of the cervical canal or the cervical os. One fetal restricted antigen is fetal fibronectin. In one embodiment of this invention, the sample is contacted with an insoluble support to which anti-(fetal restricted antigen) antibody is adhered, and the fetal restricted antigen binding to the support is determined. Alternatively, a class of substances of which the
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fetal restricted antigen is a member is captured with a general binding antibody such as an anti-(fibronectin) antibody; an anti-(fetal restricted antigen) antibody such as anti(fetal fibronectin) antibody is bound to the support; and the absence of binding with fetal restricted antigen is determined. Competition or sandwich assay procedures can be used. Reagents and reagent kits are also included. Excerpt(s): This invention relates to methods, reagents and kits for detecting ectopic pregnancy in a patient who has pregnancy indicating levels of pregnancy antigen in the blood or urine. A wide variety of tests have been developed for the determination of pregnancy. These methods, in general, involve the testing of blood or urine for levels of pregnancy antigens or other compounds which are indicative of pregnancy. Ectopic pregnancies, however, are not reliably distinguished from normal pregnancies by these methods, and ectopic pregnancies remain a major cause of morbidity and mortality for women. Commercial early pregnancy determinations include the rabbit ovulation test of urine (5.5 wk), rat ovarian hyperemia test of urine (5.5 wk), hemagglutination inhibition latex particle test of urine (5.5 wk), RIA (radioimmunoassay) test of blood using competition with.sup.125 I labeled hCG for anti-(hCG) antibodies (3.5 wk), RIA test of blood using competition with.sup.125 I labeled hCG for anti-(.beta.-hCG) antibodies (3.5 wk), and RRA (radioreceptor assay) test of blood using competition with.sup.125 I labeled hCG for specific receptor sites. The RIA tests have been refined to provide qualitative results the same day but require an additional day to determine the exact titer of hCG or.beta.-hCG in the serum. The RRA assay is more rapid, but is currently less sensitive than the RIA test. Web site: http://www.delphion.com/details?pn=US05236846__ •
Reagents and kits for determination of fetal fibronectin in a vaginal sample Inventor(s): Senyei; Andrew E. (San Juan Capistrano, CA), Teng; Nelson N. H. (Hillsborough, CA) Assignee(s): Adeza Biomedical Corporation (Sunnyvale, CA) Patent Number: 5,281,522 Date filed: December 14, 1990 Abstract: This invention relates to methods, reagents and kits for detection of normal or ectopic pregnancy, the termination of pregnancy, or increased risk of preterm labor and rupture of membranes. Each embodiment involves sampling from the vaginal cavity, and determining the presence or absence of a specific analyte in the test sample. Sandwich or competition assay procedures can be used. Reagents and reagent kits for the above assays are included. The kit contains anti-(fetal fibronectin) antibody and an anti-fibronectin antibody. Excerpt(s): This invention relates to reagents and kits for immunological detection of normal and ectopic pregnancy; the termination of pregnancy; and increased risk of preterm labor and rupture of membranes. A wide variety of tests have been developed for the determination of pregnancy. Commercial early pregnancy determinations generally involve assay of urine or serum. Home pregnancy tests for hCG (human chorionic gonadotropin) in urine include a variety of enzyme immunoassays, hemagglutination inhibition, and antibody-indicator agglutination tests which are effective to indicate pregnancy from 0 to 7 days after a missed period. Confirmation by physician is recommended, particularly to determine abnormal gestation such as ectopic pregnancy. We have discovered that normal uterine pregnancies can be reliably
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determined early in the gestation cycle by testing a sample removed from the vicinity of the cervical canal, cervical os or posterior fornix of the vagina, preferably the external cervical os or posterior fornix, for the presence of fetal restricted antigens, that is, compounds or materials which are produced in the placental tissue and which do not pass in any substantial amounts into the maternal blood. Included in this class of antigens are fetal fibronectins. Web site: http://www.delphion.com/details?pn=US05281522__
Patent Applications on Ectopic Pregnancy As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to ectopic pregnancy: •
Diagnostic device for distinguishing between normal and ectopic pregnancy and method for preparing the same Inventor(s): Cha, Jung-Hak; (Gunpo-si, KR), Chang, Jin-Dong; (Yangcheon-gu, KR), Nam, Jung-Hyun; (Uiwang-si, KR) Correspondence: Heslin Rothenberg Farley & Mesiti PC; 5 Columbia Circle; Albany; NY; 12203; US Patent Application Number: 20030153093 Date filed: February 10, 2003 Abstract: A one-step diagnostic device for simultaneously detecting and distinguishing between a normal pregnancy and an ectopic pregnancy and methods for preparing the device are disclosed. Utilizing the device and principles of the present invention, normal pregnancy and ectopic pregnancy can be rapidly and accurately determined at an early stage by immunologically detecting the morphological differences between human chorionic gonadotropin (hCG) and modified forms thereof, which are secreted into the body fluid of a pregnant female. Excerpt(s): The present application is a continuation of International Patent Application Number PCT/KR01/01365, filed Aug. 10, 2001 and published Feb. 21, 2002 as WO 02/13685, and claims foreign priority benefits from Korean Patent Application Number 2000/46755, which was filed Aug. 12, 2000. The entire content of each of the earlier applications is incorporated herein. The present invention relates to various embodiments of diagnostic devices for distinguishing between a normal pregnancy and an ectopic pregnancy and methods for preparing these devices. More particularly, the present invention relates to diagnostic devices requiring a one-step procedure for the rapid and accurate determination of a normal pregnancy versus an ectopic pregnancy at an early stage. During a normal pregnancy, human chorionic gonadotropin ("hCG") is secreted into the body fluid of the female; with an ectopic pregnancy, a modified form of hCG is secreted. The device of the present invention immunologically detects these morphological differences. In a normal pregnancy, the fertilized egg implants itself within the uterine endometrial lining. With an ectopic pregnancy, the fertilized egg is implanted outside of the uterine endometrial lining. Depending upon the actual site of
9
This has been a common practice outside the United States prior to December 2000.
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implantation, an ectopic pregnancy may be classified, for example, as a tubal pregnancy, a cervical pregnancy, an ovarian pregnancy, or a peritoneal pregnancy. More than 95% of ectopic pregnancies are tubal pregnancies, which therefore is often used as a general designation for an ectopic pregnancy. The etiology of ectopic pregnancy includes previous tubal ligation (contraception), PID (Pelvic Inflammatory Disease), administration of ovulation controlling formulations and STD (Sexually Transmitted Disease). The incidence of ectopic pregnancy is quite high, approaching as many as one per about 64-241 pregnant females. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with ectopic pregnancy, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “ectopic pregnancy” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on ectopic pregnancy. You can also use this procedure to view pending patent applications concerning ectopic pregnancy. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 5. BOOKS ON ECTOPIC PREGNANCY Overview This chapter provides bibliographic book references relating to ectopic pregnancy. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on ectopic pregnancy 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 “ectopic pregnancy” (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 ectopic pregnancy: •
Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss Source: Lanham, MD: Taylor Trade Publishing/Rowman and Littlefield Publishing Group. 2000. 321 p. Contact: Available from Taylor Trade Publishing/Rowman and Littlefield Publishing Group, 4720 Boston Way, Lanham, MD 20706. (301) 459-3366, (800) 462-6420 (orders and customer service), (800) 338-4550 (Fax),
[email protected] (E-mail), http://www.rlpgbooks.com (Web Site). $16.95. ISBN 0-87833-182-4. Summary: This book is intended to give women and their partners the information and reassurance they need to withstand the physical and emotional difficulties of a high-risk subsequent pregnancy. The book focuses on the kinds of issues that are of primary concern to couples who are embarking on pregnancy after miscarriage, stillbirth, or infant death. The following topics are covered: risk factors for and causes of ectopic
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pregnancy, molar pregnancy, miscarriage, recurrent miscarriage, and stillbirth; tests that can determine the causes of miscarriage, recurrent miscarriage, and stillbirth; the 10 leading causes of infant death; emotional and physical factors involved in a couple's decision to attempt another pregnancy; preparing for another pregnancy, including having a preconception health checkup; how one's reproductive history will affect the next pregnancy; determining whether a couple is a good candidate for genetic counseling; what couples can do to increase their odds of conceiving quickly; how couples can tell if they have a fertility problem; the challenges of coping with infertility after pregnancy loss or infant death; the emotions a couple may experience when the pregnancy test comes back positive; components of a healthy lifestyle and what pregnant women can do to ensure the healthiest possible baby; the pros and cons of prenatal testing; coping with the unique physical and emotional challenges of a highrisk pregnancy; chronic conditions in the mother that can put the pregnancy at risk; problems that can occur during a multiple pregnancy; preparing for the birth by taking prenatal classes, writing a birth plan, and hiring a doula; pain relief options during labor; the signs of labor and the three stages of labor; what to expect during a cesarean delivery; and how to survive the emotional highs and lows that can occur after birth. The more than 100 parents who were interviewed for this book answered a series of questionnaires that focused on every aspect of pregnancy after a loss: how they decided it was time to start trying to conceive again, how they maintained their sanity when they didn't conceive as quickly as they wanted, whether they stayed with the same physician or midwife they had worked with in the past, whether they went through prenatal testing, how they coped with their fear that something also would happen to this baby, and what they did to prepare themselves for the upcoming birth. Appendixes contain a table of infant deaths and infant mortality rates for the year 1997, a directory of relevant organizations in the United States and Canada, and a directory of internet resources. Numerous references. •
After the Loss of Your Baby: For Teen Mothers. Third Edition Source: Frankfort, IL: For Teen Moms Only. 1996. 28 p. Contact: Available from For Teen Moms Only, P.O. Box 962, Frankfort, IL 60423-0962. (815) 464-5465, (888) 367-8336 (National toll-free number),
[email protected] (Email), http://www.forteenmomsonly.com (Website). $3.50 each; 2-10 copies, $3.00 each; 11-100 copies, $2.75 each; 101-500 copies, $2.50 each, plus shipping and handling. ISBN 1-888231-00-9. Summary: This booklet is written specifically for teenage mothers who have lost a baby, whether because of ectopic pregnancy, miscarriage, stillbirth, neonatal death, or infant death, including sudden infant death syndrome (SIDS). The booklet begins by providing medical definitions of the types of loss just mentioned and then describes the phases of grief the teenage mom can expect to experience: shock, searching and yearning, disorientation and despair, reorganization, and acceptance. The remainder of the booklet focuses on the importance of healing physically and emotionally before becoming pregnant again. This section lists 11 questions the teenage mom should ask herself if she is contemplating another pregnancy, describes the special physical needs of pregnant teenagers and how they can plan for a safe subsequent pregnancy, and shows how a teenage mom can prepare herself for the insensitive things that others may say and do after the loss of the baby. The booklet also outlines the possible reactions of grandparents and the baby's father to the loss. The booklet, written by a professional childbirth educator, is intended to convey understanding and compassion to teenage mothers, help them want to take good care of themselves before having other children,
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and help reduce the incidence of rapid repeat pregnancy among teenagers. Descriptions of and contact information for eight organizations that can help grieving teenage parents are provided. The booklet also is available in Spanish. •
Reproductive Tract Infections: Challenges for International Health Policy, Programs, and Research Source: Reproductive Tract Infections. Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. Plenum Publishing Corporation, Plenum Medical Book Company, 233 Spring St, New York, NY, 10013-1578, (888) 640-7378, http://www.wkap.nl. Summary: This publication examines the demographic, societal, biomedical, and technological developments that affect reproductive tract infections (RTI). It summarizes the human and socioeconomic costs of RTI developing countries, and discusses program and policy implications. It addresses the prevalence of these diseases and their costs in terms of infertility, ectopic pregnancy, cervical cancer, adverse outcomes of pregnancy, HIV transmission, and sexually transmitted diseases.
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 “ectopic pregnancy” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “ectopic pregnancy” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “ectopic pregnancy” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Ectopic Pregnancy by Alan H. Decherney (Editor); ISBN: 0871892979; http://www.amazon.com/exec/obidos/ASIN/0871892979/icongroupinterna
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Ectopic Pregnancy : Diagnosis and Management by Isabel Stabile (Author) (1996); ISBN: 0521496128; http://www.amazon.com/exec/obidos/ASIN/0521496128/icongroupinterna
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Ectopic pregnancy surveillance : summary, 1970-1978 (SuDoc HE 20.7611/2:970-78) by U.S. Dept of Health and Human Services; ISBN: B0001019PE; http://www.amazon.com/exec/obidos/ASIN/B0001019PE/icongroupinterna
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Ectopic Pregnancy: Pathophysiology and Clinical Management by Christopher M. Fredericks, et al (1989); ISBN: 0891168079; http://www.amazon.com/exec/obidos/ASIN/0891168079/icongroupinterna
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Extrauterine Pregnancy by Alvin Langer, Leslie Iffy (Editor); ISBN: 0884164810; http://www.amazon.com/exec/obidos/ASIN/0884164810/icongroupinterna
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Extrauterine Pregnancy: Clinical Diagnosis and Management by Thomas G., Md Stovall, Frank W., MD Ling (Editor); ISBN: 0071054561; http://www.amazon.com/exec/obidos/ASIN/0071054561/icongroupinterna
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Hidden Loss: Miscarriage & Ectopic Pregnancy by Valerie Hey (Editor), et al (1997); ISBN: 0704344572; http://www.amazon.com/exec/obidos/ASIN/0704344572/icongroupinterna
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Hidden Loss: Miscarriage and Ectopic Pregnancy (Women's Press Handbook Series) by Valerie Hey, et al; ISBN: 0704341247; http://www.amazon.com/exec/obidos/ASIN/0704341247/icongroupinterna
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Management of Ectopic Pregnancy by Richard E. Leach (Editor), Steven J. Ory (Editor); ISBN: 0632044691; http://www.amazon.com/exec/obidos/ASIN/0632044691/icongroupinterna
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Ultrasonic Diagnosis of Ectopic Pregnancy by Nabil F. Maklad; ISBN: 0875272223; http://www.amazon.com/exec/obidos/ASIN/0875272223/icongroupinterna
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When Pregnancy Fails: Families Coping With Miscarriage, Ectopic Pregnancy, Stillbirth and Infant Death by Susan Borg, Judith Lasker; ISBN: 055334594X; http://www.amazon.com/exec/obidos/ASIN/055334594X/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “ectopic pregnancy” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •
An enquiry into ectopic pregnancy and the intrauterine device. Author: University of Exeter. Family Planning Research Unit.; Year: 1989; Devon, England, University of Exeter, Family Planning Research Unit, 1974
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Atypical endometrial changes associated with ectopic pregnancy. Author: Battaglino, John Joseph,; Year: 1961; [Minneapolis] 1961
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Ectopic pregnancy: an analysis of aetiological risk factors and subsequent fertility Author: Tuomivaara, Leena.; Year: 1945; Oulu: Ouluensis Universitas, 1990; ISBN: 9514229452
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Ectopic pregnancy in Finland in 1966-1986 Author: Mäkinen, Juha.; Year: 1970; Turku, Finland: Dept. of Obstetrics and Gynaecology, University of Turku, 1988; ISBN: 9518801800
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Ectopic pregnancy surveillance: summary, 1970-1978. Author: Center for Health Promotion and Education (U.S.). Family Planning Evaluation Division.; Year: 1863; Atlanta, Ga.: U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Family Planning Evaluation Division, 1982
10
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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•
Ectopic pregnancy. Author: Tan, Tjeng Thay.; Year: 1980; Malang, Paragon Press, 1959
•
Effect of the venereal diseases epidemic on the incidence of ectopic pregnancy: implications for the evaluation of contraceptives Author: Urquhart, J.; Year: 1997; [1979]
Chapters on Ectopic Pregnancy In order to find chapters that specifically relate to ectopic pregnancy, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and ectopic pregnancy 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 “ectopic pregnancy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on ectopic pregnancy: •
Abdominal Pain Source: in Reisman, A.B.; Setevens, D.L., eds. Telephone Medicine: A Guide for the Practicing Physician. Philadelphia, PA: American College of Physicians. p. 107-122. Contact: Available from American College of Physicians (ACP). 190 N. Independence Mall West, Philadelphia, PA 19106-1572. (800) 523-1546 or (215) 351-2600. Website: www.acponline.org. PRICE: $40.00 plus shipping and handling. ISBN: 0943126878. Summary: This chapter on abdominal pain is from a reference book for practicing physicians who are providing information for their patients over the telephone. The author notes that abdominal pain is one of the more challenging medical complaints to evaluate over the telephone. The chapter summarizes key points, then outlines an approach to acute abdominal pain and to chronic abdominal pain that has acutely changed in the adult patient. Topics include epidemiology, utility of early diagnosis, early diagnosis in the elderly, the general approach to the telephone evaluation, determining whether the patient requires emergency evaluation, small bowel obstruction, acute appendicitis, acute cholecystitis (gallbladder infection, often due to gallstones), ectopic pregnancy, dyspepsia, biliary colic, what to tell the patient, and what to document. The author stresses that the telephone physician should have a lower threshold for in-person evaluation of elderly patients with any acute abdominal pain because older patients are more likely to present late in the course of their illness and to have a poor clinical outcome. Abdominal pain in the setting of significant bleeding, trauma, or recent abdominal surgery should prompt a referral to the emergency room without delay. For patients in whom the disposition is not clear, the physician should consider calling back within a few hours to reassess the symptoms for resolution or progression. A patient care diagnostic algorithm is provided. 1 figure. 38 references.
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CHAPTER 6. MULTIMEDIA ON ECTOPIC PREGNANCY Overview In this chapter, we show you how to keep current on multimedia sources of information on ectopic pregnancy. 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.
Bibliography: Multimedia on Ectopic Pregnancy The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in ectopic pregnancy (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on ectopic pregnancy: •
Conservative management of tubal pregnancy [motion picture] Source: a Billy Burke production; presented by Southern California Permanente Medical Group and Kaiser Foundation Hospitals, Los Angeles; by Jack Godfrey Hallatt; Year: 1967; Format: Motion picture; United States: The Group and The Hospitals, [1967]
•
Contemporary laporoscopic surgery for endometriosis, hysterectomy, ovarian cyst, ectopic pregnancy [videorecording] Source: by Camran Nezhat, Farr Nezhat, Ceana Nezhat; Year: 1993; Format: Videorecording; Pearl River, N.Y.: Parthenon Pub. Group, c1993
•
Ectopic pregnancy [electronic resource]. Year: 1997; Format: Electronic resource; Montreal, Quebec: SSB Multimedia, c1997
•
Ectopic pregnancy [slide] Source: Steering Committee for Cooperative Teaching, Association of Professors of Gynecology and Obstetrics; Year: 1978; Format: Slide; Washington: National Audiovisual Center, 1978
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Ectopic pregnancy [sound recording]: a surgical or non-surgical disease Source: American College of Surgeons; Year: 1991; Format: Sound recording; [Chicago, Ill.]: The College, [1991]
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•
Ectopic pregnancy [videorecording] Source: Emory University School of Medicine; Year: 1975; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library], 1975
•
Ectopic pregnancy [videorecording] Source: [presented by] the American College of Obstetricians and Gynecologists; produced by Ciné-Med; Year: 1992; Format: Videorecording; Woodbury, Conn.: Ciné-Med, c1992
•
Ectopic pregnancy [videorecording]: a new U.S. epidemic? Source: presented by the Department of Gynecology/Obstetrics, Emory University, School of Medicine; Year: 1984; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1984
•
Ectopic pregnancy [videorecording]: impact of endovaginal sonography Source: a production of the Office of Learning Resources-Television, University of California, School of Medicine, San Diego; Year: 1990; Format: Videorecording; [Berkeley, Calif.]: UC Regents, c1990
•
Treatment of ectopic pregnancy [videorecording] Source: [presented by] Camran Nezhat in association with LaserSonics; Year: 1986; Format: Videorecording; Santa Clara, CA: Cooper LaserSonics, [1986]
•
Ultrasonic diagnosis of ectopic pregnancy [slide] Source: Thomas L. Lawson; Year: 1979; Format: Slide; [New York]: Medcom, c1979
•
Understanding obstetric malpractice, abortion, miscarriage, and ectopic pregnancy [videorecording] Source: PESI; Year: 1987; Format: Videorecording; [Eau Claire, Wis.]: PESI, c1987
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CHAPTER 7. PERIODICALS AND NEWS ON ECTOPIC PREGNANCY Overview In this chapter, we suggest a number of news sources and present various periodicals that cover ectopic pregnancy.
News Services and Press Releases One of the simplest ways of tracking press releases on ectopic pregnancy 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 “ectopic pregnancy” (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 ectopic pregnancy. 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 “ectopic pregnancy” (or synonyms). The following was recently listed in this archive for ectopic pregnancy: •
Smoking, pelvic infections up tubal pregnancy risk Source: Reuters Health eLine Date: February 14, 2003
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•
Infectious history, smoking status main risk factors for ectopic pregnancy Source: Reuters Medical News Date: February 13, 2003
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Ectopic pregnancy risk seen with progestogen-only emergency contraceptive Source: Reuters Industry Breifing Date: January 30, 2003
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Elevated shock index predicts ruptured ectopic pregnancy Source: Reuters Medical News Date: March 06, 2002
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Fertility after ectopic pregnancy not strongly associated with treatment type Source: Reuters Medical News Date: April 09, 2001
•
IUDs may play role in ectopic pregnancy Source: Reuters Health eLine Date: December 07, 2000
•
IUD use may increase risk of ectopic pregnancy Source: Reuters Industry Breifing Date: December 01, 2000
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Expectant management of ectopic pregnancy does not compromise future fertility Source: Reuters Medical News Date: November 28, 2000
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Serum progesterone helps stratify ectopic pregnancy risk Source: Reuters Medical News Date: August 17, 2000
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Conservative treatment of tubal pregnancy best for women with infertility factors Source: Reuters Medical News Date: July 24, 2000
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Success rate, tubal patency high with methotrexate for ectopic pregnancy Source: Reuters Medical News Date: May 22, 2000
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Methotrexate cost-effective first-line treatment for unruptured ectopic pregnancy Source: Reuters Medical News Date: March 13, 2000
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High hCG concentration predicts failure of methotrexate to treat tubal ectopic pregnancy Source: Reuters Medical News Date: December 23, 1999
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Changes in hCG may indicate ectopic pregnancy Source: Reuters Medical News Date: December 15, 1999
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Growth factor may facilitate early diagnosis of ectopic pregnancy Source: Reuters Medical News Date: December 06, 1999
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Ectopic pregnancy rates vary with seasons Source: Reuters Health eLine Date: June 07, 1999
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•
Ruptured tubal ectopic pregnancy usually does not affect subsequent fertility Source: Reuters Medical News Date: May 05, 1999
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NIH study to evaluate methotrexate regimens for termination of ectopic pregnancy Source: Reuters Medical News Date: April 29, 1999
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Surgery not usually indicated for pain after methotrexate therapy for ectopic pregnancy Source: Reuters Medical News Date: April 09, 1999
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Fallopian tube infection with Chlamydia in ectopic pregnancies more common than expected Source: Reuters Medical News Date: November 18, 1998
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Laparoscopic surgery for ectopic pregnancy results in higher fertility rate than laparotomy Source: Reuters Medical News Date: October 29, 1998
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Ectopic pregnancy "epidemic" tied to "boomers" Source: Reuters Health eLine Date: August 17, 1998
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Laparoscopic removal of abdominal pregnancy saves intrauterine fetus Source: Reuters Medical News Date: July 21, 1998
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Decline in ectopic pregnancy parallels chlamydia drop in Sweden Source: Reuters Medical News Date: June 24, 1998
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Risk factors cannot predict ruptured tubal ectopic pregnancy Source: Reuters Medical News Date: June 12, 1998
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Induced Abortion Linked To Increased Risk Of Ectopic Pregnancy Source: Reuters Medical News Date: March 20, 1998
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Transvaginal Sonography Improves Diagnosis Of Ectopic Pregnancy Source: Reuters Medical News Date: February 12, 1998
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Expectant Management Of Ectopic Pregnancy: Good Fertility Outcome Source: Reuters Medical News Date: January 06, 1998
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Methotrexate Versus Laparoscopic Salpingostomy For Tubal Pregnancy: Jury Still Out Source: Reuters Medical News Date: September 12, 1997
•
Drug Treatment for Tubal Pregnancy Source: Reuters Health eLine Date: September 12, 1997
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•
Type Of Surgery For Tubal Pregnancy Does Not Affect Later Fertility Source: Reuters Medical News Date: August 13, 1997
•
Ultrasound Detects Ectopic Pregnancies In Women With Low hCG Levels Source: Reuters Medical News Date: August 11, 1997
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Vaginal Douching Increases Risk Of Ectopic Pregnancy Source: Reuters Medical News Date: June 30, 1997
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Induced Abortion Does Not Increase Risk Of Ectopic Pregnancy Source: Reuters Medical News Date: April 03, 1997
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Tube Tying Ups Tubal Pregnancy Risk Source: Reuters Health eLine Date: March 13, 1997
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Tubal Sterilization Doesn't Eliminate Risk Of Ectopic Pregnancy Source: Reuters Medical News Date: March 13, 1997
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Prophylactic Methotrexate Effective In Women With Persistent Ectopic Pregnancy Source: Reuters Medical News Date: January 22, 1997
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Monitoring A Must After Conservative Surgery For Tubal Pregnancy Source: Reuters Medical News Date: October 28, 1996
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Methotrexate: Cost-Effective Way To Manage Small Unruptured Ectopic Pregnancy Source: Reuters Medical News Date: July 08, 1996
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Top Risk Factors for Ectopic Pregnancy Determined Source: Reuters Medical News Date: June 04, 1996
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Elevated Serum Creatine Kinase Levels Do Not Predict Ectopic Pregnancy. Source: Reuters Medical News Date: May 24, 1996
•
New President Installed At ACOG Meeting; Shoulder Dystocia, Ectopic Pregnancy Highlights Source: Reuters Medical News Date: May 02, 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.
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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 “ectopic pregnancy” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “ectopic pregnancy” (or synonyms). If you know the name of a company that is relevant to ectopic pregnancy, 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 “ectopic pregnancy” (or synonyms).
Newsletters on Ectopic Pregnancy Find newsletters on ectopic pregnancy using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “ectopic pregnancy.” 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.” Type “ectopic pregnancy” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •
Tears Together Source: La Crosse, WI: RTS Bereavement Services. 1986-.
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Contact: Available from RTS Bereavement Services, Gundersen/Lutheran Medical Center, 1910 South Avenue, La Crosse, WI 54601. (608) 791-4747, (800) 362- 9567, (608) 791-5137 (Fax),
[email protected] (Email). Summary: This newsletter allows parents who have experienced the death of a child from miscarriage, ectopic pregnancy, stillbirth, or newborn death share their feelings with other bereaved parents. Each issue includes personal accounts and poetry from parents who have experienced a pregnancy or neonatal loss, dates and times of upcoming parent support meetings and memorial events, and birth announcements.
Academic Periodicals covering Ectopic Pregnancy Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to ectopic pregnancy. In addition to these sources, you can search for articles covering ectopic pregnancy that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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CHAPTER 8. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for ectopic pregnancy. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with ectopic pregnancy. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).
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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to ectopic pregnancy: Chorionic Gonadotropin •
Systemic - U.S. Brands: A.P.L.; Pregnyl; Profasi http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202266.html
Dactinomycin •
Systemic - U.S. Brands: Cosmegen http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202179.html
Leucovorin •
Systemic - U.S. Brands: Wellcovorin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202321.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.
Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
11
These publications are typically written by one or more of the various NIH Institutes.
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•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 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:13 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
•
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
•
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
•
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
12
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). 13 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 Combined Health Information Database
A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “ectopic pregnancy” using the “Detailed Search” option. Go directly to the following hyperlink: 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 the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “ectopic pregnancy” (or synonyms) into the “For these words:” box. The following is a sample result: •
Increasing Incidence of Gonorrhea - Minnesota, 1994 Source: Morbidity and Mortality Weekly Report; Vol. 44, No. 14, April 14, 1995. Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. Summary: In the United States, gonorrhea is an important cause of urethritis in men and cervicitis in women; reproductive complications include infertility and ectopic pregnancy. During 1981-1993, the annual incidence rate of gonorrhea in Minnesota declined; the average annual change in the rate of infection was - 8.5 percent (Figure 1). However, in 1994, the incidence rate increased 32 percent (from 56 cases per 100,000 persons in 1993 to 74 cases per 100,000 in 1994). No corresponding increases occurred in rates of other reportable sexually transmitted diseases (STDs), including chlamydial infection and early syphilis. To elucidate possible explanations for the increased rate of gonorrhea in Minnesota in 1994, the Minnesota Department of Health (MDH) analyzed surveillance data for 1994 and compared it with data for 1993. This report presents the findings of the analysis.
The NLM Gateway14 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.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “ectopic pregnancy” (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. 14 15
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).
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Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 9506 543 951 19 5 11024
HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 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.18 Simply search by “ectopic pregnancy” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists19 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.20 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.21 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/.
16
Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.
17
The HSTAT URL is http://hstat.nlm.nih.gov/.
18
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. 19 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 20
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. 21 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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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/.
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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 ectopic pregnancy can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased 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 ectopic pregnancy. 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 ectopic pregnancy. 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 “ectopic pregnancy”:
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•
Other guides Birth Defects http://www.nlm.nih.gov/medlineplus/birthdefects.html Cervical Cancer http://www.nlm.nih.gov/medlineplus/cervicalcancer.html High Risk Pregnancy http://www.nlm.nih.gov/medlineplus/highriskpregnancy.html Infertility http://www.nlm.nih.gov/medlineplus/infertility.html Interstitial Cystitis http://www.nlm.nih.gov/medlineplus/interstitialcystitis.html Ovarian Cancer http://www.nlm.nih.gov/medlineplus/ovariancancer.html Pregnancy Loss http://www.nlm.nih.gov/medlineplus/pregnancyloss.html
Within the health topic page dedicated to ectopic pregnancy, the following was listed: •
General/Overviews Complications of Pregnancy Source: Merck & Co., Inc. http://www.merck.com/mrkshared/mmanual_home/sec22/245.jsp JAMA Patient Page: Miscarriage Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZZIS5Y47D& sub_cat=2005
•
Diagnosis/Symptoms hCG Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/hcg/test.html How Is Gestational Trophoblastic Disease Diagnosed? Source: American Cancer Society http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_gestational_tr ophoblastic_disease_diagnosed_49.asp?sitearea= Progesterone Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/progesterone/test.html Ultrasound Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/pnhec/159_523.asp
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Treatment About D&C for Miscarriage http://www.facs.org/public_info/operation/dncmiss.pdf Dilation and Curettage http://www.nlm.nih.gov/medlineplus/tutorials/dilationandcurettageloader.html
•
Coping Grieving Is a Process Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/pnhec/572_4010.asp Stillbirth, Miscarriage, and Infant Death Source: Compassionate Friends http://www.compassionatefriends.org/Brochures/stillbirth.htm What Do I Say? For Those Who Are Close to the Family Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/pnhec/572_4057.asp
•
Specific Conditions/Aspects Do We Know What Causes Gestational Trophoblastic Disease? Source: American Cancer Society http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Do_we_know_what_c auses_gestational_trophoblastic_disease_49.asp?sitearea= Ectopic and Molar Pregnancy Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/professionals/681_1189.asp Ectopic Pregnancy Source: Nemours Foundation http://kidshealth.org/parent/pregnancy_newborn/pregnancy/ectopic.html Gestational Trophoblastic Tumors (PDQ): Treatment Source: National Cancer Institute http://www.cancer.gov/cancerinfo/pdq/treatment/gestationaltrophoblastic/patie nt/ Immunology May Be Key to Pregnancy Loss Source: International Council on Infertility Information Dissemination http://www.inciid.org/immune.html Neonatal Death Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/professionals/681_1196.asp Repeated Miscarriage Source: American College of Obstetricians and Gynecologists http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZANQ5H97C &sub_cat=2005 Risk of Ectopic Pregnancy after Tubal Sterilization Source: Centers for Disease Control and Prevention http://www.cdc.gov/nccdphp/drh/mh_ectopic.htm
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Stillbirth Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/pnhec/188_1121.asp When You're Ready to Try Again Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/pnhec/572_4049.asp •
Latest New Hot Tubs May Raise Miscarriage Risk - Or Maybe Not Source: 11/14/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14680 .html NICHD Funds Major Effort to Determine Extent and Causes of Stillbirth Source: 11/19/2003, National Institute of Child Health and Human Development http://www.nih.gov/news/pr/nov2003/nichd-19.htm U.S. Plans to Study Stillbirths Source: 11/20/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14776 .html Violence in Pregnancy Not Linked to Miscarriage Source: 11/11/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14620 .html
•
Organizations Compassionate Friends http://www.compassionatefriends.org/ International Council on Infertility Information Dissemination http://www.inciid.org/ March of Dimes Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/ National Institute of Child Health and Human Development http://www.nichd.nih.gov/
•
Research Abortion, Miscarriage, and Breast Cancer Risk Source: National Cancer Institute http://cis.nci.nih.gov/fact/3_75.htm Folate Deficiency Associated with Higher Early Miscarriage Risk Source: National Institute of Child Health and Human Development http://www.nih.gov/news/pr/oct2002/nichd-15.htm
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Oral Diabetes Drug Shows Promise in Preventing Miscarriage in Common Infertility Source: National Institute of Child Health and Human Development http://www.nih.gov/news/pr/feb2002/nichd-27.htm Researchers Discover How Embryo Attaches to the Uterus Source: National Institute of Child Health and Human Development http://www.nih.gov/news/pr/jan2003/nichd-16.htm Taking Ibuprofen, Naproxen, and Aspirin during Pregnancy Increases the Risk of Miscarriage Source: Nemours Foundation http://kidshealth.org/research/pain_relievers_miscarriage.html •
Statistics Infant Mortality Rates, Fetal Mortality Rates, & Perinatal Mortality Rates, According to Race, U.S., Selected Years, 1950-2000 http://www.cdc.gov/nchs/data/hus/tables/2002/02hus023.pdf Motor Vehicle Crashes Are Leading Cause of Trauma-Related Fetal Deaths Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZGSFLJXSC& sub_cat=2005 What Are the Key Statistics for Gestational Trophoblastic Disease? Source: American Cancer Society http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_sta tistics_for_gestational_trophoblastic_disease_49.asp?sitearea=
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on ectopic pregnancy. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
Early Pregnancy Loss: Miscarriage, Ectopic Pregnancy, and Molar Pregnancy Source: Washington, DC: American College of Obstetricians and Gynecologists. 1998. 6 p.
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Contact: Available from American College of Obstetricians and Gynecologists, Distribution Center, P.O. Box 4500, Kearneysville, WV 25430-4500. (800) 762-2264, ext. 931 (orders), (304) 725-8410, ext. 339 (orders), (800) 525-5562 (Fax),
[email protected] (Email), http://www.acog.org (Web Site). $17.50 for a package of 50 brochures. Order No. AP090. Summary: This pamphet addresses the problem of early pregnancy loss, which is defined as the loss of a pregnancy before 20 weeks' gestation. Most often this kind of loss is a miscarriage, but ectopic pregnancy and molar pregnancy also can be causes of early pregnancy loss. Miscarriages occur in 15 to 20 percent of all pregnancies, and most occur in the first 13 weeks. A woman can miscarry without even being aware that she is pregnant. More than half of miscarriages in the first trimester of pregnancy are caused by abnormalities in the chromosomes of the fetus. Most chromosomal abnormalities are not inherited, but happen by chance and are not likely to occur again in a later pregnancy. Other causes of miscarriage are problems with the mother's health, such as an abnormally shaped uterus, an incompetent cervix, chronic disease, and genital tract infections. Lifestyle factors also can cause miscarriage, notably, smoking, heavy alcohol use, and use of illegal drugs. Bleeding is the most common sign of miscarriage. When a miscarriage occurs early in pregnancy, tissue may remain in the uterus. If this happens, the tissue will have to be removed by dilation and curettage. Generally, this does not require a hospital stay. Recovery may take some time, but a woman can ovulate and become pregnant as soon as 2 weeks after an early miscarriage. Ectopic pregnancy occurs when the fertilized egg doesn't reach the uterus and begins to grow in the fallopian tube or, rarely, attaches to an ovary or other organ in the stomach. About 1 in 60 pregnancies is ectopic. Most ectopic pregnancies occur in the fallopian tube. The tube is narrow, so the pregnancy can only grow to the size of a walnut before rupture occurs. If the tube bursts it will cause major bleeding, which is why ectopic pregnancy must be treated promptly. The symptoms of ectopic pregnancy are vaginal bleeding, abdominal pain, shoulder pain, weakness, dizziness, or fainting. Treatment for ectopic pregnancy depends on the size of the pregnancy, whether the tube has ruptured, and the amount of bleeding. If the tube bursts, there will be heavy bleeding inside the stomach and emergency surgery will be required. In many cases, a ruptured tube will have to be removed. If the tubes have been left in place, there is a good chance that the woman can have a normal pregnancy in the future. But women who have experienced ectopic pregnancy are at higher risk for having another one. In molar pregnancy, the pregnancy is not an embryo but a mass of abnormal tissue. This type of pregnancy occurs in only 1 of 1,000 to 1,200 pregnancies. A genetic error causes the abnormal cells to grow. The most common symptom of this condition is vaginal bleeding during the first trimester. Other signs, an enlarged uterus or ovaries, can only be detected by a doctor. The doctor can test for molar pregnancy by analyzing the blood for a specific hormone or doing an ultrasound. Treatment for molar pregnancy is dilation of the cervix and removal of the mole. Careful followup treatment is necessary, as abnormal cells may remain. Women who have molar pregnancies should wait 6 months to a year before getting pregnant again. For many women the emotional healing after a pregnancy loss takes longer than the physical healing. They should not blame themselves for early pregnancy loss because most early losses cannot be prevented. Most women who suffer early pregnancy loss have a healthy pregnancy later. It is important that they allow enough time for physical and emotional healing before trying to get pregnant again.
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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to ectopic pregnancy. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDHealth: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to ectopic pregnancy. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with ectopic pregnancy. 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 ectopic pregnancy. 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
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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 “ectopic pregnancy” (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 “ectopic pregnancy”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “ectopic pregnancy” (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 “ectopic pregnancy” (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.22
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
22
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)23: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
23
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on ectopic pregnancy: •
Basic Guidelines for Ectopic Pregnancy Ectopic pregnancy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000895.htm PID Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000888.htm
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Signs & Symptoms for Ectopic Pregnancy Abnormal vaginal bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003156.htm Amenorrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003149.htm Back pain, low Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm
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Breast tenderness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003152.htm Fainting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Shoulder pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003171.htm Spotting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003156.htm Syncope Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Tenesmus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003131.htm •
Diagnostics and Tests for Ectopic Pregnancy ALT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm AMP Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003368.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Culdocentesis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003919.htm ECT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003324.htm HCT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003646.htm Hematocrit Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003646.htm Laparoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003918.htm MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003335.htm Pregnancy test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003432.htm
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Pregnancy ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003778.htm Serum HCG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003509.htm Serum progesterone Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003714.htm Transvaginal ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003779.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm White blood count Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003643.htm •
Nutrition for Ectopic Pregnancy Dand C Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002914.htm
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Surgery and Procedures for Ectopic Pregnancy Dand C Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002914.htm Hysterectomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002915.htm Laparotomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002928.htm Tubal ligation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002913.htm Tubal sterilization Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002913.htm
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Background Topics for Ectopic Pregnancy Cervix Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002317.htm Endocrine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002351.htm Epithelium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002363.htm
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Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Intrauterine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002389.htm Invasive Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002384.htm Shock Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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ECTOPIC PREGNANCY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 17-Hydroxyprogesterone: A hydroxyprogesterone with medical uses similar to that of progesterone. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acatalasia: A rare autosomal recessive disorder resulting from the absence of catalase activity. Though usually asymptomatic, a syndrome of oral ulcerations and gangrene may be present. [NIH] Acetylgalactosamine: The N-acetyl derivative of galactosamine. [NIH] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Acupuncture Analgesia: Analgesia produced by the insertion of acupuncture needles at certain points in the body. These activate the small myelinated nerve fibers in the muscle which transmit impulses to the spinal cord and then activate three centers - the spinal cord, midbrain and pituitary hypothalamus - to produce analgesia. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]
Aetiology: Study of the causes of disease. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps
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to calculate or determine a given task. [NIH] Allogeneic: Taken from different individuals of the same species. [NIH] Alopecia: Absence of hair from areas where it is normally present. [NIH] Alpha-Defensins: Defensins found in azurophilic granules of neutrophils and in the secretory granules of intestinal paneth cells. [NIH] Alpha-fetoprotein: AFP. A protein normally produced by a developing fetus. AFP levels are usually undetectable in the blood of healthy nonpregnant adults. An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. [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] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]
Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH]
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Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antidote: A remedy for counteracting a poison. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antigen-presenting cell: APC. A cell that shows antigen on its surface to other cells of the immune system. This is an important part of an immune response. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU]
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Asymptomatic: Having no signs or symptoms of disease. [NIH] Atony: Lack of normal tone or strength. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autosuggestion: Suggestion coming from the subject himself. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Beta-Defensins: Defensins found mainly in epithelial cells. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile 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] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers
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include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blennorrhoea: A general term including any inflammatory process of the external eye which gives a mucoid discharge, more exactly, a discharge of mucus. [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] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [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] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Broad Ligament: A broad fold of peritoneum that extends from the side of the uterus to the wall of the pelvis. [NIH] Caesarean section: A surgical incision through the abdominal and uterine walls in order to deliver a baby. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary
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for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [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] Catalase: An oxidoreductase that catalyzes the conversion of hydrogen peroxide to water and oxygen. It is present in many animal cells. A deficiency of this enzyme results in acatalasia. EC 1.11.1.6. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [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 Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Aggregation: The phenomenon by which dissociated cells intermixed in vitro tend to group themselves with cells of their own type. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Chaperonin 10: Members of the chaperonin heat-shock protein family. Chaperonin 10 purified from bacteria, plastids, or mitochondria occurs as an oligomer of seven identical subunits arranged in a single ring. [NIH] Chaperonin 60: Members of the chaperonin heat-shock protein family. Chaperonin 60 purified from bacteria, plastids, or mitochondria is an oligomeric protein with a distinctive
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structure of fourteen subunits, arranged in two rings of seven subunits each. [NIH] Chaperonins: A class of sequence-related molecular chaperones found in bacteria, mitochondria, and plastids. Chaperonins are abundant constitutive proteins that increase in amount after stresses such as heat shock, bacterial infection of macrophages, and an increase in the cellular content of unfolded proteins. Bacterial chaperonins are major immunogens in human bacterial infections because of their accumulation during the stress of infection. Two members of this class of chaperones are chaperonin 10 and chaperonin 60. [NIH] Checkup: A general physical examination. [NIH] Chemokines: Class of pro-inflammatory cytokines that have the ability to attract and activate leukocytes. They can be divided into at least three structural branches: C (chemokines, C), CC (chemokines, CC), and CXC (chemokines, CXC), according to variations in a shared cysteine motif. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chimeras: Organism that contains a mixture of genetically different cells. [NIH] Chlamydia: A genus of the family Chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is Chlamydia trachomatis. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choriocarcinoma: A malignant tumor of trophoblastic epithelium characterized by secretion of large amounts of chorionic gonadotropin. It usually originates from chorionic products of conception (i.e., hydatidiform mole, normal pregnancy, or following abortion), but can originate in a teratoma of the testis, mediastinum, or pineal gland. [NIH] Chorion: The outermost extraembryonic membrane. [NIH] Chorionic Villi: The threadlike, vascular projections of the chorion which enter into the formation of the placenta. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chromosome Abnormalities: Defects in the structure or number of chromosomes resulting in structural aberrations or manifesting as disease. [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] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Circadian: Repeated more or less daily, i. e. on a 23- to 25-hour cycle. [NIH] Circadian Rhythm: The regular recurrence, in cycles of about 24 hours, of biological processes or activities, such as sensitivity to drugs and stimuli, hormone secretion, sleeping,
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feeding, etc. This rhythm seems to be set by a 'biological clock' which seems to be set by recurring daylight and darkness. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]
Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clomiphene: A stilbene derivative that functions both as a partial estrogen agonist and complete estrogen antagonist depending on the target tissue. It antagonizes the estrogen receptor thereby initiating or augmenting ovulation in anovulatory women. [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] Codons: Any triplet of nucleotides (coding unit) in DNA or RNA (if RNA is the carrier of primary genetic information as in some viruses) that codes for particular amino acid or signals the beginning or end of the message. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Commensal: 1. Living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. An organism living on or within another, but not causing injury to the host. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1
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to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being
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studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]
Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH]
Creatine Kinase: A transferase that catalyzes formation of phosphocreatine from ATP + creatine. The reaction stores ATP energy as phosphocreatine. Three cytoplasmic isoenzymes have been identified in human tissues: MM from skeletal muscle, MB from myocardial tissue, and BB from nervous tissue as well as a mitochondrial isoenzyme. Macro-creatine kinase refers to creatine kinase complexed with other serum proteins. EC 2.7.3.2. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]
Curette: A spoon-shaped instrument with a sharp edge. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized
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subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Defensins: Family of antimicrobial peptides that have been identified in humans, animals, and plants. They are thought to play a role in host defenses against infections, inflammation, wound repair, and acquired immunity. Based on the disulfide pairing of their characteristic six cysteine residues, they are divided into alpha-defensins and beta-defensins. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Dendritic cell: A special type of antigen-presenting cell (APC) that activates T lymphocytes. [NIH]
Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dilatation: The act of dilating. [NIH] 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] Dilation and curettage: D&C. A minor operation in which the cervix is expanded enough (dilation) to permit the cervical canal and uterine lining to be scraped with a spoon-shaped instrument called a curette (curettage). [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Susceptibility: A constitution or condition of the body which makes the tissues react in special ways to certain extrinsic stimuli and thus tends to make the individual more than usually susceptible to certain diseases. [NIH]
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Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissection: Cutting up of an organism for study. [NIH] 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] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Douche: A procedure in which water or a medicated solution is used to clean the vagina and cervix. [NIH] Douching: A jet or current of water, sometimes a dissolved medicating or cleansing agent, applied to a body part, organ or cavity for medicinal or hygienic purposes. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus. [NIH]
Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures
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that are advantageous to the patient but not urgent. [EU] 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] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Emergency Medicine: A branch of medicine concerned with an individual's resuscitation, transportation and care from the point of injury or beginning of illness through the hospital or other emergency treatment facility. [NIH] Emergency Treatment: First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured. [NIH] Encephalocele: Cerebral tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur. [NIH]
Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] 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] Endotoxin: Toxin from cell walls of bacteria. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences,
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or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] 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] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]
Etoposide: A semisynthetic derivative of podophyllotoxin that exhibits antitumor activity. Etoposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent entry into the mitotic phase of cell division, and lead to cell death. Etoposide acts primarily in the G2 and S phases of the cell cycle. [NIH] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH]
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Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Fallopian Tubes: Two long muscular tubes that transport ova from the ovaries to the uterus. They extend from the horn of the uterus to the ovaries and consist of an ampulla, an infundibulum, an isthmus, two ostia, and a pars uterina. The walls of the tubes are composed of three layers: mucosal, muscular, and serosal. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetal Blood: Blood of the fetus. Exchange of nutrients and waste between the fetal and maternal blood occurs via the placenta. The cord blood is blood contained in the umbilical vessels at the time of delivery. [NIH] Fetal Development: Morphologic and physiologic growth and development of the mammalian embryo or fetus. [NIH] Fetoprotein: Transabdominal aspiration of fluid from the amniotic sac with a view to detecting increases of alpha-fetoprotein in maternal blood during pregnancy, as this is an important indicator of open neural tube defects in the fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibronectin: An adhesive glycoprotein. One form circulates in plasma, acting as an opsonin; another is a cell-surface protein which mediates cellular adhesive interactions. [NIH] Flagellum: A whiplike appendage of a cell. It can function either as an organ of locomotion or as a device for moving the fluid surrounding the cell. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH]
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Fornix: A bundle of nerves connected to the hippocampus. [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] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Fusion: Fusion of structural genes to analyze protein behavior or fusion of regulatory sequences with structural genes to determine mechanisms of regulation. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gestational trophoblastic disease: A rare cancer in women of child-bearing age in which
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cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic tumor, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic neoplasia: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic tumor, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic tumor: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [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] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Gonorrhoea: Infection due to Neisseria gonorrhoeae transmitted sexually in most cases, but also by contact with infected exudates in neonatal children at birth, or by infants in households with infected inhabitants. It is marked in males by urethritis with pain and purulent discharge, but is commonly asymptomatic in females, although it may extend to produce suppurative salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. Bacteraemia occurs in both sexes, resulting in cutaneous lesions, arthritis, and rarely meningitis or endocarditis. Formerly called blennorrhagia and blennorrhoea. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of
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peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granule: A small pill made from sucrose. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [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] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [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] Hemoperitoneum: Hemorrhage into the peritoneal cavity. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterodimer: Zippered pair of nonidentical proteins. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU]
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Humour: 1. A normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. A secretion that is itself an excitant of activity (as certain hormones). [EU] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydatidiform Mole: A trophoblastic disease characterized by hydrops of the mesenchymal portion of the villus. Its karyotype is paternal and usually homozygotic. The tumor is indistinguishable from chorioadenoma destruens or invasive mole ( = hydatidiform mole, invasive) except by karyotype. There is no apparent relation by karyotype to choriocarcinoma. Hydatidiform refers to the presence of the hydropic state of some or all of the villi (Greek hydatis, a drop of water). [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperglycaemia: Abnormally increased content of sugar in the blood. [EU] Hyperstimulation: Excessive stimulation. [EU] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hysterectomy: Excision of the uterus. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH]
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Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunofluorescence: A technique for identifying molecules present on the surfaces of cells or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH] Immunogen: A substance that is capable of causing antibody formation. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] 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] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indolent: A type of cancer that grows slowly. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant Mortality: Perinatal, neonatal, and infant deaths in a given population. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be
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clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inoculum: The spores or tissues of a pathogen that serve to initiate disease in a plant. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-10: Factor that is a coregulator of mast cell growth. It is produced by T-cells and B-cells and shows extensive homology with the Epstein-Barr virus BCRFI gene. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [NIH]
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Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Karyotype: The characteristic chromosome complement of an individual, race, or species as defined by their number, size, shape, etc. [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] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Leucovorin: The active metabolite of folic acid. Leucovorin is used principally as its calcium salt as an antidote to folic acid antagonists which block the conversion of folic acid to folinic acid. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Levonorgestrel: A progestational hormone with actions similar to those of progesterone and about twice as potent as its racemic or (+-)-isomer (norgestrel). It is used for contraception, control of menstrual disorders, and treatment of endometriosis. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum
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likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Liposomes: Artificial, single or multilaminar vesicles (made from lecithins or other lipids) that are used for the delivery of a variety of biological molecules or molecular complexes to cells, for example, drug delivery and gene transfer. They are also used to study membranes and membrane proteins. [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 cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [NIH]
Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] 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] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] 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] Malformation: A morphologic developmental process. [EU]
defect
resulting
from
an
intrinsically
abnormal
Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH]
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Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Mediastinum: The area between the lungs. The organs in this area include the heart and its large blood vessels, the trachea, the esophagus, the bronchi, and lymph nodes. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [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] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]
Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Mesoderm: The middle germ layer of the embryo. [NIH]
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Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] 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] Microbicide: Any substance (gels, creams, suppositories, etc.) that can reduce transmission of sexually transmitted infections. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the second trimester. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molar pregnancy: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, gestational trophoblastic tumor, or choriocarcinoma. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Chaperones: A family of cellular proteins that mediate the correct assembly or disassembly of other polypeptides, and in some cases their assembly into oligomeric structures, but which are not components of those final structures. It is believed that chaperone proteins assist polypeptides to self-assemble by inhibiting alternative assembly pathways that produce nonfunctional structures. Some classes of molecular chaperones are the nucleoplasmins, the chaperonins, the heat-shock proteins 70, and the heat-shock proteins 90. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA,
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can be made up of many thousands of atoms. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]
Multidose: Occurring in, or using multiple doses. [EU] Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables. [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] Naive: Used to describe an individual who has never taken a certain drug or class of drugs (e. g., AZT-naive, antiretroviral-naive), or to refer to an undifferentiated immune system cell. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] 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] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida,
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anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neutralization: An act or process of neutralizing. [EU] Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Neutrophil: A type of white blood cell. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nidation: Implantation of the conceptus in the endometrium. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norgestrel: (+-)-13-Ethyl-17-hydroxy-18,19-dinorpregn-4-en-20-yn-3-one. A progestational agent with actions similar to those of progesterone. This racemic or (+-)-form has about half the potency of the levo form (levonorgestrel). Norgestrel is used as a contraceptive and ovulation inhibitor and for the control of menstrual disorders and endometriosis. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oophoritis: Inflammation of an ovary. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Open Reading Frames: Reading frames where successive nucleotide triplets can be read as codons specifying amino acids and where the sequence of these triplets is not interrupted by
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stop codons. [NIH] Operating Rooms: Facilities equipped for performing surgery. [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Ornithosis: Infection with Chlamydophila psittaci (formerly Chlamydia psittaci), transmitted to man by inhalation of dust-borne contaminated nasal secretions or excreta of infected birds. This infection results in a febrile illness characterized by pneumonitis and systemic manifestations. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovarian Cysts: General term for cysts and cystic diseases of the ovary. [NIH] Ovarian Follicle: Spheroidal cell aggregation in the ovary containing an ovum. It consists of an external fibro-vascular coat, an internal coat of nucleated cells, and a transparent, albuminous fluid in which the ovum is suspended. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Ovum Implantation: Endometrial implantation of the blastocyst. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] 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] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Particle: A tiny mass of material. [EU] Pathogen: Any disease-producing microorganism. [EU] 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] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Patient Satisfaction: The degree to which the individual regards the health care service or
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product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] PDQ: Physician Data Query. PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information is available on the CancerNet Web site, and more specific information about PDQ can be found at http://cancernet.nci.nih.gov/pdq.html. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Peripheral blood: Blood circulating throughout the body. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering 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] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH]
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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] Pineal gland: A tiny organ located in the cerebrum that produces melatonin. Also called pineal body or pineal organ. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Placental tissue: The tissue intervening between fetal blood and maternal blood in the placenta; it acts as a selective membrane regulating the passage of substances from the maternal to the fetal blood. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasmids: Any extrachromosomal hereditary determinant. Plasmids are self-replicating circular molecules of DNA that are found in a variety of bacterial, archaeal, fungal, algal, and plant species. [NIH] Plastids: Self-replicating cytoplasmic organelles of plant and algal cells that contain pigments and may synthesize and accumulate various substances. Plastids are used in phylogenetic studies. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Pneumonitis: A disease caused by inhaling a wide variety of substances such as dusts and molds. Also called "farmer's disease". [NIH] Podophyllotoxin: The main active constituent of the resin from the roots of may apple or mandrake (Podophyllum peltatum and P. emodi). It is a potent spindle poison, toxic if taken internally, and has been used as a cathartic. It is very irritating to skin and mucous membranes, has keratolytic actions, has been used to treat warts and keratoses, and may have antineoplastic properties, as do some of its congeners and derivatives. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [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] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH]
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Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Pre-Eclampsia: Development of hypertension with proteinuria, edema, or both, due to pregnancy or the influence of a recent pregnancy. It occurs after the 20th week of gestation, but it may develop before this time in the presence of trophoblastic disease. [NIH] Pregnancy Complications: The co-occurrence of pregnancy and a disease. The disease may precede or follow conception and it may or may not have a deleterious effect on the pregnant woman or fetus. [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] 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] 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] Progestogen: A term applied to any substance possessing progestational activity. [EU] 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] 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 over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent
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mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] 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] Prostatitis: Inflammation of the prostate. [EU] 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] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psittaci: Causal agent of ornithosis. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]
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Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]
Pupil: The aperture in the iris through which light passes. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] 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] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radioimmunoassay: Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Nonimmunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing antibody formation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [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]
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Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] 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] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]
Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA
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attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Saline: A solution of salt and water. [NIH] Salpingectomy: Excision if a uterine tube. [NIH] Salpingitis: 1. Inflammation of the uterine tube. 2. Inflammation of the auditory tube. [EU] Salpingostomy: Formation of an artificial opening in a fallopian tube. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] 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] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sexual Partners: Married or single individuals who share sexual relations. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Shoulder Pain: Unilateral or bilateral pain of the shoulder. It is often caused by physical activities such as work or sports participation, but may also be pathologic in origin. [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] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the
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GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatic cells: All the body cells except the reproductive (germ) cells. [NIH] 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] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sperm: The fecundating fluid of the male. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spirochete: Lyme disease. [NIH]
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Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stromal: Large, veil-like cell in the bone marrow. [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] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Superovulation: Occurrence or induction of release of more ova than are normally released at the same time in a given species. The term applies to both animals and humans. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [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] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH]
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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] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]
Systemic: Affecting the entire body. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Teratoma: A type of germ cell tumor that may contain several different types of tissue, such as hair, muscle, and bone. Teratomas occur most often in the ovaries in women, the testicles in men, and the tailbone in children. Not all teratomas are malignant. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [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]
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Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Trachoma: A chronic infection of the conjunctiva and cornea caused by Chlamydia trachomatis. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [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] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transvaginal ultrasound: A procedure used to examine the vagina, uterus, fallopian tubes, and bladder. An instrument is inserted into the vagina, and sound waves bounce off organs inside the pelvic area. These sound waves create echoes, which a computer uses to create a picture called a sonogram. Also called TVS. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trichomonas: A genus of parasitic flagellate protozoans distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. [NIH] Trichosanthin: Plant-derived ribosome-inactivating protein purified from the Chinese medicinal herb tian-hua-fen which is obtained from the root tubers of Trichosanthes kirilowii. It has been used as an abortifacient and in the treatment of trophoblastic tumors. GLQ223 (Compound Q), a highly purified form of trichosanthin, has been proposed as antiviral treatment for AIDS. [NIH] Trophoblast: The outer layer of cells of the blastocyst which works its way into the endometrium during ovum implantation and grows rapidly, later combining with mesoderm. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for
174 Ectopic Pregnancy
nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] TYPHI: The bacterium that gives rise to typhoid fever. [NIH] Typhoid fever: The most important member of the enteric group of fevers which also includes the paratyphoids. [NIH] Typhoid fever: The most important member of the enteric group of fevers which also includes the paratyphoids. [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] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urethritis: Inflammation of the urethra. [EU] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] 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] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [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] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginosis: A condition caused by the overgrowth of anaerobic bacteria (e. g., Gardnerella vaginalis), resulting in vaginal irritation and discharge. [NIH]
Dictionary 175
Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular endothelial growth factor: VEGF. A substance made by cells that stimulates new blood vessel formation. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Villus: Cell found in the lining of the small intestine. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zygote: The fertilized ovum. [NIH]
177
INDEX 1 17-Hydroxyprogesterone, 77, 135 A Abdomen, 3, 135, 139, 153, 155, 156, 157, 163, 171, 172 Abdominal, 3, 18, 24, 33, 53, 84, 97, 103, 122, 135, 139, 140, 142, 155, 162, 163 Abdominal Pain, 3, 18, 33, 97, 122, 135, 163 Abscess, 88, 135, 151 Acatalasia, 135, 140 Acetylgalactosamine, 135, 151 Acetylglucosamine, 135, 151 Acuity, 13, 135 Acupuncture Analgesia, 81, 135 Adaptation, 16, 135 Adjustment, 6, 135 Adrenal Cortex, 135, 148, 165 Adverse Effect, 135, 169 Aerosol, 135, 171 Aetiology, 52, 135 Agonist, 135, 142 Algorithms, 24, 50, 135, 139 Allogeneic, 12, 136 Alopecia, 64, 136 Alpha-Defensins, 136, 145 Alpha-fetoprotein, 47, 136, 149 Alternative medicine, 105, 136 Amino Acid Sequence, 136, 137, 150 Amino Acids, 136, 150, 161, 163, 166, 169, 173 Amniotic Fluid, 136, 150 Amplification, 27, 136 Ampulla, 136, 149 Anaerobic, 12, 136, 174 Anaesthesia, 83, 136, 154 Anal, 136, 160 Analytes, 118, 136 Anaphylatoxins, 136, 143 Anatomical, 76, 136, 139, 154 Angiogenesis, 136, 158 Angiography, 31, 137 Animal model, 7, 8, 10, 137 Antibiotic, 137, 163, 172 Antibodies, 18, 22, 31, 56, 89, 137, 148, 152, 153, 154, 157, 164 Antibody, 8, 12, 15, 17, 22, 88, 89, 137, 142, 152, 154, 155, 158, 167, 169
Antidote, 137, 156 Antigen, 6, 8, 19, 22, 28, 88, 89, 137, 143, 145, 148, 152, 154, 155, 158, 167, 169 Antigen-Antibody Complex, 137, 143 Antigen-presenting cell, 19, 137, 145 Antimicrobial, 5, 20, 137, 145 Antiviral, 137, 173 Anus, 136, 137, 155 Aorta, 137 Aortic Aneurysm, 4, 137 Appendicitis, 6, 13, 37, 62, 85, 97, 137 Arachidonic Acid, 137, 165 Arterial, 55, 137, 153, 166 Arteries, 137, 139, 144, 159, 160 Arterioles, 137, 139 Aseptic, 137, 162, 171 Assay, 6, 12, 27, 89, 137, 167 Asymptomatic, 4, 7, 10, 16, 18, 19, 22, 26, 27, 28, 135, 138, 151 Atony, 65, 138 Atypical, 35, 41, 96, 138 Auditory, 138, 169 Autologous, 51, 53, 138 Autosuggestion, 138, 153 B Bacteria, 12, 88, 137, 138, 140, 141, 147, 151, 152, 156, 159, 173, 174 Bacterial Physiology, 135, 138 Bacterium, 7, 138, 174 Base, 138, 145, 150, 156, 172 Basement Membrane, 138, 148 Basophils, 138, 152, 156 Benign, 11, 46, 138, 160 Beta-Defensins, 138, 145 Bilateral, 33, 34, 46, 64, 68, 138, 169 Bile, 5, 138, 150, 153, 157 Bile Acids, 138 Bile Acids and Salts, 138 Bile Ducts, 138, 150 Biliary, 97, 138 Bilirubin, 138, 150 Biochemical, 7, 19, 138, 156, 169 Biomarkers, 20, 138 Biopsy, 10, 25, 69, 132, 139, 163 Biosynthesis, 21, 137, 139 Biotechnology, 28, 29, 96, 105, 113, 139 Bladder, 35, 139, 161, 166, 173, 174 Blastocyst, 139, 143, 147, 162, 164, 173
178 Ectopic Pregnancy
Blennorrhoea, 139, 151 Blood transfusion, 51, 53, 139 Blood vessel, 24, 136, 137, 139, 158, 170, 172, 175 Blot, 12, 139 Body Fluids, 138, 139, 147, 174 Body Regions, 139, 142 Bone Marrow, 17, 139, 154, 157, 160, 171 Bowel, 4, 97, 136, 139, 155, 161, 163 Branch, 129, 139, 147, 162, 167, 170, 172 Broad Ligament, 61, 139 C Caesarean section, 37, 53, 139 Calcium, 139, 142, 147, 156, 158, 170 Carbon Dioxide, 139, 164 Carcinogenic, 140, 155 Cardiac, 83, 140, 147, 160, 168 Carrier Proteins, 140, 167 Case report, 34, 35, 37, 40, 42, 47, 51, 56, 57, 61, 68, 74, 76, 77, 83, 84, 140 Catalase, 16, 135, 140 Caudal, 140, 153, 164 Cause of Death, 24, 140 Cell Adhesion, 70, 140 Cell Aggregation, 140, 162 Cell Cycle, 140, 148 Cell Differentiation, 140, 169 Cell Division, 138, 140, 148, 158, 164 Cell proliferation, 140, 169 Cerebral, 24, 140, 147, 148 Cerebral Palsy, 24, 140 Cerebrum, 140, 164 Cervical, 19, 22, 23, 29, 35, 49, 74, 75, 77, 82, 84, 88, 90, 91, 95, 118, 140, 145 Cervix, 25, 88, 122, 133, 140, 145, 146 Cesarean Section, 37, 140 Chaperonin 10, 140, 141 Chaperonin 60, 140, 141 Chaperonins, 28, 141, 159 Checkup, 94, 141 Chemokines, 7, 11, 141 Chemotactic Factors, 141, 143 Chemotaxis, 28, 141 Chemotherapy, 74, 76, 141 Chest Pain, 5, 141 Chimeras, 17, 141 Chlamydia, 4, 6, 7, 8, 11, 16, 17, 18, 21, 22, 23, 25, 26, 27, 31, 35, 56, 71, 103, 141, 162, 173 Cholecystitis, 97, 141 Cholesterol, 138, 141, 150 Choriocarcinoma, 46, 141, 151, 153, 159
Chorion, 141 Chorionic Villi, 37, 141 Chromosomal, 36, 122, 136, 141 Chromosome, 65, 141, 156, 157 Chromosome Abnormalities, 65, 141 Chronic, 4, 6, 8, 10, 11, 13, 16, 18, 20, 27, 36, 40, 69, 94, 97, 122, 141, 155, 171, 173 Chronic Disease, 122, 141 Ciliary, 48, 141 Circadian, 20, 141 Circadian Rhythm, 20, 141 CIS, 120, 142 Clinical Medicine, 9, 142, 165 Clinical trial, 4, 9, 10, 20, 59, 113, 142, 143, 144, 160, 163, 166, 167 Clomiphene, 83, 142 Cloning, 139, 142 Codons, 142, 150, 161 Cofactor, 142, 166 Colic, 97, 142 Collagen, 138, 142, 148, 149, 158 Colloidal, 142, 169, 171 Commensal, 88, 142 Complement, 16, 136, 142, 143, 150, 156 Complementary and alternative medicine, 81, 86, 143 Complementary medicine, 81, 143 Computational Biology, 113, 143 Conception, 24, 141, 143, 149, 151, 159, 165, 171 Concomitant, 13, 143 Confusion, 143, 146 Conjunctiva, 143, 173 Connective Tissue, 139, 142, 143, 157, 158 Consciousness, 143, 146, 168 Constipation, 143, 163 Consumption, 143, 145 Contamination, 35, 88, 143 Contraception, 37, 41, 43, 52, 62, 63, 64, 91, 143, 156 Contraceptive, 11, 45, 62, 102, 143, 161 Contraindications, ii, 143 Control group, 18, 143, 167 Controlled study, 29, 144 Cornea, 144, 173 Coronary, 144, 159, 160 Coronary Thrombosis, 144, 159, 160 Corpus, 37, 74, 75, 144, 165 Corpus Luteum, 37, 74, 75, 144, 165 Cortex, 144, 148, 152 Creatine, 43, 44, 104, 144 Creatine Kinase, 43, 44, 104, 144
Index 179
Creatinine, 144 Curative, 144, 161, 172 Curettage, 40, 119, 144, 145 Curette, 144, 145 Cutaneous, 144, 151 Cyclic, 144, 166 Cyst, 30, 99, 144 Cysteine, 141, 144, 145 Cytokine, 7, 10, 12, 144 Cytotoxic, 5, 12, 144, 170 Cytotoxicity, 5, 8, 18, 144 D Data Collection, 9, 144, 149 Databases, Bibliographic, 113, 144 Decidua, 56, 145, 164 Defensins, 25, 136, 138, 145 Dendrites, 145 Dendritic, 6, 19, 145 Dendritic cell, 6, 19, 145 Density, 21, 28, 145, 161, 170 Depolarization, 145, 170 Detergents, 5, 145 Deuterium, 145, 153 Developing Countries, 41, 95, 145 Diagnostic procedure, 43, 87, 105, 145 Diffusion, 145, 155 Digestion, 138, 139, 145, 146, 155, 157, 171 Dilatation, 145, 165 Dilation, 119, 122, 145 Dilation and curettage, 122, 145 Direct, iii, 12, 40, 107, 142, 145, 168 Discrimination, 70, 145 Disease Susceptibility, 10, 145 Disorientation, 94, 143, 146 Disposition, 97, 146 Dissection, 8, 27, 146 Dissociation, 15, 146 Dissociative Disorders, 146 Distal, 78, 146, 166 Dizziness, 122, 146 Dorsal, 146, 164 Douche, 88, 146 Douching, 11, 69, 70, 88, 104, 146 Drive, ii, vi, 16, 73, 146 Drug Interactions, 108, 146 Duodenum, 138, 146, 171 Dyspepsia, 97, 146 E Edema, 146 Effector, 6, 7, 12, 17, 142, 146 Efficacy, 5, 7, 9, 19, 21, 26, 146 Ejaculation, 146, 169
Elective, 47, 146 Electrolytes, 138, 147 Emboli, 29, 147 Embolization, 29, 147 Embryo, 28, 34, 39, 64, 67, 78, 121, 122, 139, 140, 147, 149, 154, 158, 165, 171 Embryo Transfer, 28, 34, 39, 64, 67, 78, 147, 165 Emergency Treatment, 147 Encephalocele, 147, 161 Endocarditis, 147, 151 Endocrine System, 147 Endocrinology, 9, 147, 152 Endometrial, 7, 10, 15, 23, 25, 31, 35, 52, 55, 69, 90, 96, 147, 162 Endometriosis, 57, 68, 78, 99, 147, 156, 161 Endometrium, 15, 16, 145, 147, 158, 161, 173 Endotoxin, 147, 174 Environmental Health, 112, 114, 147 Enzymatic, 139, 143, 148 Enzyme, 56, 89, 140, 146, 148, 156, 166, 169, 172, 175 Eosinophils, 148, 152, 156 Epidemic, 19, 23, 27, 75, 97, 100, 103, 148 Epidemiological, 10, 22, 23, 27, 61, 148 Epithelial, 7, 8, 27, 138, 145, 148 Epithelial Cells, 7, 8, 28, 138, 148 Epithelium, 133, 138, 141, 148 Epitopes, 8, 18, 148 Erythrocytes, 139, 148 Esophagus, 148, 158, 171 Estradiol, 16, 47, 148 Estrogen, 28, 142, 148 Estrogen receptor, 142, 148 Etoposide, 83, 84, 148 Evoke, 12, 148, 171 Extracellular, 8, 17, 143, 148, 149, 158 Extracellular Matrix, 17, 143, 148, 149, 158 Extracellular Matrix Proteins, 148, 158 Extracellular Space, 148, 149 F Fallopian Tubes, 17, 71, 149, 173, 174 Family Planning, 11, 42, 63, 96, 113, 149 Fat, 137, 138, 139, 147, 149, 170 Fatty acids, 149, 165 Fertilization in Vitro, 149, 165 Fetal Blood, 149, 164 Fetal Development, 149, 160 Fetoprotein, 149 Fetus, 103, 122, 136, 140, 149, 164, 165, 171, 174
180 Ectopic Pregnancy
Fibrin, 62, 149, 163, 172 Fibrinogen, 149, 172 Fibroblasts, 149, 155 Fibronectin, 35, 88, 89, 149 Flagellum, 149, 173 Focus Groups, 23, 149 Folate, 84, 120, 149 Fold, 23, 139, 149 Folic Acid, 149, 156 Fornix, 90, 150 Fungi, 150, 159, 171, 175 G Gallbladder, 97, 135, 138, 141, 150 Gallstones, 97, 138, 150 Gas, 139, 145, 150, 153, 161, 171 Gastrin, 150, 152 Gels, 150, 159 Gene, 16, 17, 19, 21, 27, 96, 139, 150, 155, 157, 162 Gene Expression, 16, 150 Gene Fusion, 16, 150 Genetic Code, 150, 161 Genetic Counseling, 94, 150 Genetic Engineering, 19, 139, 142, 150 Genetics, 48, 64, 68, 150, 163 Genital, 4, 6, 7, 10, 12, 16, 17, 18, 22, 25, 28, 46, 88, 122, 150, 152, 174 Genitourinary, 150, 174 Genotype, 150, 163 Germ Cells, 150, 158, 162, 170, 172 Gestation, 24, 89, 122, 150, 163, 164, 165, 171 Gestational, 24, 31, 46, 58, 118, 119, 121, 150, 151, 159 Gestational Age, 24, 31, 150 Gestational trophoblastic disease, 150, 151, 159 Gestational trophoblastic neoplasia, 151, 159 Gestational trophoblastic tumor, 151, 159 Gland, 135, 151, 157, 162, 166, 169, 171, 172 Glucose, 67, 76, 151 Glycogen, 141, 151 Glycoprotein, 14, 149, 151, 174 Glycosaminoglycans, 5, 148, 151 Gonad, 15, 151 Gonadal, 15, 151 Gonadotropin, 31, 33, 35, 40, 46, 48, 49, 55, 71, 89, 90, 108, 141, 151 Gonorrhea, 5, 11, 14, 16, 25, 114, 151 Gonorrhoea, 12, 151
Governing Board, 151, 165 Graft, 151, 152 Grafting, 151, 154 Gram-negative, 141, 151 Gram-positive, 152, 156 Granule, 25, 152, 168 Granulocytes, 152, 170, 175 Gravidity, 152, 162 Growth, 8, 18, 20, 27, 102, 136, 137, 140, 145, 149, 152, 155, 157, 160, 162, 164, 172, 173 H Haptens, 152, 167 Health Services, 23, 152 Health Status, 24, 152 Hemoperitoneum, 30, 51, 53, 61, 71, 152 Hemorrhage, 66, 152 Hereditary, 152, 164 Heredity, 150, 152 Heterodimer, 14, 152 Heterogeneity, 10, 152 Hippocampus, 150, 152 Histology, 26, 152 Homologous, 16, 152, 172 Hormonal, 8, 12, 50, 67, 152 Hormone, 14, 20, 28, 37, 122, 141, 148, 150, 152, 156, 158, 165, 169, 172 Host, 5, 8, 10, 14, 16, 18, 22, 27, 142, 145, 152, 154, 174, 175 Humoral, 8, 12, 152 Humour, 152, 153 Hybridomas, 153, 155 Hydatidiform Mole, 62, 141, 153 Hydrogen, 12, 138, 140, 145, 148, 153, 159, 166 Hydrogen Peroxide, 140, 153 Hydrophilic, 145, 153 Hydrophobic, 145, 153 Hygienic, 146, 153 Hyperglycaemia, 65, 153 Hyperstimulation, 59, 153 Hypertension, 153, 165 Hyperthermia, 74, 153 Hypothalamus, 135, 153 Hysterectomy, 99, 133, 153 Hysterotomy, 140, 153 I Iatrogenic, 50, 153 Id, 79, 85, 123, 128, 130, 153 Immune function, 12, 154 Immune response, 7, 8, 10, 12, 16, 17, 18, 22, 137, 152, 154, 171, 174, 175
Index 181
Immune Sera, 154 Immune system, 6, 137, 154, 157, 160, 174, 175 Immunity, 7, 8, 17, 19, 145, 154, 173 Immunization, 6, 18, 154 Immunofluorescence, 56, 154 Immunogen, 19, 154 Immunogenic, 19, 154, 167 Immunologic, 141, 150, 154 Immunology, 18, 22, 38, 70, 119, 154 Immunosuppressive, 12, 154 Impairment, 24, 154, 155, 158 Implantation, 12, 15, 91, 143, 154, 161, 162 In situ, 12, 154 In vitro, 5, 6, 7, 8, 14, 17, 18, 21, 22, 34, 39, 42, 64, 68, 75, 78, 140, 147, 154, 169, 172 In vivo, 6, 7, 14, 16, 17, 154 Incision, 139, 153, 154, 156 Indicative, 89, 95, 154, 162, 175 Indolent, 22, 154 Induction, 7, 19, 154, 171 Infant Mortality, 94, 121, 154 Infarction, 154 Infection, 5, 6, 7, 8, 10, 11, 14, 16, 17, 18, 20, 22, 23, 25, 27, 56, 88, 97, 103, 114, 135, 137, 141, 151, 154, 157, 162, 163, 171, 173, 175 Infiltration, 48, 50, 155 Inflammation, 16, 137, 141, 145, 155, 158, 161, 163, 166, 169, 174 Infusion, 48, 83, 155, 173 Initiation, 9, 155 Inoculum, 27, 155 Interleukin-1, 11, 155 Interleukin-10, 11, 155 Interleukin-2, 65, 155 Interleukin-6, 11, 155 Internal Medicine, 147, 155 Interstitial, 30, 50, 51, 56, 57, 75, 76, 84, 118, 149, 155 Intestinal, 6, 13, 136, 155, 156 Intestinal Obstruction, 6, 13, 155 Intestine, 138, 139, 155, 170 Intracellular, 4, 7, 8, 18, 22, 155, 158, 166, 169 Intracellular Membranes, 155, 158 Intraepithelial, 19, 155 Intraperitoneal, 66, 155 Intravenous, 155, 156 Invasive, 12, 26, 28, 43, 58, 134, 153, 154, 156, 157 Involuntary, 16, 20, 23, 156, 160
Ions, 138, 146, 147, 153, 156 Isoenzyme, 144, 156 K Karyotype, 153, 156 Kb, 112, 156 Kinetics, 11, 156 L Labile, 142, 156 Lactobacillus, 12, 156 Laparoscopy, 24, 40, 41, 44, 48, 54, 61, 67, 132, 156 Laparotomy, 24, 29, 54, 61, 103, 133, 156 Least-Squares Analysis, 156, 168 Lectin, 156, 158 Leucovorin, 48, 83, 108, 156 Leukocytes, 7, 138, 139, 141, 148, 152, 156, 160, 174 Levonorgestrel, 41, 156, 161 Library Services, 128, 156 Ligation, 156 Likelihood Functions, 156, 168 Linear Models, 157, 168 Linkages, 151, 157 Liposomes, 28, 157 Liver, 135, 136, 137, 138, 149, 150, 151, 157 Liver cancer, 136, 157 Localized, 155, 157, 164 Logistic Models, 157, 168 Lymph, 140, 153, 157, 158 Lymph node, 140, 157, 158 Lymphatic, 155, 157, 158, 172 Lymphocyte, 6, 12, 22, 137, 157, 158 Lymphoid, 137, 157 Lytic, 157, 169 M Macrophage, 155, 157 Magnetic Resonance Imaging, 60, 82, 157 Malformation, 31, 157 Malignant, 141, 157, 160, 172 Malignant tumor, 141, 157 Matrix metalloproteinase, 17, 158 Mediastinum, 141, 158 Mediator, 155, 158, 169 Medical Records, 6, 24, 158 MEDLINE, 113, 158 Meiosis, 15, 158, 172 Membrane, 8, 14, 18, 19, 21, 141, 143, 145, 147, 152, 157, 158, 160, 164, 170, 173 Membrane Proteins, 19, 157, 158 Memory, 17, 158 Meningitis, 151, 158 Menstrual Cycle, 158, 165
182 Ectopic Pregnancy
Menstruation, 8, 145, 158 Mental Disorders, 158, 166 Mental Health, iv, 4, 112, 115, 158, 167 Mental Processes, 146, 158, 167 Mental Retardation, 24, 158 Mesenchymal, 153, 158 Mesoderm, 158, 173 Meta-Analysis, 37, 67, 159 Metabolite, 156, 159 Metastasis, 158, 159 MI, 122, 134, 159 Microbicide, 5, 159 Microbiology, 12, 16, 17, 18, 22, 26, 27, 135, 138, 159 Micronutrients, 8, 159 Microorganism, 142, 159, 162, 175 Microscopy, 28, 32, 138, 159 Migration, 6, 159 Miscarriage, 15, 25, 93, 94, 96, 100, 106, 118, 119, 120, 121, 122, 159 Mitochondria, 140, 141, 159 Mitotic, 148, 159 Modification, 150, 159, 167 Molar pregnancy, 47, 94, 122, 151, 159 Molecular, 7, 12, 13, 15, 19, 27, 113, 115, 136, 139, 141, 143, 149, 157, 159, 174 Molecular Chaperones, 141, 159 Molecule, 6, 8, 70, 137, 138, 143, 146, 156, 159, 168, 169 Monocytes, 155, 156, 160 Mononuclear, 160, 174 Morphological, 61, 90, 147, 160 Mucosa, 4, 6, 7, 12, 19, 88, 160 Multicenter study, 45, 160 Multidose, 67, 160 Multivariate Analysis, 13, 160 Mydriatic, 145, 160 Myocardial infarction, 4, 5, 144, 159, 160 Myocardium, 159, 160 N Naive, 18, 160 NCI, 1, 111, 120, 142, 160, 163 Necrosis, 154, 159, 160 Need, 3, 5, 9, 13, 20, 39, 43, 93, 97, 105, 114, 124, 151, 158, 160 Neonatal, 24, 42, 94, 106, 119, 151, 154, 160 Neoplasia, 160 Neoplasm, 160 Neoplastic, 59, 76, 153, 160 Nerve, 135, 145, 158, 160, 164, 171 Nerve Fibers, 135, 160 Neural, 84, 147, 149, 152, 160
Neural tube defects, 84, 149, 160 Neurogenic, 4, 161, 174 Neutralization, 8, 161 Neutropenia, 54, 161 Neutrophil, 16, 25, 28, 161 Niacin, 161, 174 Nidation, 147, 161 Nitrogen, 148, 161, 174 Norgestrel, 156, 161 Nuclei, 150, 157, 161, 166 Nucleic acid, 27, 150, 161 Nucleus, 138, 144, 145, 148, 158, 160, 161, 166 O Observational study, 48, 161 Ocular, 19, 161 Odds Ratio, 161, 168 Oophoritis, 151, 161 Opacity, 14, 16, 145, 161 Open Reading Frames, 21, 161 Operating Rooms, 5, 162 Operon, 21, 162, 168 Organ Culture, 5, 162, 172 Ornithosis, 162, 166 Outpatient, 19, 20, 23, 26, 76, 162 Ovarian Cysts, 59, 76, 162 Ovarian Follicle, 15, 144, 162 Ovaries, 122, 149, 162, 172, 174 Ovary, 15, 122, 144, 148, 151, 161, 162 Ovulation, 83, 89, 91, 142, 161, 162 Ovum, 37, 144, 145, 150, 162, 165, 173, 175 Ovum Implantation, 162, 173 P Palliative, 162, 172 Pancreas, 135, 139, 162, 174 Parasitic, 162, 173 Parity, 24, 162 Particle, 89, 162, 170, 173 Pathogen, 4, 14, 16, 17, 18, 155, 162 Pathogenesis, 4, 7, 8, 10, 14, 15, 16, 18, 21, 22, 25, 162 Pathologic, 139, 144, 162, 169 Patient Education, 121, 126, 128, 134, 162 Patient Satisfaction, 23, 162 PDQ, 119, 163 Pelvic inflammatory disease, 4, 6, 7, 10, 11, 13, 17, 19, 20, 21, 22, 23, 25, 27, 56, 88, 163 Penicillin, 5, 163 Peptide, 163, 166 Percutaneous, 55, 163 Perforation, 52, 163
Index 183
Perinatal, 27, 121, 154, 163 Peripheral blood, 6, 163 Peritoneal, 91, 152, 155, 163 Peritoneal Cavity, 152, 155, 163 Peritoneum, 139, 163 Peritonitis, 4, 151, 163 Peroxide, 12, 163 Pharmacologic, 163, 173, 174 Phenotype, 10, 16, 163 Phospholipases, 163, 170 Physical Examination, 3, 48, 141, 150, 163 Physiologic, 15, 78, 135, 139, 149, 158, 159, 164, 166, 168 Physiology, 147, 152, 164 Pilot study, 9, 21, 164 Pineal gland, 141, 164 Placenta, 35, 141, 148, 149, 164, 165 Placental tissue, 90, 164 Plants, 140, 145, 151, 156, 164, 171, 173 Plasma, 137, 149, 164, 169 Plasma cells, 137, 164 Plasmids, 18, 164 Plastids, 140, 141, 164 Platelet Activation, 164, 170 Pneumonitis, 18, 162, 164 Podophyllotoxin, 148, 164 Polymorphic, 21, 164 Polysaccharide, 137, 164 Posterior, 90, 136, 146, 162, 164 Postsynaptic, 164, 170 Potentiates, 155, 165 Potentiation, 165, 170 Practice Guidelines, 115, 165 Precursor, 137, 146, 148, 165, 174 Pre-Eclampsia, 24, 165 Pregnancy Complications, 24, 165 Pregnancy Outcome, 15, 36, 165 Pregnancy Tests, 89, 150, 165 Prenatal, 24, 94, 147, 165 Prevalence, 23, 27, 95, 161, 165 Probe, 70, 165 Progesterone, 47, 48, 61, 77, 102, 118, 133, 135, 156, 161, 165 Progestogen, 63, 102, 165 Progression, 4, 97, 137, 165 Progressive, 17, 140, 152, 160, 164, 165 Prophylaxis, 165, 174 Prospective study, 36, 165 Prostaglandin, 74, 75, 77, 78, 165 Prostaglandins A, 166 Prostate, 139, 166, 174 Prostatitis, 27, 166
Protein S, 96, 139, 150, 166, 168, 172 Proteinuria, 165, 166 Proteolytic, 142, 149, 166 Protocol, 9, 10, 18, 25, 39, 57, 62, 71, 166 Protons, 153, 166, 167 Proximal, 78, 146, 166 Psittaci, 56, 162, 166 Psychiatry, 10, 166 Psychogenic, 166, 174 Psychology, 146, 167 Psychotherapy, 167, 168 Public Health, 9, 12, 25, 27, 96, 115, 167 Public Policy, 113, 167 Publishing, 28, 93, 95, 167 Pupil, 144, 145, 160, 167 Purulent, 135, 151, 167 Q Quality of Life, 20, 23, 167, 171 R Race, 121, 156, 159, 161, 167 Radiation, 153, 167 Radioactive, 153, 154, 167 Radiography, 137, 150, 167 Radioimmunoassay, 89, 167 Radiological, 163, 167 Random Allocation, 167 Randomization, 26, 167 Randomized, 9, 20, 26, 45, 67, 74, 146, 167, 168 Randomized clinical trial, 20, 74, 168 Reagent, 89, 168 Reassurance, 93, 168 Receptor, 6, 28, 89, 135, 137, 167, 168, 169 Recombinant, 19, 168 Recurrence, 23, 141, 168 Refer, 1, 142, 146, 150, 160, 168 Regimen, 19, 21, 146, 168 Regression Analysis, 11, 168 Relative risk, 27, 168 Remission, 168 Repressor, 162, 168 Reproduction Techniques, 165, 168 Resection, 49, 168 Resuscitation, 147, 168 Retrospective, 11, 24, 25, 28, 35, 168 Ribosome, 168, 173 Risk factor, 11, 26, 50, 52, 64, 93, 96, 102, 103, 157, 165, 168, 169 Rod, 138, 156, 169 S Saline, 55, 169 Salpingectomy, 35, 41, 57, 64, 78, 169
184 Ectopic Pregnancy
Salpingitis, 7, 8, 151, 169 Salpingostomy, 44, 61, 65, 103, 169 Screening, 19, 23, 26, 28, 69, 142, 163, 169 Secretion, 7, 28, 141, 153, 169 Semen, 9, 38, 146, 166, 169 Semisynthetic, 148, 169 Serologic, 25, 169 Serology, 25, 35, 169 Serotonin, 169, 174 Serum, 31, 40, 43, 55, 65, 77, 89, 102, 104, 133, 136, 142, 144, 151, 154, 163, 167, 169, 174 Serum Albumin, 167, 169 Sexual Partners, 27, 169 Sexually Transmitted Diseases, 11, 18, 21, 23, 25, 27, 35, 95, 114, 169 Shock, 22, 47, 61, 94, 102, 134, 140, 141, 159, 169, 173 Shoulder Pain, 122, 169 Side effect, 21, 88, 107, 135, 169, 171, 172 Signal Transduction, 14, 169 Signs and Symptoms, 3, 168, 170 Skeletal, 144, 170 Skeleton, 166, 170 Skull, 147, 160, 170, 172 Small intestine, 138, 146, 152, 155, 170, 175 Social Environment, 167, 170 Soft tissue, 139, 170 Somatic, 152, 158, 170 Somatic cells, 158, 170 Sonogram, 170, 173 Sound wave, 170, 173 Spatial disorientation, 146, 170 Specialist, 123, 145, 170 Species, 8, 21, 136, 141, 156, 158, 159, 162, 164, 167, 170, 171, 173, 175 Sperm, 141, 170, 172 Spermatozoa, 169, 170 Spina bifida, 160, 170 Spinal cord, 135, 141, 160, 170 Spirochete, 170, 172 Spontaneous Abortion, 69, 165, 171 Spores, 155, 171 Stasis, 78, 85, 171 Statistically significant, 24, 171 Sterilization, 40, 64, 104, 119, 133, 171 Stillbirth, 93, 94, 96, 106, 119, 120, 165, 171 Stimulus, 146, 171, 172 Stomach, 122, 135, 148, 150, 152, 163, 170, 171 Stress, 141, 171 Stromal, 147, 171
Subacute, 155, 171 Subclinical, 22, 27, 155, 171 Subspecies, 8, 170, 171 Substance P, 159, 165, 169, 171 Superovulation, 10, 171 Supplementation, 84, 171 Supportive care, 163, 171 Suppositories, 159, 171 Suppurative, 151, 171 Suspensions, 55, 171 Symptomatic, 12, 18, 25, 27, 28, 172 Synaptic, 170, 172 Syphilis, 11, 114, 172 Systemic, 31, 36, 50, 74, 75, 77, 108, 137, 155, 162, 172, 173 T Temporal, 12, 152, 172 Teratoma, 46, 141, 172 Testicles, 172 Testis, 15, 141, 148, 172 Tetracycline, 5, 172 Therapeutics, 108, 172 Thermal, 146, 172 Thorax, 4, 135, 172 Threshold, 97, 153, 172 Thrombin, 149, 172 Thrombosis, 166, 172 Thymus, 154, 157, 172 Thyroid, 14, 172 Tissue Culture, 14, 172 Tooth Preparation, 135, 172 Topical, 5, 153, 172 Toxic, iv, 144, 154, 164, 172, 173 Toxicity, 146, 173 Toxicology, 114, 173 Toxins, 137, 155, 173 Trachea, 158, 172, 173 Trachoma, 8, 173 Transduction, 169, 173 Transfection, 139, 173 Transfer Factor, 154, 173 Transfusion, 173 Translation, 15, 26, 173 Translational, 15, 173 Transplantation, 12, 147, 154, 173 Transvaginal ultrasound, 38, 67, 133, 173 Trauma, 5, 97, 121, 160, 173 Trichomonas, 11, 173 Trichosanthin, 75, 82, 85, 173 Trophoblast, 12, 77, 139, 173 Tryptophan, 21, 142, 169, 173 Tubal ligation, 91, 133, 174
Index 185
Tumor marker, 139, 174 Tumor Necrosis Factor, 65, 174 TYPHI, 6, 174 Typhoid fever, 174 U Ultrasonography, 40, 51, 66, 68, 70, 150, 174 Unconscious, 153, 174 Urethra, 166, 174 Urethritis, 7, 114, 151, 174 Urinary, 30, 150, 174 Urinary Retention, 30, 174 Urinate, 174 Urine, 27, 33, 35, 47, 69, 89, 139, 144, 166, 174 Urogenital, 13, 17, 150, 151, 174 V Vaccination, 18, 19, 174 Vaccine, 6, 7, 8, 11, 17, 18, 19, 166, 174 Vagina, 25, 88, 90, 140, 146, 153, 156, 158, 173, 174 Vaginal, 11, 12, 16, 33, 69, 70, 88, 89, 104, 122, 131, 174 Vaginosis, 11, 12, 25, 174 Vascular, 4, 54, 70, 141, 154, 155, 162, 164, 175
Vascular endothelial growth factor, 54, 70, 175 Veins, 139, 175 Venereal, 97, 172, 175 Venous, 166, 175 Venules, 139, 175 Veterinary Medicine, 113, 175 Villi, 153, 175 Villus, 153, 175 Virulence, 8, 173, 175 Virus, 150, 155, 173, 175 Vitro, 5, 14, 34, 62, 67, 77, 175 Vivo, 14, 16, 17, 175 Volition, 156, 175 W White blood cell, 137, 156, 157, 161, 164, 175 Windpipe, 172, 175 Womb, 174, 175 Wound Healing, 158, 175 X Xenograft, 137, 175 Y Yeasts, 150, 163, 175 Z Zygote, 143, 175
186 Ectopic Pregnancy
Index 187
188 Ectopic Pregnancy
