EPIGLOTTIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Epiglottis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00411-9 1. Epiglottis-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 epiglottis. 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 EPIGLOTTIS................................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Epiglottis....................................................................................... 4 The National Library of Medicine: PubMed ................................................................................ 10 CHAPTER 2. NUTRITION AND EPIGLOTTIS ...................................................................................... 29 Overview...................................................................................................................................... 29 Finding Nutrition Studies on Epiglottis...................................................................................... 29 Federal Resources on Nutrition ................................................................................................... 30 Additional Web Resources ........................................................................................................... 30 CHAPTER 3. ALTERNATIVE MEDICINE AND EPIGLOTTIS................................................................ 33 Overview...................................................................................................................................... 33 National Center for Complementary and Alternative Medicine.................................................. 33 Additional Web Resources ........................................................................................................... 34 General References ....................................................................................................................... 34 CHAPTER 4. PATENTS ON EPIGLOTTIS ............................................................................................ 35 Overview...................................................................................................................................... 35 Patents on Epiglottis.................................................................................................................... 35 Patent Applications on Epiglottis ................................................................................................ 56 Keeping Current .......................................................................................................................... 59 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 63 Overview...................................................................................................................................... 63 NIH Guidelines............................................................................................................................ 63 NIH Databases............................................................................................................................. 65 Other Commercial Databases....................................................................................................... 67 APPENDIX B. PATIENT RESOURCES ................................................................................................. 69 Overview...................................................................................................................................... 69 Patient Guideline Sources............................................................................................................ 69 Finding Associations.................................................................................................................... 71 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 73 Overview...................................................................................................................................... 73 Preparation................................................................................................................................... 73 Finding a Local Medical Library.................................................................................................. 73 Medical Libraries in the U.S. and Canada ................................................................................... 73 ONLINE GLOSSARIES.................................................................................................................. 79 Online Dictionary Directories ..................................................................................................... 79 EPIGLOTTIS DICTIONARY......................................................................................................... 81 INDEX .............................................................................................................................................. 111
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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 epiglottis 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 epiglottis, 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 epiglottis, 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 epiglottis. 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 epiglottis, 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 epiglottis. 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 EPIGLOTTIS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on epiglottis.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and epiglottis, 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 “epiglottis” (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: •
Differential Diagnosis of Dysphagia in Children Source: Otolaryngologic Clinics of North America. 31(3): 435-451. June 1998. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: This article explores the differential diagnosis of dysphagia in children. Dysphagia is defined as any process that produces difficulty with active transport of food and liquid from mouth to stomach. The authors divide diagnostic pediatric dysphagia into categories including congenital, infectious or inflammatory, systemic, neoplastic, traumatic, and miscellaneous causes. In the first section, the authors discuss choanal atresia (complete nasal obstruction), congenital nasal masses, and cleft lip or cleft palate, laryngomalacia, vocal cord paralysis, laryngeal clefts, tracheoesophageal
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fistula or esophageal atresia, foregut malformations, and vascular rings. Infectious causes considered include acute pharyngitis, tonsillitis, peritonsillar abscess, retropharyngeal abscess, other deep neck abscesses, epiglottis, and esophagitis. Other causes covered are neurologic causes of dysphagia, central nervous system diseases, diseases of the neuromuscular junction, neoplastic causes of dysphagia (hemangioma, lymphangioma, papilloma, leiomyoma, neurofibroma), oral cavity and posterior pharyngeal injury, surgically related dysphagia, external trauma, caustic ingestion, gastroesophageal reflux, and foreign bodies of the upper aerodigestive tract. The authors caution that the diagnostic work up can be extremely difficult and exhaustive in many cases. Typical of any diagnostic dilemma, emphasis on history and physical examination remains paramount. Imaging studies can be extremely valuable in certain cases. Once a diagnosis has been established, treatment options are often less problematic. 4 figures. 1 table. 43 references. •
Treatment of Apthous Ulcers in AIDS Patients Source: Laryngoscope. 104(5): 566-570. May 1994. Summary: This article reports on a study, from 1987 to 1992, of 240 AIDS patients with oral, laryngeal, and pharyngeal ulcers. In 180 patients, ulcers resolved in less than 2 weeks without treatment. Of the 60 patients whose ulcers persisted for more than 2 weeks, 24 were culture positive for herpes simplex virus, Cryptococcus organisms, cytomegalovirus, or Mycobacterium organisms and were treated accordingly. The remaining 36 patients were diagnosed as having major aphthous ulcers. The usual sites for these ulcers were the floor of the mouth, tonsillar fossa, and epiglottis. The most common symptoms were pain and weight loss. The patients were treated with intralesional injection with triamcinolone acetonide and examined weekly. Ulcers were reinjected biweekly as needed. Response to treatment was evaluated by pain relief, ulcer healing, and weight gain. All patients reported pain relief within 2 days of initial injection. Most had marked reduction in ulcer size and subsequent weight gain, and many experienced total resolution of symptoms and complete healing. 5 figures. 1 table. 21 references. (AA-M).
Federally Funded Research on Epiglottis The U.S. Government supports a variety of research studies relating to epiglottis. 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 epiglottis. 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 2
Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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animals or simulated models to explore epiglottis. The following is typical of the type of information found when searching the CRISP database for epiglottis: •
Project Title: AERODYNAMIC AND ACOUSTIC MODELS OF PHONATION Principal Investigator & Institution: Scherer, Ronald C.; Professor; Communication Disorders; Bowling Green State Univ Bowling Green 220 Mcfall Ctr Bowling Green, Oh 43403 Timing: Fiscal Year 2002; Project Start 01-JAN-1998; Project End 30-JUN-2006 Summary: (provided by applicant): Phonation is a component of speech communication with a highly complex interplay of physiological and physical properties. Phonation is the vibratory system in the larynx that changes air flow from the lungs into sound in the throat. The process of vocal fold vibration and the conversion of air flow into sound is insufficiently understood for the purposes of making precise diagnostic decisions in the voice clinic, targeting optimal intervention strategies for voice problems, and achieving high quality articulatory speech synthesis. The long-range goal of this research program is to develop an efficient and highly effective computer model of phonation that takes into account the tissue and flow-acoustic dynamics for both normal and pathological laryngeal conditions. This continuation application focuses on the details of the basic physics dealing with the flow-acoustic interactions and driving intraglottal pressures by using various physical, computational, and tissue models of phonation. The aims are to 1) extend phonatory modeling to three dimensions with greater geometric complexity, 2) gain a thorough understanding of the aerodynamics and aeroacoustics for steady and pulsatile flows in rigid and moving-wall laryngeal airways, 3) develop detailed predictive models to explain the flow physics of phonation, in parallel with simpler models that are computationally efficient and clinically applicable, and 4) determine the effects of glottal jet flow for normal and pathological conditions of the glottis using an in-vivo canine model. The three types of models (physical, computational, and tissue) are used to cross-validate new information that bridges between basic modeling and real larynx phonation. This research program is a collaboration among laboratories at Bowling Green State University, Purdue University, the University of Toledo, and Washington University in Saint Louis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: AIRWAY PROTECTION DURING VOMITING Principal Investigator & Institution: Lang, Ivan M.; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532260509 Timing: Fiscal Year 2002 Summary: Vomiting is a complex motor behavior that requires the coordinated action of musculature within the gastrointestinal and aerodigestive tracts. The mechanisms of airway protection during vomiting have not been studied and are presently unknown. This is in contrast to an extensive body of literature providing information on airway protective mechanisms operational during swallowing. Acute and chronic animal models will be utilized to study the role of the laryngeal, pharyngeal and hyoid muscles during vomiting. Investigation of the associated movements of the tongue base, hyoid bone, cricoid and thyroid cartilage, and epiglottis will also be studied. The action of these aerodigestive muscles will be temporally correlated with the action of the esophagus and gastrointestinal tract, and lower respiratory musculature. Finally, the relative contribution of peripheral reflexes and direct central nervous system control over the motor events that comprise vomiting will be studied.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ANATOMICAL SPECIALIZATIONS OF THE HUMAN PHARYNX Principal Investigator & Institution: Mu, Liancai; Otolaryngology; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2002; Project Start 01-FEB-2001; Project End 31-JAN-2005 Summary: (Applicant's abstract): What variables in the neuromuscular properties of the human pharynx make some patients more susceptible to aspiration, obstructive sleep apnea (OSA), acid reflux, cricopharyngeal spasm and other disorders of the pharyngeal region? In most mammals (and neonatal humans) the respiratory system is protected by overlapping the epiglottis and soft palate, however with separation of these structures the human at risk of aspiration, and this is often the cause of death in the elderly and neurologically impaired. At present the basic neuromuscular specializations of the human pharynx are poorly understood. In preliminary work numerous novel observations were made, one example is that of the human cricopharyngeus (CP) muscle; That the CP receives its innervation from multiple nerves, each of which supplies a distinct region within the muscle, and that it contains specialized muscle fibers. One of these, slow tonic muscle fibers (STMF) has a unique physiology. STMF are extremely rare in mammals but preliminary work has shown that they are widespread in human upper airway structures including the tongue and larynx. Moreover the particular distribution of these fiber suggests that they are directly related to distinct biomechanics. The proposed work will focus on clarifying the peripheral organization patterns of the human pharyngeal plexus and characterizing the intrinsic properties of the CP and the muscles surrounding the pharynx to answer the questions: what anatomic specializations are present that appear specific to humans and possibly speech and swallowing related? What variations in these specializations correlate with certain ethnic (black males OSA), genders (males reflux, OSA) and especially geriatric (CP spasm and aspiration) susceptibility to specific disorders? All studies will be done in human post-mortem tissue. The motor and sensory nerve supply to the pharyngeal region will be studied using Sihler's stain. An additional hypothesis to be tested is that the human glossopharyngeal nerve (IX) provides motor innervation not only to the traditionally described stylopharyngeus, but also to the CP and pharyngeal constrictor muscles as demonstrated by our preliminary studies. This will be studied by triple approaches: Sihler's stain whole-mount acetylcholinesterase (AChE) and silver stain, and Karnovsky-Roots' method. Another hypothesis to be tested is that most swallowingrelated muscles are specialized and composed of neuromuscular compartments (NMC) as functional requirements. Our preliminary studies provided evidence for the existence of the NMC within the human CP inferior constrictor and geniohyoid muscles. In addition, the human CP appears to be a specialized skeletal muscle as it contains slow tonic and a-cardiac myosin heavy chain isoforms that are not normally present in limb muscles. The muscular specializations of the upper esophageal sphincter, pharyngeal constrictor and suprahyoid muscles will be explored using a wide variety of histochemical, immunohistochemical, electrophoretic and immunoblotting techniques The muscle fiber architecture, distribution of the fiber types and the major and unusual myosin heavy chain isoforms will be studied. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DIFFERENCES IN SWALLOW MECHANICS IN INFANTS Principal Investigator & Institution: German, Rebecca Z.; Professor; Biological Sciences; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221
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Timing: Fiscal Year 2002; Project Start 01-JUL-1998; Project End 31-JUL-2006 Summary: (provided by applicant): Swallowing requires the coordination of a large number of muscles; this complexity arises partly from the need for airway protection. In the previous funding period, we added to the understanding of muscle activity and oropharyngeal kinematics in infant deglutition. However, the role of the majority of muscles during emptying of the valleculae and in the transport of the bolus past the laryngeal opening or the natural stimuli that initiate the emptying of the valleculae over maturation is not well understood. Our preliminary data suggest that two distinct pathways of bolus movement exist, either around the epiglottis/laryngeal opening (in the newborn) or over it (by the age of weaning). However the timing of the transition, from one path to the other and the associated changes in the kinematics or motor patterns, are unknown. The decerebrate pig is an excellent model for studying vallecular emptying because this phase of the swallow can be isolated experimentally. We propose to apply our existing techniques both to this model and to intact animals, in order to answer the following questions. What natural stimuli initiate vallecular emptying, and do they change during maturation? What is the pattern of muscle activity during vallecular emptying in terms of the order and amplitude of muscle activation? Does change in the consistency of the bolus alter the motor pattern during vallecular emptying, and does this change over developmental time? Does epiglottal movement result from: (i) direct muscle contraction; (ii) indirect movement of the rest of the larynx, (iii) the mechanical action of food on the epiglottis, or a combination of all three? Current studies of human dysphagia and rehabilitation rely heavily on several older studies of oral function in adult man and animal; these studies did not have the means to examine the ontogeny of vallecular function in detail. The proposed study of the maturation of motor patterns will provide an important baseline for treatment strategies aimed at human infant dysphagia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: FLOW VISUALIZATION IN THE CANINE LARYNX DURING PHONATION Principal Investigator & Institution: Khosla, Siddarth M.; Otolaryngology; Medical College of Ohio at Toledo Research & Grants Admin. Toledo, Oh 436145804 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The primary purpose of this grant is to train the candidate to be able to independently derive computational and theoretical models of laryngeal diseases, to verify these models by experiments in animals, and to use the results of theoretical and animal models to design new medical and surgical therapies for diseases of the larynx. Coursework in fluid mechanics, computational flow dynamics, vibrations, and acoustics will give the candidate the necessary knowledge to derive new theoretical models for laryngeal diseases. In addition the candidate will develop his own computational model of airflow in the canine larynx during phonation. The coursework will be supplemented by tutorials in speech science given by the candidate?s mentor, Dr. Ron Scherer. Experience in verifying theory in animal experiments will be obtained in the research part of this proposal. For his research, the candidate will use the flow visualization method he has already developed to determine the patterns of airflow in the larynx during phonation. The pattern of airflow in the larynx is important because flow produces forces that drive vocal fold (cord) vibrations, and certain airflow patterns may also produce sound by mechanisms other than vocal fold vibration. Current computational and theoretical models make assumptions about the flow patterns that have not yet been experimentally verified. The investigator will
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use flow visualization and the particle image velocimetry method to determine whether flow separation occurs in the glottis, whether vortices occur above the glottis, and whether the flow directly above the glottis is laminar. The candidate will then compare his experimental findings with current theoretical and computational models and with his computational model. Training in recognizing clinical applications of the work will be fostered by consultations with two prominent laryngologists, Dr. Gerald Berke and Dr. Randal Paniello. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GLOTTAL JET AERODYNAMICS Principal Investigator & Institution: Krane, Michael H.; None; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, Nj 08901 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2005 Summary: (provided by applicant): The proposed research will address unresolved issues regarding the airflow involved in human voice production, focusing on the formation and evolution of jet flows in the glottal and pharyngeal regions. The glottal jet is hypothesized to play a key role in the flow-induced vibration of the vocal folds and in the production of voiced sound, as well as a central role in determining both voice efficiency (through turbulent dissipation) and voice quality (through producing perturbations and fluctuations in voiced sound output). This hypothesis rests on the well-established instability of jet flows, which may lead to variations in the formation and evolution of the jet across vocal fold vibration cycles. A central consideration to the proposed work is, then, to what extent glottal aerodynamics may be considered quasisteady. The degree to which the glottal jet manifests these effects has not yet been directly addressed, in part because what experimental data exists concerning glottal jet behavior was obtained using invasive point measurement techniques. These methods preclude systematic study of cycle-to-cycle variations in both the spatial and temporal structure of the jet. In addition, previous modeling of glottal flow has considered the effect of the jet in a limited manner. The proposed research will address these issues directly, making use of recent advances in computational and experimental fluid dynamics techniques, which have not yet been applied to speech science. In vitro experiments in which the instantaneous particle velocity and acceleration fields of a water flow through a moving vocal fold wall model are successively measured in real time using video Particle Image Velocimetry/Accelerometry (PIV/A). In order to assure spatial and temporal resolution, the glottal model is scaled up and the appropriate Reynolds number and Strouhal number ranges (500
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Project Title: PHYSIOLOGICAL CONSTRAINTS IN THE MODELING OF PROSODY Principal Investigator & Institution: Hanson, Helen M.; None; Massachusetts Institute of Technology Room E19-750 Cambridge, Ma 02139 Timing: Fiscal Year 2002; Project Start 15-AUG-2000; Project End 31-JUL-2004
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Summary: The objectives of the proposed research are to develop and to implement a model of prosody in which the control parameters are based on physiological parameters. In particular, the model will specify the control of intonation and the state of the glottal source during the production of continuous speech. In the model, phonological descriptors of intonation will first be mapped to physiological control parameters consisting of the subglottal pressure and parameters relating to the vocalfold tension and the glottal configuration. These physiological control parameters will then be transformed into parameters specifying the acoustic attributes of the glottal source, including the frequency (FO), amplitude, and waveform shape of the glottal pulses, and the presence of glottalization. Variations in fundamental frequency and glottal waveform due to intrinsic effects of vowel height and obstruent voicing are incorporated in the model. A second, related, objective is to implement this model and to incorporate it into an existing quasi-articulatory speech synthesizer, HLsyn. The effectiveness of the model in creating improved prosody in the synthetic speech will be evaluated, through tests in which listeners make judgments of the intelligibility and quality of the speech. Development of the model will be based on data obtained from simultaneous acoustic and physiological measures of airflows and pressures from utterances with a variety of prosodic shapes produced by several talkers. From the acoustic and aerodynamic data, some of the physiological parameters such as glottal configuration, subglottal pressure, and vocal-fold stiffness will be inferred. These data will be used to answer two questions: (1) When sequences of syllables with specified pitch accents and degrees of reduction are produced, how do the physiological measures change with time? (2) What are the equations relating the physiological parameters to the acoustic parameters that describe the glottal source? This research will lead to proposed methods for classifying prosodic elements such as pitch accents and boundary tones in terms of physiological parameters that specify how these elements are produced. It is recognized that deficiencies in respiratory and laryngeal control underlie a variety of speech disorders. The models developed here will provide some insight into how human speakers control these structures to produce the prosodic aspects of speech. This knowledge will help clinicians in the development of procedures for remediating prosodic disorders of speech production. The synthesizer will also have the capability of demonstrating to clinicians or students the consequences of deviant control of respiration and of laryngeal state. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PHYSIOLOGY & MEASUREMENT OF VOCAL FOLD VIBRATION Principal Investigator & Institution: Jiang, Jack J.; Associate Professor; Surgery; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 31-JUL-2006 Summary: Biomechanical research approaches have contributed information about vocal fold vibration that has become important to clinical decision making. However, the increasingly sophisticated surgical techniques available to clinicians will make it critical to improve the scientific base understanding specific abnormalities of vocal production. This application requests support to continue development of research in the related fields of laryngeal physiology, pathophysiology and biomechanics. The longrange goals of this experimental work are to better understand both normal and pathological phonation and to contribute to the development of valid, comprehensive and noninvasive clinically feasible methods of representing and measuring the physiology of phonation. This proposal has two related parts. The first addresses the physiology of specific vocal fold pathologies and how particular biomechanical
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variations cause pathological phonation. An excised larynx model will be used to stimulate abnormal variations in vocal fold mechanical properties such as stiffness, tension, variations in approximation, and alterations in the vertical tension of vocal fold cover. The studies will measure the effects of stiffness, variations in the adduction of upper and lower lips of the folds and asymmetry of the glottis and of vocal fold tension. The results of vocal fold mass changes, the specific effects of surgical augmentation of the vocal folds and changes associated with dehydration of the vocal folds will be examined. Measurements will be made of vocal fold stiffness, amplitude of vocal fold vibration and mucosal epithelial wave. Additional measures will assess stability and efficiency of vibration, phonation threshold pressure, vocal fold contact area and the spatial distribution of the contact area and intraglottal stress. As a supplement to the excised larynx model, a finite element analysis (FEA) computer model and a mucosal wave model will be studied. The purpose of these series of systematic measurements of the effects of specific biomechanical variables is to better understand the mechanisms that result in abnormal phonation. The second part of this proposal focuses on development of a multiple-measurement approach in order to non-invasively evaluate the characteristics of vocal fold vibration patterns. This part of the study will integrate data from high-speed video, PGG and EGG to improve the measurement of vocal fold vibration based upon system analyses. Measurements using non-invasive methodologies will be compared with direct measurements in the excised larynx model of pathological conditions in order to establish validity and calibration for the noninvasive measures. The data from these controlled experimental studies will be compared to data from a large database of simultaneously recorded multiple measurements from patients with known laryngeal pathologies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with epiglottis, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “epiglottis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for epiglottis (hyperlinks lead to article summaries): •
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A case of chondronecrosis of the epiglottis after laser chordotomy. Author(s): Muller A, Gottschall R, Paulsen F. Source: Eur Arch Otorhinolaryngol. 2002 November;259(10):524-6. Epub 2002 June 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12434185
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 case of pleomorphic adenoma of the epiglottis. Bilateral vocal-cord paralysis after YAG laser surgery. Author(s): Ito A, Sone M, Kitamura Y, Fukuta S, Nakashima T, Yanagita N. Source: Auris, Nasus, Larynx. 1997 July; 24(3): 303-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9251860
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A case of zygomycosis and invasive candidiasis involving the epiglottis and tongue in an immunocompromised patient. Author(s): Chemaly RF, Fox SB, Alkotob LM, Scharpf J, Sobecks R, Eliachar I, Procop GW, Smith M, Avery RK, Schmitt SK. Source: Scandinavian Journal of Infectious Diseases. 2002; 34(2): 149-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11928855
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A high, large epiglottis disturbs proper positioning of the laryngeal mask and cuffed oropharyngeal airway. Author(s): Kawana S, Matsuno A, Nakabayashi K, Yamamoto S, Iwasaki H, Watanabe H, Namiki A, Hirano T. Source: Anesthesia and Analgesia. 1998 August; 87(2): 489-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9706956
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A large floppy epiglottis as a cause of difficult tracheal intubation. Author(s): Asai T, Shingu K. Source: European Journal of Anaesthesiology. 2001 May; 18(5): 339-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11350481
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A reappraisal of the radiologic findings of acute inflammation of the epiglottis and supraglottic structures in adults. Author(s): Nemzek WR, Katzberg RW, Van Slyke MA, Bickley LS. Source: Ajnr. American Journal of Neuroradiology. 1995 March; 16(3): 495-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7793372
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Acquired factor VIII inhibitor with squamous cell cancer of the epiglottis. Author(s): Shastri KA, Logue GL, Zeid MY, Behrens AN, Lenahan EJ, Haar JG. Source: Archives of Otolaryngology--Head & Neck Surgery. 1990 March; 116(3): 350-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2106329
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Acquired laryngomalacia: epiglottis prolapse as a cause of airway obstruction. Author(s): Rowe-Jones J, Moore-Gillon V, Hamilton P. Source: The Annals of Otology, Rhinology, and Laryngology. 1993 June; 102(6): 485-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8512280
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Acquired laryngomalacia: epiglottis prolapse as a cause of airway obstruction. Author(s): Woo P. Source: The Annals of Otology, Rhinology, and Laryngology. 1992 April; 101(4): 314-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1562135
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Acute epiglottis associated with nasal foreign body: occurrence in a 30-month-old girl. Author(s): Oh TH, Gaudet T. Source: Clinical Pediatrics. 1977 November; 16(11): 1067-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=913010
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Acute epiglottis in adults. Author(s): Wick F, Ballmer PE, Haller A. Source: Swiss Medical Weekly : Official Journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology. 2002 October 12; 132(37-38): 541-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12557859
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Acute epiglottis in children and adults. Nasotracheal intubation, tracheostomy or careful observation? Current status in Scandinavia. Author(s): Arndal H, Andreassen UK. Source: The Journal of Laryngology and Otology. 1988 November; 102(11): 1012-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3209934
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Acute epiglottis with Ludwig's angina. Author(s): Sinha SN. Source: Eye Ear Nose Throat Mon. 1973 February; 52(2): 66-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4684024
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Acute epiglottis. Author(s): Kumar RK, Maskell K. Source: Journal of Paediatrics and Child Health. 1998 December; 34(6): 594. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9928662
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Acute epiglottis. Author(s): Diliberti JH. Source: Am J Dis Child. 1976 June; 130(6): 676. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=937289
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Acute epiglottis: a case cluster. Author(s): Murphy PG, Barr JG. Source: Ulster Med J. 1988 October; 57(2): 205-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3266044
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Acute epiglottis: pitfalls in diagnosis and management. Author(s): Rapkin RH. Source: Clinical Pediatrics. 1971 June; 10(6): 312-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5578151
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Acute upper airway obstruction. Sodium warfarin-induced hemorrhage into the base of the tongue and epiglottis. Author(s): Lee M, Berger HW, Granada MG. Source: Chest. 1980 March; 77(3): 454-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6965638
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Adenocarcinoma of the epiglottis. Report of a case and review of the literature. Author(s): Bloom J, Behar AJ, Zikk D, Shanon E. Source: Archives of Otolaryngology--Head & Neck Surgery. 1987 December; 113(12): 1330-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2823851
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Adenocarcinoma of the epiglottis: report of a case. Author(s): Lands RH. Source: J Tenn Med Assoc. 1995 September; 88(9): 350. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7674665
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Adult floppy epiglottis: a simple surgical remedy. Author(s): Harries PG, Randall CJ. Source: The Journal of Laryngology and Otology. 1995 September; 109(9): 871-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7494124
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Agenesis of the epiglottis and false vocal folds with maxillary hypoplasia in an adult. Author(s): Hong KH, Yang YS. Source: The Journal of Laryngology and Otology. 2003 November; 117(11): 895-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14670154
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Age-related changes in the epiglottis causing failure of nasal continuous positive airway pressure therapy. Author(s): Verse T, Pirsig W. Source: The Journal of Laryngology and Otology. 1999 November; 113(11): 1022-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10696386
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Amelanotic melanoma metastatic to the epiglottis. Author(s): Ikeda M, Takahashi H, Karaho T, Kitahara S, Inouye T. Source: The Journal of Laryngology and Otology. 1991 September; 105(9): 776-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1919354
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An abnormal epiglottis as a cause of difficult intubation--airway assessment using magnetic resonance imaging. Author(s): Hotchkiss RS, Hall JR, Braun IF, Schisler JQ. Source: Anesthesiology. 1988 January; 68(1): 140-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3337369
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An abnormal epiglottis but an easy intubation. Author(s): Graig RG, Patwardhan A. Source: Anaesthesia. 1998 October; 53(10): 1036. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9893564
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An unusual case of respiratory obstruction due to inhalation of the epiglottis with an unusual attempt at self-treatment. Author(s): Hardingham M, Young PN. Source: British Medical Journal. 1979 August 4; 2(6185): 309-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=476442
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Angioedema for the epiglottis associated with enalapril. Author(s): Tsunoda K, Hozaki F, Aikawa J. Source: The Laryngoscope. 2000 December; 110(12): 2147-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11129038
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Ankyloglossia with deviation of the epiglottis and larynx. Author(s): Mukai S, Mukai C, Asaoka K. Source: Ann Otol Rhinol Laryngol Suppl. 1991 May; 153: 3-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2024905
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Aplasia of the epiglottis: a rare congenital anomaly. Author(s): Bonilla JA, Pizzuto MP, Brodsky LS. Source: Ear, Nose, & Throat Journal. 1998 January; 77(1): 51-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9473833
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Aspergillus infection of the epiglottis in a HIV positive patient. Author(s): Sriskandabalan P, Roy RB. Source: Genitourinary Medicine. 1996 December; 72(6): 431-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9038641
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Bifid epiglottis and polydactyly: a new genetic syndrome. Author(s): McClay JE, Wiatrak B, Proud VK. Source: Otolaryngology and Head and Neck Surgery. 1997 January; 116(1): 129-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9018273
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Bifid epiglottis associated with Joubert's syndrome. Author(s): Sung MW, Kim JW, Kim KH. Source: The Annals of Otology, Rhinology, and Laryngology. 2001 February; 110(2): 1946. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11219529
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Bifid epiglottis syndrome. Author(s): Sturgis EM, Howell LL. Source: International Journal of Pediatric Otorhinolaryngology. 1995 October; 33(2): 14957. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7499047
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Bifid epiglottis, hand anomalies, and congenital hypopituitarism. Author(s): Graham JM, Brown FE, Saunders RL, Hinkle AJ, Frank JE, Harris MS, Klein RZ. Source: Lancet. 1985 August 24; 2(8452): 443. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2863464
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Bifid epiglottis. Author(s): Stroh B, Rimell FL, Mendelson N. Source: International Journal of Pediatric Otorhinolaryngology. 1999 January 25; 47(1): 81-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10206398
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Bifid epiglottis. Author(s): Goldenberg JD, Holinger LD, Bressler FJ, Hutchinson LR. Source: The Annals of Otology, Rhinology, and Laryngology. 1996 February; 105(2): 1557. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8659937
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Bifid epiglottis. Report of a case. Author(s): DelMonico ML, Haar JG. Source: Arch Otolaryngol. 1972 August; 96(2): 178-81. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5081924
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Bifid epiglottis: a case report. Author(s): Prescott CA. Source: International Journal of Pediatric Otorhinolaryngology. 1994 August; 30(2): 16770. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8063503
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Bifid epiglottis: a rare laryngeal anomaly. Author(s): Healy GB, Holt GP, Tucker JA. Source: The Laryngoscope. 1976 October; 86(10): 1459-68. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=966913
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Biomechanics of the human epiglottis. Author(s): Fink BR, Martin RW, Rohrmann CA. Source: Acta Oto-Laryngologica. 1979 May-June; 87(5-6): 554-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=463526
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Carcinoma arising in a pleomorphic adenoma of the epiglottis. Author(s): Milford CA, Mugliston TA, O'Flynn P, McCarthy K. Source: The Journal of Laryngology and Otology. 1989 March; 103(3): 324-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2539422
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Cartilaginous metaplasia of the epiglottis. Author(s): Lee AH, Ramsay AD. Source: The Journal of Laryngology and Otology. 1990 November; 104(11): 903-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2266320
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Case report: chondrosarcoma of the epiglottis. Author(s): Cheung W, Leong LL, Chan FL. Source: The British Journal of Radiology. 1993 May; 66(785): 471-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8319072
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Chondrodysplasia, situs inversus totalis, cleft epiglottis and larynx, hexadactyly of hands and feet, pancreatic cystic dysplasia, renal dysplasia/absence, micropenis and ambiguous genitalia, imperforate anus. Author(s): Fraser FC, Jequier S, Chen MF. Source: American Journal of Medical Genetics. 1989 November; 34(3): 401-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2596528
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Chondrosarcoma of the epiglottis with regional and distant metastasis. Author(s): Jacobs RD, Stayboldt C, Harris JP. Source: The Laryngoscope. 1989 August; 99(8 Pt 1): 861-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2755296
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Chondrosarcoma of the epiglottis. Author(s): Kasanzew M, John DG, Newman P, Lesser TJ, Thomas PL. Source: The Journal of Laryngology and Otology. 1988 April; 102(4): 374-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3385336
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Chromosome 9 anomalies as the primary clonal alteration in a case of squamous cell carcinoma of the epiglottis. Author(s): Sen P. Source: Cancer Genetics and Cytogenetics. 1993 March; 66(1): 23-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8467470
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Complete median cleft of the mandible and aplasia of the epiglottis. A case report. Author(s): Constantinides CG, Cywes S. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1983 August 20; 64(8): 293-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6879386
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Computed tomography of hamartoma of the epiglottis. Author(s): Eustace S, Suojanen J. Source: Clinical Imaging. 1995 October-December; 19(4): 237-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8564865
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Congenital absence of the epiglottis and its potential role in obstructive sleep apnea. Author(s): Reyes BG, Arnold JE, Brooks LJ. Source: International Journal of Pediatric Otorhinolaryngology. 1994 November; 30(3): 223-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7836035
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Congenital absence of the epiglottis. Author(s): Koempel JA, Holinger LD. Source: International Journal of Pediatric Otorhinolaryngology. 1998 October 15; 45(3): 237-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9865440
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Congenital ankyloglossia with deviation of the epiglottis and larynx: symptoms and respiratory function in adults. Author(s): Mukai S, Mukai C, Asaoka K. Source: The Annals of Otology, Rhinology, and Laryngology. 1993 August; 102(8 Pt 1): 620-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8352487
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Congenital laryngeal stridor secondary to flaccid epiglottis, anomalous accessory cartilages and redundant aryepiglottic folds. Author(s): Templer J, Hast M, Thomas JR, Davis WE. Source: The Laryngoscope. 1981 March; 91(3): 394-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7464401
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Correct positioning of the epiglottis for application of the Brain laryngeal mask airway. Author(s): Fukutome T. Source: Anaesthesia. 1995 September; 50(9): 818-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7573878
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Crohn's disease of the epiglottis, aryepiglottic folds, anus, and rectum. Author(s): Wilder WM, Slagle GW, Hand AM, Watkins WJ. Source: Journal of Clinical Gastroenterology. 1980 March; 2(1): 87-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7347358
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Cyst of epiglottis. Author(s): McHugh P. Source: Anaesthesia. 1989 June; 44(6): 522. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2757165
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Double epiglottis in Weyer's acrofacial dysostosis. Author(s): Wittig FJ, Hickey SA, Kumar M. Source: The Journal of Laryngology and Otology. 1998 October; 112(10): 976-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10211227
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Double trouble: prolapsing epiglottis and unexpected dual pathology in an infant. Author(s): De Beer D, Chambers N. Source: Paediatric Anaesthesia. 2003 June; 13(5): 448-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12791121
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Downfolding of the epiglottis induced by the laryngeal mask airway in children: a comparison between two insertion techniques. Author(s): Tsujimura Y. Source: Paediatric Anaesthesia. 2001 November; 11(6): 651-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11696139
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Epiglottis acuta treated with nasotracheal intubation. Author(s): Enoksen A, Bryne H, Hoel TM, Havnen J. Source: Acta Anaesthesiologica Scandinavica. 1979 October; 23(5): 422-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=316956
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Epiglottis in reconstruction of the larynx and trachea. Author(s): Olson NR, Sullivan MJ. Source: The Annals of Otology, Rhinology, and Laryngology. 1985 September-October; 94(5 Pt 1): 437-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4051398
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Epiglottis involvement in a visceral leishmaniasis. Author(s): Granel B, Serratrice J, Christides C, Richard-Vitton T, Minodier P, Horshowski N, Disdier P, Thomassin JM, Weiller PJ. Source: The Journal of Infection. 2002 October; 45(3): 196-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12387777
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Expression of epithelial membrane antigen and secretory component in carcinomas of the laryngeal ventricle, epiglottis and vocal cord. Author(s): Nakashima T, Nomura Y, Matsumara Y, Hayashi I. Source: Acta Oto-Laryngologica. 1992 September; 112(5): 890-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1456046
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Extraskeletal myxoid chondrosarcoma of the epiglottis: case report and review of the literature. Author(s): Wilkinson AH 3rd, Beckford NS, Babin RW, Parham DM. Source: Otolaryngology and Head and Neck Surgery. 1991 February; 104(2): 257-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1901157
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Fungal infection of the epiglottis simulating a clinical malignancy. Author(s): Makitie AA, Back L, Aaltonen LM, Leivo I, Valtonen M. Source: Archives of Otolaryngology--Head & Neck Surgery. 2003 January; 129(1): 124-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12525207
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Glial fibrillary acidic protein in chondrocytes of elastic cartilage in the human epiglottis: an immunohistochemical study with polyvalent and monoclonal antibodies. Author(s): Kepes JJ, Perentes E. Source: The Anatomical Record. 1988 March; 220(3): 296-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3364756
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Graft-vs-host disease as a cause of enlargement of the epiglottis in an immunocompromised child. Author(s): de Diego JI, Prim MP, Hardisson D, del Palacio AJ, Rabanal I. Source: Archives of Otolaryngology--Head & Neck Surgery. 2001 April; 127(4): 439-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11296055
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Granulocytic sarcoma (chloroma) of the epiglottis. Author(s): Ferguson JL, Maragos NE, Weiland LH. Source: Otolaryngology and Head and Neck Surgery. 1987 December; 97(6): 588-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3124040
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Herpes simplex of the epiglottis. Author(s): Schwenzfeier CW, Fechner RE. Source: Arch Otolaryngol. 1976 June; 102(6): 374-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=776155
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Heterotopic gastric mucosa in the epiglottis and rectum. Author(s): Picard EJ, Picard JJ, Jorissen J, Jardon M. Source: Am J Dig Dis. 1978 March; 23(3): 217-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=665609
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Hypoplasia of the epiglottis: case report and review. Author(s): Benjamin B, Dalton C. Source: International Journal of Pediatric Otorhinolaryngology. 1996 December 5; 38(1): 65-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9119594
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Intrinsic fibre architecture and attachments of the human epiglottis and their contributions to the mechanism of deglutition. Author(s): Vandaele DJ, Perlman AL, Cassell MD. Source: Journal of Anatomy. 1995 February; 186 ( Pt 1): 1-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7649805
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Jaw thrust manoeuvre for repositioning the epiglottis down folded by the ILM. Author(s): Murashima K, Fukutome T. Source: Anaesthesia. 2000 September; 55(9): 921-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10947772
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Kimura's disease of the epiglottis. Author(s): Cho MS, Kim ES, Kim HJ, Yang WI. Source: Histopathology. 1997 June; 30(6): 592-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9205867
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Laryngeal reconstruction with epiglottis after vertical hemilaryngectomy. Author(s): Kambic V, Radsel Z, Smid L. Source: The Journal of Laryngology and Otology. 1976 May; 90(5): 467-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1270919
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Leech in the epiglottis: an unusual discovery in our times. Author(s): Garcia AC, Martin AM, De Luna Gijon CA, Martin Anaya AS, Mondejar AR. Source: American Journal of Otolaryngology. 2002 March-April; 23(2): 91-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11893976
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Lipoma of the epiglottis and lipoma of the hypopharynx in the same patient. Author(s): Eagle WW. Source: The Annals of Otology, Rhinology, and Laryngology. 1965 September; 74(3): 851-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5846541
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Lipoma of the epiglottis and lipoma of the hypopharynx in the same patient. Author(s): Eagle WW. Source: Trans Am Laryngol Assoc. 1965; 86: 133-46. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5862572
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Mallampati test and the epiglottis. Author(s): Palmer J. Source: Anaesthesia. 1999 February; 54(2): 202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10216034
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Malposition of the epiglottis after tracheal intubation via the intubating laryngeal mask. Author(s): Takenaka I, Aoyama K, Nagaoka E, Seto A, Niijima K, Kadoya T. Source: British Journal of Anaesthesia. 1999 December; 83(6): 962-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10700803
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Mast cells in elastic cartilage of the human epiglottis. Author(s): Pawlicki R. Source: Folia Histochem Cytobiol. 1993; 31(4): 207-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8138001
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Maturational descent of the epiglottis. Author(s): Schwartz DS, Keller MS. Source: Archives of Otolaryngology--Head & Neck Surgery. 1997 June; 123(6): 627-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9193225
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Melanoma of the epiglottis. A case treated by supraglottic laryngectomy. Author(s): Shanon E, Covo J, Loeventhal M. Source: Arch Otolaryngol. 1970 March; 91(3): 304-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5414089
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Mixed tumor of the epiglottis: case report. Author(s): Tobin HA. Source: Otolaryngology and Head and Neck Surgery. 1981 November-December; 89(6): 953-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6278381
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Movement of the epiglottis during deglutition. A cineradiographic study. Author(s): Ekberg O, Sigurjonsson SV. Source: Gastrointest Radiol. 1982; 7(2): 101-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7084590
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Mucosa and taste buds of the human epiglottis. Author(s): Jowett A, Shrestha R. Source: Journal of Anatomy. 1998 November; 193 ( Pt 4): 617-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10029195
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Nasogastric tube knotting over the epiglottis: a cause of respiratory distress. Author(s): Agarwal A, Gaur A, Sahu D, Singh PK, Pandey CK. Source: Anesthesia and Analgesia. 2002 June; 94(6): 1659-60, Table of Contents. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12032048
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Nerve endings in the epithelium and submucosa of human epiglottis. Author(s): Villaverde R, Pastor LM, Calvo A, Ferran A, Sprekelsen C. Source: Acta Oto-Laryngologica. 1994 July; 114(4): 453-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7976319
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Obstructive sleep apnea initiated by a lax epiglottis. A contraindication for continuous positive airway pressure. Author(s): Andersen AP, Alving J, Lildholdt T, Wulff CH. Source: Chest. 1987 April; 91(4): 621-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3549178
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Oncocytoma of the epiglottis. Author(s): Sasaki CT, Holmes RE. Source: Ear, Nose, & Throat Journal. 1976 September; 55(9): 14-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=971667
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Ontogenesis of the elastic cartilage of the human epiglottis. A light microscopy study. Author(s): Adam P, Pohunkova H. Source: Folia Morphol (Praha). 1986; 34(4): 419-29. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3804099
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Ossification of the epiglottis. Author(s): Milroy CM. Source: The Journal of Laryngology and Otology. 1992 February; 106(2): 180-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1556499
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Pathology forum: quiz case 1. Diagnosis: posttransplant lymphoproliferative disease (PTLD) of the epiglottis. Author(s): Rosbe KW, Perez-Atayde AR, Roberson DW, Kenna M. Source: Archives of Otolaryngology--Head & Neck Surgery. 2000 September; 126(9): 1153; Discussion 1157-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10979133
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Pedunculated lipoma of the epiglottis. Second known case reported. Author(s): Di Bartolomeo JR, Olsen AR. Source: Arch Otolaryngol. 1973 July; 98(1): 55-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4713142
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Pleomorphic adenoma of the epiglottis. Author(s): Baptista PM, Garcia-Tapia R, Vazquez JJ. Source: The Journal of Otolaryngology. 1992 October; 21(5): 355-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1335093
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Pleomorphic adenoma of the epiglottis: report of a case. Author(s): Cotelingam JD, Barnes L, Nixon VB. Source: Arch Otolaryngol. 1977 April; 103(4): 245-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=849205
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Polypoid adenosquamous carcinosarcoma of the epiglottis with blastomatous features. Author(s): McGregor DH, Lee SH, McMahon MF. Source: Ann Clin Lab Sci. 1991 November-December; 21(6): 413-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1781665
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Postnatal descent of the epiglottis in man. A preliminary report. Author(s): Sasaki CT, Levine PA, Laitman JT, Crelin ES Jr. Source: Arch Otolaryngol. 1977 March; 103(3): 169-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=836246
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Rare case of obscure haemorrhage in the upper digestive tract (epiglottis). Author(s): Manni JJ, Schaafsma HE, Westerbeek GF, Yap SH. Source: The Journal of Laryngology and Otology. 1989 March; 103(3): 331-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2703779
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Reconstruction of pharyngoesophagus using mucosa of epiglottis. Author(s): Sabri JA. Source: Otolaryngology and Head and Neck Surgery. 1981 September-October; 89(5): 746-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6799901
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Respiratory obstruction by epiglottis. Author(s): Davies JR. Source: British Medical Journal. 1979 September 8; 2(6190): 610. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=497734
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Respiratory obstruction due to impaction of epiglottis. A case report. Author(s): Morrow WF. Source: British Journal of Anaesthesia. 1965 December; 37(12): 980-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5856659
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Retention cyst of the epiglottis: CT appearance. Author(s): Stark P. Source: Journal of Computer Assisted Tomography. 1985 May-June; 9(3): 582-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3989061
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Schwannoma of the epiglottis: first report of a case. Author(s): Martin PA, Church CA, Chonkich G. Source: Ear, Nose, & Throat Journal. 2002 September; 81(9): 662-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12353445
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Sensory nerve endings in the mucosa of the epiglottis--morphologic investigations with silver impregnation, immunohistochemistry, and electron microscopy. Author(s): Shin T, Watanabe S, Wada S, Maeyama T. Source: Otolaryngology and Head and Neck Surgery. 1987 January; 96(1): 55-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2444915
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Significance of site and nodal metastases in squamous cell carcinoma of the epiglottis. Author(s): Razack MS, Silapasvang S, Sako K, Shedd DP. Source: American Journal of Surgery. 1978 October; 136(4): 520-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=707735
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Solitary extramedullary plasmacytoma of the epiglottis: a case report and review of the literature. Author(s): Rolins H, Levin M, Goldberg S, Mody K, Forte FJ. Source: Otolaryngology and Head and Neck Surgery. 1995 June; 112(6): 754-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7777365
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Solitary plasmacytoma of the epiglottis: a case report and review of the literature. Author(s): Welsh J, Westra WH, Eisele D, Hogan R, Lee DJ. Source: The Journal of Laryngology and Otology. 1998 February; 112(2): 174-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9578880
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Squamous carcinoma of the epiglottis with sebaceous differentiation. Report of a case. Author(s): Baiocco R, Palma O, Locatelli G. Source: Pathologica. 1995 October; 87(5): 531-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8868182
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Squamous cell carcinoma of the epiglottis in a homosexual man at risk for AIDS. Author(s): Alhashimi MM, Krasnow SH, Johnston-Early A, Cohen MH. Source: Jama : the Journal of the American Medical Association. 1985 April 26; 253(16): 2366. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3981763
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Stridor from edema of the arytenoids, epiglottis, and vocal cords after use of free-base cocaine. Author(s): Silverman RS, Lee-Chiong TL Jr, Sherter CB. Source: Chest. 1995 November; 108(5): 1477-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7587472
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The enlarged epiglottis. Author(s): Watts FB Jr, Slovis TL. Source: Pediatric Radiology. 1977 March 17; 5(3): 133-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=846759
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The epiglottis and obstructive sleep apnoea syndrome. Author(s): Catalfumo FJ, Golz A, Westerman ST, Gilbert LM, Joachims HZ, Goldenberg D. Source: The Journal of Laryngology and Otology. 1998 October; 112(10): 940-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10211216
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The epiglottis: a structure not normally seen during routine oral examination. Author(s): Krier PW. Source: Gen Dent. 1979 July-August; 27(4): 26-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=297636
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The function of the epiglottis in monkey and man. Author(s): Laitman JT, Crelin ES, Conlogue GJ. Source: Yale J Biol Med. 1977 January-February; 50(1): 43-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=403687
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The function of the epiglottis in speech. Author(s): Laufer A, Condax ID. Source: Language and Speech. 1981 January-March; 24(Pt 1): 39-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7266191
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The glycosaminoglycans of the human epiglottis. Author(s): Solheim K. Source: J Oslo City Hosp. 1968 March; 18(3): 45-50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4233137
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The lymphatic tissue of the dorsal surface of the epiglottis--the "epiglottal tonsil". Author(s): Holibkova A. Source: Folia Morphol (Praha). 1972; 20(2): 204-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5021687
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The mechanism of the larynx. II. The epiglottis and closure of the larynx. Author(s): Ardran GM, Kemp FH. Source: The British Journal of Radiology. 1967 May; 40(473): 372-89. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6022785
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The use of the epiglottis as an autologous composite graft in eyelid reconstruction. Author(s): Adams JL, Olson NR, Siders DB. Source: Ophthalmic Plastic and Reconstructive Surgery. 1993; 9(3): 206-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8217963
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Traumatic epiglottis following blind finger sweep to remove a pharyngeal foreign body. Author(s): Kabbani M, Goodwin SR. Source: Clinical Pediatrics. 1995 September; 34(9): 495-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7586923
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Treatment of carcinoma of the epiglottis. Author(s): Nadol JB Jr. Source: The Annals of Otology, Rhinology, and Laryngology. 1981 September-October; 90(5 Pt 1): 442-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7305196
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Tubercular granuloma of the epiglottis. Author(s): Khan IU. Source: J Pak Med Assoc. 1982 May; 32(5): 128-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6811777
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Tuberculous granuloma of the epiglottis. Author(s): Khan I. Source: The Journal of Laryngology and Otology. 1983 October; 97(10): 969-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6619659
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Ultrastructure of the glomerular corpuscular nerve endings in the subepithelium of human epiglottis. Author(s): Chiba T, Watanabe S, Shin T. Source: Arch Histol Jpn. 1985 April; 48(2): 213-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4038005
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Visualization of the epiglottis in routine oral examinations. Author(s): Mader CL, Lewis DM. Source: Alumni Bull Sch Dent Indiana Univ. 1984 Spring; : 29-31, 82. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6596884
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Well-differentiated liposarcoma of the epiglottis. Author(s): Brauchle RW, Farhood AI, Pereira KD. Source: The Journal of Laryngology and Otology. 2001 July; 115(7): 593-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11485600
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CHAPTER 2. NUTRITION AND EPIGLOTTIS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and epiglottis.
Finding Nutrition Studies on Epiglottis The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “epiglottis” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
4 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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The following information is typical of that found when using the “Full IBIDS Database” to search for “epiglottis” (or a synonym): •
Response characteristics of lamb pontine neurons to stimulation of the oral cavity and epiglottis with different sensory modalities. Author(s): Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor 48109-1078. Source: Sweazey, R D Bradley, R M J-Neurophysiol. 1993 September; 70(3): 1168-80 0022-3077
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/
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 EPIGLOTTIS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to epiglottis. 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 epiglottis 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 “epiglottis” (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 epiglottis: •
Colovesical fistula an unusual complication of cytotoxic therapy in a case of nonHodgkin's lymphoma. Author(s): Ansari MS, Nabi G, Singh I, Hemal AK, Pandey G. Source: International Urology and Nephrology. 2001; 33(2): 373-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12092659
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Intralesional vinblastine therapy for Kaposi's sarcoma of the epiglottis. Author(s): Tami TA, Sharma PK. Source: Otolaryngology and Head and Neck Surgery. 1995 September; 113(3): 283-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7675491
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Results in fifty cases of advanced squamous cell carcinoma of the head and neck treated by intravenous chemotherapy. Author(s): Priestman TJ.
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Source: British Journal of Cancer. 1973 May; 27(5): 400-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4713171
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/
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 EPIGLOTTIS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.5 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “epiglottis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on epiglottis, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Epiglottis By performing a patent search focusing on epiglottis, 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
5Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on epiglottis: •
Adjustable supraglottiscope and methods therefor Inventor(s): Zeitels; Steven M. (20 Burroughs St., Jamaica Plain, MA 02130) Assignee(s): none reported Patent Number: 5,092,314 Date filed: May 8, 1990 Abstract: An adjustable supraglottiscope designed to be used in the supraglottic larynx is disclosed, in particular, an improved apparatus for endoscopic surgery in the supraglottis and the lower pharynx is disclosed by having at least one blade that is at least as wide as the normal, human epiglottis in its natural position within the body. The blades of the supraglottiscope have a length to width ratio that is about one-half of that found in conventional instruments. This unique ratio enables a wider exposure of the supraglottic larynx and lower pharynx. Methods of performing surgery on the supraglottic larynx of a patient are also described. Excerpt(s): Laryngoscopes are routinely used to facilitate endotracheal intubation of patients, to provide an air passage for administration of anesthesia and/or to establish an airway that is obstructed. In addition, laryngoscopes are commonly used in surgery to displace pharyngeal tissues to permit direct inspection of the larynx (i.e. direct laryngoscopy). Anesthesiologists use laryngoscopes that are L-shaped having a handle connected to single curved or straight blade. Otolaryngologists typically use a tubed laryngoscope to view the larynx and operate endoscopically on the true vocal cords (i.e. glottis). Modern adjustable laryngoscopes, the forerunners of which first appeared in the early decades of the twentieth century, are all bivalved glottiscopes designed for use on the true vocal cords. They characteristically possess long and narrow blades. Adjustable glottiscopes are designed to be inserted into the mouth and down the throat. The superior blade engages the tongue and supraglottis while the inferior blade engages the roof of the mouth and the posterior pharyngeal wall. The length of the blades allows for exposure of the true vocal cords. Examples of such laryngoscopes include the Weerda Laryngoscope (Karl Storz Co., Culver City, Calif.) and the Steiner Laryngoscope (Richard Wolf Co., Rosemont, Ill.). They are conveniently used for surgery in the lower larynx (true vocal cords/glottis). Web site: http://www.delphion.com/details?pn=US05092314__
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Anti-choking manikin Inventor(s): Heller; Robert D. (Green Bay, WI) Assignee(s): Medical Plastics Laboratory, Inc. (Gatesville, TX) Patent Number: 4,194,303 Date filed: June 2, 1978 Abstract: Apparatus for teaching a technique known as the "abdominal thrust" or "upward thrust" for dislodging food from the throat of a choking victim. The device comprises a plastic manikin in the shape of a upper torso of a human being having an air bellows secured to the rear portion of the manikin within the hollow portion of the manikin and engaging a soft, flexible solar plexus plate located in a simulated position
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between where the lower rib would end and the lower portion of the stomach. The air bellows communicates with a tubular passage which is connected to the mouth of the victim. A bolus simulating a food particle is placed in the simulated throat and mouth piece and lodges against a shoulder which simulates the epiglottis in the esophagus. By engaging the solar plexus plate in the proper place and thrusting in the proper direction as taught by the technique, sufficient air is forced through the tubular passage to dislodge the bolus from the mouthpiece. Excerpt(s): Several people each year die from food stuck in their throat. Food strangulation can happen to anyone, healthy or old people, and often is the result of not carefully cutting the meat into small pieces or chewing it adequately. If the windpipe is completely blocked, death can occur within four to five minutes. There are a large number of first aid measures which have been developed in attempting to rescue someone who is choking, such as forcing a cough, bending a person over and giving him a hard slap on the shoulder blades, attempting to remove lodged objects with the fingers, or even cutting a hole through the neck into the windpipe to perform a tracheotomy to create an emergency airway. Most of these methods are only partially successful and can create a hazard for the victim. A new method of technique has been developed by a surgeon, Dr. Henry J. Heimlich of Cincinnati, which involves an abrupt upward squeeze of the choking victim's upper abdomen to expel the object blocking the windpipe. The techique utilizes the air within the lungs and a utilization of a soft spot in the solar plexus to quickly move the diaphragm to a position to expel the air in the lung at a rapid rate to expel the blocking object. Web site: http://www.delphion.com/details?pn=US04194303__ •
Balloon laryngoscope Inventor(s): Rolnick; Michael A. (Chevy Chase, MD) Assignee(s): American Medical and Emergency Research Corporation (Chevy Chase, MD) Patent Number: 4,681,094 Date filed: November 27, 1985 Abstract: A laryngoscope comprising a disposable blade unit including two full length blades releasably interconnected along the length thereof to define a tubular passage. A reusable handle unit removably receives one end of the blade unit and retains the blades thereof. The blade unit includes an inflatable balloon expandable against the roof of the mouth to center an inserted laryngoscope and effect movement thereof against the tongue and epiglottis. A pair of suction channels are defined through the blade unit and communicated with the interior of the tubular passage at the leading end thereof. The handle unit includes means for communicating the balloon and suction passages with sources of positive and negative air pressure respectively. The handle unit also mounts illuminating means and a selectively usable adapter for accommodating a hand manipulable air bag for emergency respiration directly through the laryngoscope. Excerpt(s): The invention herein generally involves medical devices, and more particularly concerns devices for the reestablishment of an air passageway through the throat effected initially by the introduction of the device itself followed by intubation, the introduction of an endotracheal tube into the trachea. Such devices are commonly referred to as laryngoscopes and, in use, are intended to provide a direct line viewing or exposure of the larynx by a pushing back or retracting of the tongue, epiglottis and
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other soft structures within the mouth. As frequently occurs with a critically ill, anesthetized or injured patient, the normal spontaneous respiratory function is affected and could result in a life threatening situation. Under such circumstances, provision must be made for introducing air into the lungs to prevent suffocation. This is normally effected by the placing of a tube through the mouth and into the larynx or trachea to define an open airway through which the attending person can pump air to inflate the lungs and assist in breathing. The actual introduction of the air can be effected by a manual bag pump, as is frequently used in emergency respiratory equipment, or through use of a mechanical pumping device. In using breathing apparatus, it is essential that the windpipe or trachea be kept clear of food or other substances which might affect the free air flow sought. This function, under normal breathing circumstances, is performed by a fleshy, flap-like cover over the trachea, called the epiglottis. In situations where an airway must be established and maintained, the patient is most frequently in a semi-conscious or unconscious state, usually lying on his back. Unfortunately, in this position, the lax tongue of the patient tends to fall back into the throat blocking the epiglottis and closing off the windpipe. Therefore, in order to insert the airway or endotracheal tube, the physician frequently relies upon a device called a laryngoscope. The laryngoscope will normally be positioned within the mouth in a manner so as to move the tongue to a non-blocking position, lift the epiglottis away from the windpipe, and provide for a visual view of the opening of the trachea, normally in the vicinity of the vocal chords, to allow for a manual insertion of the endotracheal tube. As will be readily appreciated, it is important that this procedure be performed as rapidly as possible and air flow reestablished and maintained to prevent permanent injury or asphyxiation. Web site: http://www.delphion.com/details?pn=US04681094__ •
Copa method for fiberoptic endotracheal intubation Inventor(s): Greenberg; Robert S. (Glenelg, MD) Assignee(s): Johns Hopkins University (Baltimore, MD) Patent Number: 5,976,072 Date filed: January 29, 1998 Abstract: For fiberoptic endotracheal intubation, a method is disclosed that uses a device having a cannula with a first, distal end for placement within the pharynx of a patient, a second, proximal end for being disposed outside of the patient's oral cavity, and a flow passage between the first and second ends. The cannula has a length such that, when the distal end is placed within the pharynx, it terminates distally at a point near the patient's epiglottis. The device includes an inflatable cuff structure for forming a seal between a wall of the cannula and the patient's pharynx. The cuff is positioned adjacent to the distal end of the device and defines, on inflation, a ventral/anterior portion and a posterior portion. The method involves a step of inserting the device, with cuff deflated, into a patient's mouth so that the distal end of the device is disposed at a point near the patient's epiglottis to establish an airway column down the core of the device. Once the cuff structure is inflated, the patient's airway is supported to provide spontaneous breathing and controlled ventilation through the flow passage of the device. Then, a fiberoptic scope, on which an endotracheal tube has been preloaded so that the distal tip of the scope projects beyond the endotracheal tube, is inserted into the patient through the patient's oral cavity so that the lip is in the throat past the uvula, whereby after insertion of the device and insertion of the fiberoptic scope, the scope is disposed
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exteriorly of the device. Then, the tip of the fiberoptic scope is advanced so that it enters the trachea. The endotracheal tube is then advanced through the oral cavity and into the trachea using the fiberoptic scope as a guide. Finally, the fiberoptic scope is removed from the trachea. Excerpt(s): The present invention relates to fiberoptic endotracheal intubation and, more particularly, to a method for fiberoptic endotracheal intubation using a cuffed oropharyngeal airway (COPA). Fiberoptic endotracheal intubation has been used for several years and may be performed orally or nasally. Conventional methods of fiberoptic endotracheal intubation use the internal passage of a device, such as a laryngeal masked airway, Combitube.RTM., Ovassapian Airway, or the like. The main disadvantage of passing the fiberoptic scope through an airway device is the increased airway resistance encountered, since the fiberscope occupies a significant portion of the lumen of the device. Moreover, it is impossible with such techniques to provide continuous airway support, either controlled inspired gas concentration or assisted/controlled positive pressure manual ventilation. Fiberoptic intubation with the patient under general anesthesia presents special problems. The main disadvantage of intubation under general anesthesia is that the tongue and pharyngeal tissues lose their tonicity and close down the pharyngeal space, blocking visualization of the larynx. Thus, in such circumstances, to minimize apnea time, and to facilitate laryngeal exposure, an assistant is required. Web site: http://www.delphion.com/details?pn=US05976072__ •
Cuffed oro-pharyngeal airway Inventor(s): Greenberg; Robert S. (Baltimore, MD) Assignee(s): The Johns Hopkins University (Baltimore, MD) Patent Number: 5,443,063 Date filed: August 31, 1993 Abstract: A new type of airway, the cuffed oro-pharyngeal airway (COPA), is described, which may be used as a less cumbersome alternative to face mask/oral airway technique for maintenance of general anesthesia. The airway includes an elongated tube having a length such that the proximal end is adapted to be disposed adjacent to but outside the oral cavity of the patient and the distal end is adapted to be disposed in the lower pharynx of the patient, above the epiglottis. An inelastic, inflatable cuff is mounted to the tube adjacent the distal end. On inflation, the inflatable cuff displaces the soft palate against the nasopharynx to seal-off the nasal passages and defines a seal between the tube and the pharyngeal wall. The inflatable cuff also displaces the base of the patient's tongue, thereby locking the tube in the pharynx and displacing the patient's epiglottis to a more open disposition for more effective anesthesia gas delivery to the lungs. Excerpt(s): The present invention relates to the establishment and maintenance of an airway, particularly during administration of anesthesia. The administration of anesthesia via face mask/oral airway technique requires continuous hands-on management in many cases, and can be quite cumbersome in various situations. Indeed, for example, it is difficult to administer intravenous medications while attempting to maintain an airway with this technique. Likewise, it is cumbersome to attempt to perform face mask anesthesia during ophthalmologic examination, ear examinations or similar procedures. This is because the mask, the anesthesiologist's hands, and the
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surgeon's hands are all in too small an area. Also, because of awkward hand positioning, a patent airway cannot be reasonably assured without repeated manipulation. This is both dangerous to the patient and interrupting to the surgeon. Radiation therapy is another situation where an anesthesiologist needs to maintain a patent airway yet must be distant from the patient, and may be reluctant to instrument the trachea repeatedly. Solutions to this problem have taken form of (i) use of general anesthesia with endotracheal intubation, (ii) use of intravenous techniques without securing the airway with adjunctive devices, and (iii) use of the laryngeal mask. Endotracheal intubation will subject the patient to the risks of this procedure, including laryngoscopy, tracheal irritation, the need for deeper anesthetic, and the possible use of neuromuscular blocking agents. Intravenous techniques alone do not address the issue of a patent airway any more effectively. The laryngeal mask airway has gained some acceptance as a solution to these problems; however, it does require some technical facility, and at times, adjunctive equipment for application and is not itself without complications. Web site: http://www.delphion.com/details?pn=US05443063__ •
Endotracheal tube and method of intubation Inventor(s): Tonrey; Francis G. (P.O. Box 2157, Corrales, NM 87048) Assignee(s): none reported Patent Number: 5,259,371 Date filed: August 13, 1992 Abstract: The present invention is an endotracheal tube and the corresponding method of utilizing the endotracheal tube in an intubation procedure. The endotracheal tube is orally advanced past the epiglottis of a patient. The endotracheal tube then rests upon the patient's larynx which serves to create a base reference point for the positioning of the endotracheal tube within the trachea of the patient. By knowing how far the endotracheal tube is advanced beyond the point of contact with the larynx, the person administering the intubation procedure can accurately position the end of the endotracheal tube safely within the patient's trachea. Excerpt(s): The present invention relates to endotracheal tubes of the type used in the oral intubation of small children, neonate and premature neonate patients, and more particularly to such endotracheal tubes that include a radially extending flange that rests upon the arytenoid cartilages within the larynx of the intubated patient, thereby limiting the depth for which the endotracheal tube can be advanced into the trachea and providing a base point from which the depth of the endotracheal tube below the vocal cords can be measured. Accidental right mainstream endotracheal intubation is a common cause of pulmonary morbidity (i.e. lung collapse, hypoxemia, cardiac arrest, etc.) in all patients undergoing an endotracheal intubation procedure. Accidental right mainstream endotracheal intubation occurs when an endotracheal tube is advanced too far within a patient's trachea. In such a situation, the endotracheal tube enters the right bronchi of the lung causing the left lung to collapse. Such accidental right mainstream endotracheal intubation results in many deaths each year and causes surviving patients to incur extensive pulmonary care. The dangers of accidental right mainstream endotracheal intubation is of particular concern during the intubation of small children, neonate and premature neonate patients. With such patients, the physical length of the patient's trachea is very short. Additionally, the lungs of such patients are often weak, leaving the patient particularly susceptible to the disastrous consequences of accidentally advancing an endotracheal tube beyond the trachea and into the bronchi of
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a lung. As will be recognized by a person skilled in the art, the trachea lays between the larynx of a patient and the left and right bronchi of a patient's lungs. To properly perform an endotracheal intubation procedure, the distal end of an endotracheal tube must be positioned within the patient's trachea. If the distal end of an endotracheal tube were to move out of the trachea, above the larynx, the vocal cords may close, preventing the intubation of the lungs and possibly causing such consequences as suffocation or should the vocal cords not close, gastric content aspiration could occur. If the distal end of the endotracheal tube descends below the trachea, the endotracheal tube typically enters the right mainstream bronchus of the lung causing the pulmonary morbidity effects previously described. Web site: http://www.delphion.com/details?pn=US05259371__ •
Endotracheal-tube guidance system with epiglottis-elevating feature Inventor(s): Brain; Archibald Ian Jeremy (Sandford House Fan Court Gardens, Longcross Road, Chertsey, Surrey, GB) Assignee(s): none reported Patent Number: 5,896,858 Date filed: April 4, 1997 Abstract: An artificial airway device to facilitate a patient's lung ventilation comprises an airway tube and a laryngeal mask at one end of the tube. The mask is of generally elliptical configuration, with an inflatable peripheral cuff of flexible material around the edges of the mask, for sealed support of the mask around the inlet to the patient's larynx. The mask has an aperture through which the airway tube opens into the interior of the mask. The mask also comprises a longitudinally directed bar, extending across the mask aperture, from the central upper edge or rim of the mask aperture, to which it has effectively a hinged attachment, to the posterior rim of the mask aperture, at which the bar is free. The hinged mounting of this bar is so positioned at longitudinal offset from the distal end of the mask (which locates in the upper sphincter or oesophageal inlet) that the introduction of an inserted endotracheal tube will automatically engage and swing the bar backward into camming engagement with the epiglottis, thus easily folding the epiglottis backward against the wall of the laryngeal inlet and permitting undeflected insertional passage of the endotracheal tube to and through the laryngeal inlet, and permitting undeflected insertional passage of the endotracheal tube to and through the laryngeal inlet. Excerpt(s): This invention relates to an endotracheal-guidance system, such as an artificial airway device, or laryngeal-mask airway (LMA) device, of the type that finds use in anaesthetic procedures. Patent No. GB 2,205,499 describes a miniature mask attached to a tube designed to fit into the lower throat as a means of securing the airway of an unconscious patient during anaesthesia. Such devices have met with quite remarkable success and are currently used in some 50 percent of general anaesthetic procedures in the United Kingdom. The use of such masks continues to spread throughout the world. The principal advantages associated with the use of such a mask are the simplicity of its installation and uses, the freeing of the anaesthetist's hands, and the lack of trauma to airway structures, as compared with the conventional and more traditional endotracheal tube (ET). An important limiting factor in the use of the LMA device is its failure to adequately protect the lungs of an unconscious patient when regurgitation of stomach contents unexpectedly occurs. An endotracheal tube (ET), once placed in the windpipe, is still considered to be the definitive solution to this problem in
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patients at risk. However, it is sometimes difficult or even impossible to correctly position an ET owing to anatomical factors which may be unpredictable, and there is therefore always a risk that intubation of the windpipe will fail. This has resulted in death or brain damage of previously completely healthy people. While the LMA device can prevent this disaster, if there is also a risk of stomach contents entering and damaging the lungs (for example, in the case of anaesthesia for Caesarian Section), then most practitioners will want to subsequently achieve insertion of an ET even if disaster has been averted by supplying oxygen to the lungs via an LMA device. Web site: http://www.delphion.com/details?pn=US05896858__ •
Esophageal tracheal intubator airway Inventor(s): Flam; Gary H. (2244 Robinhood, Houston, TX 77005) Assignee(s): none reported Patent Number: 5,513,627 Date filed: January 27, 1995 Abstract: An esophageal tracheal intubator airway device which allows rapid blind access to the larynx and esophagus of a patient for lung ventilation, stomach suctioning, fiberscopic examination of the upper respiratory and upper gastrointestinal tracts, and passage of an endotracheal tube into the trachea. The device has a conical positioning element which conforms to the base of the throat beneath the epiglottis and an elongate tubular esophageal conduit which extends through the positioning element and rearwardly therefrom in an arcuate curve. The esophageal conduit is sized to allow passage of a gastric suction tube and related medical instruments therethrough into the patient's esophagus. A laryngeal channel extends inwardly from the positioning element proximal end and curves outwardly to define an opening through the side wall of the positioning element. The channel is sized to allow passage of a cuffed endotracheal tube and related medical instruments therethrough into the patient's larynx and trachea. An inflatable tubular ring secured to the positioning element side wall surrounds the opening and when inflated, forms a sealing relation around the patient's laryngeal inlet while causing the positioning element to back out relative to the throat a sufficient distance for a lip at its proximal end to lift the tip of the epiglottis up and out of the way of the side wall opening. Excerpt(s): This invention relates generally to blind intubating devices, and more particularly to an esophageal tracheal intubator airway device that is placed in the oropharynx of a patient and seals around the laryngeal opening to prevent obstruction of the patient's airway and allow immediate ventilation of the lungs, passage of an endotracheal tube into the trachea, stomach suctioning, and fiberscopic examination of the upper respiratory and upper gastrointestinal tracts. If a patient is unconscious, either during general anesthesia or for any other reason, it is the first responsibility of the anesthesiologist or emergency medical provider to ensure adequate spontaneous or controlled ventilation of the patient through an unobstructed airway. Face mask ventilation with "chin lift" and "jaw thrust" maneuvers, oral airways, and laryngeal mask airways are used frequently for ventilation, and prevent the tongue and soft tissues of the throat from falling backward and obstructing the patient's airway. Brain, U.S. Pat. Nos. 4,509,514, 4,995,388, and 5,297,547 disclose laryngeal mask airway devices which are conduits that are inserted into the throat and when properly positioned, terminate at the laryngeal inlet, thereby preventing the tongue and soft tissues of the throat from falling backward and obstructing airflow to and from the patient's lungs.
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Web site: http://www.delphion.com/details?pn=US05513627__ •
Gastro-laryngeal mask Inventor(s): Brain; Archibald I.J. (Sandford House, Fan Court Gardens, Longcross Road, Chertsey, Surrey KT16 0DJ, GB) Assignee(s): none reported Patent Number: 5,878,745 Date filed: August 29, 1997 Abstract: A gastro-laryngeal mask features softly compliant construction of the distal half of the mask, wherein the mask is of generally elliptical configuration, with an inflatable peripheral cuff to seal and support the mask around the laryngeal inlet. A back cushion is inflatable to engage the back wall of the pharynx and thus to forwardly load the peripheral-cuff seal to the laryngeal inlet. An evacuation tube for external removal of a possible gastric discharge completes an evacuation or discharge passage contained within the mask and opening through the distal end of the peripheral cuff. Special provision is made for assuring integrity of the discharge passage within the flexible distal half of the mask, i.e., assuring against collapse of the distal-end half of the softly compliant evacuation tube in the distal region of the mask, such that inflation of the mask does not compromise viability of the evacuation tube by compressing softly compliant material of the evacuation tube during periods of mask inflation. The special provision also favors such collapse of the mask when deflated as to provide a leading flexible edge for piloting a safe and correct advancing insertional advance of the deflated mask in the patient's throat, in avoidance of epiglottis interference and to the point of locating engagement in the upper sphincter of the oesophagus. Excerpt(s): This invention relates to a laryngeal-mask airway (LMA) device, which is an artificial airway device designed to facilitate lung ventilation in an unconscious patient by forming a low-pressure seal around the laryngeal inlet. An inflatable-ring seal surrounds an appropriately shaped mask which fits into the lower pharynx and is attached to a tube which emerges from the mouth, as for connection to medical gassupply tubing. More particularly, the invention relates to a variety of laryngeal masks, known as gastro-laryngeal masks (GLM), wherein. provision is made for airway assurance to the patient who is at. risk from vomiting or regurgitation of stomach contents while unconscious. U.S. Pat. No. 5,241,956 deals with this problem by providing an evacuation tube which is open through the center of the inflatable seal of the laryngeal mask, thus utilizing the distal end of the inflatable ring as an inflatablecuff formation which establishes peripherally sealed engagement to the upper sphinctral region of the oesophagus and centrally supports the distal end of the evacuation tube. In addition, said U.S. Pat. No. 5,241,956 discloses a further inflatable cuff carried by the laryngeal mask and by the evacuation tube, for referencing inflation against the back wall of the pharynx, thus making it possible to establish the laryngeal-inlet seal with reduced inflation pressure, as compared with prior structures not having such an additional inflatable cuff. U.S. Pat. No. 5,305,743 discloses moulding techniques for manufacture of a variety of laryngeal masks, including a gastro-laryngeal mask, wherein an inflatable back cushion provides such referencing inflation against the back wall of the pharynx as to widely distribute the back-wall reference, over substantially the full area of the laryngeal mask. Such a back-cushion construction has been found to be mechanically simple and highly effective, and U.S. Pat. No. 5,355,879 discloses such a back cushion for each of several representative laryngeal-mask constructions.
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Web site: http://www.delphion.com/details?pn=US05878745__ •
Intubating assembly Inventor(s): Gomez; Richard J. (17830 SW. 152nd Ave., Miami, FL 33196) Assignee(s): none reported Patent Number: 6,053,166 Date filed: February 9, 1998 Abstract: An intubating assembly used to position an intubation tube having a distal end, a proximal end and a generally resilient tubular configuration, into a trachea of a patient, the intubating assembly having a guide assembly that receives the intubation tube therein and conforms the intubation tube to its configuration. The guide assembly includes first and second introduction segments hingedly coupled to one another and positionable between a closed orientation, which defines a generally curved configuration of the guide assembly, and an open orientation, which defines a generally straight configuration of the guide assembly. The intubating assembly further includes a positioning assembly structured to selectively position the first and second introduction segments between the open orientation, wherein the intubation tube is generally straightened to facilitate direct introduction thereof into an airway of the patient to a point posterior of a tip of an epiglottis of the patient, and the closed orientation, wherein the intubation tube is generally curved in order to angle the distal end thereof towards the trachea of the patient and thereby introduce the intubation tube directly into the trachea of the patient. Excerpt(s): The present invention relates to an intubating assembly structured to facilitate the safe, rapid and aligned positioning and introduction of an intubation tube into a trachea of a patient in a manner which minimizes the risk of accidental introduction of the intubation tube into the esophagus, pyriform sinus or vallecula of the patient by guiding the intubation tube through the airway of the patient until it may be directed specifically into the trachea. Frequently, patients undergoing medical treatment and patients in emergency situations experience some form of trauma and/or medical problem that tends to require that they have some breathing assistance or control. As a result, it is frequently necessary to intubate a patient immediately at an emergency site in order to resume breathing, or in a surgical setting when respiratory muscles must be paralyzed. Specifically, endotracheal intubation of a patient involves the introduction of an elongate, tubular intubation tube through the mouth of a patient and into the trachea of the patient for communication with the lungs of the patient. Once effectively positioned, the intubation tube is connected with a conventional ventilator assembly and is utilized for continuous, direct ventilation of the patient. Unfortunately, however, proper introduction of the intubation tube into the patient's airway can be quite difficult, and often involves extensive training in specialized techniques in order to accomplish it rapidly and effectively. Web site: http://www.delphion.com/details?pn=US06053166__
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Intubation device Inventor(s): Shaikh; Amer (London, GB) Assignee(s): Intavent Orthofix Limited (GB) Patent Number: 6,722,368 Date filed: March 19, 2001 Abstract: An intubation device comprises an airway tube (10) a distal end of which is surrounded by an inflatable cuff (12) which is shaped and dimensioned to lie, in use, between the soft palate and the laryngeal inlet posteriorly of the palatopharyngeal folds. When inflated the cuff (12) has roughly the shape of the frustum of a four-sided pyramid with rounded corners and tapers away from its distal end. The distal end of the tube (10) is recessed ID into the distal end of the cuff so that the latter is an annular protrusion (13) adapted to straddle the upper region of but not to surround the elliptical epiglottis (14) and to fill the piriform fossae (15) on either side thereof. Excerpt(s): This invention relates to an improved intubation device for use in assisting the breathing of a patient and in administering anaesthetics to a patient, for example during a surgical procedure. To prevent asphyxiation it is essential to maintain a patent airway to the larynx but it is also essential to prevent penetration of blood and other secretions to the lungs. For purposes of maxillary, facial, oral, dental, nasal, ear and throat surgery it has therefore been common to use an endotracheal tube, which has an inflated cuff which seals the trachea below the vocal cords. However an endotracheal tube cannot be used without first inducing neuromuscular paralysis in the patient, as otherwise touching the vocal cords will induce a reflex spasm which will close the larynx. International Patent Application publication No. WO 95/33506 and the British patent publications to which it refers disclose a laryngeal mask which, because it is located around the epiglottis and outside the laryngeal inlet, may be used without neuromuscular paralysis. However this mask is a relatively large object and because of its shape presents problems of location which give rise to dangers of injury to the patient. International Patent Application publication No. WO 95/06492 discloses an alternative to the laryngeal mask, the so-called COPA, which is located higher in the throat and which seals it by forcing forward the tongue and closing the naso-pharynx by lifting the soft palate. Both of these devices must be introduced orally, the laryngeal mask because it is too large to be introduced through the nose and the COPA not only for this reason but because it must close the back of the nose. Therefore both are unsuitable when access to the mouth is required and the COPA device is particularly unsuitable for operations on the back of the mouth or the throat, such as tonsilectomy, because its cuff projects into the oral cavity obscuring both the red tonsils and the uvula. Web site: http://www.delphion.com/details?pn=US06722368__
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Jaw thrust support Inventor(s): Cotroneo; James L. (7092 Thames Rd., Woodbury, MN 55125) Assignee(s): none reported Patent Number: 5,682,632 Date filed: April 25, 1996 Abstract: A jaw thrust support suitable for engaging the angles of the mandible of a patient for accomplishing a jaw thrust maneuver to proved a patient with a patent
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airway. The device is constructed of polymeric materials suitable for conforming to the angles of the patient's jaw while continuing to provide suitable support to the jaw by distracting the jaw forward away from the patient's head and neck thus distracting the patient's tongue and associated support structures lifting the tongue from the patient's oropharynx and hypopharynx and lifting the epiglottis from in front of the patient's laryngeal opening. Excerpt(s): The present invention relates to headrests for use with patients and in particular to headrest providing mandibular, or jaw, support. Patient airway management is vital to appropriate patient care in a multitude of varying circumstances. The rationale supporting and driving this approach is the acutely injured person is often unable to maintain their own airway secondary to their lethargic, obtunded or unconscious condition. Even in the more controlled settings, such as operating room environments, patients about to undergo anesthesia are given medications that may impair the patient's ability to maintain their own airway. In all of these circumstances, appropriately trained medical personnel must intervene on behalf of the patient to establish and maintain patent airways in all of these patients. Securing a patent airway is taught to all medical care providers as the first step in appropriate management. See Resuscitating CPR, Looking at the Basics and Adjuncts, Mikel A. Rothenberg, M.D., Journal of Emergency Medical Services, February, 1996, pp. 45-50. There are several recognized maneuvers medical personnel may use with these patients in order to adequately open the patient's airway. In one such emergency medical publication titled Trauma Life Support Manual, in chapter one: Respiratory Procedures, the authors Joseph E. Clinton and Ernest Ruiz, strongly recommend that some type of jaw thrust or chin lift maneuver should be performed on every unconscious patient to ensure airway patency. Id., chapter one, page one. However, a chin lift maneuver requires at least one hand in order to accomplish the maneuver and a jaw thrust maneuver uses two hands to complete the maneuver. In order to maintain the airway patency, the chin lift or jaw thrust maneuver must be maintained until the patient either regains consciousness and is able to protect their own airway or an artificial airway is placed by the emergency medical personnel, such as an oropharyngeal airway, an orotracheal airway, etc. Web site: http://www.delphion.com/details?pn=US05682632__ •
Laryngeal mask construction Inventor(s): Brain; Archibald I. J. (Sandford House, Sancourt Gardens, Longcross Road, Chertsey, Surrey KT16 0DJ, GB) Assignee(s): none reported Patent Number: 5,297,547 Date filed: July 30, 1992 Abstract: A laryngeal mask has an inflatable ring configured, upon inflation, to establish a peripheral seal around a patient's laryngeal inlet. Installation (insertion) is made in the fully deflated state, wherein the structural relation between the body of the mask and the inflatable ring is such that deflated ring surfaces become tightly opposed to each other so as to form a thin flange which peripherally surrounds the body of the mask and is concave on the posterior side of the mask; the concave flange effectively displaces all ring material away from the aperture of the mask, in the manner of the upturned brim of a hat. The concave flange is softly yieldable in its confinement by local body structures encountered in the course of mask insertion. And it is an important feature that the distal end of the deflated ring is adapted not only to smoothly ride posterior
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contours of the throat and pharynx but also to gently cam the epiglottis out of the path of insertial displacement of the mask while also assuring that the distal end of the deflated mask smoothly enters the upper sphinctral region of the oesophagus. Once thus insertionally located, ring inflation will assuredly establish the desired peripheral seal of the mask around the laryngeal inlet. Excerpt(s): The invention relates to laryngeal masks, illustratively of varieties disclosed in U.S. Pat. Nos. 4,509,514 and 4,995,388, and in U.K. Patent No. 2,205,499. Such masks are artificial airway devices to facilitate lung ventilation in an unconscious patient. More specifically, the invention pertains to such a device designed for placement in the pharynx of the patient in order to prevent airway obstruction and to permit either spontaneous or controlled ventilation. U.K. Patent No. 2,205,499 describes a flexible web closing the rear of the lumen of the mask and providing a pocket having a transverse slit opening toward the aperture of the airway tube, for receiving the end of a substantially rigid introducing tool. This pocket is effective when used with the introducing tool; however, it may act as a dirt-trap since secretions or blood may lodge in the pocket and thereby escape sterilization. The introducing tool may be required to elevate the epiglottis after inserting the mask, since insertion may push the epiglottis into a downfolded position, causing partial airway obstruction. It is an object of the invention to provide laryngeal-mask construction which features ease and enhance reliability of correct insertion. Web site: http://www.delphion.com/details?pn=US05297547__ •
Laryngoscope blade with a bendable tip Inventor(s): Bauman; Jack (1677 San Onofre Dr., Pacific Palisades, CA 90272) Assignee(s): none reported Patent Number: 4,573,451 Date filed: November 8, 1984 Abstract: The invention is directed to a laryngoscope blade which has a tip at the distal end thereof which is capable of being bent or flexed in the direction of the handle of the laryngoscope. Operable means are provided, preferably at the proximal end of the blade, to bend or flex the tip. When the blade is inserted into a patient's throat so that the bendable tip is located at the base of the patient's epiglottis, the operable means of the bendable tip can be actuated so the tip will bend and thereby further lift the patient's epiglottis in order to expose the patient's larynx. The laryngoscope blade is particularly suitable to the few patients in which the usual laryngoscopic procedures do not adequately expose the patient's larynx. Excerpt(s): This invention generally relates to examining or viewing devices such as laryngoscopes, and particularly to an improved blade therefore having a bendable tip. Laryngoscopes generally comprise a blade and a cooperating, detachable handle which are connected together into an L-shaped configuration. When using the device to view the larynx, the surface on the blade adjacent the handle is used to press against the tongue and mandible of a patient in a supine position in order to prevent the patient's tongue from obstructing the view during the visual examination. While the instrument is useful in examining the larynx, the primary function of the laryngoscope is to expose the larynx in order to facilitate the insertion of an endotracheal tube into the trachea of the lungs to administer gases. During the use of the instrument, when pressed against the patient's tongue and mandible, the tip or distal end of the blade is usually positioned
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at the junction between the base of the tongue and the base of the epiglottis which is thin, leaf shaped lamella in front of the superior opening of the larynx. With most patients, the epiglottis will be lifted sufficiently to expose the larynx by rotating the instrument anteriorly (i.e., longitudinally). Usually the patient's head is tilted backwardly to facilitate the examination. Web site: http://www.delphion.com/details?pn=US04573451__ •
Method for measuring cardiac output Inventor(s): Abrams; Jerome H. (Minneapolis, MN), Hovland; Claire T. (Mound, MN) Assignee(s): Applied Biometrics, Inc. (Mound, MN) Patent Number: 4,671,295 Date filed: November 11, 1986 Abstract: Blood flow in the aorta and pulmonary artery of a mammal, most typically a human, is measured volumetrically by a non-invasive, ultrasound method and apparatus. The method comprises placing a piezoelectric ultrasound transducer in the trachea in great proximity to the aorta or pulmonary artery by passage through the oral or nasal cavity past the epiglottis and into the trachea or by passage through the surgical opening into the trachea in the case of patients who have had a tracheotomy. Ultrasound waves are transmitted toward the path of flow of blood in the artery. Reflected waves are received. The average Doppler frequency difference between transmitted and received waves is measured. The cross-sectional size of the artery is measured. Blood flow rate is determined from the measurements. The apparatus comprises a tracheal tube or probe with one or two transducers mounted at one end the tube. The transducer(s) is (are) disposed to transmit ultrasound in selected directions. Electrical conductors extend from the transducers the length of the probe. Excerpt(s): Measurement of cardiac output is crucial in the care of critically ill patients such as patients with multiple trauma, patients in overwhelming sepsis, and patients with acute myocardial infarction. In the case of patients with acute myocardial infarction, there is a worsening prognosis with decrease in cardiac output. Knowledge of the cardiac output provides information useful in determining the clinical state of a given patient and in rationally planning therapy for the patient. Such information is not contained in the usually measured vital signs. For example, a low mean arterial pressure with elevated pulse does not adequately distinguish between cardiogenic and septic shock, the treatments for which are quite different. Consequently, a method that distinguishes between cardiogenic and septic shock would be important in planning appropriate therapy. The measurement of cardiac output, in this case, would provide valuable information that would allow an appropriate diagnosis to be made. The importance of knowing cardiac output has led to many methods for its determination. The most commonly used method in widespread clinical use is thermodilution. In the thermodilution method a catheter is placed into the central venous circulation, usually by percutaneous entry into the internal jugular or subclavian vein. A balloon at the end of the catheter is inflated, and the normal flow of blood is employed to direct the tip of the catheter into the pulmonary artery. Measurement of cardiac output is made by observing the dissipation of a temperature pulse, usually a bolus of iced sterile water or saline solution. As is evident, the method cannot be used without invasion of the vascular tree. Indeed, the catheter is threaded through the heart and the heart valves. Flow direction is not entirely reliable. In certain patients access to the pulmonary artery is impossible. During placement of the catheter cardiac arrhythmias are not uncommon.
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Other complications include sepsis, thrombosis of the central veins, emboli, and fatal rupture of the pulmonary artery. Other disadvantages of the technique include lack of continuous information about the cardiac output and chance location of the catheter, such as in an unfavorable pulmonary artery branch, with erroneous values for the cardiac output. Analysis of the error inherent in the measurement of blood flow by thermodilution has revealed a standard deviation of 20-30%. Measurement of cardiac output has also been done by the indocyanine green dye technique, which suffers from several disadvantages. The technique is cumbersome, it requires the placement of an arterial catheter, is not accurate at low levels of cardiac output and is difficult to use for repeated measurements in the same patient. Complications include catheter site hematoma, sepsis from the catheter, thromboses of the artery containing the indwelling catheter, and pseudoaneurysm formation at the site of arterial puncture. Web site: http://www.delphion.com/details?pn=US04671295__ •
Methods for performing tracheal intubation on an animal and endotracheal tubes therefore Inventor(s): Anderson; Scott M. (821 Toyopa Dr., Pacific Palisades, CA 90272) Assignee(s): none reported Patent Number: 6,705,320 Date filed: December 23, 2002 Abstract: Methods for performing tracheal intubation of small animals are shown utilizing an endotracheal tube specifically designed for them. The endotracheal tube has a zigzag bend and a distal portion having an outwardly facing surface. The outwardly facing surface is used to depress the epiglottis of the animal thereby giving a doctor a clear view of the animal's trachea. The endotracheal tube also includes a tapered end which is easily inserted between the arytenoid cartilages of the larynx, and a pressure sensor which provides a quantitative indication of the air pressure within the cuff of the endotracheal tube. Excerpt(s): The present invention pertains generally to tracheal intubation, and more particularly to methods and apparatus for performing tracheal intubation on animals. Tracheal intubation is commonly used in human patients during medical procedures in order to keep air passing into the lungs and to prevent foreign matter from entering the lungs. An endotracheal tube typically made from polyvinyl chloride, rubber, silicone, or the like is inserted into the trachea. A cuff on the tube is then inflated until the cuff seals off the trachea leaving only the endotracheal tube as the source of air to the lungs. As air is injected, an external pilot balloon also inflates thereby giving the doctor a subjective indication of the degree of cuff inflation. Methods and devices for tracheal intubation are well known in the art. For example, U.S. Pat. No. 4,850,371 shows a non-invasive apparatus for continuously measuring the cardiac output and cardio-respiratory function including a gas sampling device which is inserted into the mouth of a human subject. The gas sampling device may be a disposable endotracheal tube or a smaller disposable mouthpiece. Each of these gas sampling devices is provided with a plurality of passages for sampling the lung gases and for continuously sampling the gas pressure on opposite sides of a capillary restriction member. A miniature motor pump mass spectrometer module is mounted on the upper end of the endotracheal tube or mouthpiece. Electronic circuitry connected to the mass spectrometer permits constant visual monitoring of the cardiac output and cardio-respiratory function.
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Web site: http://www.delphion.com/details?pn=US06705320__ •
Nasogastric intubation process Inventor(s): Micek; Frank C. (343 Ridge Rd., Barrington Hills, IL 60010) Assignee(s): none reported Patent Number: 4,747,827 Date filed: September 25, 1986 Abstract: Nasogastric intubation process in which a stylet is employed to bend the tube to approximate the arch of the pharyngeal recess. After being so bent, the tube is inserted trans-pharyngeal recess until the tip is supra epiglottis. The stylet is withdrawn and the tube flexes adjacent the posterior esophageal wall for assured, quick passage to the stomach. Excerpt(s): Nasogastric intubation is a medical process by which a flexible plastic tube (nasal-gastric tube) is passed through the nasal passage trans-soft palate, transpharyngeal recess, past (trans) the epiglottis and into the esophagus until the distal end section of the tube has been located in the stomach. The tube is perforated for a short distance at the distal end to permit negative pressure to be communicated to the stomach to withdraw fluids, or to permit fluids to be fed to the stomach through the tube, usually under emergency conditions. About six or seven inches of the tube will be located in the stomach. The present invention relates to an intubation technique. The nasal-gastric tube is relatively large in diameter (e.g. about 6 mm.) and somewhat thick walled because the negative pressure employed is sometimes intense. Therefore the tube must be strong enough to avoid collapse. The distal end is closed, not open, and consequently is somewhat rigid and tough. The attendant, whether physician or skilled nurse, must be very careful during the insertion process not only to avoid delicate tissue trauma, but also to be certain the distal end of the tube does not enter the trachea, leading to the lungs, which is extremely undesirable for the well-being of the patient. The time required to assure passage of the tough end of the tube into the esophagus may be critical in emergency cases, where a few seconds may count, and the object of my invention is to assure that the nasal-gastric tube will be assuredly positioned for quick esophageal passage. Web site: http://www.delphion.com/details?pn=US04747827__
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Orotracheal intubation guide Inventor(s): Parker; Jeffrey D. (Cincinnati, OH) Assignee(s): Parker Medical Limited Partnership (Cincinnati, OH) Patent Number: 5,743,254 Date filed: March 31, 1997 Abstract: A blind intubation guide (10) including a tube-receiving space (46) with a tube-supporting spout (50) which effectively overhangs the epiglottis (90) so as to prevent an orotracheal tube (60) from catching thereon as such tube (60) is advanced through the guide (10). A guide wall (42), which aims the tube (60) into the laryngeal opening (82) and has an upper edge below the level of the junction of the spout (50) and an aft member (16) and a support member (30) of the guide, cooperates with a free edge
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(52) of the spout (50) to rotate the tube (60) into position for advancement into the laryngeal opening (82) and the trachea (96). Excerpt(s): The present invention relates to orotracheal intubation guides and more particularly to blind intubation guides for insertion of an orotracheal tube into a patient's trachea. When a patient stops breathing, it is imperative that effective ventilation be instituted as soon as possible. Ventilation is best accomplished by forcing air through an orotracheal tube inserted through the mouth and laryngeal opening and into the trachea. A commonly employed method of orotracheal intubation relies on a blade laryngoscope by which to visualize the laryngeal opening so as to facilitate insertion of the tube. Intubation with the blade laryngoscope presents significant difficulties and risks. In addition to possible injury or trauma to the patient in the utilization of the blade laryngoscope, it is not uncommon for the orotracheal tube to be accidentally inserted into anatomical spaces surrounding the larynx, such as the closely adjacent esophagus. Such misintubation, if not quickly recognized and corrected, may have fatal consequences. Another approach to intubation is so-called blind intubation in which a guide device is inserted into the throat to guide the orotracheal tube into the laryngeal opening without requiring visualization of the laryngeal opening. Such devices might reduce the injury and trauma to patients that occurs with use of blade laryngoscopes, but they usually have no means to prevent misintubation. I have developed several blind intubation guides which not only minimize injury and trauma in use, but also substantially reduce the risk of misintubation. One particularly advantageous blind intubation guide is described in my U.S. Pat. No. 5,339,805, the disclosure of which is incorporated herein in its entirety. Web site: http://www.delphion.com/details?pn=US05743254__ •
Perilaryngeal oral airway Inventor(s): Alfery; David D. (22 Wynstone, Nashville, TN 37215) Assignee(s): none reported Patent Number: 6,386,199 Date filed: September 29, 1999 Abstract: An oral airway (510) includes an elongate tubular member (512) having a distal (510) and a proximal end (514) with an enlarged wedge-shaped housing (520) at the distal end. The wedge-shaped housing (520) is for insertion into the mouth (1) and pharynx (7A) of a patient with the proximal end of the tubular member extending from the mouth of the patient. The wedge-shaped housing (520) has anterior (522) and posterior (524) walls forming an enlarged proximal portion (530) tapering to a smaller distal portion (532) with a leading opening (534) separating the anterior (522) and posterior (524) walls at the distal end of the housing. A grate (537) covers the leading opening. Sidewalls (526, 528) extend between the anterior (522) and posterior (524) walls and the wedge-shaped housing (520) is configured so that the sidewalls abut the aryepiglottic folds (576) as the wedge-shaped housing is inserted in to the hypopharynx (7) of a patient to arrest insertion of the wedge-shaped housing and seat the wedgeshaped housing with the leading opening (534) adjacent to the glottis (9). The grate (537) is inclined between the anterior and posterior walls (522, 524) so that as a patient's epiglottis (4) is engaged by the grate (537) during insertion of the wedge-shaped housing into the hypopharynx (7), the epiglottis (4) slides up the grate (537) and into abutment with the anterior wall (522) of the wedge-shaped housing. A method of providing an oral airway to a patient includes inserting the wedge-shaped housing (520)
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into the mouth (1) of the patient, axially advancing the wedge-shaped housing (520) to slide the epiglottis (4) over the grate (537) and seating the wedge-shaped housing (520) with a leading surface of the enlarged proximal portion (530) abutting the patient's aryepiglottic folds (576), the anterior wall (522) of the wedge-shaped housing (520) abutting the epiglottis (4) and the grate (537) adjacent to the glottis (9). Excerpt(s): The present invention relates generally to a class of medical devices commonly referred to as oral airways and supraglottic airways which are inserted through a patient's mouth and into the patient's pharynx while the patient is undergoing general anesthesia or is undergoing respiratory treatment such as is carried out with cardiopulmonary resuscitation. More specifically, the present invention is directed to a perilaryngeal oral airway and perilaryngeal supraglottic airway which is capable of acting as an endotracheal tube guide and which seats deep in a patient's hypopharynx to prevent the soft tissue of the glottis and epiglottis from obstructing the airway. Oral airways were introduced into the practice of anesthesia and cardiopulmonary resuscitation several decades ago for two basic purposes. First, they prevent the patient's biting down on and occlusion of a previously placed oral endotracheal tube. Second, and most important, oral airways help to provide a patent airway that allows positive pressure ventilation to be carried out by the practitioner. More recently, some oral airways have been developed to facilitate blind (not visually directed) placement of an endotracheal tube. For most patients, mask ventilation is carried out successfully by insertion of an oral airway and by a variety of physical adjustments, such as extension of the patient's neck and elevation of the patient's jaw. However, in some patients, no matter what physical adjustments are made or the particular oral airway which is inserted, mask ventilation cannot be successfully achieved. Such cases are literally lifethreatening as hypoxemia and death can quickly ensue if the patient's blood is deprived of oxygen due to a lack of ventilation. Web site: http://www.delphion.com/details?pn=US06386199__ •
Self retaining laryngoscope Inventor(s): Minson; Matthew Alan (1530 Sul Ross #1, Houston, TX 77006) Assignee(s): none reported Patent Number: 5,938,591 Date filed: June 9, 1998 Abstract: The invention is a self-retaining disposable laryngoscope having dual light conductive blades that open and lock apart laterally and/or radially. The invention has two curved blades: a tongue blade and a palate blade. These two blades may be separated and locked apart by a ratchet mechanism in the instrument's handle while they remain parallel. This provides a bite block, pushes down the tongue, and makes the invention self-retaining in the airway. The palate blade may be rotated about an axis in the handle of the instrument and locked in position by a ratchet mechanism to spread the distal ends of the blades. This lifts the palate and epiglottis and opens the airway. Excerpt(s): The present invention relates generally to medical devices and more specifically to disposable self-retaining laryngoscopes useful for orally intubating a patient with an endotracheal tube. Laryngoscopes have long been used to open the mouth and airway to allow examination of the larynx and to assist in oral intubation of the compromised airway with an endotracheal tube. To better understand the present invention, it is useful to review the prior art and the current state of the art in
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laryngoscopes. It is also necessary to understand why laryngoscope aided intubation is clinically important; why it is frequently difficult or impossible to accomplish with the prior art and to briefly discuss the consequences to the patient that can be caused by problems resulting from the use of prior art laryngoscopes. Web site: http://www.delphion.com/details?pn=US05938591__ •
Sterile disposable linguiform laryngoscope blade sheath Inventor(s): Sun; William Y. (401 N. Armistead St., Apt. 104, Alexandria, VA 22312) Assignee(s): none reported Patent Number: 4,979,499 Date filed: May 26, 1989 Abstract: A sterile, disposable laryngoscope blade sheath for use in the intubation process is disclosed. The sheath either provides for or permits the laryngoscope structure to perform the desired or designed functions. Such functions may be, for example, the manipulation of the epiglottis while maintaining the tongue positioned. This is accomplished by either providing an opening in the end of a rigid sheath for the shaped blade end to project through, or by shaping the rigid sheath so that it can perform the function using or independent of the blade end shape, or by providing a resilient end section that assumes or conforms to the shape of the blade. Excerpt(s): The invention is to a sheath for use with laryngoscope blades. These blades are used by physicians and others for inspection of patients' throats, intubation procedures, and for manipulation of body parts. The blades in use are shaped for viewing and manipulation of body parts, but are too narrow and too slippery to hold and control the tongue. As a result, the epiglottis is difficult to visualize and it is difficult to insert the endotracheal tube into the trachea. In the event of cardiac or respiratory arrest, an endotracheal tube must be inserted promptly to avoid irreversible brain damage. Web site: http://www.delphion.com/details?pn=US04979499__
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Tracheal intubation guide Inventor(s): Augustine; Scott D. (1601 Stonecrest Ct., Blue Springs, MO 64015) Assignee(s): none reported Patent Number: 4,832,020 Date filed: November 30, 1987 Abstract: A tracheal intubation guide comprises a tubular member having a curved forward end shaped to follow the curvature of the back of the tongue and throat of a patient, and a rear end for projecting out through the mouth of the patient, and an anterior guide surface extending along at least part of the length of the member to its forward end for guiding the member into the throat into a position opposite the opening into the larynx. The tubular member has a through bore for holding an endotracheal tube, and the guide surface has a forward edge of concave shape for engaging the front of the epiglottis and seating over the hyo-epiglottic ligament when the member is accurately positioned. Correct positioning can be detected by external palpation of the neck.
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Excerpt(s): The present invention relates to a guide for assisting medical personnel in inserting an endotracheal tube into the trachea, or windpipe, of a patient. Endotracheal intubation is the technique of inserting a tube into the trachea of a patient in order to aid in or permit respiration. It is commonly used in surgery and in emergency care situations, for example in the case of trauma or cardiac arrest victims suffering from breathing difficulties. Various other techniques for securing an airway are known, such as the esophageal obturator airway, the esophageal gastric tube airway, and the pharyngeal tracheal lumen airway, as well as mouth to mouth or bag and mask respiration. However, none of these places an airway into the trachea and thus none of them will truly secure the airway to prevent potential aspiration of blood, vomitus, or other foreign material into the lungs. Additionally, some of these techniques can induce major additional trauma in the patient. Thus endotracheal intubation is generally considered to be the superior method of securing an airway and assuring adequate ventilation. However, one problem with this technique is that it requires significant operator skill and experience. Unskilled insertion can cause additional injuries, for example to the front incisors. Another problem is that many existing techniques for inserting a tube into the trachea require special positioning of the patient's head, and thus cannot be done with trauma victims until cervical spine fractures have been ruled out, because of the possibility of additional spinal cord damage. Web site: http://www.delphion.com/details?pn=US04832020__ •
Tracheal intubation guide Inventor(s): Augustine; Scott D. (Blue Springs, MO) Assignee(s): Augustine Medical, Inc. (Eden Prairie, MN) Patent Number: 5,203,320 Date filed: July 12, 1991 Abstract: A tracheal intubation guide having a tubular member with a curved forward end shaped to follow the curvature of the back of the tongue and throat of a patient, and a rear end for projecting out through the mouth of the patient, and an anterior guide surface extending along at least part of the length of the member to its forward end for guiding the member into the throat into a position opposite the opening into the larynx. The tubular member has a through bore for holding an endotracheal tube, and the guide surface has a forward edge of concave shape for engaging the front of the epiglottis and seating over the hyo-epiglottic ligament when the member is accurately positioned. Correct positioning can be detected by external palpation of the neck. Excerpt(s): The present invention relates to a guide for assisting medical personnel in inserting an endotracheal tube into the trachea, or windpipe, of a patient. Endotracheal intubation is the technique of inserting a tube into the trachea of a patient in order to aid in or permit respiration. It is commonly used in surgery and in emergency care situations, for example, in the case of trauma or cardiac arrest victims suffering from breathing difficulties. Various other techniques for securing an airway are known, such as the esophageal obturator airway, the esophageal gastric tube airway, and the pharyngeal tracheal lumen airway, as well as mouth to mouth or bag and mask respiration. However, none of these places an airway into the trachea, and, thus, none of them will truly secure the airway to prevent potential aspiration of blood, vomitus, or other foreign material into the lungs. Additionally, some of these techniques can induce major additional trauma in the patient. Thus, endotracheal intubation is generally considered to be the superior method of securing an airway and assuring adequate
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ventilation. However, one problem with this technique is that it requires significant operator skill and experience. Unskilled insertion can cause additional injuries, for example, to the front incisors. Another problem is that many existing techniques for inserting a tube into the trachea require special positioning of the patient's head, and thus cannot be done with trauma victims until cervical spine fractures have been ruled out, because of the possibility of additional spinal cord damage. Web site: http://www.delphion.com/details?pn=US05203320__ •
Tracheal intubation with a stylet guide Inventor(s): Augustine; Scott D. (Bloomington, MN) Assignee(s): Augustine Medical, Inc. (Eden Prairie, MN) Patent Number: 5,235,970 Date filed: June 23, 1992 Abstract: An endotracheal stylet guide includes an elongate, arcuate section, and a substantially J-shaped tracheal-seeking section on the distal end of the arcuate section. The stylet guide is inserted, distal end first, into an endotracheal tube. The tube is positioned in the throat such that the J-shaped, tracheal-seeking section is adjacent the epiglottis, opposing the opening to the larynx. The stylet guide is advanced in the endotracheal tube, and the J-shaped section enters and tracks down the trachea. The endotracheal tube is then advanced on the stylet guide, into the trachea. The stylet guide is removed and intubation then proceeds conventionally. Excerpt(s): This invention relates to a stylet guide insertable in an endotracheal tube which is used to guide the endotracheal tube into the trachea (windpipe) of a patient. As taught in my U.S. Pat. No. 4,832,020, endotracheal intubation is greatly assisted by my tracheal intubation guide which includes a tubular member having a curved forward end shaped to follow the curvature of the back of the tongue and anterior surface of the throat of a patient and a rear end for projecting out through the mouth of the patient. An anterior guide surface beneath the tubular member guides the member into the throat of a patient. The guide surface has a forward indent for engaging the front of the epiglottis and for seating over the hyo-epiglottic ligament. When seated, the tubular member is positioned opposite the opening to the larynx, and an endotracheal tube previously inserted into the tubular member can be advanced through the guide into the trachea. My tracheal intubation guide has met with wide acceptance and in most applications works as intended. In order to guide the tube into the larynx, a sharp anterior bend must be imposed on the end of the tube to orient the end toward the epiglottus. This bend is imposed by the configuration at the end of my intubation guide. However, the very short distance between the larynx and the end of the intubation guide prevents the end of the tube being pointed downwardly in the trachea. Instead, it must be turned downwardly by contacting the anterior surface of the larynx. Occasionally, the edge at the end of the anteriorly directed tube will catch on surface irregularities of the larynx, preventing advancement into the trachea. Web site: http://www.delphion.com/details?pn=US05235970__
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Patent Applications on Epiglottis As of December 2000, U.S. patent applications are open to public viewing.6 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to epiglottis: •
AIRWAY DEVICE WITH PROVISION FOR COUPLING TO AN INTRODUCER Inventor(s): ARNOLD, RANDALL CHARLES; (MINNETONKA, MN), AUGUSTINE, SCOTT DOUGLAS; (BLOOMINGTON, MN), MCGRAIL, THOMAS WAYNE; (CHASKA, MN) Correspondence: Terrance A Meador; Gray Cary Ware & Freidenrich; 401 B Street; Suite 1700; San Diego; CA; 92101 Patent Application Number: 20020011249 Date filed: November 25, 1998 Abstract: A laryngeal airway device for sealing against the laryngeal opening includes an air tube with proximal and distal ends and a sealing member attached to the distal end. The sealing member includes a coupler for coupling the device to an introducer. Complementing the laryngeal airway device is an introducer that includes a track for receiving the coupler of the laryngeal airway device and guiding the sealing member to a sealing position with respect to the laryngeal inlet. The introducer may include an epiglottic engager on a distal end to engage the epiglottis and retain it while the sealing member is being tracked to engagement with the laryngeal inlet. Excerpt(s): U.S. patent application Ser. No. ______, filed on even date herewith, for AIRWAY DEVICE WITH PROVISION FOR LATERAL ALIGNMENT, DEPTH POSITIONING, AND RETENTION IN AN AIRWAY. This invention is concerned with the management of a human airway in order to control respiration. More particularly, the invention concerns a device that brings an airway tube reliably and safely into communication with the laryngeal opening, the upper end of the trachea, which is the breathing passageway that leads to the lungs. The device seats in the throat immediately adjacent the laryngeal opening, tensions and erects the laryngeal opening, and seals with it to provide a channel through the airway tube for artificial ventilation of the lungs. In particular, the invention concerns a laryngeal airway device that can be coupled to an introducer and guided to this position through the throat. For this purpose a tracking introducer is provided. The invention also concerns a laryngeal blade used to access the laryngeal anatomy in order to support access to the laryngeal opening by an airway device. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
6
This has been a common practice outside the United States prior to December 2000.
Patents 57
•
Laryngeal mask assemblies Inventor(s): Landuyt, Christophe Van; (London, GB) Correspondence: Law Offices OF Louis Woo; 1901 North Fort Myer Drive, Suite 501; Arlington; VA; 22209; US Patent Application Number: 20020112728 Date filed: February 1, 2002 Abstract: A laryngeal mask assembly has a tube with a mask at one end defining a cavity surrounded by a sealing cuff. A blocker is operable to prevent entry of the epiglottis into the cavity during insertion of the assembly but does not hinder gas passage along the assembly after insertion. The blocker may be a ballon that is inflated during insertion and is then deflated. Alternatively, the blocker may be a web attached to the patient end of the assembly by a rupturable joint. In another arrangement the blocker is an insert with an end that expands to fill the cavity but that is compressible to allow the insert to be pulled out from the machine end of the assembly. Excerpt(s): It is common practice to use an airway known as a laryngeal mask for administering anaesthetic and ventilation gases to a patient. These airways comprise a tube with an inflatable mask or cuff at one end, the tube being inserted in the patient's mouth so that one end is located in the hypopharynx and so that the mask forms a seal in this region with the surrounding tissue. Laryngeal masks are described in, for example, U.S. Pat. Nos. 5,355,879, U.S. 5,305,743, U.S. 5,297,547, U.S. 5,282,464, GB 2267034, U.S. Pat. Nos. 5,249,571, U.S. 5,241,956, U.S. 5,303,697, GB 2249959, GB 2111394, EP 448878, U.S. Pat. No. 4,995,388, GB 2205499, GB 2128561, GB 2298797, GB 2334215, GB 0020274 and GB 0002805. Laryngeal masks have several advantages over endotracheal tubes, which are longer and seal with the trachea below the vocal folds. One potential problem with laryngeal masks is that there is a risk that they may be blocked by the epiglottis during insertion. It is an object of the present invention to provide an alternative laryngeal mask assembly. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
•
Laryngoscope Inventor(s): Friesen, John H.P.; (Manitoba, CA) Correspondence: Ade & Company; 1700 360 Main Street; Winnipeg Manitoba; R3c 3z3; CA Patent Application Number: 20030032864 Date filed: September 4, 2002 Abstract: A laryngoscope has a blade mounted on a bracket and handle for manipulation by the doctor. The blade is generally concave with an inner surface for engaging and compressing the tongue of the patient onto the lower jaw of the patient, a tip portion remote from the bracket for engaging the hyoid bone of the patient to effect moving of the epiglottis and an outer surface over which the doctor obtains a direct line of sight through the mouth past the moved epiglottis to the opening through the larynx to the trachea. The blade is substantially rigid with an apex at a position thereon which in use is located adjacent the tongue of the patient. A portion of the blade from the apex to the tip portion is substantially straight and has a length which is adjustable by a manually operable slide.
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Excerpt(s): This invention relates to a laryngoscope which is shaped and arranged to improve direct vision of the opening to the larynx of the patient while increasing the area available for accommodating the tongue of the patient. Chapter 20 in airway management ("Airway Management: Principles and Practice by Jonathan L. Benumof (1996)") relates to a number of arrangements of laryngoscope blades. The present invention is concerned with blades of this type which allow direct vision of the doctor across an outer surface of the generally concave blade shape for a position adjacent the upper teeth of the patient over the tongue of the patient to the epiglottis and the opening in the larynx to the trachea. In order to obtain this direct line of sight, it is necessary to compress the tongue of the patient into the space behind the mandible of the patient and the curvature of the blade is shaped so that the tongue can be compressed while a tip of the blade engages the hyoid bone of the patient. With the device in place, the device can be pulled in a direction relative to the patient upwardly and toward the tongue to effect compression of the tongue and to effect lifting of the hyoid bone and the epiglottis of the patient thus allowing direct vision of the opening in the larynx. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Superglottic and peri-laryngeal apparatus for supraglottic airway insertion Inventor(s): Loubser, Paul G.; (Sugarland, TX) Correspondence: AL Harrison; Harrison & Egbert; 1018 Preston #100; Houston; TX; 77002; US Patent Application Number: 20010039949 Date filed: January 29, 2001 Abstract: A superglottic and peri-laryngeal apparatus for supraglottic airway device insertion that contemporaneously clears a patient's upper airway of the tongue and other pharyngeal tissues, and raises the epiglottis without use of the medical practitioner's fingers in the upper airway. The insertion apparatus comprises an offset member with a compressor-lever shield at a distal insertion end and a handle at the proximal end thereof. The offset member, medially disposed between the handle and the compressor-lever shield, should preferably be configured to be substantially flat, consistent in thickness throughout and having a tight, arcuate shape. The compressorlever shield member preferably widens from its junction with the offset member into a broad tip at its leading distal edge. Excerpt(s): This application is a continuation-in-part of U.S. application Ser. No. 09/305,167 filed May 4, 1999. The present invention pertains to control of the human upper airway to facilitate insertion of airway maintenance devices for management of respiration, and, more particularly, pertains to superglottic and peri-laryngeal means and methods for optimizing the rapid, proper insertion of a laryngeal mask airway and other supraglottic airway devices into the supraglottic space disposed above the larynx. It is well known in the art that human airway management requires speed and efficiency. Successful insertion of an airway maintenance device into a patient must take place within 15-20 seconds to avoid hypoxia or even death. Before an airway maintenance device can be introduced into a patient, a medical practitioner must first complete certain preparatory airway control steps focused on clearing the patient's upper airway. For an unconscious patient, airway control includes clearing the tongue and other pharyngeal tissues that often obstruct the upper airway, both the buccal cavity in the mouth and the pharyngeal cavity in the throat.
Patents 59
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 epiglottis, 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 “epiglottis” (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 epiglottis. You can also use this procedure to view pending patent applications concerning epiglottis. 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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APPENDICES
63
APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute7: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
•
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
•
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
•
National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
•
National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
•
National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
•
National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
•
National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
7
These publications are typically written by one or more of the various NIH Institutes.
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•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
•
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
•
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
•
National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
•
National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
•
National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
•
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
•
National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
•
National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
•
National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
•
National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
•
National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
•
National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
•
Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
•
National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
•
National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
•
Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
•
Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:9 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
•
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
•
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
•
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
•
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
•
Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
•
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
•
Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
•
Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
•
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
•
MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
8
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 9 See http://www.nlm.nih.gov/databases/databases.html.
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•
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
•
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM Gateway10 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “epiglottis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 2378 17 9 1 21 2426
HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.14 Simply search by “epiglottis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
10
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
11
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
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Coffee Break: Tutorials for Biologists15 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.16 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.17 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
•
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
15 Adapted 16
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 17 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on epiglottis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to epiglottis. 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 epiglottis. 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 “epiglottis”:
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Anatomy http://www.nlm.nih.gov/medlineplus/anatomy.html Cartilage Disorders http://www.nlm.nih.gov/medlineplus/cartilagedisorders.html COPD http://www.nlm.nih.gov/medlineplus/copdchronicobstructivepulmonarydisease.t ml Digestive Diseases http://www.nlm.nih.gov/medlineplus/digestivediseases.html Throat Disorders http://www.nlm.nih.gov/medlineplus/throatdisorders.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The 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 epiglottis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/specific.htm
•
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
•
Med Help International: http://www.medhelp.org/HealthTopics/A.html
•
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
•
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
•
WebMDHealth: http://my.webmd.com/health_topics
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Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to epiglottis. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with epiglottis. 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 epiglottis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “epiglottis” (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 “epiglottis”. 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 “epiglottis” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.
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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 “epiglottis” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.18
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
18
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)19: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
•
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
•
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
•
California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
•
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
•
California: Gateway Health Library (Sutter Gould Medical Foundation)
•
California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
•
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
•
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
•
California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
•
California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
•
California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
•
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
•
California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
•
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
•
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
•
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
19
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries
75
•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
•
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
•
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
•
Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
•
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
•
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
•
Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
•
Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
•
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
•
Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
•
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
•
Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
•
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
•
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
•
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
•
Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
•
Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
•
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
•
Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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•
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
•
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
•
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
•
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
•
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
•
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
•
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
•
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
•
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
•
Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
•
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
•
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
•
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
•
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
•
Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
•
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
•
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
•
National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
•
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
Finding Medical Libraries
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•
Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
•
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
•
New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
•
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
•
New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
•
New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
•
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
•
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
•
Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
•
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
•
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
•
Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
•
Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
•
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
•
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
•
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
•
Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
•
Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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•
South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
•
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
•
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
•
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
79
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
•
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
81
EPIGLOTTIS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Ablation: The removal of an organ by surgery. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] Acetylgalactosamine: The N-acetyl derivative of galactosamine. [NIH] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Adduction: The rotation of an eye toward the midline (nasally). [NIH] Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Air Pressure: The force per unit area that the air exerts on any surface in contact with it. Primarily used for articles pertaining to air pressure within a closed environment. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Airway Resistance: Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] 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]
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Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] 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] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angina: Chest pain that originates in the heart. [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] Anomalies: Birth defects; abnormalities. [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] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aplasia: Lack of development of an organ or tissue, or of the cellular products from an organ or tissue. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Apnoea: Cessation of breathing. [EU] Approximate: Approximal [EU]
Dictionary 83
Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriosus: Circle composed of anastomosing arteries derived from two long posterior ciliary and seven anterior ciliary arteries, located in the ciliary body about the root of the iris. [NIH]
Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Arytenoid Cartilage: One of a pair of small pyramidal cartilages that articulate with the lamina of the cricoid cartilage. The corresponding vocal ligament and several muscles are attached to it. [NIH] Aspiration: The act of inhaling. [NIH] Atresia: Lack of a normal opening from the esophagus, intestines, or anus. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]
Axillary Vein: The venous trunk of the upper limb; a continuation of the basilar and brachial veins running from the lower border of the teres major muscle to the outer border of the first rib where it becomes the subclavian vein. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Basal cells: Small, round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] 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 duct: A tube through which bile passes in and out of the liver. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived
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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] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]
Blotting, Western: Identification of proteins or peptides that have been electrophoretically separated by blotting and transferred to strips of nitrocellulose paper. The blots are then detected by radiolabeled antibody probes. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] 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] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchus: A large air passage that leads from the trachea (windpipe) to the lung. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Calibration: Determination, by measurement or comparison with a standard, of the correct value of each scale reading on a meter or other measuring instrument; or determination of the settings of a control device that correspond to particular values of voltage, current, frequency, or other output. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]
Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a
Dictionary 85
network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]
Carcinosarcoma: A malignant tumor that is a mixture of carcinoma (cancer of epithelial tissue, which is skin and tissue that lines or covers the internal organs) and sarcoma (cancer of connective tissue, such as bone, cartilage, and fat). [NIH] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiogenic: Originating in the heart; caused by abnormal function of the heart. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH] Carotid Sinus: The dilated portion of the common carotid artery at its bifurcation into external and internal carotids. It contains baroreceptors which, when stimulated, cause slowing of the heart, vasodilatation, and a fall in blood pressure. [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] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] 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] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH]
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Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Diseases: Diseases of any component of the brain (including the cerebral hemispheres, diencephalon, brain stem, and cerebellum) or the spinal cord. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral hemispheres: The two halves of the cerebrum, the part of the brain that controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. The right hemisphere controls muscle movement on the left side of the body, and the left hemisphere controls muscle movement on the right side of the body. [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] Chemoreceptors: Cells specialized to detect chemical substances and relay that information centrally in the nervous system. Chemoreceptors may monitor external stimuli, as in taste and olfaction, or internal stimuli, such as the concentrations of oxygen and carbon dioxide in the blood. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Choanal Atresia: Congenital bony or membranous occlusion of one or both choanae, due to failure of the embryonic bucconasal membrane to rupture. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Chondrocytes: Polymorphic cells that form cartilage. [NIH] Chondrosarcoma: A type of cancer that forms in cartilage. [NIH] Chorda Tympani Nerve: A branch of the facial (7th cranial) nerve which passes through the middle ear and continues through the petrotympanic fissure. The chorda tympani nerve carries taste sensation from the anterior two-thirds of the tongue and conveys parasympathetic efferents to the salivary glands. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Cleft Lip: Congenital defect in the upper lip where the maxillary prominence fails to merge with the merged medial nasal prominences. It is thought to be caused by faulty migration of the mesoderm in the head region. [NIH] Cleft Palate: Congenital fissure of the soft and/or hard palate, due to faulty fusion. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic
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engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in 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] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH]
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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] 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] Constriction: The act of constricting. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Conus: A large, circular, white patch around the optic disk due to the exposing of the sclera as a result of degenerative change or congenital abnormality in the choroid and retina. [NIH] Convulsive: Relating or referring to spasm; affected with spasm; characterized by a spasm or spasms. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cricoid Cartilage: The small thick cartilage that forms the lower and posterior parts of the laryngeal wall. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyanosis: A bluish or purplish discoloration of the skin and mucous membranes due to an increase in the amount of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule. [NIH]
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Cyst: A sac or capsule filled with fluid. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytotoxic: Cell-killing. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Deglutition: The process or the act of swallowing. [NIH] Dehydration: The condition that results from excessive loss of body water. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilator: A device used to stretch or enlarge an opening. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Disposition: A tendency either physical or mental toward certain diseases. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] 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] Duct: A tube through which body fluids pass. [NIH]
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Duodenum: The first part of the small intestine. [NIH] Dysostosis: Defective bone formation. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Electric shock: A dangerous patho-physiological effect resulting from an electric current passing through the body of a human or animal. [NIH] Electroshock: Induction of a stress reaction in experimental subjects by means of an electrical shock; applies to either convulsive or non-convulsive states. [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] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [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] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endotracheal intubation: Insertion of an airtube into the windpipe. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidermoid carcinoma: A type of cancer in which the cells are flat and look like fish scales. Also called squamous cell carcinoma. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Atresia: Congenital failure of the full esophageal lumen to develop that commonly occurs with tracheoesophageal fistula. Symptoms include excessive salivation, gagging, cyanosis, and dyspnea. [NIH]
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Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Evacuation: An emptying, as of the bowels. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Facial: Of or pertaining to the face. [EU] Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [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] Fibroid: A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called leiomyoma. [NIH] Finite Element Analysis: A computer based method of simulating or analyzing the behavior of structures or components. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flaccid: Weak, lax and soft. [EU] Flatus: Gas passed through the rectum. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Fossa: A cavity, depression, or pit. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [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] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH]
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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] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Geriatric: Pertaining to the treatment of the aged. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]
Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [NIH] Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords (plica vocalis) and the opening between them (rima glottidis). [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] 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] 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]
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Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Hamartoma: A focal malformation resembling a neoplasm, composed of an overgrowth of mature cells and tissues that normally occur in the affected area. [NIH] Heart Arrest: Sudden and usually momentary cessation of the heart beat. This sudden cessation may, but not usually, lead to death, sudden, cardiac. [NIH] Heart Valves: Flaps of tissue that prevent regurgitation of blood from the ventricles to the atria or from the pulmonary arteries or aorta to the ventricles. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypopharynx: The portion of the pharynx between the inferior portion of the oropharynx and the larynx. [NIH] Hypopituitarism: Diminution or cessation of secretion of one or more hormones from the anterior pituitary gland (including LH; FSH; somatotropin; and corticotropin). This may result from surgical or radiation ablation, non-secretory pituitary neoplasms, metastatic tumors, infarction, pituitary apoplexy, infiltrative or granulomatous processes, and other conditions. [NIH] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU] Hypoxemia: Deficient oxygenation of the blood; hypoxia. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunoblotting: Immunologic methods for isolating and quantitatively measuring immunoreactive substances. When used with immune reagents such as monoclonal antibodies, the process is known generically as western blot analysis (blotting, western). [NIH]
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Immunocompromised: Having a weakened immune system caused by certain diseases or treatments. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Imperforate Anus: A birth defect in which the anal canal fails to develop. The condition is treated with an operation. [NIH] Incision: A cut made in the body during surgery. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Indocyanine Green: A tricarbocyanine dye that is used diagnostically in liver function tests and to determine blood volume and cardiac output. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Insertional: A technique in which foreign DNA is cloned into a restriction site which occupies a position within the coding sequence of a gene in the cloning vector molecule. Insertion interrupts the gene's sequence such that its original function is no longer expressed. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Intercostal: Situated between the ribs. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH]
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Intramuscular: IM. Within or into muscle. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [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] Lamella: A layer of the iris containing the fibrils of the dilator pupillae muscle, exclusive of their cell bodies, located between the anterior pigment layer of Fuchs and the stroma. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Laryngeal Diseases: General or unspecified disorders of the larynx. [NIH] Laryngeal Masks: A type of oropharyngeal airway that provides an alternative to endotracheal intubation and standard mask anesthesia in certain patients. It is introduced into the hypopharynx to form a seal around the larynx thus permitting spontaneous or positive pressure ventilation without penetration of the larynx or esophagus. It is used in place of a facemask in routine anesthesia. The advantages over standard mask anesthesia are better airway control, minimal anesthetic gas leakage, a secure airway during patient transport to the recovery area, and minimal postoperative problems. [NIH] Laryngectomy: Total or partial excision of the larynx. [NIH] Laryngoscope: A thin, lighted tube used to examine the larynx (voice box). [NIH] Laryngoscopy: Examination, therapy, or surgery of the interior of the larynx performed with a specially designed endoscope. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laser Surgery: The use of a laser either to vaporize surface lesions or to make bloodless cuts in tissue. It does not include the coagulation of tissue by laser. [NIH] Leiomyoma: A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissues, probably arising from the smooth muscle of small blood vessels in these tissues. [NIH]
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Leishmaniasis: A disease caused by any of a number of species of protozoa in the genus Leishmania. There are four major clinical types of this infection: cutaneous (Old and New World), diffuse cutaneous, mucocutaneous, and visceral leishmaniasis. [NIH] Lesion: An area of abnormal tissue change. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] 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] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipoma: A benign tumor composed of fat cells. [NIH] Liposarcoma: A rare cancer of the fat cells. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [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] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lymphoproliferative: Disorders characterized by proliferation of lymphoid tissue, general or unspecified. [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
Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH]
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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] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]
Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mesoderm: The middle germ layer of the embryo. [NIH] Metaplasia: A condition in which there is a change of one adult cell type to another similar adult cell type. [NIH] 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] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [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] 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] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA,
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can be made up of many thousands of atoms. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Mononuclear: A cell with one nucleus. [NIH] Mucocutaneous: Pertaining to or affecting the mucous membrane and the skin. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multiple Trauma: Physical insults or injuries occurring simultaneously in several parts of the body. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [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] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Nasal Cavity: The proximal portion of the respiratory passages on either side of the nasal septum, lined with ciliated mucosa, extending from the nares to the pharynx. [NIH] Nasal Obstruction: Any hindrance to the passage of air into and out of the nose. The obstruction may be in the nasal vestibule, fossae, or other areas of the nasal cavity. [NIH] Nasal Septum: The partition separating the two nasal cavities in the midplane, composed of cartilaginous, membranous and bony parts. [NIH] Nasopharynx: The nasal part of the pharynx, lying above the level of the soft palate. [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] 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]
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Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuroeffector Junction: The synapse between a neuron (presynaptic) and an effector cell other than another neuron (postsynaptic). Neuroeffector junctions include synapses onto muscles and onto secretory cells. [NIH] Neurofibroma: A fibrous tumor, usually benign, arising from the nerve sheath or the endoneurium. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Blocking Agents: Drugs that interrupt transmission of nerve impulses at the skeletal neuromuscular junction. They can be of two types, competitive, stabilizing blockers (neuromuscular nondepolarizing agents) or noncompetitive, depolarizing agents (neuromuscular depolarizing agents). Both prevent acetylcholine from triggering the muscle contraction and they are used as anesthesia adjuvants, as relaxants during electroshock, in convulsive states, etc. [NIH] Neuromuscular Depolarizing Agents: Drugs that interrupt transmission at the skeletal neuromuscular junction by causing sustained depolarization of the motor end plate. These agents are primarily used as adjuvants in surgical anesthesia to cause skeletal muscle relaxation. [NIH] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuromuscular Nondepolarizing Agents: Drugs that interrupt transmission at the skeletal neuromuscular junction without causing depolarization of the motor end plate. They prevent acetylcholine from triggering muscle contraction and are used as muscle relaxants during electroshock treatments, in convulsive states, and as anesthesia adjuvants. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Ophthalmologic: Pertaining to ophthalmology (= the branch of medicine dealing with the eye). [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Oropharynx: Oral part of the pharynx. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the
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outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Papilloma: A benign epithelial neoplasm which may arise from the skin, mucous membranes or glandular ducts. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Particle: A tiny mass of material. [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharyngitis: Inflammation of the throat. [NIH] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phonation: The process of producing vocal sounds by means of vocal cords vibrating in an expiratory blast of air. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Pituitary Apoplexy: Sudden hemorrhage or ischemic necrosis involving the pituitary gland which may be associated with acute visual loss, severe headache, meningeal signs, cranial nerve palsies, panhypopituitarism, and rarely coma. The most common cause is hemorrhage (intracranial hemorrhages) related to a pituitary adenoma. Ischemia, meningitis, intracranial hypertension, and other disorders may be associated with this condition. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Pituitary Neoplasms: Neoplasms which arise from or metastasize to the pituitary gland.
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The majority of pituitary neoplasms are adenomas, which are divided into non-secreting and secreting forms. Hormone producing forms are further classified by the type of hormone they secrete. Pituitary adenomas may also be characterized by their staining properties (adenoma, basophil; adenoma, acidophil; and adenoma, chromophobe). Pituitary tumors may compress adjacent structures, including the hypothalamus, several cranial nerves, and the optic chiasm. Chiasmal compression may result in bitemporal hemianopsia. [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] Plasmacytoma: Any discrete, presumably solitary, mass of neoplastic plasma cells either in bone marrow or various extramedullary sites. [NIH] Pleomorphic: Occurring in various distinct forms. In terms of cells, having variation in the size and shape of cells or their nuclei. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyvalent: Having more than one valence. [EU] Polyvinyl Chloride: A polyvinyl resin used extensively in the manufacture of plastics, including medical devices, tubing, and other packaging. It is also used as a rubber substitute. [NIH] Positive pressure ventilation: Provision of oxygen under pressure by a mechanical respirator. [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] Postoperative: After surgery. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [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
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exploring or sounding body cavities. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]
Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [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] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [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] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reference point: The midpoint of a line connecting the centers of the two end faces of the acoustic test fixture. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward
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flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]
Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory Muscles: These include the muscles of the diaphragm and the intercostal muscles. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva). [EU] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebum: The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. [NIH] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and cause the growth of a new tumor. When this happens, the disease is called metastatic breast cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [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] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the
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quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] 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]
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] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [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] Somatotropin: A small peptide hormone released by the anterior pituitary under hypothalamic control. Somatotropin, or growth hormone, stimulates mitosis, cell growth, and, for some cell types, differentiation in many tissues of the body. It has profound effects on many aspects of gene expression and metabolism. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [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] Spectrometer: An apparatus for determining spectra; measures quantities such as wavelengths and relative amplitudes of components. [NIH] Speech Disorders: Acquired or developmental conditions marked by an impaired ability to comprehend or generate spoken forms of language. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] 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]
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Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cells: Flat cells that look like fish scales under a microscope. These cells cover internal and external surfaces of the body. [NIH] Sterile: Unable to produce children. [NIH] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [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] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strangulation: Extreme compression or constriction of the trachea or of any part. [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] Stridor: The loud, harsh, vibrating sound produced by partial obstruction of the larynx or trachea. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclavian: The direct continuation of the axillary vein at the lateral border of the first rib. It passes medially to join the internal jugular vein and form the brachiocephalic vein on each side. [NIH] Subclavian Artery: Artery arising from the brachiocephalic trunk on the right side and from the arch of the aorta on the left side. It distributes to the neck, thoracic wall, spinal cord, brain, meninges, and upper limb. [NIH] Subclavian Vein: The continuation of the axillary vein which follows the subclavian artery and then joins the internal jugular vein to form the brachiocephalic vein. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU]
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Subcutaneous: Beneath the skin. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Supine: Having the front portion of the body upwards. [NIH] Supine Position: The posture of an individual lying face up. [NIH] Supraglottis: The upper part of the larynx (voice box), including the epiglottis; the area above the vocal cords. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Systemic: Affecting the entire body. [NIH] Taste Buds: Small sensory organs which contain gustatory receptor cells, basal cells, and supporting cells. Taste buds in humans are found in the epithelia of the tongue, palate, and pharynx. They are innervated by the chorda tympani nerve (a branch of the facial nerve) and the glossopharyngeal nerve. [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] Thermodilution: Measurement of blood flow based on induction at one point of the circulation of a known change in the intravascular heat content of flowing blood and detection of the resultant change in temperature at a point downstream. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]
Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thrush: A disease due to infection with species of fungi of the genus Candida. [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] Thyroid Cartilage: The largest cartilage of the larynx consisting of two laminae fusing anteriorly at an acute angle in the midline of the neck. The point of fusion forms a subcutaneous projection known as the Adam's apple. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH]
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Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonsil: A round-to-oval mass of lymphoid tissue embedded in the lateral wall of the pharynx situated on each side of the fauces, between the anterior and posterior pillars of the soft palate. [NIH] Tonsillitis: Inflammation of the tonsils, especially the palatine tonsils. It is often caused by a bacterium. Tonsillitis may be acute, chronic, or recurrent. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] 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] Tracheoesophageal Fistula: Abnormal communication between the esophagus and the trachea, acquired or congenital, often associated with esophageal atresia. [NIH] Tracheostomy: Surgical formation of an opening into the trachea through the neck, or the opening so created. [NIH] Tracheotomy: Surgical incision of the trachea. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Triamcinolone Acetonide: An esterified form of triamcinolone. It is an anti-inflammatory glucocorticoid used topically in the treatment of various skin disorders. Intralesional, intramuscular, and intra-articular injections are also administered under certain conditions. [NIH]
Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]
Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH]
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Uvula: Uvula palatinae; specifically, the tongue-like process which projects from the middle of the posterior edge of the soft palate. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]
Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venter: Belly. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vinblastine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. It is a mitotic inhibitor. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [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]
Dictionary 109
Vivo: Outside of or removed from the body of a living organism. [NIH] Vocal cord: The vocal folds of the larynx. [NIH] Voice Quality: Voice quality is that component of speech which gives the primary distinction to a given speaker's voice when pitch and loudness are excluded. It involves both phonatory and resonatory characteristics. Some of the descriptions of voice quality are harshness, breathiness and nasality. [NIH] Vomitus: 1. Vomiting. 2. Matter vomited. [EU] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] Zygomycosis: Infection in humans and animals caused by fungi in the class Zygomycetes. It includes mucormycosis and entomophthoramycosis. The latter is a tropical infection of subcutaneous tissue or paranasal sinuses caused by fungi in the order Entomophthorales. Phycomycosis, closely related to zygomycosis, describes infection with members of Phycomycetes, an obsolete classification. [NIH]
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INDEX A Abdomen, 37, 81, 96, 100, 105, 106 Abdominal, 36, 81, 89, 100 Ablation, 81, 93 Abscess, 4, 81 Acetylcholine, 81, 86, 99 Acetylcholinesterase, 6, 81 Acetylgalactosamine, 81, 92 Acetylglucosamine, 81, 92 Acoustic, 5, 9, 81, 102 Acrylonitrile, 81, 103 Actin, 81, 98 Adduction, 10, 81 Adenoma, 11, 16, 23, 81, 100, 101 Air Pressure, 37, 49, 81 Airway Resistance, 39, 81 Algorithms, 81, 84 Alkaloid, 81, 87 Alternative medicine, 81 Alveoli, 82, 108 Amphetamines, 82, 87 Ampulla, 82, 90 Anaesthesia, 14, 18, 20, 21, 24, 41, 82, 94 Anaesthetic, 41, 57, 82 Anal, 82, 94 Anatomical, 19, 42, 51, 82, 83, 86 Anesthesia, 11, 22, 36, 39, 42, 46, 52, 81, 82, 95, 99 Angina, 12, 82 Animal model, 5, 7, 82 Anomalies, 15, 17, 82 Antibodies, 82, 94, 96, 98, 101 Antibody, 82, 84, 87, 94, 98 Antigen, 19, 82, 87, 94 Anti-inflammatory, 82, 92, 107 Anus, 18, 82, 83, 87, 94 Aorta, 48, 82, 93, 105, 108 Aplasia, 14, 17, 82 Apnea, 39, 82 Apnoea, 25, 82 Approximate, 50, 82 Arterial, 48, 83, 88, 93, 102 Arteries, 82, 83, 84, 88, 93, 97, 98 Arterioles, 83, 84 Arteriosus, 83, 102 Artery, 48, 83, 85, 88, 90, 100, 102, 105 Articular, 83, 107 Arytenoid Cartilage, 40, 49, 83
Aspiration, 6, 41, 54, 83 Atresia, 83, 88 Atrium, 83, 88, 108 Autologous, 26, 83 Autonomic, 81, 83, 92 Axillary, 83, 105 Axillary Vein, 83, 105 B Bacteria, 82, 83, 90, 91, 97, 104, 108 Bacterium, 83, 107 Basal cells, 83, 106 Benign, 81, 83, 91, 95, 96, 98, 99, 100 Benign tumor, 83, 95, 96 Bile, 83, 91, 92, 94, 96 Bile Acids, 83, 92 Bile duct, 83, 94 Biomechanics, 6, 9, 16, 83 Biopsy, 83, 100 Biotechnology, 10, 65, 83 Blood vessel, 84, 85, 86, 88, 92, 93, 95, 100, 104, 105, 106, 108 Blood Volume, 84, 94 Blot, 84, 93 Blotting, Western, 84, 93 Bolus, 7, 37, 48, 84 Bolus infusion, 84 Bone Marrow, 84, 96, 101 Brain Stem, 84, 86 Bronchi, 40, 84, 107 Bronchus, 41, 84 Buccal, 58, 84 C Calibration, 10, 84 Candidiasis, 11, 84 Candidosis, 84 Cannula, 38, 84 Capillary, 49, 84, 108 Carbon Dioxide, 85, 86, 92, 103 Carcinoma, 16, 25, 27, 85 Carcinosarcoma, 23, 85 Cardiac, 6, 40, 48, 49, 53, 54, 85, 88, 90, 92, 93, 94, 98, 103 Cardiac arrest, 40, 54, 85 Cardiac Output, 48, 49, 85, 94 Cardiogenic, 48, 85 Cardiopulmonary, 52, 85 Cardiopulmonary Resuscitation, 52, 85 Carotid Sinus, 85, 92
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Case report, 16, 17, 19, 20, 22, 23, 24, 25, 85 Catheter, 48, 85, 95 Catheterization, 85, 95 Caudal, 85, 89, 101 Cause of Death, 6, 85 Caustic, 4, 85 Cell, 11, 81, 83, 85, 87, 89, 91, 94, 95, 96, 97, 98, 99, 101, 102, 103, 104 Cell Respiration, 85, 103 Central Nervous System, 4, 5, 81, 82, 86, 87 Central Nervous System Diseases, 4, 86 Cerebellum, 86 Cerebral, 84, 86, 91 Cerebral hemispheres, 84, 86 Cervical, 54, 55, 86 Cervix, 86 Chemoreceptors, 86, 92 Chemotherapy, 33, 86 Chin, 42, 46, 86, 97 Choanal Atresia, 3, 86 Choline, 81, 86 Chondrocytes, 19, 86 Chondrosarcoma, 16, 17, 19, 86 Chorda Tympani Nerve, 86, 106 Chronic, 5, 86, 91, 94, 105, 107 Cleft Lip, 3, 86 Cleft Palate, 3, 86 Clinical trial, 4, 65, 86 Cloning, 84, 86, 94 Coca, 87 Cocaine, 25, 87 Collapse, 40, 43, 50, 87, 104 Colon, 87, 94, 95 Complement, 87 Complementary and alternative medicine, 33, 34, 87 Complementary medicine, 33, 87 Compress, 58, 87, 101 Computational Biology, 65, 88 Connective Tissue, 84, 85, 88, 96, 103 Consciousness, 46, 88, 103 Constriction, 88, 105 Contraindications, ii, 88 Conus, 88, 102 Convulsive, 88, 90, 99 Coordination, 7, 86, 88 Cor, 88, 93 Coronary, 88, 97, 98 Coronary Thrombosis, 88, 97, 98 Cranial, 86, 88, 91, 92, 100, 101 Cricoid Cartilage, 83, 88, 109
Cutaneous, 84, 88, 96 Cyanosis, 88, 90 Cyst, 18, 24, 89 Cytomegalovirus, 4, 89 Cytotoxic, 33, 89 D Decision Making, 9, 89 Deglutition, 7, 20, 22, 89 Dehydration, 10, 89 Dendrites, 89, 99 Diagnostic procedure, 35, 89 Diaphragm, 37, 89, 103 Diencephalon, 86, 89 Digestion, 83, 89, 96, 105 Digestive tract, 24, 89, 105 Dilator, 89, 95 Direct, iii, 5, 7, 10, 36, 37, 44, 48, 57, 58, 89, 102, 105, 106 Discrete, 89, 101 Disposition, 39, 89 Distal, 38, 39, 41, 43, 44, 45, 46, 47, 49, 50, 51, 52, 55, 56, 58, 89, 92, 101 Dopamine, 87, 89 Dorsal, 26, 89, 101 Dorsum, 89 Drive, ii, vi, 3, 7, 29, 89 Duct, 82, 84, 85, 89, 103 Duodenum, 83, 90, 100, 105 Dysostosis, 18, 90 Dysphagia, 3, 7, 90 Dysplasia, 16, 90 Dyspnea, 90 E Edema, 25, 90 Elastic, 19, 21, 22, 90 Electric shock, 85, 90 Electroshock, 90, 99 Emboli, 49, 90 Embolus, 90, 94 Enalapril, 14, 90 Endocarditis, 84, 90 Endoscope, 90, 95 Endoscopic, 36, 90 Endotracheal intubation, 36, 38, 39, 40, 44, 54, 55, 90, 95 Environmental Health, 64, 66, 90 Enzyme, 81, 90, 108 Epidermoid carcinoma, 90, 105 Epithelial, 10, 19, 81, 85, 90, 100 Epithelial Cells, 90 Epithelium, 22, 90, 92, 95 Esophageal, 4, 6, 42, 50, 54, 90, 107
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Esophageal Atresia, 4, 90, 107 Esophagitis, 4, 91 Esophagus, 5, 37, 42, 44, 50, 51, 83, 89, 90, 91, 92, 95, 96, 100, 102, 105, 107 Evacuation, 43, 91 Expiration, 91, 103 Expiratory, 91, 100 Extravasation, 91, 93 F Facial, 45, 86, 91, 100, 106 Facial Nerve, 91, 100, 106 Family Planning, 65, 91 Fat, 84, 85, 88, 90, 91, 96, 103, 104 Fibroid, 91, 95 Finite Element Analysis, 10, 91 Fissure, 86, 91 Fistula, 33, 91 Flaccid, 18, 91 Flatus, 91, 92 Fold, 5, 7, 8, 9, 91 Foramen, 86, 91 Fossa, 4, 86, 91 Friction, 81, 91 Fungi, 91, 97, 106, 108, 109 Fungus, 84, 91 G Gallbladder, 81, 91 Gas, 39, 43, 49, 57, 85, 91, 92, 95, 102, 103, 106, 108 Gas exchange, 92, 103, 108 Gastric, 20, 41, 42, 43, 50, 54, 92 Gastric Mucosa, 20, 92 Gastroesophageal Reflux, 4, 92 Gastrointestinal, 5, 42, 91, 92, 95 Gastrointestinal tract, 5, 42, 91, 92, 95 Gene, 84, 92, 94, 104 Geriatric, 6, 92 Gland, 92, 96, 100, 103, 105, 106 Glomerular, 27, 92 Glomerulus, 92 Glossopharyngeal Nerve, 6, 92, 106 Glottis, 5, 8, 10, 36, 51, 52, 92 Glucocorticoid, 92, 107 Glycosaminoglycans, 26, 92 Governing Board, 92, 101 Graft, 19, 26, 92 Granuloma, 27, 93 H Haematoma, 93 Haemorrhage, 24, 93 Hamartoma, 17, 93 Heart Arrest, 85, 93
Heart Valves, 48, 93 Hematoma, 49, 93 Hemorrhage, 13, 93, 100, 102, 105 Herpes, 4, 20, 93 Herpes Zoster, 93 Hormone, 93, 101, 104, 106 Hydrolysis, 81, 93 Hypertension, 88, 90, 93, 100 Hypopharynx, 21, 46, 51, 52, 57, 93, 95 Hypopituitarism, 15, 93 Hypoplasia, 13, 20, 93 Hypoxemia, 40, 52, 93 Hypoxia, 58, 93 I Immune response, 82, 93, 108 Immune system, 93, 94, 96 Immunoblotting, 6, 93 Immunocompromised, 11, 19, 94 Immunoglobulin, 82, 94, 98 Immunohistochemistry, 24, 94 Impaction, 24, 94 Imperforate Anus, 16, 94 Incision, 94, 95, 107 Incompetence, 92, 94 Indocyanine Green, 49, 94 Induction, 90, 94, 106 Infarction, 48, 93, 94 Infection, 14, 19, 84, 89, 94, 96, 105, 106, 109 Inflammation, 11, 82, 91, 93, 94, 100, 101, 107, 108 Ingestion, 4, 94 Inhalation, 14, 94 Innervation, 6, 91, 94 Insertional, 41, 43, 94 Insight, 9, 94 Intercostal, 94, 103 Intestines, 81, 83, 92, 94 Intracellular, 94 Intramuscular, 95, 107 Intravascular, 95, 106 Intravenous, 33, 39, 95 Intrinsic, 6, 9, 20, 95 Intubation, 11, 12, 14, 18, 21, 37, 39, 40, 42, 44, 45, 49, 50, 51, 52, 53, 54, 55, 85, 95 Invasive, 8, 10, 11, 48, 49, 95, 96 Involuntary, 95, 98, 102, 104 Iris, 83, 95 K Kb, 64, 95 L Lamella, 48, 95
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Large Intestine, 89, 94, 95, 102 Laryngeal Diseases, 7, 95 Laryngeal Masks, 43, 47, 57, 95 Laryngectomy, 21, 95 Laryngoscope, 4, 14, 16, 18, 36, 37, 38, 47, 51, 52, 53, 57, 58, 95 Laryngoscopy, 36, 40, 95 Laser Surgery, 11, 95 Leiomyoma, 4, 91, 95 Leishmaniasis, 19, 96 Lesion, 93, 96, 107 Ligament, 53, 54, 55, 83, 96 Linkages, 92, 96 Lip, 38, 42, 86, 96 Lipoma, 21, 23, 96 Liposarcoma, 27, 96 Liver, 81, 83, 89, 91, 94, 96 Localization, 94, 96 Localized, 81, 93, 94, 96, 101, 107 Lower Esophageal Sphincter, 92, 96 Lymph, 83, 86, 96 Lymph node, 83, 86, 96 Lymphatic, 26, 94, 96, 101, 105, 106 Lymphocyte, 82, 96 Lymphoid, 82, 96, 107 Lymphoma, 33, 96 Lymphoproliferative, 23, 96 M Magnetic Resonance Imaging, 14, 96 Malformation, 93, 96 Malignancy, 19, 96 Malignant, 85, 97, 98, 103 Malignant tumor, 85, 97 Mandible, 17, 45, 47, 58, 86, 97 Maxillary, 13, 45, 86, 97 Meat, 37, 97 Medial, 86, 97 MEDLINE, 65, 97 Melanocytes, 97 Melanoma, 14, 21, 97 Membrane, 19, 86, 87, 95, 97, 98 Meninges, 86, 97, 105 Mental, iv, 4, 64, 66, 86, 89, 94, 97, 102 Mesoderm, 86, 97 Metaplasia, 16, 97 Metastasis, 16, 97 Metastatic, 14, 93, 97, 103 MI, 79, 97 Microorganism, 97, 108 Migration, 86, 97 Mitotic, 97, 108 Modeling, 5, 8, 97
Molecular, 65, 67, 84, 88, 97, 103 Molecule, 82, 87, 88, 93, 94, 97, 102, 108 Monoclonal, 19, 93, 98 Monoclonal antibodies, 19, 93, 98 Mononuclear, 93, 98 Mucocutaneous, 96, 98 Mucosa, 22, 24, 92, 98 Multiple Trauma, 48, 98 Muscle Contraction, 7, 98, 99 Muscle Fibers, 6, 98 Musculature, 5, 98 Myocardial infarction, 48, 88, 97, 98 Myocardium, 97, 98 Myosin, 6, 98 N Nasal Cavity, 48, 98 Nasal Obstruction, 3, 98 Nasal Septum, 98 Nasopharynx, 39, 92, 98 Necrosis, 94, 97, 98, 100 Neonatal, 6, 98 Neoplasia, 98 Neoplasm, 93, 98, 100, 103 Neoplastic, 3, 96, 98, 101 Nerve, 6, 22, 24, 27, 82, 86, 89, 91, 92, 94, 98, 99, 100, 105 Nerve Endings, 24, 27, 99 Nervous System, 86, 98, 99, 101 Neuroeffector Junction, 99 Neurofibroma, 4, 99 Neurologic, 4, 99 Neuromuscular, 4, 6, 40, 45, 81, 99 Neuromuscular Blocking Agents, 40, 99 Neuromuscular Depolarizing Agents, 99 Neuromuscular Junction, 4, 81, 99 Neuromuscular Nondepolarizing Agents, 99 Neurons, 30, 87, 89, 99, 106 Nuclei, 96, 99, 101 O Ophthalmologic, 39, 99 Ophthalmology, 99 Oropharynx, 42, 46, 93, 99 Oxygen Consumption, 99, 103 Oxygenation, 93, 99 P Palate, 6, 39, 45, 50, 52, 86, 92, 98, 99, 106, 107, 108 Palpation, 53, 54, 99 Pancreas, 81, 100 Pancreatic, 16, 92, 100 Pancreatic Juice, 92, 100
115
Papilloma, 4, 100 Paralysis, 3, 11, 45, 100 Parotid, 92, 100 Particle, 8, 37, 100 Pathologies, 9, 100 Pathophysiology, 9, 100 Pelvis, 81, 100, 107 Percutaneous, 48, 100 Perfusion, 93, 100 Petechiae, 93, 100 Pharmacologic, 82, 100, 107 Pharyngitis, 4, 100 Pharynx, 6, 36, 38, 39, 43, 45, 47, 51, 52, 92, 93, 98, 99, 100, 106, 107 Phonation, 5, 7, 9, 100 Physical Examination, 4, 100 Physiology, 6, 9, 100 Pigment, 95, 97, 100 Pitch, 9, 100, 109 Pituitary Apoplexy, 93, 100 Pituitary Gland, 93, 100 Pituitary Neoplasms, 93, 100 Plants, 81, 85, 86, 87, 101, 107 Plasma, 82, 84, 101 Plasma cells, 82, 101 Plasmacytoma, 25, 101 Pleomorphic, 11, 16, 23, 101 Plexus, 6, 36, 37, 101 Pneumonia, 88, 101 Polysaccharide, 82, 101 Polyvalent, 19, 101 Polyvinyl Chloride, 49, 101 Positive pressure ventilation, 52, 95, 101 Posterior, 4, 36, 38, 41, 44, 46, 50, 51, 82, 83, 86, 88, 89, 92, 95, 99, 100, 101, 107, 108 Postoperative, 95, 101 Practice Guidelines, 66, 101 Presynaptic, 99, 101 Presynaptic Terminals, 99, 101 Probe, 48, 101 Progression, 82, 102 Projection, 102, 106 Prolapse, 11, 12, 102 Protein S, 84, 102 Proteins, 82, 84, 87, 97, 101, 102, 107, 108 Protozoa, 96, 97, 102, 108 Psychiatry, 102, 108 Public Policy, 65, 102 Pulmonary, 40, 48, 81, 88, 93, 102, 103, 108 Pulmonary Artery, 48, 102, 108 Pulmonary Ventilation, 102, 103
Pulse, 48, 102 Purpura, 93, 102 R Radiation, 40, 93, 102 Radioactive, 98, 102 Radiological, 100, 102 Receptor, 82, 89, 102, 106 Rectum, 18, 20, 82, 87, 89, 91, 92, 95, 102 Refer, 1, 84, 87, 91, 93, 96, 102 Reference point, 40, 102 Reflex, 45, 102 Reflux, 6, 92, 102 Regurgitation, 41, 43, 92, 93, 102 Reliability, 47, 103 Respiration, 9, 37, 54, 56, 58, 82, 85, 103 Respirator, 101, 103 Respiratory Muscles, 44, 103 Respiratory Physiology, 103, 108 Respiratory System, 6, 103 Resuscitation, 52, 85, 103 Rubber, 49, 81, 101, 103 S Saline, 48, 103 Salivary, 86, 89, 91, 103 Salivary glands, 86, 89, 91, 103 Salivation, 90, 103 Sarcoma, 20, 33, 85, 103 Screening, 86, 103 Sebaceous, 25, 103 Sebum, 103 Secondary tumor, 97, 103 Secretion, 93, 103 Secretory, 19, 93, 99, 103 Sensibility, 82, 103 Sensor, 49, 104 Sepsis, 48, 104 Septic, 48, 104 Shock, 48, 90, 104, 107 Skeletal, 6, 99, 104 Skeleton, 81, 104 Skull, 104, 106 Sleep apnea, 6, 17, 22, 104 Smooth muscle, 82, 91, 95, 104 Soft tissue, 42, 52, 84, 104 Somatic, 92, 104 Somatotropin, 93, 104 Spasm, 6, 45, 88, 104 Specialist, 71, 104 Species, 96, 97, 98, 104, 106, 109 Spectrometer, 49, 104 Speech Disorders, 9, 104 Sphincter, 6, 41, 43, 95, 104
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Spinal cord, 54, 55, 84, 86, 97, 99, 102, 104, 105 Spleen, 89, 96, 105 Squamous, 11, 17, 24, 25, 33, 90, 105 Squamous cell carcinoma, 17, 24, 25, 33, 90, 105 Squamous cells, 105 Sterile, 48, 53, 105 Sterilization, 47, 105 Stimulus, 89, 94, 102, 105, 106 Stomach, 3, 37, 41, 42, 43, 50, 81, 89, 90, 91, 92, 93, 94, 96, 100, 102, 105 Stool, 87, 94, 95, 105 Strangulation, 37, 105 Stress, 10, 90, 103, 105 Stridor, 18, 25, 105 Stroke, 64, 85, 105 Stroma, 95, 105 Styrene, 103, 105 Subacute, 94, 105 Subclavian, 48, 83, 105 Subclavian Artery, 105 Subclavian Vein, 48, 83, 105 Subclinical, 94, 105 Subcutaneous, 90, 95, 106, 109 Suction, 37, 42, 106 Supine, 47, 106 Supine Position, 47, 106 Supraglottis, 36, 106 Symphysis, 86, 106 Synapse, 99, 101, 106 Systemic, 3, 82, 84, 94, 106 T Taste Buds, 22, 106 Temporal, 8, 106 Thermodilution, 48, 106 Thoracic, 89, 105, 106, 109 Thorax, 81, 106 Threshold, 10, 93, 106 Thromboses, 49, 106 Thrombosis, 49, 102, 105, 106 Thrombus, 88, 94, 106 Thrush, 84, 106 Thymus, 96, 106 Thyroid, 5, 106 Thyroid Cartilage, 5, 106 Tomography, 17, 24, 106 Tone, 107 Tonic, 6, 107 Tonicity, 39, 107 Tonsil, 26, 107 Tonsillitis, 4, 107
Torsion, 94, 107 Toxic, iv, 105, 107 Toxicology, 66, 107 Toxins, 82, 94, 98, 107 Tracheoesophageal Fistula, 4, 90, 107 Tracheostomy, 12, 107 Tracheotomy, 37, 48, 107 Transfection, 84, 107 Trauma, 4, 41, 44, 46, 50, 51, 54, 91, 98, 107 Trees, 103, 107 Triamcinolone Acetonide, 4, 107 Tunica, 98, 107 U Ulcer, 4, 107 Unconscious, 38, 41, 42, 43, 46, 47, 58, 107 Uterus, 86, 91, 95, 107, 108 Uvula, 38, 45, 108 V Vaccines, 108 Vagina, 84, 86, 108 Vaginitis, 84, 108 Vascular, 4, 48, 94, 106, 108 Vector, 94, 108 Vein, 95, 100, 105, 108 Venous, 48, 83, 102, 108 Venter, 108 Ventilation, 38, 39, 41, 42, 43, 44, 47, 51, 52, 54, 55, 56, 57, 85, 108 Ventral, 38, 108 Ventricle, 19, 88, 102, 108 Venules, 84, 108 Vertebrae, 104, 108 Vestibule, 98, 108 Veterinary Medicine, 65, 108 Vinblastine, 33, 108 Vinca Alkaloids, 108 Virus, 4, 108 Visceral, 19, 92, 96, 108 Visceral Afferents, 92, 108 Vitro, 8, 108 Vivo, 5, 109 Vocal cord, 3, 19, 25, 36, 40, 45, 92, 100, 106, 109 Voice Quality, 8, 109 Vomitus, 54, 109 W Windpipe, 37, 38, 41, 54, 55, 84, 90, 100, 106, 109 X Xenograft, 82, 109 Z Zygomycosis, 11, 109
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