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

LAPAROSCOPY 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., 1960Laparoscopy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84478-X 1. Laparoscopy-Popular works. I. Title.

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

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

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on laparoscopy. 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 LAPAROSCOPY .......................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Laparoscopy................................................................................. 20 E-Journals: PubMed Central ....................................................................................................... 40 The National Library of Medicine: PubMed ................................................................................ 42 CHAPTER 2. NUTRITION AND LAPAROSCOPY ................................................................................ 59 Overview...................................................................................................................................... 59 Finding Nutrition Studies on Laparoscopy ................................................................................. 59 Federal Resources on Nutrition ................................................................................................... 67 Additional Web Resources ........................................................................................................... 67 CHAPTER 3. DISSERTATIONS ON LAPAROSCOPY ............................................................................ 69 Overview...................................................................................................................................... 69 Dissertations on Laparoscopy ...................................................................................................... 69 Keeping Current .......................................................................................................................... 69 CHAPTER 4. CLINICAL TRIALS AND LAPAROSCOPY ....................................................................... 71 Overview...................................................................................................................................... 71 Recent Trials on Laparoscopy ...................................................................................................... 71 Keeping Current on Clinical Trials ............................................................................................. 74 CHAPTER 5. PATENTS ON LAPAROSCOPY ....................................................................................... 77 Overview...................................................................................................................................... 77 Patents on Laparoscopy................................................................................................................ 77 Patent Applications on Laparoscopy.......................................................................................... 102 Keeping Current ........................................................................................................................ 123 CHAPTER 6. BOOKS ON LAPAROSCOPY ........................................................................................ 125 Overview.................................................................................................................................... 125 Book Summaries: Federal Agencies............................................................................................ 125 Book Summaries: Online Booksellers......................................................................................... 128 Chapters on Laparoscopy ........................................................................................................... 135 CHAPTER 7. MULTIMEDIA ON LAPAROSCOPY .............................................................................. 137 Overview.................................................................................................................................... 137 Video Recordings ....................................................................................................................... 137 CHAPTER 8. PERIODICALS AND NEWS ON LAPAROSCOPY ........................................................... 141 Overview.................................................................................................................................... 141 News Services and Press Releases.............................................................................................. 141 Newsletters on Laparoscopy....................................................................................................... 145 Newsletter Articles .................................................................................................................... 146 Academic Periodicals covering Laparoscopy.............................................................................. 147 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 151 Overview.................................................................................................................................... 151 NIH Guidelines.......................................................................................................................... 151 NIH Databases........................................................................................................................... 153 Other Commercial Databases..................................................................................................... 155 APPENDIX B. PATIENT RESOURCES ............................................................................................... 157 Overview.................................................................................................................................... 157 Patient Guideline Sources.......................................................................................................... 157 Finding Associations.................................................................................................................. 161 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 163 Overview.................................................................................................................................... 163 Preparation................................................................................................................................. 163

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Finding a Local Medical Library................................................................................................ 163 Medical Libraries in the U.S. and Canada ................................................................................. 163 ONLINE GLOSSARIES................................................................................................................ 169 Online Dictionary Directories ................................................................................................... 169 LAPAROSCOPY DICTIONARY ................................................................................................ 171 INDEX .............................................................................................................................................. 229

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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 laparoscopy 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 laparoscopy, 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 laparoscopy, 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 laparoscopy. 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 laparoscopy, 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 laparoscopy. 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 LAPAROSCOPY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on laparoscopy.

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

Laparoscopic Heller Myotomy and Fundoplication for Achalasia Source: Annals of Surgery. 225(6): 655-665. June 1997. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030. Summary: Esophageal achalasia, a rare, benign condition characterized by dysphagia, regurgitation, and chest pain, is shown manometrically by a hypertensive nonrelaxing lower esophageal sphincter (LES). This article reports on a study undertaken to review the authors results with laparoscopic cardiomyotomy and partial fundoplication for achalasia. Pneumatic dilatation and injection of botulinum toxin (BOTOX) into the LES have largely replaced cardiomyotomy for the treatment of achalasia. After a brief experience with a thoracoscopic approach, the authors elected to perform laparoscopic

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cardiomyotomy, in combination with a partial fundoplication (anterior or posterior). They report on 40 patients who were treated between July 1992 and November 1996. Thirty patients had previous therapy for achalasia, 21 with pneumatic dilation, 1 with BOTOX, 6 with balloon and BOTOX, and 2 with transthoracic cardiomyotomy. Three patients had previous laparoscopic fundoplication for gastroesophageal reflux. Laparoscopic Heller myotomy and fundoplication were performed through five upper abdominal trocars. A 7 cm myotomy extended 6 cm above the gastroesophageal junction and 1 cm below it. A posterior fundoplication was performed in 32 patients, anterior fundoplication in 7 patients, and no fundoplication at all in 1 patient. Mean operative duration was 199 minutes (plus or minus 36.2 minutes). Mean hospital stay was 2.75 days. Dysphagia was alleviated in all but 4 patients (90 percent) and regurgitation in all but 2 patients (95 percent). Chest pain and heartburn improved significantly as well. Intraoperative complications included mucosal laceration in 6 patients and hypercarbia in 1. Postoperative pneumonia developed in 2 patients, and 1 patient had moderate hemorrhage from an esophageal ulcer 2 weeks after surgery. The authors conclude that laparoscopic cardiomyotomy and fundoplication appear to provide definitive treatment for achalasia with rapid rehabilitation and few complications. The article is appended with a discussion and commentary by four other authors. 8 figures. 21 references. (AAM). •

Laparoscopic Cholecystectomy Source: Lancet. 338(8770): 801-803. September 28, 1991. Summary: In laparoscopic cholecystectomy, the diseased gallbladder is removed by means of instruments introduced through cannulas; vision of the operative field is maintained by use of a high resolution television camera-monitor system (video laparoscope). This review article brings the reader up to date on the safety, efficacy, and patient selection issues involved in laparoscopic cholecystectomy. The author concludes that the significant reduction in morbidity by using the newer procedure minimizes both in-hospital and postdischarge recuperative time, and may allow surgical treatment of patients whose operative risk factors would make them marginal candidates for laparoscopy. 25 references.

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Open Donor, Laparoscopic Donor and Hand Assisted Laparoscopic Donor Nephrectomy: A Comparison of Outcomes Source: Journal of Urology. 166(4): 1270-1274. October 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: In experienced hands, laparoscopic surgery has been shown to be safe for procuring kidneys for transplantation that function identically to open nephrectomy (surgical removal of a kidney) controls. This article reports on a study of allograft function in patients (n = 48) with greater than 1 year followup who underwent open donor, classic laparoscopic, and hand assisted laparoscopic nephrectomy. Of these patients, 34 underwent consecutive laparoscopic live donor nephrectomy and 14 underwent open donor nephrectomy. Mean patient age was 36.5 years (plus or minus 8.4 years) for donors and 29 years (plus or minus 17 years) for recipients at transplantation (range of 13 months to 69 years). In the laparoscopic group, 11 patients underwent the transperitoneal technique, and 23 underwent hand assisted laparoscopic nephrectomy. Total operating time was significantly reduced with the hand assisted laparoscopic technique, as was the time from skin incision to kidney removal and warm

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ischemic (without blood flow) time. No blood transfusions were necessary. Complications included adrenal vein injury in 1 patient, small bowel obstruction in 2 patients, abdominal hernia at the trocar site in 1 patient, and deep venous thrombosis in 1 patient. The authors conclude that both classic laparoscopic donor and hand assisted laparoscopic donor nephrectomies appear to be safe procedures for harvesting kidneys. The recipient graft function is similar in the laparosocpic and open surgery groups. An editorial comment is appended to the article. 2 figures. 3 tables. 14 references. •

Laparoscopic Marsupialization of the Painful Polycystic Kidney Source: Journal of Urology. 153(4): 1105-1107. April 1995. Contact: Available from Williams and Wilkins. 428 East Preston Street, Baltimore, MD 21202-3993. (800) 638-6423. Summary: In this article the authors report the use of laparoscopic renal cyst marsupialization for painful autosomal dominant polycystic kidney disease (ADPKD) among 6 patients who failed prior percutaneous drainage. Mean surgical and anesthesia times were 3 hours and 3 hours 35 minutes, respectively. Median intervals to ambulation, oral intake, and hospital discharge were 1.5, 1.5, and 3 days, respectively. All 6 patients reported pain relief with followup of 6 to 40 months. The authors conclude that this technique is technically feasible and safe, and the laparoscopic approach may offer a palliative option for patients in whom prior percutaneous management failed. 1 figure. 19 references. (AA-M).

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New Applications of Laparoscopy in Gastrointestinal Surgery Source: American Family Physician. 53(1): 237-242. January 1996. Summary: In this article, the author outlines new applications of laparoscopy in gastrointestinal surgery. After a brief history of laparoscopic techniques, the author describes procedures used for each component of the gastrointestinal tract. Laparoscopic operations must conform to principles for open general surgery, especially in cases of oncologic resection. Procedures for treatment of conditions such as hiatal hernia, gastroesophageal reflux, intractable peptic ulcer disease, bypass for malignant pancreatic obstruction, and repair of rectal prolapse have received immediate acceptance. Other procedures, such as Whipple's operation and colectomy for cancer, have met with a more guarded response. 3 figures. 1 table. 18 references. (AA-M).

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Physiology of Laparoscopy: Basic Principles, Complications and Other Considerations Source: Journal of Urology. Volume 152: 294-302. August 1994. Contact: Available from Williams and Wilkins. 428 East Preston Street, Baltimore, MD 21202. (800) 638-6423. Summary: In this article, the authors discuss the physiology of laparoscopy, including basic principles and complications. They begin with a review of the basic cardiovascular and pulmonary physiology of laparoscopy. Next, they describe the cardio-respiratory complications of laparoscopy and some specific physiological issues that should be considered when a laparoscopic procedure is planned. The authors note that the physiological burden of a laparoscopic procedure may be greater than that of the same procedure done in an open fashion. They stress that knowledge of the underlying pathophysiologic aids in the prevention, diagnosis, and treatment of the complications of laparoscopy. 2 figures. 2 tables. 126 references.

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Laparoscopic Surgery for Important Gastrointestinal Diseases Source: Seminars in Gastrointestinal Disease. 5(3): 107-149. July 1994. Contact: Available from W.B. Saunders Company, Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: In this issue of Seminars in Gastrointestinal Disease, leaders in the new field of laparoscopic surgery present the current status of minimally invasive approaches to important gastrointestinal diseases. Six articles review minimally invasive approaches to achalasia; laparoscopic approaches to symptomatic gastroesophageal reflux disease (GERD); laparoscopic management of gallstone disease; laparoscopic truncal and selective vagotomy for intractable ulcer disease; laparoscopic colectomy; and laparoscopic appendectomy. In each article, the author or authors review the current data regarding outcome of the pertinent minimally invasive operations, briefly describe the operative techniques, and provide a perspective on the role of these operations in current patient care. Each article is illustrated with medical line drawings and references are included.

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Should Laparoscopy Be the Standard Approach Used for Pelvic Lymph Node Dissection? Source: Current Urology Reports. 2(2): 171-179. April 2001. Contact: Current Science, Inc. 400 Market Street, Suite 700, Philadelphia, PA 19106 (800) 427-1796. Fax (215) 574-2225. E-mail: [email protected]. Website: http://www.current-reports.com. Summary: Involvement of the pelvic lymph nodes in patients with prostate cancer worsens the overall prognosis of this common disease entity. The gold standard for the evaluation of pelvic lymph nodes in men with prostate cancer involves performing a lymphadenectomy. Historically, this procedure was performed using an open surgical technique; however, this invasive procedure is associated with significant morbidity. In response, modern surgical technology has provided newer, less invasive techniques, including laparoscopic pelvic lymphadenectomy (LPLND). This article reviews these techniques, focusing on LPLND. The authors note that improved detection of localized prostate cancer through the institution of screening protocols and early detection programs has decreased the number of patients presenting with lymph node involvement. The authors conclude that the technique of LPLND is a valid option in the armamentarium for staging of prostate cancer. The laparoscopic approach provides the same staging accuracy as the open surgical technique and is superior with respect to morbidity. LPLND is limited to patients who present with a high risk of advanced prostate cancer. In addition, the urologist must accept the additional training, financial expense, and 'learning curve' associated with this technique. 1 figure. 2 tables. 71 references.

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Preoperative Assessment of Laparoscopic Live Kidney Donors by GadoliniumEnhanced Magnetic Resonance Angiography Source: Transplantation Proceedings. 34(3): 795-796. May 2002. Contact: Available from Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010. (212) 633-3730. Website: www.elsevier.com. Summary: Kidney transplantation from living related and unrelated donors has become increasingly common due to the shortage of cadaveric organs. In this context,

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laparoscopic nephrectomy is now often proposed to encourage donation because it offers the well known advantages of minimally invasive surgery. Before operation, a careful radiologic assessment is essential, however, because arterial and venous anatomy may be more difficult to appreciate during laparoscopy than at open surgery. This article describes and evaluates the use of a new noninvasive technique for preoperative assessment: three dimensional gadolinium (Gd)-enhanced magnetic resonance angiography (MRA). Findings in 7 patients are presented. The ability of MRA to detect the main and accessory arteries has been 100 percent and 86 percent, respectively. Its sensitivity to detect anomalies of the veins has been 86 percent and to image early branching of the arteries, detection has been 100 percent. None of the findings missed by MRA resulted in deleterious consequences at surgery for the donor and the graft. 12 references. •

Factors Associated with Conversion to Laparotomy in Patients Undergoing Laparoscopic Appendectomy Source: Journal of the American College of Surgeons. 193(3): 298-305. March 2002. Contact: Available from Journal of the American College of Surgeons. P.O. Box 2127, Marion, OH 43306-8227. (800) 214-8489 or (740) 382-3322. Fax (740) 382-5866. Summary: Laparoscopic appendectomy (LA) has been increasingly adopted for its advantages over the open technique, but there is a possibility of conversion to open appendectomy (OA) if complications occur or the extent of inflammation of the appendix prohibits successful dissection. This article reports on a study undertaken to identify the preoperative predictors for conversion from laparoscopic to open appendectomy. The authors retrospectively reviewed the medical records of 705 consecutive patients who underwent surgery for suspected appendicitis (inflamed appendix). LA was attempted in 595 patients by 25 different surgeons. Conversion to OA occurred in 58 of these 595 patients (9.7 percent). The most common reason for conversion was dense adhesions due to inflammation, followed by localized perforation and diffuse peritonitis. Based on 261 patients evaluated by CT scan preoperatively, significant factors associated with conversion to OA were age, diffuse tenderness on physical examination, and a surgeon with less experience. The presence of significant fat stranding associated with fluid accumulation, inflammatory mass, or localized abscess in CT scan also significantly increased the possibility of conversion. 5 tables. 38 references.

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Laparoscopic Versus Open Bowel Resection for Crohn's Disease Source: Canadian Journal of Gastroenterology. 15(4): 237-242. April 2001. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Fax (905) 829-4799. E-mail: [email protected]. Summary: Laparoscopic bowel resection is an alternative to open surgery for patients with Crohn's disease requiring surgical resection. This article describes a seven year experience with the laparoscopic treatment of Crohn's disease compared with the open technique in a tertiary Canadian center. The retrospective analysis included 61 consecutive patients undergoing elective resection for Crohn's disease (October 1992 through June 1999). The analysis included 32 laparoscopic resections (mean patient age 33 years) and 29 open resections (mean patient age 42 years). Patient demographics were compared, as well as short and long term outcomes after surgery (mean followup 39 months). Patients in the laparoscopic group were younger and had fewer previous bowel surgeries than patients who had open resections. Indications for surgery and

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operative times were similar between the groups. Patients who underwent laparoscopic resections required fewer doses of narcotic analgesics (painkillers). The resumption of bowel function after surgery, and tolerance of a clear liquid and solid diet was quicker in the laparoscopic group. Patients who underwent laparoscopic resections had significantly shorter hospital stays than those who underwent open resections. Fifteen patients (48.4 percent) in the laparoscopic group experienced recurrence of disease compared with 13 patients (44.8 percent) in the open group. In both groups, the most common site of recurrence was at the anastomosis. The disease free interval was the same length for both groups (23.9 months). The authors conclude that laparoscopic resection for Crohn's disease can be performed safely and effectively. Quicker resumption of oral feeds, less postoperative pain, and earlier discharge from hospital are advantages of the laparoscopic method over open surgery. No differences in the recurrence rate or the disease free interval were noted. 2 figures. 6 tables. 14 references. •

Outcomes of Pediatric Living Donor Renal Transplant After Laparoscopic Versus Open Donor Nephrectomy Source: Transplantation Proceedings. 34(7): 3097-3098. November 2002. Contact: Available from Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010. (212) 633-3730. Website: www.elsevier.com. Summary: Laparoscopic donor nephrectomy (LDN, removal of a donor kidney with a laparoscopic procedure) was designed to reduce postoperative pain, shorten convalescence, improve cosmetic results, and reduce the financial disincentives to organ donation. The procedure has been found to be an acceptable alternative to open donor nephrectomy (ODN) for adult recipients. This article reports on a study of the safety and efficacy of LDN for pediatric recipients. The authors compared pediatric and infant recipients of living donor kidneys obtained from either ODN or LDN to assess for differences in graft function and early complications following kidney transplantation. The authors found equivalent early graft function and complication rates among pediatric recipients of laparoscopic and open donor kidneys. Importantly, this was true even in low-weight children. 1 table. 9 references.

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Laparoscopic Donor Nephrectomy Is a Safe and Effective Alternative Source: Contemporary Urology. 13(5): 94, 103-108. May 2001. Contact: Available from Medical Economics Publishing Inc. Montvale, NJ 07645. (800) 432-4570. Summary: Laparoscopic donor nephrectomy (removal of a kidney), or LDN, is rapidly replacing traditional open (abdominal surgery) donor nephrectomy (ODN) in many transplant centers across the country. Controversy exists regarding the merits of this particular application of laparoscopic techniques. This article, one side in a point and counterpoint series, argues that LDN is safe, effective, and, in many aspects, superior to the traditional open approach. The authors note that the laparoscopic approach offers a technique with less associated pain and disfigurement, disincentives to renal donation. Furthermore, extended time away from work and regular activity can dissuade potential renal donors. The authors report on the results of LDN from the recipient's perspective as well. Posttransplant short term renal (kidney) function may be slightly less in LDN than in ODN; however, long term renal function of LDN and ODN allografts was equivalent. Allograft survival rates (how long the transplanted organ functions) were also comparable. Complication rates of LDN and ODN donors are comparable (the most common complications are pneumothorax and urinary tract

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infection). The authors conclude that with the issues of safety and efficacy addressed, LDN offers additional benefits to the donor with respect to comfort, cosmetic issues, and postoperative recovery. 1 figure. 1 table. 20 references. •

Lateral Approach to Laparoscopic Sigmoid Colon Resection Source: Journal of the American College of Surgeons. 193(1): 105-108. July 2001. Contact: Available from Journal of the American College of Surgeons. P.O. Box 2127, Marion, OH 43306-8227. (800) 214-8489 or (740) 382-3322. Fax (740) 382-5866. Summary: Laparoscopic sigmoid colon resection has been traditionally performed using an anterior (front) approach with the patient placed in a modified lithotomy position. In this article, the authors report their experience and describe their technique for laparoscopic sigmoid colon resection using a lateral approach. The lateral position provides excellent visualization of the splenic flexure, and the entire left colon can be moved easily without the need for excessive retraction. This position allows gravity to aid in the retraction of the left colon. Once the lateral peritoneal reflection is incised, the left colon falls away from the retroperitoneum, exposing the ureter and the gonadal vessels on the lateral side and the mesenteric vessels, including the inferior mesenteric artery and vein, on the medial side. In addition, the cosmetic results of this approach are superior to those of the anterior approach. The authors report on 8 sigmoid colon resections that were performed using the laparoscopic lateral approach. The patients were eight men with ages ranging between 32 and 70 years (average 48.5 years). All procedures were performed for diverticular disease. Mean operative time was 152 minutes (range 125 to 216 minutes). Of the eight patients, three had the procedure using only three trocars, and five patients required the placement of four trocars. None of the patients required an open procedure. 4 figures. 4 references.

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Laparoscopic Urologic Surgery Outcome Assessment Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. 7(2): 77-86. April 1997. Contact: Available from Mary Ann Liebert, Inc. 2 Madison Avenue, Larchmont NY 10538. (914) 834-3100. Fax (914) 834-3582. E-Mail: [email protected]. Summary: Laparoscopic surgery is an evolving technique that began to be applied widely in urology in the early 1990s. This article reports on an ongoing multicenter study of laparoscopic urologic surgery undertaken to identify any changes in utilization, complications, and short-and longterm outcomes. Laparoscopic urologic surgical procedures were assessed in three successive phases, based on the year of surgery. In the P1 group (before 1991), 114 patients are included: 105 underwent laparoscopic pelvic lymph node dissection (LPLND), 7 underwent laparoscopic variocele ligation (LVL), and 2 underwent other procedures. The complication rates in P1 are 21 percent (total): 10.5 percent (major) and 10.5 percent (minor). The P2 group (1991-1992) includes 148 patients: 132 underwent LPLND, 10 underwent LVL, and 6 underwent other procedures. The complication rates decreased to 16.2 percent (total): 6 percent major and 10.1 percent minor complications. The latest group (P3, 1993-1994) includes 326 subjects: 245 had LPLND, 39 had LVL, and 42 had other procedures. More improvement in outcome is shown in this phase, with a total complication rate of 7.98 percent (0.92 percent major and 7.05 percent minor). In addition, other parameters such as operative time and hospital stay show improvement through the successive phases. There were no significant longterm complications in the latest study group. The authors conclude that these data demonstrate a continual improvement in outcome and changes

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in utilization patterns as urologists become more experienced with laparoscopic surgery. The complexity of the procedures performed has increased with a decrease in the complication rates overall. 9 tables. 26 references. (AA-M). •

Laparoscopic Radical Prostatectomy Source: Current Urology Reports. 3(2): 141-147. April 2002. Contact: Current Science, Inc. 400 Market Street, Suite 700, Philadelphia, PA 19106 (800) 427-1796. Fax (215) 574-2225. E-mail: [email protected]. Website: http://www.current-reports.com. Summary: Laparoscopy has become an integral part of urologic surgery, including for radical prostatectomy (removal of the prostate). The indications of laparoscopy have been progressively extended to the most advanced oncologic (cancer) and reconstructive procedures. Within this frame, radical prostatectomy is of major interest, especially considering the incidence and clinical significance of prostate cancer. The procedure comprises several steps of challenging dissection in which the preservation of delicate nerve and muscular structure must be balanced with safe tumor excision. The intervention ends with vesicourethral anastomosis, which is considered the most difficult reconstructive procedure in urologic laparoscopy. Laparoscopic radical prostatectomy has gradually become a wholly standardized procedure, and it is now routinely performed in several centers throughout the world. 1 figure. 14 references.

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Laparoscopy in Pediatric Urology Source: Current Urology Reports. 2(2): 132-137. April 2001. Contact: Current Science, Inc. 400 Market Street, Suite 700, Philadelphia, PA 19106 (800) 427-1796. Fax (215) 574-2225. E-mail: [email protected]. Website: http://www.current-reports.com. Summary: Laparoscopy in pediatric urology is a rapidly evolving field that is becoming part of the operative repertoire of an increasing number of pediatric urologists. This review article summarizes the latest ideas and issues in the expanding field of laparoscopy in pediatric urology. New methods of obtaining laparoscopic access and retraction are discussed. The authors review laparoscopic experiences in urologic reconstruction, diagnosis and treatment of the nonpalpable testis, renal surgery, ureteral reimplantation, varicocelectomy, hydrocelectomy, and herniorrhaphy. The authors also discuss articles assessing the safety of a pneumoperitoneum in patients with a ventriculoperitoneal shunt. 37 references.

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Laparoscopic Management of Urachal Cysts in Adulthood Source: Journal of Urology. 164(5): 1526-1528. November 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: Managing persistent and symptomatic urachal anomalies requires wide surgical excision. The urachus is a remnant fibrous cord derived from involution of the allantois that extends from the bladder to the umbilicus. The surgical intervention for symptomatic urachal cysts is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. However, traditional open surgery is associated with significant morbidity and prolonged convalescence. This article reports the authors' experience with the laparoscopic excision of urachal remnants as a

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less morbid, minimally invasive surgical alternative. Between October 1993 and December 1999, four patients (mean age 43.3 years) who had a symptomatic urachal cyst underwent laparoscopic radical excision of the urachal remnant. All four procedures were completed successfully. No intraoperative or postoperative complications were reported at a mean followup of 15 months (range 2 to 24 months). Mean operative time was 180 minutes (range 150 to 210 minutes) and average hospital stay was 2.75 days (range 1 to 4 days). Pathological evaluation confirmed a benign urachal remnant in each case. All patients resumed normal activity within 2 weeks. The authors conclude that the laparoscopic management of benign urachal remnants in adulthood is efficacious and the preferred method of management. 1 figure. 1 tables. 19 references. •

Role of Laparoscopic Antireflux Surgery in the Management of Chronic GERD Symptoms Source: Canadian Journal of Gastroenterology. 13(9): 761-764. November 1999. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Fax (905) 829-4799. E-mail: [email protected]. Summary: Since the application of minimally invasive techniques to antireflux surgery 8 years ago, there has been a rapid increase in the use of laparoscopic antireflux surgery, including as an alternative to long term medical therapy with proton pump inhibitors. This article reviews the factors responsible for the rapid popularity of this procedure, the choice of techniques, current indications and patient selection considerations, and the available literature on the outcomes of these procedures. The author notes that increasing evidence suggests that the surgeon's skill and experience have a direct impact on the morbidity and success of the procedure. Laparoscopic antireflux surgery requires a high degree of two handed laparoscopic skill and has a longer learning curve than simpler laparoscopic procedures such as laparoscopic cholecystectomy or appendectomy. The most common procedures used are laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication. The most problematic complication of antireflux surgery is dysphagia (swallowing disorders). The incidence of postoperative dysphagia in the immediate period after surgery remains high, but for most patients the symptoms completely subside by 6 to 8 weeks after surgery. Appropriate selection of patients with full preoperative workup, including 24 h pH testing, esophageal manometry, and endoscopy, is recommended. Overall, the rate of complications after laparoscopic fundoplication in an appropriately selected patient and when performed by an experienced surgeon remains low. 32 references.

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Laparoscopy: New Applications of an Established Technique Source: Urologic Nursing. 12(1): 2-8. March 1992. Summary: The author contends that initial results of laparoscopic pelvic lymph node dissection reveal sufficient patient benefits to warrant further work with these less invasive techniques. This article discusses these new applications of the established technique of laparoscopy, including the history of laparoscopy; urologic applications, including the evaluation of undescended testes, selected biopsies, ligation of varices, laparoscopic nephrectomy, and pelvic lymph node dissection used to diagnose and stage prostate and bladder cancers; and nursing considerations for these procedures. The authors stress that nurses can help to minimize the steep learning curve for the physician developing skills in these techniques by taking an active interest in the current and future practice of laparoscopic surgery and by sharing their knowledge and

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enthusiasm. A post-test with which the reader can obtain continuing education credits (CEUs) is appended. 1 table. 6 references. •

Surgical Techniques in Right Laparoscopic Donor Nephrectomy Source: Journal of the American College of Surgeons. 195(1): 131-137. July 2002. Contact: Available from Journal of the American College of Surgeons. P.O. Box 2127, Marion, OH 43306-8227. (800) 214-8489 or (740) 382-3322. Fax (740) 382-5866. Summary: The benefits of laparoscopic donor nephrectomy (LDN, removal of a donated kidney using laparoscopic, rather than open surgery, techniques) have been well described, but limitations in the technical performance of LDN of the right kidney have isolated its performance to only a few advanced laparoscopic centers. This article reviews the technical challenges of right LDN and offers several approaches for improving the right LDN technique. Topics include port placement and liver retraction, inferior vena caval dissection, arterial mobilization, division of the renal vessels, and anticipated results of the procedure. The authors conclude by noting that a considerable proportion of living donors should undergo right rather than left donor nephrectomy for anatomical reasons, including multiple renal arteries, smaller right kidney, or undiagnosed lesions within the right donor kidney. The ability to perform right LDN allows the inclusion of those donors with only right kidneys suitable for donation. When the operation is performed with attention to potential complications, right LDN can provide kidneys without increased risk for thrombosis or other technical complications. 1 table. 6 figures. 13 references.

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Laparoscopic Radical Nephrectomy for Advanced Kidney Cancer Source: Current Urology Reports. 3(1): 21-24. February 2002. Contact: Current Science, Inc. 400 Market Street, Suite 700, Philadelphia, PA 19106 (800) 427-1796. Fax (215) 574-2225. E-mail: [email protected]. Website: http://www.current-reports.com. Summary: The management of advanced renal cell carcinoma (RCC) continues to evolve. With the advent of laparoscopic radical nephrectomy (LRN), minimally invasive approaches to kidney cancer have developed. Laparoscopic resection of locally advanced RCC yields a similar cancer-control rate with the advantage of decreased morbidity (complications and associated illness). With respect to cytoreductive nephrectomy in asymptomatic patients being considered for systemic therapies (chemotherapy or immunotherapy), the timing of nephrectomy is somewhat controversial. However, several practical points support initial cytoreductive nephrectomy prior to systemic therapy. Although cytoreductive LRN is a technically challenging procedure, it may be completed safely in selected patients. Further prospective study of the role of LRN for advanced RCC is warranted. 3 figures. 1 table. 24 references.

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Laparoscopic Procurement of Kidney Grafts from Living Donors Does Not Impair Initial Renal Function Source: Transplantation Proceedings. 34(3): 787-790. May 2002. Contact: Available from Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010. (212) 633-3730. Website: www.elsevier.com.

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Summary: The persistent shortage of kidneys available for transplantation has stimulated live donation. The excellent results obtained with both genetically related and unrelated donors have increased this trend. The recent use of laparoscopic allograft harvesting has promoted this option even further. The benefits of the laparoscopic procedure for the donor have been extensively described, but whether the functional results of the laparoscopically procured grafts are equivalent to those obtained by the classical open surgical method remains to be proved. This article reports on a single center study that compared the early function of the grafts harvested by laparoscopy and by the open technique. Altogether, 31 consecutive renal transplants from living donors in 31 recipients were analyzed, 17 in the open nephrectomy (ON) group and 14 in the laparoscopic nephrectomy (LN) group. The study found no functional difference between the ON and the LN groups. The similar early graft function is very encouraging. However, it does not follow automatically that the long term survival of the laparoscopic grafts will be the same as those from open donors. Many factors may interfere, like fine differences in the renal inflammatory response that may influence the development of chronic allograft nephropathy. 3 figures. 12 references. •

Laparoscopic Cut Collis Gastroplasty: A Novel Technique Source: Diseases of the Esophagus. 11(4): 260-262. October 1998. Contact: Available from Harcourt Brace and Company, Ltd. Journal Subscription Department. Foots Cray, Sidcup, Kent, DA 14 5HP. Summary: This article reports on laparoscopic cut Gollis gastroplasty, which is used for the surgical treatment of gastroesophageal reflux disease (GERD). Patients with severe disease such as Barrett's esophagus, esophageal stricture, or giant mixed hernias may present with the technical difficulty of a shortened esophagus. The authors report on three consecutive patients with shortened esophagus who underwent the Collis gastroplasty laparoscopically. All patients had preoperative esophagitis and failed symptomatic control on proton pump inhibitors. The peristaltic function of all three patients was normal on manometry. The operation duration decreased progressively with familiarization from 240 minutes in the first case to 140 minutes in the third case. Postoperative management consisted of a 48 hour total fast, then a contrast swallow prior to consuming oral fluids. Two patients were discharged well on day 5, and one on day 4, postoperatively. There were no complications, and all three are symptomatically excellent 1, 2, and 3 months postoperatively. All are tolerating a normal diet, and all have control of heartburn and regurgitation; one suffered mild transient dysphagia, which has resolved. Each patient has undergone a delayed barium meal showing intact fundoplication and gastroplasty tube. The authors conclude that laparoscopic Collis gastroplasty appears technically feasible and that further clinical experience to assess the clinical outcome of the operation performed by laparoscopy is justified. 2 figures. 10 references.

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Patient Satisfaction Following Laparoscopic and Open Antireflux Surgery Source: Archives of Surgery. 130(3): 289-294. March 1995. Summary: This article reports on a study that compared laparoscopic Nissen fundoplication (LNF) with open Nissen fundoplication (ONF) in terms of hospital charges, efficacy, and patient satisfaction. The prospective, nonrandomized study featured a followup of 370 days for 86 patients with complications of gastroesophageal reflux who had not had previous antireflux surgery. Patients chose ONF or LNF following discussion with the surgeon; 12 underwent ONF and 74 underwent LNF, of

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whom eight required conversion to laparotomy. Overall satisfaction scores were similar, irrespective of operative technique. The authors conclude that LNF is as effective as ONF in the treatment of complications of gastroesophageal reflux disease and appears to cost less and lead to faster recovery from surgery but does not result in higher patient satisfaction than ONF. They note that the most important factor in patient satisfaction is the elimination of preoperative symptoms, rather than the type of operation. A commentary to the article is appended. 4 tables. 12 references. (AA-M). •

Laparoscopic-Assisted Colorectal Surgery: Lessons Learned from 240 Consecutive Patients Source: Diseases of the Colon and Rectum. 39(2): 155-159. February 1996. Summary: This article reports on a study to audit the development and outcomes of laparoscopic colorectal surgery at the Royal Brisbane Hospital, Herston, Australia. The authors summarize the outcome for the first 240 patients who underwent a laparoscopic colorectal procedure. All laparoscopic data were collected prospectively. For selected studies, data were compared with open surgical controls. Nineteen patients required open conversion (7.9 percent). A significant decrease in wound infection rates occurred in patients having a laparoscopic-assisted colectomy (3.6 percent) compared with historical controls (7.9 percent). There were five anastomotic leaks, five laparotomies for postoperative adhesive obstruction, and four perioperative deaths. Of the 79 potentially curative procedures, there have been 5 (6.3 percent) recurrences to date. The authors conclude that the overall morbidity and mortality in this series seem to be acceptable compared with that of open procedures. 6 tables. 13 references. (AA-M).

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Laparoscopy-Guided Biopsy in Diagnosis of Liver Disorders in Children Source: Liver. 17(6): 288-292. 1997. Contact: Available from Munksgaard International Publishers, Ltd. Commerce Place, 350 Main Street, Malden, MA 02148-5018. (617) 388-8273. Fax (617) 388-8274. Summary: This article reports on a study undertaken to determine the safety and advantages of laparoscopic liver biopsy in pediatric liver disorders. Medical records of 80 children affected by liver disease of various etiologies who underwent this procedure from 1986 to 1996 were reviewed. The main indicators for laparoscopic biopsy were increased risk of bleeding (i.e., mild to moderate coagulation abnormalities in patients probably affected by cirrhosis), previous uninformative blind needle liver biopsy (65 cases), or the need for a large amount of liver tissue for biochemical assays (10 cases). After inspection of the liver surface, at least two core biopsies were performed using a Tru-cut needle. The authors encountered difficulties with the biopsy in only four cases, due to a hard consistency of the liver. Bleeding time was greatly reduced by positioning a fibrin plug. In 15 patients, a large excisional biopsy was also successfully performed. The results confirm an important role for laparoscopy in diagnosing cirrhosis (30 percent of bioptic false negative diagnoses in this series) and show that in selected cases laparoscopy-guided needle or excisional biopsy is an easy, useful, and safe alternative to blind, percutaneous liver biopsy. 1 figure. 1 table. 18 references. (AA).

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Retroperitoneal Laparoscopic Management of Urolithiasis Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. 7(2): 95-98. April 1997.

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Contact: Available from Mary Ann Liebert, Inc. 2 Madison Avenue, Larchmont NY 10538. (914) 834-3100. Fax (914) 834-3582. E-Mail: [email protected]. Summary: This article reports on the use of retroperitoneal laparoscopy for the management of urolithiasis (urinary tract stones). The authors report on a series of 20 patients undergoing laparoscopic retroperitoneal pyelolithotomy (Lap PL) and 24 patients undergoing ureterolithotomy (Lap UL). The average operating time was 61.4 minutes for Lap UL and 80.2 minutes for Lap PL. The conversion rate for Lap PL was 4 patients (20 percent), and none of the Lap ULs required conversion. There were no major postoperative complications, except prolonged tube drainage in 2 patients, and the average hospital stay was 3.6 days. The authors conclude that laparoscopic urolithotomy management can be selected as an optional substitute for open management; in impacted, large ureteric calculi; when PCNL (percutaneous nephrolithotomy), ESWL (extracorporeal shock wave lithotripsy), or ureteroscopy fails; and in those patients in whom it is expected that PCNL or ESWL would probably be a repeated effort. 2 tables. 11 references. (AA-M). •

Laparoscopic Repair of Paraesophageal Hiatal Hernias Source: Journal of the American College of Surgeons. 186(4): 428-432. April 1998. Summary: This article reports the University of California (UC) at San Francisco's experience with laparoscopic repair of paraesophageal hiatal hernias, emphasizing the technical steps essential for good results. From May 1993 to September 1997, 55 patients (27 women, 28 men, mean age 67 years) underwent laparoscopic repair of paraesophageal hernias at the UC facility. Symptoms, which had been present an average of 85 months before surgery, consisted mainly of pain (55 percent), heartburn (52 percent), dysphagia (45 percent), and regurgitation (41 percent). Of the four patients who presented with acute illness, two had gastric obstruction, one had severe dyspnea, and one had gastric bleeding. Endoscopy demonstrated esophagitis in 25 (69 percent) of 36 patients, and 24 hour pH monitoring demonstrated acid reflux in 22 (67 percent) of 33 patients. Manometry detected severely impaired distal esophageal peristalsis in 17 (52 percent) of 33 patients. The preferred operation consisted of reduction of the hernia, excision of the sack and the gastric fat pad, closure of the enlarged hiatus without mesh, and construction of a fundoplication anchored by sutures within the abdomen. Of the 55 patients, the operations of 49 were completed laparoscopically; five (9 percent) were converted to laparotomies. The average operating time was 219 minutes; the average blood loss was less than 25 mL; resumption of an unrestricted diet occurred after 27 hours; and mean hospital stay was 58 hours. Intraoperative technical complications occurred in five (9 percent) patients. One patient died during surgery from a sudden pulmonary embolus; two patients (4 percent) required a second operation for recurrent paraesophageal hernias. The authors conclude that laparoscopic repair of paraesophageal hiatal hernias is safe and effective, but the operation is difficult and good results hinge on details of the operative technique and the surgeon's experience. 2 figures. 1 table. 21 references. (AA-M).

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Laparoscopic Colectomy Source: Surgical Clinics of North America. 77(1): 1-13. February 1997. Contact: Available from W.B. Saunders Company. Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: This article reviews recent advances in laparoscopic colectomy. Laparoscopic colectomy is a natural extension of the experience gained in laparoscopic

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cholecystectomy and inguinal hernia repairs. It has been shown to be an effective procedure, and consensus is growing that laparoscopic colorectal surgeries are safe, effective, and beneficial for many benign colorectal diseases. Laparoscopic colectomy has also been recently applied to malignant diseases. Much discussion has centered on whether laparoscopic surgery is appropriate for the management of potentially curable malignant diseases and whether patients are better served with minimally invasive techniques that have shortterm benefits but unknown longterm effects. Initial results of laparoscopic colon cancer surgery appear to be comparable to those of operations performed in the traditional open manner with the additional benefits of this minimally invasive technique. Longterm results are not yet available to assess changes in overall survival and recurrence rates with the laparoscopic technique, but many surgeons are cautiously optimistic. 1 table. 44 references. •

Laparoscopic Management of Gastroesophageal Reflux Disease Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. 7(6): 333-343. December 1997. Contact: Available from Mary Ann Liebert, Inc. Publishers. 2 Madison Avenue, Larchmont, NY 10538. (800) 654-3237 or (914) 834-3100. Fax (914) 834-3688. Summary: This article reviews the contemporary surgical management of gastroesophageal reflux disease (GERD), drawing primarily on the experience at Emory University Hospital. The authors emphasize the importance of precise anatomic and physiologic preoperative evaluation to confirm the diagnosis of GERD, and stress technical aspects of laparoscopic fundoplication that have improved outcomes. GERD is prevalent and usually results from dysfunction of the lower esophageal sphincter (LES). The objectives of therapy are to alleviate symptoms, promote healing of esophagitis, avoid disease progression, and prevent recurrence. Behavioral and dietary modifications, such as weight loss, smoking cessation, alcohol avoidance, decreased meal volume, and head of bed elevation, are valuable. Medical agents, including antacids, histamine antagonists, prokinetic agents, and proton pump inhibitors, control symptoms in most patients. However, no medical option is curative, and patients with severe disease who cease medical therapy will likely develop recurrent manifestations of GERD. Laparoscopic antireflux surgery is effective and safe. Existing data suggest long term outcomes will be similar to traditional open surgery, with less pain and shortened rehabilitation time. Economic analyses find contemporary antireflux surgery more cost effective than current medical strategies for the management of chronic GERD. 9 figures. 2 tables. 48 references. (AA-M).

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Laparoscopic Cholecystectomy: From Gimmick to Gold Standard Source: Journal of Clinical Gastroenterology. 19(4): 325-330. December 1994. Summary: This article reviews the history of laparoscopic cholecystectomy and compares available evidence for laparoscopic and open cholecystectomy in terms of incidence and outcome. Topics covered include the operative technique of laparoscopic cholecystectomy; the incidence of its use; outcome studies, notably focusing on length of stay and overall convalescence; common bile duct injury; mortality; complications of laparoscopy; conversion to open cholecystectomy; and the National Institutes of Health consensus development conference held in September of 1992 on this topic. The authors' review supports the notion that laparoscopic cholecystectomy is safe and effective, has an acceptable complication rate, and a considerably shorter convalescence. They conclude that laparoscopic cholecystectomy is not the treatment of choice for

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symptomatic cholelithiasis and is becoming the new standard against which other procedures should be judged. 1 figure. 31 references. (AA-M). •

Laparoscopic Biliary Surgery Source: Gastroenterology Clinics of North America. 28(1): 117-132. March 1999. Contact: Available from W.B. Saunders. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This article reviews the use of laparoscopic biliary surgery. The author notes that treatment of gallstones by laparoscopic cholecystectomy has become standard therapy over the past decade and has received wide patient acceptance. Problems are infrequent but those such as biliary injury may be serious and continue to be a cause of concern. Biliary injury is more likely when surgery is performed in the presence of acute inflammation. Laparoscopic bile duct exploration is becoming standardized and the results are good. The role of other laparoscopic biliary procedures such as biliary bypass is still uncertain. Biliary bypass is complicated by the fact that the cystic duct has a low insertion, which may limit the effectiveness of the procedure. Furthermore, internal stenting has been shown to be effective in individuals with malignant biliary obstruction, most of whom have a short life span after diagnosis. 1 figure. 69 references. (AA-M).

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The Role of Laparoscopy in Hepatobiliary Disease Source: Practical Gastroenterology. 20(4): 23-24, 26-28, 30, 35-36, 38. April 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, the fourth in a series on surgery of the gastrointestinal (GI) tract, describes the role of laparoscopy in hepatobiliary disease. The authors bring readers up to date concerning the status of laparoscopic cholecystectomy and define the role of laparoscopy for the management of common bile duct pathology, obstructive jaundice secondary to periampullary tumors, and portal hypertension. After a brief discussion of the contraindications for laparoscopic cholecystectomy, the authors outline the procedure itself, including positioning, the initial exposure, operative cholangiography, gallbladder dissection, gallbladder removal, and final inspection. Complications include common bile duct injury, cystic duct leakage, lost gallstones, bowel injury, urinary tract injury, ventral hernia, gas embolism, insufflation agent complications, wound infection, and the risks of anesthesia. 7 figures. 14 references. (AA-M).

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Laparoscopic Surgery for the Treatment of Gastroesophageal Reflux Disease Source: Practical Gastroenterology. 20(3): 8, 11-12, 14, 17-18, 21. March 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, the second in a series on surgery of the gastrointestinal (GI) tract, describes laparoscopic surgery for the treatment of gastroesophageal reflux disease (GERD). The author notes that laparoscopic fundoplication has catalyzed renewed interest in the surgical treatment of GERD. Early studies suggest control of reflux symptoms is achieved in 90 percent of patients, with a procedure that at present requires a 48 hour hospital stay, results in minimal discomfort, and can be performed with morbidity rates of less than 10 percent. Patients with recurrent and progressive

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disease as well as those less than 50 years of age should now be offered a surgical alternative for control of their reflux symptoms. Indeed, as longer term studies are published, laparoscopic antireflux surgery may become a viable option for all patients dependent on longterm medical therapy. The author's review focuses on the diagnostic approach, patient selection, and the outcome of laparoscopic Nissen fundoplication. 5 figures. 1 table. 34 references. (AA-M). •

Routine Laparoscopy in the Management of Chronic Hepatitis Source: Journal of Pediatrics. 117(3): 417-418. September 1990. Summary: This brief article discusses routine laparoscopy in the management of chronic hepatitis. The author maintains that, for physicians evaluating the treatment of chronic liver disease in children, the combination of laparoscopy with needle biopsy should enhance the ability to evaluate progression of the disease with minimal increase of risk to the child.

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Laparoscopic Cholecystectomy (editorial) Source: American Journal of Surgery. 159(3): 273. March 1990. Summary: This brief editorial considers recent experience with laparoscopic cholecystectomy. The authors stress that the most important advantage of laparascopic cholecystectomy is that it eliminates the trauma of access as well as the transient ileus that follows open abdominal surgery. The authors also contend that the need for preliminary gallstone lithotripsy and extraction prior to endoscopic cholecystectomy, the technique and use of intraoperative cholangiography, the optimal technique and instruments for dissection of the cystic artery and duct, and the possible use of lasergenerated energy or electrosurgery to dissect the gallbladder from the liver bed are but a few of the issues that require further evaluation. Other issues discussed include the need for proper training for surgeons performing laparascopic surgery, surgery performed in centers specializing in laparascopy, and accreditation.

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Laparoscopic Surgery: The Need for Self-Control (editorial) Source: Journal of Laparoendoscopic Surgery. 2(3): 131-132. 1992. Summary: This brief editorial discusses the impact of recent advances in laparoscopic surgery across the medical practice spectrum. The author notes that costs for laparoscopic procedures have actually increased compared with traditional surgery, in direct contrast to anticipated lowering of costs. The author contends that the medical and surgical community must take a responsible position and show that the new technological advances can decrease costs while increasing and improving health care. The author provides four suggestions on how surgeons can begin to take this responsibility. 4 references.

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Laparoscopic Colectomy: Prospects and Problems Source: Gastrointestinal Endoscopy Clinics of North America. 7(3): 525-539. July 1997. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This entry, from a series on evolving issues in colon endoscopy, provides a fundamental review of laparoscopic colectomies. The authors give an overview of the physiology of laparoscopic procedures as an introduction to the rationale of

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laparoscopic colectomies. The authors also review the current published literature including indications and an overview of laparoscopic bowel procedures for malignant diseases. Faster recovery of pulmonary function with fewer consequent pulmonary complications may be a major advantage of laparoscopic surgery for colorectal disease. In addition, smaller incisions lead to less pain and therefore decreased opioid use. The possibility that ileus may resolve more quickly or even be avoided after laparoscopic surgery is one of the most desirable reasons for pursuing laparoscopic treatment of intestinal diseases. The authors conclude that the true incidence and risk to the patient for laparoscopic bowel resection in the face of malignancy is not presently known. The principles of oncologic surgery developed by traditional standards must be maintained in laparoscopic procedures, and there exists a potential for abdominal wall recurrences. 89 references. (AA-M). •

Impact of Omeprazole and Laparoscopy Upon Hiatal Hernia and Reflux Esophagitis Source: Journal of the American College of Surgeons. 183(4): 413-418. October 1996. Summary: This review article analyzes the treatment successes on hiatal hernia and reflux esophagitis that are attributable to omeprazole and laparoscopy. Both approaches challenge the accepted multimodal, nonoperative therapy of the past two decades and the reproducible efficacy of the open fundoplication procedure. As a proton pump blocker, omeprazole decreases gastric acidity by directly blocking acid production. Omeprazole has a long duration of acid suppression that does not appear to affect gastroesophageal sphincter function or gastric motility. However, long-term use of omeprazole is questionable in terms of both safety and efficacy. The authors note that operative therapy, especially if minimally invasive (as in laparoscopy) is being more widely practiced. Laparoscopic Nissen fundoplication (LNF) has proved to be a very safe operation overall and the principles of reconstruction of the lower esophageal sphincter, which have been learned from open techniques, can be strictly maintained with the minimally invasive approach. The authors conclude with a call for additional studies to fully evaluate the clinical effectiveness of LNF and to define the 'learning curve' required for physicians. 6 tables. 46 references.

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Technology Assessment in Laparoscopic General Surgery and Gastrointestinal Endoscopy: Science or Convenience? Source: Gastroenterology. 110(3): 915-925. March 1996. Summary: This review article uses a clinician's point of view with relevant examples to cover the methodologies adopted in technology assessment in laparoscopic general surgical and in gastrointestinal endoscopy. The authors highlight common pitfalls encountered in study design, patient selection, timing and selection of the study, blinding, and outcome measurement. Cost and statistical considerations, as well as ethical issues, are also reviewed in the context of technology assessment. 1 figure. 110 references. (AA-M).

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Laparoscopic Colorectal Surgery: A Challenge for ET Nurses Source: Journal of Wound, Ostomy and Continence Nursing. 21(5): 179-182. September 1994. Summary: To familiarize enterostomal therapy (ET) nurses with the laparoscopic technique used for colorectal surgery, this article reports a case of laparoscopic abdominoperineal resection and some of the special considerations involved in patient care. Topics addressed in the article include the operative technique, both the abdominal

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and perineal phases; maturation of the colostomy; the immediate postoperative period; surgeon and patient selection; preoperative preparation; ostomy training; and perineal wound care. 1 figure. 7 references. (AA-M). •

Laparoscopic Donor Nephrectomy Source: Transplantation Proceedings. 32(4): 681-682. 2000. Contact: Available from Appleton and Lange. P.O. Box 86, Congers, NY 10920-0086. (203) 406-4623. Summary: With the current development of minimally invasive techniques in surgery, the use of laparoscopy may decrease the damage to kidney donors during removal surgery by decreasing the occurrence of incision associated problems, such as pain, infection, or hernia. This article reports on the authors' initial experience with the use of laparoscopy for kidney harvesting during the last year, with a comparison of similar results as published by other groups performing this procedure. The authors report on four patients (ages 35 to 56 years old) who underwent donor laparoscopic nephrectomy (removal of the kidney), describing the surgical techniques used for each. The intraoperative course was smooth in all four cases. The only problem observed was a difficulty in the specimen retrieval in one case due to a tear in the collecting bag. The warm ischemic time was 4 minutes in three donors, and 10 minutes in one (due to the above problem). Graft function was immediate in three patients, and delayed in one; the kidney with the long warm ischemic time suffered from acute tubular necrosis (ATN), regaining function after 10 days. The authors conclude that laparoscopic donor nephrectomy is feasible and can be performed safely. However, it is a demanding procedure and previous experience with advanced laparoscopic techniques is mandatory. The keys to success are keeping a well functioning kidney through the operation (good hydration, low intraabdominal pressure), getting long enough hilar vessels, keeping good vascular supply to the ureter, and keeping the extraction time as short as possible. 7 references.

Federally Funded Research on Laparoscopy The U.S. Government supports a variety of research studies relating to laparoscopy. 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 laparoscopy. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore laparoscopy. The following is typical of the type of information found when searching the CRISP database for laparoscopy: 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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Project Title: ANDROGENIZED FEMALE AS A MODEL FOR P0LYCYSTIC OVARIAN SY Principal Investigator & Institution: Abbott, David H.; Primate Research Center; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2002; Project Start 01-AUG-1999; Project End 31-JUL-2004 Summary: Polycystic ovarian syndrome (PCOS) affects 10 percent of reproductive-aged women and is characterized by hyperandrogenic anovulation. Hyperinsulinemia plays a key role in the mechanism of hyperandrogenic anovulation. The etiology of PCOS in the human, however, is unknown. Prenatal androgen excess in female rhesus monkeys results in ovarian, endocrinological and metabolic features in adulthood which closely resemble PCOS. In this nonhuman primate model for PCOS, we will test the hypothesis that a double insult is required to evoke hyperandrogenic anovulation. We propose that hyperandrogenism is required for hyperinsulinemia to effect hyperandrogenic anovulation (PCOS). Without hyperandrogenism, hyperinsulinemia may induce ovarian hyperandrogenism, but it will fail to induce hyperandrogenic anovulation. The Specific Aims of the proposed research are to (1) use an insulin-sensitizing agent to ameliorate hyperinsulinemia and induce ovulatory cycles in prenatally androgenized female rhesus monkeys that exhibit hyperandrogenic anovulation, (2) produce hyperinsulinemia in normo-insulinemic, hyperandrogenic, prenatally androgenized females and induce hyperandrogenic anovulation, and (3) use an anti-androgen in combination with hyperinsulinemia in normo-insulinemic hyperandrogenic, prenatally androgenized females to block insulin-induced hyperandrogenic anovulation. Eight anovulatory and 10 ovulatory prenatally androgenized females will be matched for age and body composition with 18 ovulatory controls. The 8 anovulatory androgenized females and their controls will receive 4 mg/kg of troglitazone (RezulinTm, Parke-Davis) daily for 6 months to ameliorate their hyperinsulinemia. The 10 ovulatory androgenized females and their controls will receive daily injections of insulin (Ultralente insulin, Eli Lilly) for 6 months, starting at 5U/day and incrementing to 20U/day. A 6-month Control Phase will be counterbalanced with each Treatment Phase. During all Phases, data will be collected on ovarian function and morphology, hyperandrogenism in the ovary and adrenal, changes in intra-ovarian follicular fluid content, degree of LH hypersecretion, glucose/insulin homeodynamics, and CT/DXA-determined body composition. If our hypothesis is correct, these data will establish that hyperinsulinemia results in hyperandrogenic anovulation only in prenatally androgenized female monkeys. Such results would offer novel insights into the origin and mechanism of PCOS, and would provide a unifying determinant for a multifactorial syndrome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ANDROGENS, POLYCYSTIC OV

INSULIN,

LUTEINIZING

HORMONE

IN

Principal Investigator & Institution: Kalro, Brinda; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002 Summary: We hypothesize that the decrease in ovarian androgen secretion that accompanies laparoscopic ovarian diathermy in women with polycystic ovary snydrome (PCOS) will cause luteinizing hormone (LH) secretion to decrease, follicle stimulating hormone (FSH) to increase, insulin sensitivity to improve and ovulation to resume. The specific aim of this proposal is to determine the effect of decreasing elevated androgen levels upon insulin resistance. To determine if the reduction of

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androgen levels will result in a reduction of LH pulse frequency and amplitude and mean LH and increase in FSH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BARIATIC PATHOPHYSIOLOGY

SURGERY:

OUTCOMES

&

IMPACT

ON

Principal Investigator & Institution: Berk, Paul D.; Chief, Division of Liver Diseases; Medicine; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): The increasing prevalence of obesity in the U.S. is well documented by a series of surveys conducted by the National Center for Health Statistics. Its 1999-2000 data revealed that a staggering 62.5 % of adult Americans aged = 20 were overweight (BMI >= 25), and 30.5 % were obese (BMI >= 30). Projections suggest that by the year 2025 45% of adult Americans will be frankly obese. The increasing prevalence of obesity has fueled an increase in obesity-associated healthcare costs that reached $100 billion annually (5.7% of our national health expenditure) by 1995, and is surely even greater today. Obesity is associated with markedly increased risks of many comorbidities, of which hypertension, non-insulin-dependent diabetes mellitus (NIDDM), dyslipidemias, and cardiovascular disease are major contributors to 300,000 obesity related deaths annually. Non-alcoholic fatty liver disease (NAFLD) has recently emerged as a serious complication of obesity, and its most severe form, nonalcoholic steatohepatitis (NASH), is now the third most common indication for liver transplantation. Medical therapies for obesity are of very limited success. The best results for long term control of weight and of the various co-morbidities of obesity derive from bariatric surgery. The Mount Sinai School of Medicine has a large and innovative bariatric surgery program, which has focused on the development of minimally invasive (laparoscopic) bariatric methods. In this application, we propose to study the efficacy and safety of a novel, two stage surgical treatment of morbid-and super-obesity (BMI = 60) that combines an initial restrictive operation (sleeve gastrectomy) with a subsequent malabsorptive procedure (biliopancreatic diversion with duodenal switch) performed after the loss of ca. 100 Ib, when the patient is a better operative risk. Preliminary data suggest the approach is both effective and safe, with an appreciable reduction in operative morbidity and mortality compared with conventional, open abdominal surgery in this population. The nature of the protocol allows collaborating scientists to conduct virtually unique studies of changes in adipose tissue fatty acid metabolism, hepatic histology, triglyceride accumulation and fibrogenesis, patterns of adipocyte and hepatocyte gene expression, alterations in levels of circulating hormones that modulate hunger and satiety, and changes in regional brain activity in response to food stimuli, that result from extensive weight loss. In a second protocol, effects of laparoscopic Roux-en-Y gastric bypass on short and long term control of weight and NIDDM in obese patients with initial BMIs = 35 will be compared with results of ADA-recommended optimal medical care. By conducting this as a cooperative study at multiple sites within the Bariatric Surgery Clinical Research Consortium, the results will make a compelling statement about the optimal approach to control of obesity and NIDDM in this population, that represents an ever-increasing subset of adult Americans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CLINICAL EPIDEMIOLOGY OF MYCOPLASMA GENITALIUM Principal Investigator & Institution: Totten, Patricia A.; Professor; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2007 Summary: Large proportions of the major reproductive tract inflammatory syndromes remain idiopathic, not attributable to the major sexually transmitted pathogens such as Chlamydia trachomatis or Neisseria gonorrhoeae. Where effective STD control programs exist, most urethritis in men and endocervicitis or mucopurulent cervicitis (MPC) in women is no longer attributable to gonococcal or chlamydial infection. This is equally true for most upper genital tract complications of urethritis (epididymitis) or endocervicitis (endometritis, salpingitis and perinatal and puerperal morbidity). Mycoplasma genitalium, a fastidious bacterium discovered in 1981, now detectable by PCR, has been significantly associated with nongonococcal urethritis (NGU) in men in 11 of 11 studies over the past decade using PCR, including our own recent study which demonstrated M. genitalium in 27 (22%) of 211 men with and 5 (4%) of 117 without NGU (OR 6.5; 95% CI 2.1- 19.9). Recognition of M. genitalium as a pathogen in the male raises the important question of its role as a pathogen in the female, both in nonpregnant and in pregnant women. Since initial submission of this proposal in February 2000, we have completed two retrospective cross- sectional studies involving women. In a random sample of female STD clinic patients, we demonstrated endocervical M. genitalium infection in 24 (13%) of 191 with MPC vs. 27 (6%) of 453 without MPC (OR adjusted for cervical pathogens 3.0; 95% CI 1.6-5.8). This study also detected M. genitalium in 10 (14.3%) of 70 women with history of spontaneous miscarriage at < 20 weeks gestation vs. 41 (7.2%) of 570 without this history (adj OR=2.5; 95% CI 1.1-5.6). A cross-sectional study of 115 Kenyan women with suspected PID demonstrated M. genitalium in endometrial biopsies from 7 (12%) of 58 women with endometritis vs. 0 of 57 without endometritis (p=0.01). In our studies of male urethritis, MPC, and endometritis, associations of M. genitalium with disease were similar to, or stronger than, the associations with chlamydial infection. These data support our proposed studies as the next logical step in clinical epidemiologic studies of this pathogen. Our three specific aims are to (1) define the role of M. genitalium in acute salpingitis in women undergoing laparoscopy in Nairobi Kenya; (2) define the association of M. genitalium with abnormal pregnancy outcomes including preterm delivery of a low birthweight infant, using data and clinical specimens already available from 2500 women prospectively followed to term at University of Washington hospitals (including 625 with gestation <37 weeks); and (3) determine (a) risk factors for M. genitalium infection in a population-based sample of young women participating in Wave 3 of the National Longitudinal Study of Adolescent Health, and in a sample of higher risk women attending the Seattle STD clinic, and (b) concordance of M. genitalium infection in these women and their sex partners. M genitalium may represent an important new pathogen in the female reproductive tract. Studies of its association with salpingitis and pregnancy morbidity are essential. Future studies should also address whether, similar to gonorrhea and chlamydial infection, it facilitates transmission of HIV infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EACT CAROLINA UNIV. BARIATRIC SURGERY CLINICAL CENTER Principal Investigator & Institution: Pories, Walter J.; Professor; Surgery; East Carolina University 1000 E 5Th St Greenville, Nc 27858 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008

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Summary: (provided by applicant): Obesity, the most prevalent, fatal, chronic disease of the 21st Century, is increasing at a rate seen before only with infectious diseases. Morbid obesity, the most severe form, afflicts 23 million Americans. These individuals are not only limited by their bulk but are sharply compromised by life-endangering comorbidities. Surgery has proven to be an effective therapy. The Greenville gastric bypass operation (GGB), developed at this institution, produces not only durable weight loss greater than 100 Ibs but also induces full remission of type 2 diabetes in 83 percent of patients, control of hypertension in over half, as well as full reversal of such comorbidities as asthma, Pickwickian syndrome, stress incontinence, and pseudotumor cerebri. The reproducible reversal of type 2 diabetes in GGB patients is a provocative finding and requires further basic research. However, the GGB, like other bariatric procedures, is associated with serious long-term nutritional deficiencies and, in vulnerable individuals, emotional disorders. Generally, there is no consensus about which of the seven common bariatric procedures should be used. There is also considerable variation in surgical outcomes across the US for the same operation due to a lack of standardization of the surgical care. Thus, bariatric surgery is ripe for a collaborative approach to answering both clinical and basic research issues. Our current center efforts include three major areas: 1. Fostering collaboration within the bariatric surgical community to promote clinical, behavioral, and basic research in morbid obesity and its co-morbidities; 2. Clinical studies of the efficacy, efficiency, and safety of two types of gastric bypass operations with an emphasis on differences in outcomes between African-American and Caucasian women. 3. Basic science studies of insulin action and sensitivity in human subjects prior to and after bariatric surgery. In addition, this application includes three proposals for inter-institutional projects: 1. Comparison of the most commonly performed bariatric operations; 2. the mechanism for increased insulin sensitivity after gastric bypass surgery; and 3. the ethics of the informed consent in bariatric surgery. Because East Carolina University has a productive tradition of interdisciplinary clinical, basic science, and behavioral research in morbid obesity as well as a record of national leadership, we submit this application to become one of the Bariatric Surgery Clinical Centers of the NIDDK. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ENDOMETRIOSIS :TRADITIONAL MEDICINE VS HORMONE THERAPY Principal Investigator & Institution: Hammerschlag, Richard; Research Director; None; Oregon College of Oriental Medicine 10525 Se Cherry Blossom Dr Portland, or 97216 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: (APPLICANT'S ABSTRACT): Endometriosis is a significant public health problem affecting 10-15% of women of childbearing age, many of whom suffer persistent pelvic pain and infertility. Therapeutic options include surgery and hormone therapy that are often temporarily effective but produce unwanted side-effects. The present proposal, based on case series reports of the effectiveness of Traditional Chinese Medicine (TCM: acupuncture and Chinese herbs) for this condition, aims to evaluate whether TCM is as effective as hormone therapy for alleviating endometriosis-related chronic pain. The study is designed as a prospective trial of 66 women, with laparoscopy-diagnosed endometriosis, randomized to TCM or hormone therapy. Women assigned to TCM will be divided into four sub-groups on the basis of the diagnostic categories of endometriosis recognized by TCM. A pre-established acupuncture protocol and herbal formula specific for each sub-group will be followed. This aspect of the research design permits an important feature of the clinical practice of

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TCM (matching treatment to sub-group diagnosis) to be adopted in a clinical trial. Women assigned to hormone therapy will be treated with the gonadotropin releasing hormone agonist (GnRHa), nafarelin, chosen for this study on the basis of its clinical trial-established efficacy, ease of patient usage via intranasal spray and milder sideeffect profile relative to other GnRHa's. Pelvic pain symptoms (patient-scored) and signs (physician-scored) will be assessed at baseline, after 12 weeks of treatment, and at 12and 24-week post-treatment follow-up. Pelvic examination scores will be determined by a physician blinded to the treatment group assignments. Side effects, including those of pseudomenopause known to result from GnRHa therapy, will be recorded in both groups at 4-week intervals during the 12-week treatment, and at each follow-up time. A further objective is to make a preliminary assessment of whether diagnostic sub-groups of endometriosis recognized by TCM serve as predictors of differential response to hormone therapy. Data obtained from this study, on treatment effectiveness, side effect profiles, recurrence of symptoms, compliance with therapy and drop-out rates, will be used to design a large-scale clinical trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ENDOMETRIOSIS IN BABOON--ESTABLISHMENT /FERTILITY Principal Investigator & Institution: Fazleabas, Asgerally T.; Professor; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2002; Project Start 02-MAY-2002; Project End 31-MAR-2007 Summary: Endometriosis is defined as the presence of endometrium-like tissue outside of the uterine cavity. It is one of the most common causes of infertility and chronic pelvic pain and affects 1 in 10 women in the reproductive age group. It is inherited in a polygenic manner with a complex and multifactorial etiology. Although existence of this disease has been known for over 100 years, our current knowledge of its pathogenesis, the pathophysiology of related infertility and its spontaneous evolution is limited. Several reasons contribute to our lack of knowledge, the most critical being the difficulty in carrying out objective long term studies in women. Therefore, we have developed an appropriate non-human primate to study the etiology of this disease. We propose that endometriosis develops in two distinct phases. Phase I is invasive and dependent on ovarian steroids. Phase II, which is the active phase of the disease, is characterized by endogenous estrogen biosynthesis. Using the baboon model for endometriosis we will; 1) explore the role of paracrine factors produced by the endometrial tissue itself in endometriosis; 2) determine the role of endocrine factors on the ectopic establishment of endometrial tissue; and 3) investigate the physiological consequences of endometriosis on reproduction. Specifically, in Specific Aim 1, we will use the in vivo model system to characterize changes in estrogen receptor and aromatase gene expression during disease progression. These changes will establish the role for estrogen to directly or indirectly regulate metalloproteinases (MMP-3 and MMP-7) and vascular endothelial growth factor (VEGF) to enable menstrual tissues to implant in an ectopic site. In Specific Aim 2 we will determine the role of ovarian steroids, particularly estradiol, in the establishment of endometriotic lesions. We propose to use three treatment modalities following introduction of menstrual effluent into the peritoneal cavity: a) suppression of ovarian function following menses with GnRH agonists; b) addition of low doses of exogenous progesterone during the follicular phases; c) ovariectomy and steroid replacement following menstruation. In Specific Aim 3 we will determine the effects of endometriotic lesions on uterine receptivity. Using a simulated pregnant baboon model we will determine if the hCG-induced, functional changes in both epithelial and stromal cells are affected in baboons with endometriosis during the period of uterine receptivity.

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In addition, we will determine if treatment with an aromatase inhibitor suppresses the disease and reverses the deleterious effects on endometriosis on uterine receptivity. These studies will provide significant information on the establishment and progression of endometriosis and its potential effects on fertility. These studies have direct relevance for the diagnosis and treatment of this disease in women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EVALUATION OF MINIMALLY INVASIVE SURGERY Principal Investigator & Institution: Rogers, Stanley J.; Surgery; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: Major advances have been made over the past decade developing minimallyinvasive endoscopic, surgical and radiographic procedures in an attempt to decrease mortality, morbidity, hospital stay and overall health care costs in treating patients with abdominal disorders. The treatment of these common gastrointestinal disorders needs to be studied in randomized controlled clinical trials. Given my training and experience in surgical endoscopy and minimally invasive surgery (laparoscopy), I propose studying in the context of randomized controlled clinical trials three distinct areas of gastrointestinal disease in which major advances have occurred employing laparoscopy, endoscopy and interventional radiological techniques. The three principal projects for this mentored clinical research are the following: 1. Randomized controlled clinical trial of laparoscopic cholecystectomy with laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography with sphincterotomy followed by laparoscopic cholecystectomy for patients with common bile duct stone disease. 2. Laparoscopic anti-reflux surgery versus long-term administration of proton pump inhibitors (lanzoprasole) for moderate to severe gastroesophageal reflux disease. 3. Intra-arterial chemoembolization alone versus intra-arterial chemoembolization plus laparoscopic, ultrasound-guided radiofrequency ablation for non-resectable hepatocellular carcinoma. All three protocols involve minimally invasive surgery and other therapies studied in a prospective randomized controlled fashion. While the technical expertise, equipment and facilities used to perform these procedures have been developed around the world, few randomized controlled clinical trials exist that critically examine outcome parameters for a sufficient period of time to document efficacy, safety, improved survival and overall cost benefits in the treatment of these disorders. These three trials will allow such an evaluation of minimally invasive procedures used to treat patients with common gastrointestinal disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EXCELLENCE IN CLINICAL RESEARCH IN CHILDREN'S SURGERY Principal Investigator & Institution: Moss, R Lawrence.; Surgery; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2003; Project Start 15-JUL-2003; Project End 31-MAY-2008 Summary: (provided by applicant): This application seeks five years of support to allow R. Lawrence Moss, MD, to make major contributions to the level of Children's Surgery by achieving his career objectives in patient-oriented clinical research. His foremost professional objective is to introduce scientific rigor and established clinical research techniques into the manner in which surgical treatments in children are evaluated. Dr. Moss is an active clinical Pediatric Surgeon and an internationally recognized and established clinical investigator. He is the principal investigator for the first ever multi-

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center clinical trial in Children's Surgery ROl HD 38462. He serves as Stanford Site Director and only surgeon of the first multi-disciplinary patient-oriented research network in Pediatrics. He holds multiple national leadership positions in Pediatric Surgery, and is recognized as a leader in clinical research in the field. He has mentored twelve postdoctoral fellows in clinical research of whom the past five have each obtained extramural funding based on their outstanding productivity. Stanford University is an exceptionally rich environment for patient-oriented research, and has identified clinical investigation as a major focus of the Medical School for the next decade. Dr. Moss' work is an integral component of this institutional mission in clinical research. Examples of work to be conducted during the training period include; 1) leading a twelve-center trial of peritoneal drainage versus laparotomy for infants with perforated necrotizing enterocolitis; 2) establishment of the first multi-center neonatal surgical database for children with congenital anomalies; and 3) development of a multiinstitutional consortium to study biliary atresia. With the support of this award, the awardee's underlying objectives are three-fold: 1) to make substantive contributions to the field Children' s Surgery that will directly impact the health and well-being of children; 2) to conduct multiple clinical research projects that change the shape of the discipline of academic Pediatric Surgery; and 3) to mentor the next generation of physician scientists in Children's Surgery to be critical thinkers who are well versed in clinical research techniques. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FEASIBILITY OF DNA DELIVERY WITH MICROELECTRODES Principal Investigator & Institution: Jaroszeski, Mark J.; Associate Professor; Rmr Technologies, Llc 4207 University Dr Coral Gables, Fl 33146 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JAN-2004 Summary: (provided by applicant): This proposed study will determine the feasibility of using an array of microelectrodes for applying electrical energy to transfer DNA in vivo to living cells. The study will first assemble appropriate microelectrodes, computer based hardware, and custom software to create a device for applying electric fields in vivo. The device will then be tested by delivering plasmid DNA to muscle in a rat model and analyzing gene expression. Results will be compared to standard "macro" electrodes that are commonly in use for DNA delivery. If successful, this study will demonstrate the utility of microelectrodes for DNA delivery to cells/tissue using a device with a lower power that can precisely deliver DNA to a desired location. Success will also be a motivator for future investigations as the microelectrodes proposed in this study can be made flexible to confirm to tissue topography, small enough to be applied laproscopically or on a catheter type device, and as an implantable device for multiple dose delivery uses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GUT ISCHEMIA/REPERFUSION INJURY: MODULATION BY NUTRIENTS Principal Investigator & Institution: Kozar, Rosemary A.; Surgery; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2002; Project Start 10-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): Candidate: Dr. Kozar is a new faculty member at the University of Texas-Houston Medical School (UTHMS), where she is a member of the Department of Surgery. She first acquired basic research skills as a NRSA Fellow while

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obtaining her PhD at Baylor College of Medicine. Following completion of her general surgery training, the candidate accepted a faculty position in Trauma and Critical Care at MCP-Hahnemann University School of Medicine under the direction of Dr. Joel Rosyln. During this time she began to develop research experience in the field of Trauma and Critical Care by investigating the activity of antioxidant enzymes in an acute lung injury model, funded by a private grant for which she was the principal investigator. Since becoming a faculty member in the Department of Surgery at UTHMS she has become very active in the NIGMS-sponsored Trauma Research Center, focusing on the role of the gut in multiple organ failure. A Career Development Award, in conjunction with the support of two highly respected mentors, would enhance the acquisition of the necessary skills and talents crucial to becoming a future independent investigator. Research: The proposed research project is an extension of the Trauma Research Center?s interest in the link between gut dysfunction and multiple organ failure. As proposed in this application, the candidate wilt test the hypothesis that specific enterat nutrients during gut ischemia/reperfusion impair gut function and enhance gut injury. The goal of the proposed project is to understand how enterat nutrients during times of metabolic stress can be detrimental to gut function. The results obtained will facilitate a better understanding of postinjury gut dysfunction and aide in future strategies to achieve enteral tolerance in patients at high risk for multiple organ failure. Environment: The UTHMS in the center of the Texas Medical Center is comprised of 42 member institutions dedicated not only to outstanding patient care but also to the highest standards and quality of research. As part of the Department of Surgery's Trauma Research Center, the candidate has the guidance and support of numerous researchers in the Department of Surgery as well as in Integrative Biology, and Medicine. The sponsors are an integral part of this arrangement and are especially suited to ensure success of the proposed project. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEMOSTATIC LIVER BIOPSY DEVICE Principal Investigator & Institution: Krause, William R.; Professor; Bioengineering Consultants, Ltd 801 W Main St, Ste 201 Charlottesville, Va 22903 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-AUG-2004 Summary: The Specific Aim of this Phase II application will be to evaluate the biopsy unit and delivery device in an animal model, make any modifications and redesign resulting from the animal trials and, upon the anticipated successful application, proceed to human clinical trials. Under the Phase I study we have designed and manufactured a functional prototype, and evaluated the device in explanted liver sections and in a live, but terminal canine model (non-NIH funded project). It was observed in an in vivo canine model that the use of the device obtained a suitable biopsy specimen and automatically delivered a coagulant plug that stopped the bleeding from occurring within 5 seconds. It is the OBJECTIVE of the proposed Phase II project will be to evaluate the device in: (i.) a fibrotic swine animal model, (ii.) a cirrhotic swine model, (iii.) a laparoscopic guided human liver biopsy procedure, and (iv.) a controlled, percutaneous human liver biopsy procedure. It is anticipated that limited commercialization of the device will be available towards the end of the study period PROPOSED COMMERCIAL APPLICATIONS: The US market for liver biopsy needles is approximately $5 million based on a conservatively estimated 100,000 liver biopsies due to the hepatitis virus and alcoholism. Although offered at a higher price than current needles, we would offer a complete needle, syringe, and delivery system that would also reduce hospital costs of more expensive procedures and complications. The

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proposed device would realize substantial profits of $600K with minimum (20%) penetration and reduce health care costs by $5M. Additional markets for other highly vascular tissue biopsies will open upon development of the device. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IN UTERO PCB EXPOSURE & MENSTRUAL DISORDERS Principal Investigator & Institution: Hauser, Russ B.; Assistant Professor; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02115 Timing: Fiscal Year 2002 Summary: (Taken from application) Currently, there is scientific and public concern about whether exposure to putative endocrine disruptors, such as polychlorinated biphenyls (PCBs), are associated with adverse reproductive health effects. This concern stems from studies showing that PCB residues are found in a large proportion in a large proportion of the general population, as well as animal and some human studies suggesting possible associations of exposure to PCBs with altered reproductive function. The proposed study will investigate the relationship between PCBs and endometriosis, which is an important public health issue because it affects more than five million women in the United States and has large social and economic impacts. Endometriosis is a relatively common disease (prevalence estimated at 5 to 10%) that can affect fertility as well as other aspects of a woman's general health and well-being. Animal and human data suggest that the critical exposure window for endocrine disruptors may be in utero because the developing fetus is extremely sensitive to endocrine hormones during reproductive development. Therefore, the proposed epidemiologic study is designed to investigate the relationship between in utero exposure, the hypothesized critical exposure window, and endometriosis and menstrual cycle dysfunction. The proposed project, a case-control study nested in the National Collaborative Perinatal Project (NCPP) cohort, will extend follow-up through the reproductive years of the daughters of the pregnant women recruited in the NCPP (1959-1966). During pregnancy, one or more blood samples were taken from the pregnant women and archived. The daughters will be traced and will complete a question on endometriosis and menstrual cycle characteristics. Cases are daughters with laparoscopy-confirmed endometriosis. The NCPP cohort provides a unique opportunity to study in utero exposure to PTCBs and female reproductive to PCBs and female reproductive health without having to initiate an expensive prospective study and follow individuals for 20 or more years. In addition, in the proposed, a current blood sample will be analyzed to reflect adult PCB levels that may confound the relationship between endometriosis and in utero PCB exposure, and will serve as a source of additional information on cumulative exposure. The area of human reproductive health effects of endocrine disrupting chemicals, such as PCBs, was identified as a current topic for special emphasis by the NIEHS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISMS OF INFERTILITY IN ENDOMETRIOSIS Principal Investigator & Institution: Bulun, Serdar E.; Professor & Head; Obstetrics and Gynecology; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2002; Project Start 01-JUN-2000; Project End 31-MAY-2003 Summary: The long-range objective is to develop a clinically useful primate model for endometriosis-associated infertility in order to define underlying molecular biological and physiologic mechanisms and to test the efficacy of experimental medical treatments. Our preliminary results are indicative that the aberrant expression of aromatase and

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cyclo-oxygenase (COX)-2 and the deficiency of 17beta-hydroxysteroid dehydrogenase type 2 (17beta-HSD-2) in endometriosis (in comparison with the eutopic endometrium) give rise to elevated local levels of estradiol, which is mitogenic for endometriotic tissue. These findings are clinically relevant, because treatment of a postinenopausal woman with an unusually-long- standing and severe case of recurrent endometriosis using an aromatase inhibitor nearly eradicated the disease. We hypothesize that excessive estrogen formation in endometriosis represents an important abnormality associated with infertility and a potential target in its treatment. Additionally, the deficiency of the progesterone-induced enzyme 17beta- HSD-2 in endometriotic tissue and severely altered ratio of progesterone receptor isoforms represent, in part, the molecular basis of a general progesterone resistance in endometriosis, which is also confirmed clinically by resistance of this disease to treatment with progestins. Results of our preliminary findings, however, can only be interpreted with caution, since the models used were either human endometriotic cell cultures or mice with transplanted uterine tissues. Baboon is an appropriate model, since these animals develop endometriosis spontaneously similar to the human disease and can be manipulated surgically and hormonally to answer fundamental questions. Consequently, we obtained institutional bridge funds for a year to perform a limited study on 6 baboons. The following studies, however, require much larger numbers of baboons. These can be performed extremely efficiently in the Institute for Primate Research in Nairobi, given the size of the colony and the level of enthusiasm and expertise in baboon endometriosis in this institution. The first specific aim of this application is to characterize the molecular and cellular mechanisms responsible for excessive estrogen formation and progesterone resistance in a baboon endometriosis model. Endometriosis will be induced by injection of menstrual material into the pelvic cavity. Alternatively, baboons that develop endometriosis spontaneously will be identified by laparoscopy. Activities of aberrant or deficient enzymes in endometriotic lesions will be determined using in vivo conversion assays. We will then determine the expression of aromatase, COX-2, 17beta-HSD- 2 and steroid receptor isoforms in endometriotic tissue biopsies. Finally, end results such as proliferation and apoptotic cell death in baboon endometriotic lesions will be determined in response to various hormonal treatments including aromatase inhibitors. The second specific aim is to determine the mechanism of infertility associated with endometriosis and the effectiveness of early medical treatment for prevention. Baboons with or without endometriosis will be monitored for ovulation. Possible defects in fertilization, implantation and early miscarriage will be detected. Once major mechanisms are characterized, we will determine whether infertility associated with endometriosis can be prevented or treated medically using novel strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MINIMALLY INVASIVE SURGERY IN THORACIC MALIGNANCIES Principal Investigator & Institution: Sugarbaker, David J.; Vice Chairman/Chief; DanaFarber Cancer Institute 44 Binney St Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 29-SEP-2004 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MINIMALLY INVASIVE SURGICAL PLANNING AND TRAINING SYSTEM Principal Investigator & Institution: Kynor, David B.; Creare, Inc. Box 71, Etna Rd Hanover, Nh 03755

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Timing: Fiscal Year 2003; Project Start 05-SEP-2003; Project End 31-AUG-2006 Summary: (provided by applicant): The goal of this project is development of an interactive, image-guided surgery (IIGS) system for use in laparoscopic liver surgery and ablation. This system will permit clinicians to use preoperative volumetric images obtained using computed tomography (CT) or magnetic resonance (MR) imaging during surgery as a means of navigational guidance. The efficacy of image-guided surgery has been demonstrated in neurosurgery. However, application of the technology to other fields of surgery has been slow. During this project, we plan to address one of the primary technical barriers by developing an endoscopic system for measurement of the shape and deformation of organs during minimally invasive surgery. The resulting data will be used for coregistration of patient and image coordinate systems and to drive deformable tissue models. The Phase II work will be evaluated using a series of phantom and experimental animal tests performed at Creare and Vanderbilt University. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OPTICAL SPECTROSCOPY OF OVARIAN CANCER Principal Investigator & Institution: Utzinger, Urs; Biomedical Engineering Div; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2006 Summary: (provided by applicant): The objective of this work is to determine the etiology of endogenous optical signals from ovarian tissue. This research will serve as the basis for development of a minimally invasive method for the diagnosis of premalignant changes as well as early ovarian cancer using fluorescence and reflectance spectroscopy. The hypothesis that drives the proposed research is that developing a series of experimental and mathematical models will allow us to explain the differences in optical signatures of normal ovaries, premalignant changes, and malignant transformations. By understanding this contrast, we will be able to derive effective early diagnostic methods for ovarian cancer and improve early detection of this highly fatal disease. Diagnostic techniques will be most useful in women at high risk of developing ovarian cancer to identify those women who need to undergo an oophorectomy. Once a serum based screening test is available for the low risk population it will be of utmost importance to perform a second lock diagnostic procedure because even excellent tests will generate a large number of false positive results. We propose the four following specific sub-projects: 1) collect spectral data of cellular and extracellular constituents of normal and transformed ovarian tissue; 2) characterize optical tissue signals in vivo and obtain biopsies from the same interrogated tissue volume; 3) use these biopsies to study etiology of the optical signals in an in vitro tissue culture model; and 4) synthesize mathematical models of remitted optical signals based on all collected data to explain the biophysical sources of spectral variations and to develop novel diagnostic metrics. The projects will advance present knowledge of the development of cancer, a health problem which, notwithstanding significant medical advances over the past fifty years, remains the second leading cause of death in the United States as we enter the new millennium. The proposed project will take an important step toward improving the overall survival in ovarian cancer, a statistic that has not changed in the last 50 years. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: POSITRON EMISSION TOMOGRAPHY IN PROSTATE CANCER Principal Investigator & Institution: Miller, Tom R.; Professor; Radiology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): The primary goal of this project is determination of the value of positron emission tomography employing the radiopharmaceutical C-11 acetate (AC-PET) in patients with medium- and high-risk prostate cancer who are candidates for treatment with curative intent by radical prostatectomy or radiation therapy because the standard clinical and imaging evaluation was negative for tumor spread beyond the prostate. The following specific aims will be pursued: 1. Determine the role of AC-PET in changing initial patient management; 2. Determine the value of AC-PET in predicting recurrence; 3. Assess the performance of AC-PET for detection of lymph nodes by comparison with biopsy. Study Design: The study includes a total of 285 patients in two groups who are scheduled for treatment with curative intent, both of whom will undergo AC-PET imaging prior to treatment. For the surgery group, if the PET examination is negative for disease outside the prostate gland, the treatment will proceed and the patient will be followed for evidence of recurrence. If the PET examination is positive, the referring physician will be encouraged to undertake confirmatory studies, which may lead to a change in therapy. All patients in the radiation therapy group will undergo the standard treatment, and they will then be followed for evidence of recurrence. The lymph node biopsy results in the surgery patients will be correlated with the PET findings to compute the positive and negative predictive values of AC-PET. Anticipated Results: AC-PET will lead to cancellation of radical prostatectomy in at least 10% of the surgical patients. It is also expected that ACPET will significantly improve the prediction of recurrence compared with conventional methods based on clinical stage, PSA and Gleason score. The predictive value of ACPET should be high when correlated with the pathological data. Health Relevance: If this project is successful, it will have a significant impact on the management of patients with moderate- and high-risk prostate cancer who are candidates for curative treatment. In some of these patients, a positive PET scan will lead to cancellation of planned surgery, sparing these men the morbidity of radical surgery while permitting some of them to receive more appropriate hormonal treatment. PET may also contribute significant prognostic information that may affect the decision to administer early adjuvant therapy to delay or prevent recurrence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PRE-CLINICAL TRIALS FOR FEMALE FERTILITY PRESERVATION Principal Investigator & Institution: Tilly, Jonathan L.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114

Associate

Professor;

Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2008 Summary: (provided by applicant): Early ovarian failure and infertility are well-known side effects of anti-cancer treatments. While the need for tumor eradication is clear, the long-term consequences of these treatments on non-target tissues, such as the ovaries, are substantial. Unfortunately, attempts to preserve fertility and ovarian function in female cancer patients have met with little success. In studies with mice, we have shown that sphingosine-1- phosphate (S1P), a metabolite of the pro-apoptotic stress sensor ceramide, completely protects the ovaries from radiation-induced damage in vivo. Long-term in vivo mating trials have further shown that S1P preserves a normal level of fertility in irradiated female mice, and that offspring conceived with oocytes protected

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from radiation by S1P in vivo show no evidence of transgenerational genomic damage. With the use of a human ovarian-mouse xenograft model, we have also shown that injecting S1P directly into ovarian tissue can prevent radiation-induced loss of human primordial and primary follicles in vivo. Although these findings support that S1Pbased strategies could be developed to combat infertility and ovarian failure, two major points still need to be addressed. The first is to establish the safety and efficacy of S1P for preserving ovarian function and fertility in non-human primates exposed to anticancer treatments. The second is to validate technologies to deliver S1P only to the ovaries, thereby preventing systemic availability of S1P that could benefit the tumor cells targeted for destruction. To accomplish these goals, the following Specific Aims are proposed: (1) to determine if S1P can be administered directly into the rhesus monkey ovary as a means to protect the gonads from radiotherapy-induced damage in vivo; (2) to evaluate the competency of the oocytes protected from radiotherapy by S1P in the non-human primate ovary for fertilization and embryogenesis; and (3) to assess if offspring conceived from non-human primate oocytes protected from radiotherapy by S1P in vivo show evidence of propagated genomic damage. The goal of our work is to develop safe and effective strategies for protecting human ovaries in vivo from the sideeffect damage caused by anti-cancer therapies. We believe that the published and preliminary data discussed herein strongly support the need for now evaluating the efficacy of, as well as the delivery mechanisms for, S1P in this regard using the nonhuman primate as a model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREVENTION OF INFERTILITY IN WOMEN WITH SUBCLINICAL PID Principal Investigator & Institution: Wiesenfeld, Harold C.; Magee-Women's Health Corporation 204 Craft Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2003; Project Start 01-MAY-1998; Project End 31-JAN-2008 Summary: (provided by applicant): The broad, long-term goals of this study are to evaluate whether longer course antibiotic therapy for women at-risk for subclinical PID prevents subsequent infertility better than currently used short course antibiotic regimens for lower genital tract infections. Subclinical pelvic inflammatory disease (PID) is an important yet overlooked cause of infertility, responsible for more cases of postinfectious tubal infertility than acute PID. Subclinical PID is present in 25% of women with gonorrhea or chlamydia, and one in seven women with bacterial vaginosis, despite the absence of symptoms of acute PID. Most importantly, there is a doubling in infertility among women with subclinical PID compared to women without PID. Current treatment strategies for cervicitis and vaginitis do not address ongoing upper genital tract inflammation. Our hypothesis is that the preservation of fertility is greater among women with subclinical PID treated with a long-course antibiotic regimen compared to women receiving standard single-dose regimens for uncomplicated lower genital tract infections. The proposed application describes a randomized, double-blind, comparative phase III clinical trial studying a novel treatment regimen that incorporates azithromycin, an antimicrobial with potent immunomodulatory properties, on fertility outcomes in women at-risk for post-infectious fallopian tube damage. The specific aims are to 1) compare fertility rate of women with subclinical PID receiving two weeks of broad-spectrum antibiotic therapy with the fertility rate of women with subclinical PID receiving single-dose antibiotic regimen, 2) determine whether the resolution of endometritis is more common in women treated with the enhanced antimicrobial regimens utilized for acute PID compared to currently recommended single-dose

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regimens for lower genital tract infections, 3) characterize the inflammatory response in the lower genital tract in women with and without subclinical PID, and 4) evaluate whether women with subclinical PID have evidence of fallopian tube inflammation. During this study, very real public health questions will be asked and answered which will affect the way that lower genital tract infections are routinely managed, potentially enhancing fertility among American women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REDUCED INFLAMMATORY RESPONSE DURING LAPAROSCOPY Principal Investigator & Institution: Talamini, Mark A.; Surgery; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2006 Summary: (provided by applicant): Laparoscopic surgery represents a new paradigm, with less pain, quicker recovery times, and reduced disability. In time, most general surgical procedures will be performed in this manner. Laparoscopic surgery is not simply a reduced surgical insult, it is a different surgical insult. Preliminary data in the rat shows that a pneumoperitoneum with CO2 gas alters the inflammatory response associated with laparoscopic surgery in the setting of sepsis. The objective of this application is to establish whether CO2 pneumoperitoneum has a modifying role, and to determine the possible mechanism(s). AIM 1: To test whether CO2 modifies the inflammatory response during laparoscopic surgery. The effect of pneumoperitoneum with CO2, helium, or air on the inflammatory response after sepsis (cecal ligation and puncture) will be compared. The parameters of the inflammatory response to be evaluated are: leukocytosis, leukocyte infiltration, hepatic acute phase gene expression, and circulating levels of cytokines. AIM 2: To determine where in the pathway of the inflammatory response CO2 pneumoperitoneum exerts its effect. Expression of the acute phase proteins will be used as an experimental paradigm. Pre-transcriptional, transcriptional, and post transcriptional regulation of the acute phase genes will be evaluated. AIM 3: To determine how the C02 pneumoperitoneum alters the inflammatory response. The hypothesis of this aim is that alteration of pH with abdominal distension alters the inflammatory response. A) Arterial pH will be measured to correlate pH changes with immune modulation. B) The pH will be artificially decreased by a comparable amount via systemic intravenous infusion of hydrochloric acid in the setting of sepsis plus C02 pneumoperitoneum, helium pneumoperitoneum, air pneumoperitoneum, and open surgery. The information provided by this investigation will be essential in patient care as increasing numbers of patients undergo operations using the CO2 pneumoperitoneum. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REGIONAL FATTY ACID METABOLISM IN HUMANS Principal Investigator & Institution: Jensen, Michael D.; Professor of Medicine; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 30-SEP-1992; Project End 29-SEP-2005 Summary: This is a competitive renewal of a project aimed at understanding regional differences in fatty acid metabolism. It is clear that there are regional differences in fat distribution, that ultimately must be due to regional differences in either lipolysis or fat uptake. However, which processes differ is not known. The P.I. has used the stable isotope tracers, delivered in meals, and combined with adipose biopsies to study fatty acid uptake and disposal. Using tracers, fat can be oxidized, stored in subcutaneous fat

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or unaccounted for. It is assumed that this fat is stored in visceral adipose tissue. The P.I. found that upper body subcutaneous fat took up more meal fatty acids than lower body subcutaneous fat, but that men and women did not differ in this process. It is thought by the P.I. that the isocaloric feeding involved in these studies may have masked gender differences and that perturbations in energy balance may also be required. Thus the P.I. proposes to study the effects of amount of dietary fat on the meal fatty acid disposal in non-obese men and women. The P.I. will also recruit patients scheduled for elective laparoscopy in order to determine if the unaccounted for tracer ends up in visceral fat. The hypothesis to be tested is that regional differences in body fat gain in response to overfeeding will be due to differences in regional differences in fatty acid uptake. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK FACTORS AS PREDICTORS OF ECTOPIC PREGNANCY Principal Investigator & Institution: Barnhart, Kurt T.; Assistant Professor; Obstetrics and Gynecology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-MAY-1999; Project End 30-APR-2004 Summary: Ectopic pregnancy (EP) is the leading pregnancy - related cause of death in the first trimester of pregnancy and a major contributor to maternal morbidity. As the tubal pregnancy progresses, it erodes into blood vessels and can cause massive intraabdominal bleeding. There are limitations in the strategies currently employed to diagnose EP. Even with the use of diagnostic algorithms that systematically evaluate all women at risk for an EP, only 50 percent of women with an EP can be diagnosed upon presentation to an Emergency Department (ED). Diagnosis in the remaining 50 percent represents a clinical conundrum and can take up to 6 weeks. If the diagnosis of EP is delayed, the abnormal gestation will continue to grow in the fallopian tube with potential rupture resulting in greater risks of morbidity, and mortality. Moreover, an EP of large size is not amenable to medical therapy, may require major surgery (laparotomy) instead of laparoscopy and can cause greater damage to fallopian tube (and greater impairment of fertility), even if treated before rupture. The aims of this proposal focus on this clinically relevant subpopulation of women at risk for an EP butwhose diagnosis cannot be confirmed during their initial presentation to the ED, and is thus delayed. The University of Pennsylvania Medical Center has used a systematic, validated, protocol to diagnose pregnant women who are at risk for EP since 1989. An existing electronic database chronicles the clinical course and contains the results of the diagnostic tests used to definitively diagnose women at risk for EP but not diagnosed upon presentation to the ED. We plan to use the information in this database to: 1) identify factors predictive of EP in this subgroup of pregnant women and derive a clinical prediction rule to help identify those at highest risk for EP in an attempt to shorten the time needed for diagnosis. And 2) to evaluate the serial betahcg determinations to assess the clinical utility defining deviations from the curves characteristic of a viable intrauterine pregnancy (IUP) or spontaneous miscarriage (SAB) to diagnose an EP. For these aims, we will use a retrospective cohort study design of greater than 2100 subjects. We also plan to perform a prospective cohort study, in the same study population to: 3) evaluate the utility of novel strong predictors of EP including the endometrial stripe thickness and chlamydia serology, independently, and in context with the derived prediction rule. And 4) to validate our derived prediction rule using a prospectively collected sample of women at high risk of EP. Finally, we plan for the first time, 5) to investigate if the different clinical situations in which a woman with EP are diagnosed represent differences in the natural history of EP. This proposal represents a unique opportunity to use large amounts of existing data,

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combined with the efficient prospective collection of data, to understand and improve upon important limitations in our ability to diagnose a reproductive disorder with important public health consequences. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SPECTROSCOPIC POLARIZED-LIGHT-BASED LAPAROSCOPY Principal Investigator & Institution: Walsh, Joseph T.; Professor & Associate Dean; Biomedical Engineering; Northwestern University 633 Clark Street Evanston, Il 60208 Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2007 Summary: (provided by applicant): We propose to improve the visibility of endometrial lesions during laparoscopy. Specifically, we propose the development of a laparoscopic system in which the polarization of the incident and detected light is controlled. The problem is that endometriosis is difficult to diagnose both noninvasively and during laparoscopy. The documented correlation between visual inspection and histological confirmation of suspected lesions is never higher than 65%. We propose to take measurements of light reflected from internal tissue structures thereby obtaining a twodimensional mapping of the polarization and allowing visualization of the differences that exists between the connective tissue matrix of the lesions and the surrounding normal tissue. The proposed solution takes advantage of several key concepts in tissue optics for the development of a novel laparascope-based system. We will test the safety and efficacy of the system in an animal model, after which the system will be refined as needed. Testing of the system in humans, which is the best model for endometriosis, will be done to demonstrate safety, efficiacy, and provide data for further device improvements. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE ESOPHAGOGASTRIC JUNCTION IN HEALTH AND DISEASE Principal Investigator & Institution: Kahrilas, Peter J.; Professor of Medicine; Medicine; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: (Verbatim from Applicant's Abstract): Gastroesophageal reflux disease (GERD) is a common disorder, affecting millions of Americans and caused by anatomical and physiological perturbations of the esophagogastric junction (EGJ). The economic impact of GERD in the US is evident by the annual expenditure of >$4 billion for pharmaceutical treatments. Although effective, medical therapy is by nature compensatory, as opposed to potentially curative surgery. However, a problem with antireflux surgery has been unpredictable postoperative dysphagia and bloating related to a diminished ability to belch. Thus, this revised RO1 application represents a collaborative effort by a gastroenterologist (Dr Kahrilas), a surgeon (Dr Joehl), and a mechanical engineer (Dr Brasseur) to study perturbations of the EGJ imposed by GERD and by surgical treatments of GERD (Nissen fundoplication). Specific aim #1 addresses antegrade EGJ function while specific aim #2 investigates mechanisms of reflux. Antegrade EGJ function will be quantified with an "esophageal stress test" using manometry with concurrent fluoroscopy while swallowing boluses of defined viscoelastic properties. These data will be complimented by a dysphagia questionnaire. Data from controls will be compared to that of GERD patients and patients after antireflux surgery. The underlying hypothesis of specific aim #1 is that a mathematical model of the EGJ, embedded within a "computer laboratory" and based on the best anatomical and physiological data obtainable will improve understanding and

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prevention of post-surgical dysphagia. Specific aim #2 is focused aboutextending our investigations into the interplay between anatomical and physiological factors in the pathophysiology of GERD. Investigational methodologies include using a barostat to create measured degrees of gastric distension and to ascertain EGJ compliance during fluoroscopy of the EGJ, using intragastric air insufflation to study the physiology of transient LES relaxations and high resolution manometry to map the geometry and mobility of the EGJ. An underlying hypothesis is that the optimal surgical management of a patient with tLESR induced reflux is different than of the patient with a patulous sphincter. The ultimate goal is to tailor the surgical management of GERD for the individual patient based on physiological studies of that patient with the hope that this will improve the efficacy and reduce the complications of antireflux surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRAINING SCHEDULE EFFECTS ON SIMULATOR PERFORMANCE Principal Investigator & Institution: Cronin, John W.; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2005 Summary: (provided by the applicant): Daily variations in physiologic and cognitive functions in human beings are driven by an endogenous circadian pacemaker. Human performance is further governed by the relative amounts of both chronic and acute sleep deprivation. Medical trainees, providing a significant amount of primary medical care in the U.S., are vulnerable to impaired performance and learning by virtue of schedules that demand long work hours. Surgical trainees, who are exposed to perhaps the greatest sleep deprivation and who are asked to perform critical tasks at adverse circadian phases, are a particularly important group. While much public policy debate has led to the mandate of reduced work hours, insufficient work has been done to determine the optimal work hours necessary to preserve top performance on critical tasks while preserving the educational opportunities for trainees. In June, 2003, ACGME work hour limitations loosely limit work hours to less than 80 hours a week and to no more than 24 hours of direct patient care. This proposal will attempt to work within that framework by testing surgical trainees on the following three schedules: 8-10 hour shift; 12-16 hour shift; and an on-call shift of 24-30 hours. Sleep will be characterized by actigraphy, diary self report, salivary cortisol assays and EEG recordings. Performance under these conditions will be measured using the MIST-VR laproscopic surgical simulator. Six critical tasks will be assessed for errors, efficiency and time on task and compared across the three schedules. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENT OF ENDOMETRIOSIS-ASSOCIATED PELVIC PAIN Principal Investigator & Institution: Guzick, David S.; Professor and Chair; Obstetrics and Gynecology; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Approximately one-third of women with chronic pelvic pain have endometriosis. Surgical treatment of endometriosis with laparoscopic excision of implants and lysis of adhesions is often successful in reducing pain in the short term. Furthermore, several postoperative medical treatments have been shown to be efficacious in maintaining pain reduction for as long as the medication is continued. After stopping the medication, however, the level of pain tends to trend upwards towards pre-treatment levels. The desired postoperative treatment is one that is can be

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used for a long period of time, so as to minimize the chance of pain recurrence. Simplicity of administration and cost-effectiveness are other desirable characteristics of an ideal postoperative regimen. The only FDA approved 12-month treatment for endometriosis-associated pain is a combination of leuprolide acetate (a GnRH analog), 11.25 mg IM q 12 weeks, and norethindrone acetate, 5 mg PO daily. Use of this regimen has been constrained by its complexity and cost. As an alternative, the continuous use of oral contraceptives has been advocated as a practical, inexpensive strategy for long-term medical treatment of endometriosis-associated pain. Although such an approach is frequently used in clinical practice, there has been no clinical trial of its efficacy. The goal of this project is to compare the efficacy and cost-effectiveness of continuous oral contraceptives and leuprolide+norethindrone in the postoperative treatment of endometriosis-associated pelvic pain. Investigators at the University of Rochester School of Medicine and Harvard Medical School will recruit 194 women for randomization to one of the two treatments, each of which will continue for 48 weeks. Randomization will occur after biopsy-proven endometriosis is established. Pelvic pain and quality-of-life assessments will be obtained at regular intervals. The recruitment goal is 88 subjects per arm after a 10% drop-our rate. Change scores for these measures will be compared between the two treatments. The study has 80% power to test non-inferiority of oral contraceptives at the 5% level of significance, using a 1-point difference in the change scores for pain as the threshold. In addition, a cost-effectiveness analysis will be performed by calculating the cost per unit reduction in pain score for each treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UNDERSTANDING OVARIAN CONTROL IN RARE BIOMEDICAL MODELS Principal Investigator & Institution: Pelican, Katharine M.; Smithsonian Institution Box 37012, Victor Bldg, Ste 9200, Mrc 903 Washington, Dc 205600903 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The candidate in this application will receive stateof-the art training while advancing scholarly knowledge on ovarian cycle control in felids (cats). Specific objectives are to investigate the mechanisms regulating ovarian activity, develop effective protocols for ovarian inhibition, and to apply these protocols to improve ovarian response to gonadotropin stimulation for AI and IVF. This, in turn, will help propagate cats valuable to biomedical research and conserve endangered felid species. Many rare cat populations are difficult to manage due to poor reproductive capacity, physical and behavioral obstacles to breeding success, and limitations on transporting animals between institutions. Unfortunately, females also experience low pregnancy success after Al and IVF due, in part, to high variability in ovarian response to exogenous gonadotropins. Controlling the ovary prior to ovulation induction improves pregnancy success in some species, but this concept has not been tested in an induced ovulator such as the cat. This project will combine basic and applied research to characterize the female response to four ovarian cycle inhibitors: 1) leuprolide acetate (Lupron), a gonadotropin releasing hormone (GnRH) agonist; 2) Antide, a GnRH antagonist; 3) levonorgestrel (Norplant), a progestogen implant; and 4) altrenogest (Regumate), an oral progestogen. The impact of ovarian cycle inhibition prior to gonadotropin stimulation will be examined at three sites: 1) the ovary during hormonal therapy, 2) the follicle and oocyte after gonadotropin stimulation, and 3) the uterus after ovulation induction and AI. Findings will be applied to rare felid models used in biomedical research and selected rare felid species to enhance propagation success. This research program is designed to provide a multidisciplinary, integrative training

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opportunity that will allow the candidate to advance as a reproductive physiologist with expertise in endocrinology, immunoassay development, noninvasive hormone monitoring, gamete metabolism, laparoscopy, AI, IVF, immunohistochemistry, reverse transcriptase polymerase chain reaction (RT-PCR) and histology. Research benefits include: 1) understanding mechanisms for controlling ovarian function in felids, 2) characterizing the impact of ovarian cycle inhibition prior to exogenous gonadotropin stimulation, 3) developing a research strategy for investigating complex mechanisms of female infertility, and 4) enhancing the efficiency of feline model propagation to ensure continued availability of cats for biomedical research and species conservation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UTILIZING ETHYL NITRATE GAS IN LAPAROSCOPIC SURGERY Principal Investigator & Institution: Reynolds, James D.; Anesthesiology; Duke University Durham, Nc 27706 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2007 Summary: The principal goal of this project is to evaluate the ability of ethyl nitrate to attenuate the reduced tissue perfusion and respiratory acidosis produced during carbon dioxide pneumoperitoneum. The studies will use a novel method of drug delivery: inclusion of ethyl nitrate in the insufflating gas. Laparoseopy has rapidly become the method of choice for surgical intervention to correct abdominal pathologies. However, pneumoperiteneum, the act of insufflating the peritoneal cavity with gas, is not without physiologic consequence: pulmonary function is impaired and organ blood flows altered. In addition, due to its plasma solubility, insufflation with CO2 will increase pCOz and decrease blood pH, actions that can produce respiratory acidosis, tachycardia, and arrhythmia. The overall effects can become profound in the presence of underlying vascular disease, in[ the elderly, if the patient is pregnant, and/or when the duration of surgery is extended. In all situations, tissue ischemia and fetal ischemia (where applicable) can produce significant morbidity. To control this, it is a logical supposition that administration of a vasoactive agent to increase tissue blood flow and gas exchange would be beneficial. For the purposes of this study, we propose to introduce a nitric oxide donator (ethyl nitrate; E-NO) into the insufflating gas. As the released nitric oxide can act locally (i.e. within the peritoneum) as well as entering the systemic circulation and, in the case of the gravid patient, the fetal circulation (either by diffusion or maternal-fetal exchange), this would appear to be an ideal methodology to abate the CO2 pnenmoperiteneum-mediated changes in physiologic status. Such abatement is expected to be of long-term benefit to all laparoscopic patients including the parturient and her fetus. To evaluate this novel therapy, we will test two research hypotheses: 1. In the non-gravida, inclusion of E-NO in the insufflating gas attenuates the tissue perfusion changes produced by CO2 pneumoperitoneum; and 2. In the parturient, inclusion of E-NO during maternal pneumoperitoneum stabilizes fetal physiologic status. Studies will utilize adult swine and pregnant sheep. Completion of this investigation will produce clinically-relevant information that will be of significant interest to surgeons With patients in need of laparoscopic surgery and to obstetricians who are presented with parturients in abdominal distress. It is expected that the results of these studies will be used to further develop and refine standards of care for human laparoscopy and will lead to a novel therapy for controlling the blood flow changes produced during pneumoperitoneum. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VIDEOSCOPIC COLLECTIONS

DRAINAGE

OF

INFECTED

PANCREATIC

Principal Investigator & Institution: Horvath, Karen D.; Surgery; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): External drainage and antibiotics are the fundamental principles of treatment for infected pancreatic fluid collections following necrotizing pancreatitis. Without proper therapy, nearly all patients will die. Open surgical necrosectomy, or the process of removing necrotic tissue, is currently the standard of care. While highly effective, the large abdominal incision is associated with significant morbidity. Percutaneous catheter drainage is another type of external drainage with variable success rates. Although minimally invasive, the necrosectum often contains particulate debris, 10-30mm in size, which are poorly drained via the 410mm catheters. When percutaneous drainage fails, all patients crossover to open surgical necrosectomy. Preliminary data suggest that videoscopic-assisted retroperitoneal debridement (VARD) is a promising new method that combines the benefits of open surgical necrosectomy and percutaneous catheter drainage. Debridement occurs under direct vision through a small flank incision with videoscopic assistance. This project is a multicenter, single-arm, Phase II safety and efficacy study of patients undergoing VARD of infected pancreatic fluid collections. Patients enrolled will be limited to hemodynamically stable patients with documented infected pancreatic necrosis or pancreatic abscess as defined by the Atlanta Symposium. Patients will be strictly classified based on: CT classification, time from onset of pancreatitis to external drainage, and patient disease severity. Five major teaching hospitals will enroll 40 patients over 18 months. All patients will be followed for 6 months from the onset of pancreatitis. Safety issues will be monitored by an External Review Board. The hypothesis is: In patients with infected pancreatic fluid collections following acute pancreatitis, VARD provides a safe and efficacious procedure for draining infected pancreatic fluid collections adequately without need for crossover to open surgical necrosectomy. The specific aims are to assess: 1) safety and efficacy of VARD of infected pancreatic fluid collections; and 2) the clinical and functional outcomes of patients treated with VARD. The long-term goal is to use data obtained from this study as the basis for a multicenter, Phase III, randomized study comparing the VARD to the current standard of care, open surgical necrosectomy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, 3 4

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

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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and type “laparoscopy” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for laparoscopy in the PubMed Central database: •

A randomised controlled trial to assess the efficacy of Laparoscopic Uterosacral Nerve Ablation (LUNA) in the treatment of chronic pelvic pain: The trial protocol [ISRCTN41196151]. by [No authors listed]; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=317334

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A randomized, placebo controlled, trial of preoperative sustained release Betamethasone plus non-controlled intraoperative Ketorolac or Fentanyl on pain after diagnostic laparoscopy or laparoscopic tubal ligation [ISRCTN52633712]. by Bagley WP, Smith AA, Hebert JD, Snider CC, Sega GA, Piller MD, Carney PC, Carroll RC.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=194702

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Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial. by Sculpher M, Manca A, Abbott J, Fountain J, Mason S, Garry R.; 2004 Jan 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=314505

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Laparoscopic and open surgery for pheochromocytoma. by Edwin B, Kazaryan AM, Mala T, Pfeffer PF, Tonnessen TI, Fosse E.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=57005

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Laparoscopic performance after one night on call in a surgical department: prospective study. by Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J.; 2001 Nov 24; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=59995

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Mini-laparoscopic versus laparoscopic approach to appendectomy. by Mostafa G, Matthews BD, Sing RF, Kercher KW, Heniford BT.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=59899

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Penetration of clindamycin, cefoxitin, and metronidazole into pelvic peritoneal fluid of women undergoing diagnostic laparoscopy. by Berger SA, Kupferminc M, Lessing JB, Gorea A, Gull I, Peyser MR.; 1990 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=171594

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Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. by Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM.; 2003 May 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=154759

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Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. by Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A, Singh R, Spiegelhalter D.; 1998 Jul 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28600

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The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. by Garry R, Fountain J, Mason S, Napp V, Brown J, Hawe J, Clayton R, Abbott J, Phillips G, Whittaker M, Lilford R, Bridgman S.; 2004 Jan 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=314503

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

A comparison of the effect of two anaesthetic techniques on surgical conditions during gynaecological laparoscopy. Author(s): Williams MT, Rice I, Ewen SP, Elliott SM. Source: Anaesthesia. 2003 June; 58(6): 574-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12846625

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A randomised trial of photographic reinforcement during postoperative counselling after diagnostic laparoscopy for pelvic pain. Author(s): Onwude JL, Thornton JG, Morley S, Lilleyman J, Currie I, Lilford RJ. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2004 January 15; 112(1): 89-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687747

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A rural, community-based program can train surgical residents in advanced laparoscopy. Author(s): Reynolds FD, Goudas L, Zuckerman RS, Gold MS, Heneghan S. Source: Journal of the American College of Surgeons. 2003 October; 197(4): 620-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14522333

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Abdominal tuberculosis: diagnosis by laparoscopy and colonoscopy. Author(s): Ibrarullah M, Mohan A, Sarkari A, Srinivas M, Mishra A, Sundar TS. Source: Trop Gastroenterol. 2002 July-September; 23(3): 150-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12693163

6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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Accuracy of laparoscopy in the diagnosis and staging of lymphoproliferative diseases. Author(s): Silecchia G, Raparelli L, Perrotta N, Fantini A, Fabiano P, Monarca B, Basso N. Source: World Journal of Surgery. 2003 June; 27(6): 653-8. Epub 2003 May 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12734679

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Application of laparoscopy for bariatric surgery in adolescents. Author(s): Garcia VF, Langford L, Inge TH. Source: Current Opinion in Pediatrics. 2003 June; 15(3): 248-55. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12806252

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Caecal volvulus following laparoscopy-assisted sigmoid colectomy for sigmoid volvulus. Author(s): Wales L, Tysome J, Menon R, Habib N, Navarra G. Source: International Journal of Colorectal Disease. 2003 November; 18(6): 529-32. Epub 2003 May 20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12756592

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Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy? Author(s): Alborzi S, Motazedian S, Parsanezhad ME. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 May; 10(2): 172-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12732767

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Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy. Author(s): Katz DL, Barrett JP, Sanfilippo JS, Badway DM. Source: American Journal of Obstetrics and Gynecology. 2003 April; 188(4): 1113-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12712124

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Comparative, double-blind, randomized, placebo-controlled trial of intraperitoneal of bupivacaine and lidocaine for pain control after diagnostic laparoscopy. Author(s): Parsanezhad ME, Lahsaee M, Alborzi S, Vafaei H, Schmidt EH. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 August; 10(3): 311-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14567803

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Complications during set-up procedures for laparoscopy in gynecology: open laparoscopy does not reduce the risk of major complications. Author(s): Chapron C, Cravello L, Chopin N, Kreiker G, Blanc B, Dubuisson JB. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 December; 82(12): 1125-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14616258

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Complications of microlaparoscopy and awake laparoscopy. Author(s): Demco L. Source: Jsls. 2003 April-June; 7(2): 141-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12856845

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Complications of operative gynecological laparoscopy. Author(s): Miranda CS, Carvajal AR. Source: Jsls. 2003 January-March; 7(1): 53-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12722999

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Complications of pediatric urological laparoscopy: mistakes and risks. Author(s): Esposito C, Lima M, Mattioli G, Mastroianni L, Centonze A, Monguzzi GL, Montinaro L, Riccipetitoni G, Garzi A, Savanelli A, Damiano R, Messina M, Settimi A, Amici G, Jasonni V, Palmer LS. Source: The Journal of Urology. 2003 April; 169(4): 1490-2; Discussion 1492. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12629398

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Desertification of the peritoneum by thin-film evaporation during laparoscopy. Author(s): Ott DE. Source: Jsls. 2003 July-September; 7(3): 189-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14558705

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Diagnosis of abdominal tuberculosis: the importance of laparoscopy. Author(s): Rai S, Thomas WM. Source: Journal of the Royal Society of Medicine. 2003 December; 96(12): 586-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14645607

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Diagnostic accuracy of laparoscopy, magnetic resonance imaging, and histopathologic examination for the detection of endometriosis. Author(s): Stratton P, Winkel C, Premkumar A, Chow C, Wilson J, Hearns-Stokes R, Heo S, Merino M, Nieman LK. Source: Fertility and Sterility. 2003 May; 79(5): 1078-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12738499

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Diagnostic laparoscopy for suspected appendicitis: only useful in young women. Author(s): Dickenson AJ, Mackie IP, Peel AL, Bergin FG, Gilliland EL, Leaper DJ. Source: International Journal of Surgical Investigation. 1999; 1(4): 343-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12774459

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Diagnostic laparoscopy in abdominal stab wounds: a prospective, randomized study. Author(s): Leppaniemi A, Haapiainen R. Source: The Journal of Trauma. 2003 October; 55(4): 636-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14566116

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Diagnostic laparoscopy in infertility: a retrospective study. Author(s): Komori S, Fukuda Y, Horiuchi I, Tanaka H, Kasumi H, Shigeta M, Tuji Y, Koyama K. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 June; 13(3): 147-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12855095

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Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. Author(s): Duepree HJ, Senagore AJ, Delaney CP, Fazio VW. Source: Journal of the American College of Surgeons. 2003 August; 197(2): 177-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12892794

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Early laparoscopy in Australia. Author(s): Stewart IF. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2003 February; 43(1): 91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12755360

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Echocardiographic and hemodynamic evaluation of cardiovascular performance during laparoscopy of morbidly obese patients. Author(s): Prior DL, Sprung J, Thomas JD, Whalley DG, Bourke DL. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2003 October; 13(5): 761-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14627473

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Elective laparoscopy for small bowel obstruction. Author(s): Suzuki K, Umehara Y, Kimura T. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 August; 13(4): 254-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12960788

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Endometriosis co-existing with bilateral dermoid cysts of the ovaries treated by laparoscopy. Author(s): Frederick J, DaCosta V, Wynter S, Tenant I, McKenzie C, McDonald Y. Source: The West Indian Medical Journal. 2003 June; 52(2): 179-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14506771

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Endometriosis: correlation between histologic and visual findings at laparoscopy. Author(s): Martin DC. Source: American Journal of Obstetrics and Gynecology. 2003 June; 188(6): 1663; Author Reply 1663-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12825014

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Experience with 109 cases of transvaginal hydrolaparoscopy. Author(s): Moore ML, Cohen M, Liu GY. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 May; 10(2): 282-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12732786

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Fluoroscopy-guided laparoscopy in the management of intraabdominal foreign body. Author(s): Ekingen G, Guvenc BH, Senel U, Korkmaz M. Source: Journal of Pediatric Surgery. 2003 September; 38(9): E19-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14523879

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Gastrointestinal injuries during laparoscopy. Author(s): Vilos GA. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 August; 10(3): 430-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14714575

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Image converter eliminates mirror imaging during laparoscopy. Author(s): Johnston WK 3rd, Low RK, Das S. Source: Journal of Endourology / Endourological Society. 2003 June; 17(5): 327-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12885360

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Impact of laparoscopy on frequency of surgery for treatment of gallstones. Author(s): Aslar AK, Ertan T, Oguz H, Gocmen E, Koc M. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 October; 13(5): 315-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14571166

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Increased carbon dioxide absorption during retroperitoneal laparoscopy. Author(s): Streich B, Decailliot F, Perney C, Duvaldestin P. Source: British Journal of Anaesthesia. 2003 December; 91(6): 793-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14633746

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Influence of different pressures of pneumoperitoneum on the autonomic system function during laparoscopy. Author(s): Barczynski M, Herman RM. Source: Folia Med Cracov. 2002; 43(1-2): 51-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12815798

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Intestinal obstruction caused by omphalomesenteric duct remnant: usefulness of laparoscopy. Author(s): Bueno Lledo J, Serralta Serra A, Planeeis Roig M, Dobon Gimenez F, Ibanez Palacin F, Rodero Rodero R. Source: Rev Esp Enferm Dig. 2003 October; 95(10): 736-8, 733-5. English, Spanish. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14588068

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Intracorporeal suturing and knot tying broadens the clinical applicability of laparoscopy. Author(s): Allen JW, Rivas H, Cocchione RN, Ferzli GS. Source: Jsls. 2003 April-June; 7(2): 137-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12856844

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Intraocular pressure changes during laparoscopy in patients anesthetized with propofol total intravenous anesthesia versus isoflurane inhaled anesthesia. Author(s): Mowafi HA, Al-Ghamdi A, Rushood A. Source: Anesthesia and Analgesia. 2003 August; 97(2): 471-4, Table of Contents. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12873937

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Intravenous fluid loading with or without supplementary dextrose does not prevent nausea, vomiting and pain after laparoscopy. Author(s): McCaul C, Moran C, O'Cronin D, Naughton F, Geary M, Carton E, Gardiner J. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2003 May; 50(5): 440-4. English, French. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12734150

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Is laparoscopy an advantage in the diagnosis of cirrhosis in chronic hepatitis C virus infection? Author(s): Wietzke-Braun P, Braun F, Schott P, Ramadori G. Source: World Journal of Gastroenterology : Wjg. 2003 April; 9(4): 745-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12679924

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Is laparoscopy still the gold standard in infertility assessment? A comparison of fertiloscopy versus laparoscopy in infertility. Results of an international multicentre prospective trial: the 'FLY' (Fertiloscopy-LaparoscopY) study. Author(s): Watrelot A, Nisolle M, Chelli H, Hocke C, Rongieres C, Racinet C; International Group for Fertiloscopy Evaluation. Source: Human Reproduction (Oxford, England). 2003 April; 18(4): 834-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12660280

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Laparoscopic Nissen fundoplication; results of a prospective pilot study. Author(s): Parshad R, Kumar MV, Bal S, Saraya A, Sharma MP. Source: Trop Gastroenterol. 2003 July-September; 24(3): 152-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978994

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Laparoscopic radical nephrectomy: incorporating advantages of hand assisted and standard laparoscopy. Author(s): Ponsky LE, Cherullo EE, Banks KL, Greenstein M, Streem SB, Klein EA, Zippe CD. Source: The Journal of Urology. 2003 June; 169(6): 2053-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12771717

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Laparoscopy 2003: oncologic perspective. Author(s): Abu-Rustum NR. Source: Clinical Obstetrics and Gynecology. 2003 March; 46(1): 61-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12686895

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Laparoscopy and its current role in the management of colorectal disease. Author(s): Chung CC, Tsang WW, Kwok SY, Li MK. Source: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2003 November; 5(6): 528-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14617236

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Laparoscopy and methylene blue intrauterine injection immediately after undiagnosed conception: effect on pregnancy and neonatal outcome. Author(s): Gerli S, Rossetti D, Unfer V, Di Renzo GC. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2004 January 15; 112(1): 102-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687750

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Laparoscopy and oncology: where do we stand today? Author(s): Theodoridis TD, Bontis JN. Source: Annals of the New York Academy of Sciences. 2003 November; 997: 282-91. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14644836

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Laparoscopy and percutaneous techniques. Author(s): Adamsen S. Source: Endoscopy. 2003 November; 35(11): 933-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14606016

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Laparoscopy and urologic oncology--I now pronounce you man and wife. Author(s): Gomella LG. Source: The Journal of Urology. 2003 June; 169(6): 2057-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12771718

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Laparoscopy diagnosis and treatment excision of bleeding Meckel's diverticulum in a child: report of one case. Author(s): Lu CC, Huang FC, Lee SY, Huang HY. Source: Acta Paediatr Taiwan. 2003 January-February; 44(1): 41-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12800384

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Laparoscopy for investigation of pelvic pain: new approaches? Author(s): Ledger WL. Source: Current Opinion in Obstetrics & Gynecology. 2003 June; 15(3): 257-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12858115

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Laparoscopy for nonpalpable testes. Author(s): Alam S, Radhakrishnan J. Source: Journal of Pediatric Surgery. 2003 October; 38(10): 1534-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14577082

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Laparoscopy for the diagnosis and treatment of radiologically occult but symptomatic hypoplastic kidneys. Author(s): Ansari MS, Hemal AK, Gupta NP, Dogra PN. Source: Urology. 2003 October; 62(4): 627-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14550430

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Laparoscopy for the treatment of women with endometrial cancer. Author(s): Liauw L, Chung YN, Tsoi CW, Pang CP, Cheung KB. Source: Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi / Hong Kong Academy of Medicine. 2003 April; 9(2): 108-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12668821

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Laparoscopy for treating a small bowel obstruction due to a Meckel's diverticulum. Author(s): Tashjian DB, Moriarty KP. Source: Jsls. 2003 July-September; 7(3): 253-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14558715

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Laparoscopy in eosinophilic jejunitis presenting as subacute bowel obstruction: a case report. Author(s): Alexander P, Jacob S, Paul V. Source: Trop Gastroenterol. 2003 April-June; 24(2): 97-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14603834

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Laparoscopy in paediatric urology: adoption of innovative technology. Author(s): Peters C. Source: Bju International. 2003 October; 92 Suppl 1: 52-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12969011

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Laparoscopy in the evaluation of penetrating thoracoabdominal trauma. Author(s): McQuay N Jr, Britt LD. Source: The American Surgeon. 2003 September; 69(9): 788-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14509328

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Laparoscopy versus laparotomy for detorsion and sparing of twisted ischemic adnexa. Author(s): Cohen SB, Wattiez A, Seidman DS, Goldenberg M, Admon D, Mashiach S, Oelsner G. Source: Jsls. 2003 October-December; 7(4): 295-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14626393

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Laparoscopy: past, present, and future. Author(s): Bieber EJ. Source: Clinical Obstetrics and Gynecology. 2003 March; 46(1): 3-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12686890

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Laparoscopy-assisted abdominal aortic aneurysm endoaneurysmorraphy: early and mid-term results. Author(s): Alimi YS, Di Molfetta L, Hartung O, Dhanis AF, Barthelemy P, Aissi K, Giorgi R, Juhan C. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 April; 37(4): 744-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12663972

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Laparoscopy-assisted colon resection for mucosa-associated lymphoid tissue (MALT) lymphoma in the cecum. Author(s): Takada M, Ichihara T, Fukumoto S, Nomura H, Kuroda Y. Source: Hepatogastroenterology. 2003 July-August; 50(52): 1003-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12845967

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Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight? Author(s): Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M. Source: Annals of Surgery. 2003 November; 238(5): 680-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14578729

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Laparoscopy-assisted intrapelvic sonography with a high-frequency, real-time miniature transducer to assess the ovary: a preliminary report. Author(s): Senoh D, Tanaka H, Shiota A, Ohno M, Hata T. Source: Gynecologic and Obstetric Investigation. 2003; 55(3): 162-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865596

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Laparoscopy-assisted repair of diaphragm injuries. Author(s): Shaw JM, Navsaria PH, Nicol AJ. Source: World Journal of Surgery. 2003 June; 27(6): 671-4. Epub 2003 May 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12732997

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Laparoscopy-assisted transinguinal extracorporeal gonadectomy in six patients with androgen insensitivity syndrome. Author(s): Yalinkaya A, Yayla M. Source: Fertility and Sterility. 2003 August; 80(2): 429-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12909509

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Laparoscopy-assisted vaginal hysterectomy clinical pathway. A multivariate analysis of impact on costs and quality of care. Author(s): Chang WC, Lee CC, Wu HC, Yeh LS. Source: Gynecologic and Obstetric Investigation. 2003; 55(4): 231-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12904698

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Liver assessment and biopsy in patients with marked coagulopathy: value of minilaparoscopy and control of bleeding. Author(s): Denzer U, Helmreich-Becker I, Galle PR, Lohse AW. Source: The American Journal of Gastroenterology. 2003 April; 98(4): 893-900. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12738474

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Measurement of glutathione S-transferase and its class-pi in plasma and tissue biopsies obtained after laparoscopy and endoscopy from subjects with esophagus and gastric cancer. Author(s): Mohammadzadeh GS, Nasseri Moghadam S, Rasaee MJ, Zaree AB, Mahmoodzadeh H, Allameh A. Source: Clinical Biochemistry. 2003 June; 36(4): 283-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12810157

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Needle and trocar injuries in diagnostic laparoscopy under local anesthesia: what is the true incidence of these complications? Author(s): Orlando R, Palatini P, Lirussi F. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 June; 13(3): 181-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12855100

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Neuroendocrine stress response in patients undergoing benign ovarian cyst surgery by laparoscopy, minilaparotomy, and laparotomy. Author(s): Marana E, Scambia G, Maussier ML, Parpaglioni R, Ferrandina G, Meo F, Sciarra M, Marana R. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 May; 10(2): 159-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12732764

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Pediatric laparoscopy 2003. Author(s): Lobe TE. Source: Clinical Obstetrics and Gynecology. 2003 March; 46(1): 98-104. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12686899

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Port site metastasis subsequent to laparoscopy for chronic pelvic pain. Author(s): Malhotra N, Deka D, Takkar D, Malhotra B. Source: Indian Journal of Cancer. 2001 March; 38(1): 17-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14758880

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Portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy. Author(s): Brink JS, Brown AK, Palmer BA, Moir C, Rodeberg DR. Source: Journal of Pediatric Surgery. 2003 April; 38(4): 644-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12677588

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Portsite recurrence after laparoscopy for staging of retroperitoneal sarcoma. Author(s): Clark MA, Thomas JM. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 August; 13(4): 290-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12960797

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Pregnancy outcome after laparoscopy or laparotomy in pregnancy. Author(s): Oelsner G, Stockheim D, Soriano D, Goldenberg M, Seidman DS, Cohen SB, Admon D, Novikov I, Maschiach S, Carp HJ, Anderman S, Ben-Ami M, Ben-Arie A, Hagay Z, Bustan M, Shalev E, Carp H, Gemer O, Golan A, Holzinger M, Beyth Y, Horowitz A, Hamani Y, Keis M, Lavie O, Luxman D, Oelsner G, Stockheim D, Rojansky N, Taichner G, Yafe C, Zohar S, Bilanca B. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 May; 10(2): 200-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12732772

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Pretransplant native nephrectomy in patients with end-stage renal failure: assessment of the role of laparoscopy. Author(s): Shoma AM, Eraky I, El-Kappany HA. Source: Urology. 2003 May; 61(5): 915-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12736004

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Pseudo-renal failure following the delayed diagnosis of bladder perforation after diagnostic laparoscopy. Author(s): Kruger PS, Whiteside RS. Source: Anaesthesia and Intensive Care. 2003 April; 31(2): 211-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12712789

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Re: Early laparoscopy instruments. Author(s): Garrett W. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2003 February; 43(1): 91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12755361

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Re: Editorial: Laparoscopy and urologic oncology--I now pronounce you man and wife. Author(s): Bhayani SB, Kavoussi LR. Source: The Journal of Urology. 2004 February; 171(2 Pt 1): 806-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14713824

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Re: Laparoscopic radical nephrectomy: incorporating the advantages of hand assisted and standard laparoscopy. Author(s): Meng MV, Stoller ML. Source: The Journal of Urology. 2003 December; 170(6 Pt 1): 2390-1; Author Reply 2391. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14634430

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Re: Transperitoneal laparoscopy into the previously operated abdomen: effect on operative time, length of stay and complications. Author(s): Ng CF, Tolley D. Source: The Journal of Urology. 2003 August; 170(2 Pt 1): 548; Author Reply 548-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12853822

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Relationships between Chlamydia trachomatis antibody titers and tubal pathology assessed using transvaginal hydrolaparoscopy in infertile women. Author(s): Shibahara H, Takamizawa S, Hirano Y, Ayustawati, Takei Y, Fujiwara H, Tamada S, Sato I. Source: American Journal of Reproductive Immunology (New York, N.Y. : 1989). 2003 July; 50(1): 7-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14506923

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Repeated inadvertent endobronchial intubation during laparoscopy. Author(s): Mackenzie M, MacLeod K. Source: British Journal of Anaesthesia. 2003 August; 91(2): 297-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12878636

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Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up. Author(s): Bentas W, Wolfram M, Jones J, Brautigam R, Kramer W, Binder J. Source: European Urology. 2003 August; 44(2): 175-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12875935

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Role of diagnostic laparoscopy in managing acute mesenteric venous thrombosis. Author(s): Cho YP, Jung SM, Han MS, Jang HJ, Kim JS, Kim YH, Lee SG. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 June; 13(3): 215-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12819509

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Role of laparoscopy in patients with previous negative exploration for impalpable testis. Author(s): Barqawi AZ, Blyth B, Jordan GH, Ehrlich RM, Koyle MA. Source: Urology. 2003 June; 61(6): 1234-7; Discussion 1237. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12809907

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Role of laparoscopy in the evaluation of the adnexa in patients with stage IV breast cancer. Author(s): Quan ML, Fey J, Eitan R, Abu-Rustum NR, Barakat RR, Borgen PI, Gemignani ML. Source: Gynecologic Oncology. 2004 January; 92(1): 327-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14751178

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Safety zones for anterior abdominal wall entry during laparoscopy: a CT scan mapping of epigastric vessels. Author(s): Saber AA, Meslemani AM, Davis R, Pimentel R. Source: Annals of Surgery. 2004 February; 239(2): 182-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14745325

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Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in women with normal hysterosalpingography? Author(s): Hourvitz A, Ledee N, Gervaise A, Fernandez H, Frydman R, Olivennes F. Source: Reproductive Biomedicine Online. 2002 May-June; 4(3): 256-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12709276

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Should every patient undergoing laparoscopy for clinical diagnosis of appendicitis have an appendicectomy? Author(s): Navez B, Therasse A. Source: Acta Chir Belg. 2003 February; 103(1): 87-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12658883

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Small evidence for small incisions: pediatric laparoscopy and the need for more rigorous evaluation of novel surgical therapies. Author(s): Rangel SJ, Henry MC, Brindle M, Moss RL. Source: Journal of Pediatric Surgery. 2003 October; 38(10): 1429-33. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14577063

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Staging laparoscopy for gastric cancer. Author(s): Ozmen MM, Zulfikaroglu B, Ozalp N, Ziraman I, Hengirmen S, Sahin B. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 August; 13(4): 241-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12960785

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Staging laparoscopy in gastric cancer: a single port method. Author(s): Lee JH, Ryu KW, Kim YW, Bae JM. Source: Journal of Surgical Oncology. 2003 September; 84(1): 50-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12949992

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Staging of abdominal metastases in pancreatic carcinoma by diagnostic laparoscopy and magnetic resonance imaging. Author(s): Schneider AR, Adamek HE, Layer G, Riemann JF, Arnold JC. Source: Zeitschrift Fur Gastroenterologie. 2003 August; 41(8): 697-702. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14579851

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Technical modification of the nerve-sparing laparoscopy-assisted vaginal radical hysterectomy type 3 for better reproducibility of this procedure. Author(s): Possover M. Source: Gynecologic Oncology. 2003 August; 90(2): 245-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12893183

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The effects of tidal volume and respiratory rate on oxygenation and respiratory mechanics during laparoscopy in morbidly obese patients. Author(s): Sprung J, Whalley DG, Falcone T, Wilks W, Navratil JE, Bourke DL. Source: Anesthesia and Analgesia. 2003 July; 97(1): 268-74, Table of Contents. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12818980

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The efficacy of ginger in prevention of post-operative nausea and vomiting after outpatient gynecological laparoscopy. Author(s): Pongrojpaw D, Chiamchanya C. Source: J Med Assoc Thai. 2003 March; 86(3): 244-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12757064

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The role of laparoscopy in patients with suspected peritonitis: experience of a single institution. Author(s): Sanna A, Adani GL, Anania G, Donini A. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 February; 13(1): 17-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12676016

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The role of laparoscopy in the chronic pelvic pain patient. Author(s): Howard FM. Source: Clinical Obstetrics and Gynecology. 2003 December; 46(4): 749-66. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14595216

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The role of laparoscopy in the management of lower gastro-intestinal bleeding. Author(s): Loh DL, Munro FD. Source: Pediatric Surgery International. 2003 June; 19(4): 266-7. Epub 2003 April 30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12721709

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The role of laparoscopy in the surgical treatment of endometrial cancer. Author(s): Holub Z. Source: Clin Exp Obstet Gynecol. 2003; 30(1): 7-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12731735

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The use of laparoscopy to assess viability of slipped content in incarcerated inguinal hernia: a case report. Author(s): Al-Naami MY, Al-Shawi JS. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 August; 13(4): 292-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12960798

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The use of simple ketamine anaesthesia for day-case diagnostic laparoscopy. Author(s): Ikechebelu JI, Udigwe GO, Obi RA, Joe-Ikechebelu NN, Okoye IC. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 November; 23(6): 650-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14617471

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The utility of flexible endoscopy during advanced laparoscopy. Author(s): Onders RP. Source: Semin Laparosc Surg. 2003 March; 10(1): 43-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12695809

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The value of laparoscopy in management of abdominal trauma. Author(s): Chelly MR, Major K, Spivak J, Hui T, Hiatt JR, Margulies DR. Source: The American Surgeon. 2003 November; 69(11): 957-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14627255

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Therapeutic laparoscopy for blunt abdominal trauma with bowel injuries. Author(s): Iannelli A, Fabiani P, Karimdjee BS, Baque P, Venissac N, Gugenheim J. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 June; 13(3): 189-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12855102

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Transvaginal laparoscopy. Author(s): Brosens I, Campo R, Puttemans P, Gordts S. Source: Clinical Obstetrics and Gynecology. 2003 March; 46(1): 117-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12686901

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Triumphs and controversies in laparoscopy: the past, the present, and the future. Author(s): Nezhat F. Source: Jsls. 2003 January-March; 7(1): 1-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12722991

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Upper quadrant access for urologic laparoscopy. Author(s): Chung HJ, Meng MV, Abrahams HM, Stoller ML. Source: Urology. 2003 December; 62(6): 1117-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14665367

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Utility of laparoscopy in chronic abdominal pain. Author(s): Onders RP, Mittendorf EA. Source: Surgery. 2003 October; 134(4): 549-52; Discussion 552-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14605614

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

Finding Nutrition Studies on Laparoscopy The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “laparoscopy” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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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 “laparoscopy” (or a synonym): •

A comparative study of the analgesia requirements following laparoscopic and open fundoplication in children. Author(s): Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Northern Ireland. Source: Dick, A C Coulter, P Hainsworth, A M Boston, V E Potts, S R J-LaparoendoscAdv-Surg-Tech-A. 1998 December; 8(6): 425-9 1092-6429

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A minimally invasive technique of appendectomy using a minimal skin incision and laparoscopic instruments. Author(s): Department of Surgery, Namkwang General Hospital, College of Medicine, Seonam University, Kwangju, Korea. Source: Suh, H H Surg-Laparosc-Endosc. 1998 April; 8(2): 149-52 1051-7200

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A prospective evaluation of intracorporeal laparoscopic small bowel anastomosis during gastric bypass. Author(s): Department of Surgery, University of California, Davis, Medical Center, Sacramento 95817-1418, USA. [email protected] Source: Nguyen, N T Neuhaus, A M Ho, H S Palmer, L S Furdui, G G Wolfe, B M ObesSurg. 2001 April; 11(2): 196-9 0960-8923

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A technique for prevention of port complications after laparoscopic adjustable silicone gastric banding. Author(s): Department of Surgery, Academic Surgical Center Stuivenberg, Antwerp, Belgium. [email protected] Source: Fabry, H Van Hee, R Hendrickx, L Totte, E Obes-Surg. 2002 April; 12(2): 285-8 0960-8923

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Advantages of laparoscopic resection for ileocolic Crohn's disease. Improved outcomes and reduced costs. Author(s): Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. [email protected] Source: Young Fadok, T M HallLong, K McConnell, E J Gomez Rey, G Cabanela, R L Surg-Endosc. 2001 May; 15(5): 450-4 1432-2218

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Analgesia following major gynecological laparoscopic surgery--PCA versus intermittent intramuscular injection. Author(s): Sydney Women's Endosurgery Centre, St. George Private Hospital, NSW, Australia. [email protected] Source: Rosen, D M Lam, A M Carlton, M A Cario, G M McBride, L J-Soc-LaparoendoscSurg. 1998 Jan-March; 2(1): 25-9 1086-8089

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Atrial natriuretic factor (ANF) after laparoscopy and morphine application for pain therapy. Author(s): Department of Obstetrics and Gynecology, University of Saarland, Homburg, Germany. Source: Friedrich, M Meyberg, R Friedrich, G Villena Heinsen, C Clin-Exp-ObstetGynecol. 2000; 27(1): 9-11 0390-6663

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Care of the laparoscopic colectomy patient. Author(s): Department of Colorectal Surgery, the Cleveland Clinic Foundation, OH, USA. Source: Senagore, A J Erwin Toth, P Adv-Skin-Wound-Care. 2002 Nov-December; 15(6): 277-83; quiz 284-5 1527-7941

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Combined laparoscopic cholecystectomy and selective vagotomy. Author(s): Department of Surgery, University of Maryland, School of Medicine, Baltimore 21201. Source: Bailey, R W Flowers, J L Graham, S M Zucker, K A Surg-Laparosc-Endosc. 1991 March; 1(1): 45-9 1051-7200

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Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis. Author(s): Department of Surgical Services, Brookdale University Hospital and Medical Center, Brooklyn, NY 11229, USA. Source: Piskun, G Kozik, D Rajpal, S Shaftan, G Fogler, R Surg-Endosc. 2001 July; 15(7): 660-2 1432-2218

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Development and initial trial of the minilaparoscopic argon coagulator. Author(s): Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA. Source: Platt, R C Heniford, B T J-Laparoendosc-Adv-Surg-Tech-A. 2000 April; 10(2): 939 1092-6429

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Dilute ornitin vasopressin and a myoma drill for laparoscopic myomectomy. Author(s): Complesso Integrato Columbus, Department of Obstetrics and Gynecology, UCSC Rome, Italy. Source: Rossetti, A Paccosi, M Sizzi, O Zulli, S Mancuso, S Lanzone, A J-Am-AssocGynecol-Laparosc. 1999 May; 6(2): 189-93 1074-3804

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Early experience with laparoscopic splenectomy. Author(s): Department of Surgery, Medical College of Wisconsin. [email protected] Source: Demeure, M J Frantzides, C T WMJ. 1998 November; 97(10): 33-4

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Effects of taurolidine and octreotide on port site and liver metastasis after laparoscopy in an animal model of pancreatic cancer. Author(s): Department of General, Visceral, Vascular and Thoracic Surgery, HumboldtUniversity of Berlin, Germany. [email protected] Source: Wenger, F A Kilian, M Braumann, C Neumann, A Ridders, J Peter, F J Guski, H Jacobi, C A Clin-Exp-Metastasis. 2002; 19(2): 169-73 0262-0898

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Elective laparoscopic sigmoid colectomy for diverticulitis. Results of a prospective study. Author(s): Department of General Surgery, Hopital Antoine Beclere, 157 rue de la Porte de Trivaux, F-92140 Clamart, University Paris XI, France. Source: Smadja, C Sbai Idrissi, M Tahrat, M Vons, C Bobocescu, E Baillet, P Franco, D Surg-Endosc. 1999 July; 13(7): 645-8 0930-2794

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Experimental laparoscopic cholecystotomy. Author(s): Abteilung fur Allgemeine Chirurgie und Poliklinik, Chirurgische Klinik der Universitat, Klinikum Schnarrenberg, Tubingen, Federal Republic of Germany. Source: Mentges, B Buess, G Melzer, A Gutt, C Becker, H D Surg-Endosc. 1991; 5(2): 51-6 0930-2794

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Fizzy drinks following laparoscopic Nissen fundoplication: a cautionary tale of explosive consequences. Author(s): University of Adelaide Department of Surgery, Royal Adelaide Hospital, South Australia, Australia. Source: Ackroyd, R Watson, D I Game, P A Aust-N-Z-J-Surg. 1999 December; 69(12): 887-8 0004-8682

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Hand-assisted laparoscopic donor nephrectomy. Ascending the learning curve. Author(s): Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. [email protected] Source: Bemelman, W A van Doorn, R C de Wit, L T Kox, C Surachno, J Busch, O R Gouma, D J Surg-Endosc. 2001 May; 15(5): 442-4 1432-2218

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Is laparoscopy safe and effective for treatment of acute small-bowel obstruction? Author(s): Huntington Memorial Hospital, Department of Medical Education, 100 West California Boulevard, Pasadena, CA 91109, USA. Source: Strickland, P Lourie, D J Suddleson, E A Blitz, J B Stain, S C Surg-Endosc. 1999 July; 13(7): 695-8 0930-2794

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Laparoscopic accessory splenectomy for recurrent idiopathic thrombocytopenic purpura and hemolytic anemia. Author(s): Advanced Endoscopic Surgery Unit, Department of Surgery B, Tel Aviv Sourasky Medical Center, Israel. Source: Szold, A Kamat, M Nadu, A Eldor, A Surg-Endosc. 2000 August; 14(8): 761-3 0930-2794

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Laparoscopic adrenalectomy for nonmalignant disease: improved safety, morbidity, and cost-effectiveness. Author(s): Department of Surgery, Johns Hopkins University, School of Medicine, 600 North Wolf Street, Blalock #688, Baltimore, MD 21287, USA. Source: Schell, S R Talamini, M A Udelsman, R Surg-Endosc. 1999 January; 13(1): 30-4 0930-2794

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Laparoscopic anterior gastroplasty. A preliminary report of a new technique. Author(s): Department of Surgery, State University of New York Health Science Center at Syracuse, 750 East Adams Street, Syracuse, NY 13210, USA. Source: Marx, W H Halverson, J D Surg-Endosc. 1998 December; 12(12): 1442-4 09302794

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Laparoscopic anti-reflux surgery in the community hospital setting: evaluation of 100 consecutive patients. Source: Althar, R A JSLS. 1999 Apr-June; 3(2): 107-12

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Laparoscopic aortic aneurysm resection. Author(s): Department of Surgery, Morristown Memorial Hospital, New Jersey, USA. Source: Edoga, J K James, K V Resnikoff, M Asgarian, K Singh, D Romanelli, J JEndovasc-Surg. 1998 November; 5(4): 335-44 1074-6218

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Laparoscopic appendectomy. Author(s): Medical Center at Bowling Green and Greenview Hospitals, Kentucky. Source: Bryson, K J-Gynecol-Surg. 1991 Summer; 7(2): 93-5 1042-4067

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Laparoscopic approach for esophageal achalasia with epiphrenic diverticulum. Author(s): Department of Surgery, Anesthesiology and Radiology, University of Ferrara, Italy. [email protected] Source: Feo, C V Zamboni, P Zerbinati, A Pansini, G C Liboni, A Surg-Laparosc-EndoscPercutan-Tech. 2001 April; 11(2): 112-5 1530-4515

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Laparoscopic colorectal procedures: a multicenter Brazilian experience. Author(s): Brazilian Registry. Source: Regadas, F S Ramos, J R Souza, J V Neto, J A Gama, A H Campos, F Pandini, L C Marchiori, M Cutait, R Neto, J A Neto, T S Regadas, S M Surg-Laparosc-EndoscPercutan-Tech. 1999 December; 9(6): 395-8 1530-4515

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Laparoscopic duodenojejunostomy for treatment of superior mesenteric artery syndrome. Author(s): Department of General Surgery, Cleveland Clinic Foundation, OH, USA. Source: Gersin, K S Heniford, B T J-Soc-Laparoendosc-Surg. 1998 Jul-September; 2(3): 281-4 1086-8089

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Laparoscopic enucleation of giant liver hemangioma. Author(s): Department of General Surgery, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey. [email protected] Source: Karahasanoglu, T Altinli, E Erguney, S Ertem, M Numan, F Surg-Endosc. 2001 December; 15(12): 1489 1432-2218

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Laparoscopic exploration in the management of retroperitoneal masses. Author(s): Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. Source: Shalhav, A L Chan, S W Bercowsky, E Elbahnassy, A M McDougall, E M Clayman, R V JSLS. 1999 Jul-September; 3(3): 209-14

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Laparoscopic gastric banding for morbid obesity. Author(s): Chirurgische Klinik, Frankfurt am Main, Germany. [email protected] Source: Weiner, R Wagner, D Bockhorn, H J-Laparoendosc-Adv-Surg-Tech-A. 1999 February; 9(1): 23-30 1092-6429

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Laparoscopic lateral L4-L5 disc exposure. Author(s): Minimally Invasive Surgery Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Derk A-80, Cleveland, OH, 44195, USA. [email protected] Source: Brody, F Rosen, M Tarnoff, M Lieberman, I Surg-Endosc. 2002 April; 16(4): 650-3 1432-2218

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Laparoscopic management of mechanical small bowel obstruction: are there predictors of success or failure? Author(s): Department of Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. Source: Suter, M Zermatten, P Halkic, N Martinet, O Bettschart, V Surg-Endosc. 2000 May; 14(5): 478-83 0930-2794

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Laparoscopic pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy. Author(s): Section of Pediatric Surgery, University of Tennessee, 777 Washington Avenue, Ste. P220, Memphis, TN 38105, USA. Source: Blakely, M L Lobe, T E Cohen, J Burghen, G A Surg-Endosc. 2001 August; 15(8): 897-8 1432-2218

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Laparoscopic posterior truncal vagotomy and anterior highly selective vagotomy--a case report. Author(s): Department of Surgery, National University Hospital, Singapore. Source: Kum, C K Goh, P Singapore-Med-J. 1992 June; 33(3): 302-3 0037-5675

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Laparoscopic removal of an Angelchik prosthesis. Author(s): Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO 63110, USA. Source: Underwood, R A Weinstock, L B Soper, N J Quasebarth, M A Brunt, L M SurgEndosc. 1999 June; 13(6): 615-7 0930-2794

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Laparoscopic repair of ventral incisional hernia. Author(s): Department of Surgery, Royal Brisbane Hospital, Brisbane, Queensland, Australia. [email protected] Source: Kua, Keith B Coleman, Mark Martin, Ian O'Rourke, Nicholas ANZ-J-Surg. 2002 April; 72(4): 296-9 1445-1433

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Laparoscopic resection of gastric diverticulum. Author(s): Department of Surgery, Korea University Ansan Hospital, Kyung Gi Do, Korea. [email protected] Source: Kim, S H Lee, S W Choi, W J Choi, I S Kim, S J Koo, B H J-Laparoendosc-AdvSurg-Tech-A. 1999 February; 9(1): 87-91 1092-6429

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Laparoscopic right donor nephrectomy: technique and comparison with left nephrectomy. Author(s): Division of General Surgery, Department of Surgery, University of Maryland, 22 South Greene Street, Baltimore, MD 21201, USA. Source: Swartz, D E Cho, E Flowers, J L Dunkin, B J Ramey, J R Bartlett, S T Jarrell, B Jacobs, S C Surg-Endosc. 2001 December; 15(12): 1390-4 1432-2218

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Laparoscopic sigmoid resection for acute and chronic diverticulitis. An outcomes comparison with laparoscopic resection for nondiverticular disease. Author(s): The University of Toronto Centre for Minimally Invasive Surgery, St. Michael's Hospital, University of Toronto, 160 Wellesley Street East, Toronto, Ontario, Canada, M4Y 1J3. Source: Schlachta, C M Mamazza, J Poulin, E C Surg-Endosc. 1999 July; 13(7): 649-53 0930-2794

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Laparoscopic surgery for abdominal aortic aneurysms. Technical elements of the procedure and a preliminary report of the first 22 patients. Author(s): Department of Surgery, Morristown Memorial Hospital, NJ 07960, USA. Source: Edoga, J K Asgarian, K Singh, D James, K V Romanelli, J Merchant, S Romano, D Joostema, B Street, J Surg-Endosc. 1998 August; 12(8): 1064-72 0930-2794

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Laparoscopic treatment of duodenal diverticulum. Author(s): Department of Surgery of The Federal University of Parana, Curitiba, Brazil. Source: Coelho, J C Sousa, G S Salvalaggio, P R Surg-Laparosc-Endosc. 1999 January; 9(1): 74-7 1051-7200

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Laparoscopic vs open adrenalectomy for benign adrenal neoplasm. Author(s): Department of Surgery B, Hadassah University Hospital, Jerusalem 91120, Israel. Source: Hazzan, D Shiloni, E Golijanin, D Jurim, O Gross, D Reissman, P Surg-Endosc. 2001 November; 15(11): 1356-8 1432-2218

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Laparoscopically assisted anterior resection for rectal prolapse. Author(s): Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06510. Source: Ballantyne, G H Surg-Laparosc-Endosc. 1992 September; 2(3): 230-6 1051-7200

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Laparoscopic-assisted abdominoperineal resection for low rectal adenocarcinoma. Author(s): Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories. Source: Leung, K L Kwok, S P Lau, W Y Meng, W C Chung, C C Lai, P B Kwong, K H Surg-Endosc. 2000 January; 14(1): 67-70 0930-2794

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Laparoscopy: the preferred method of cholecystectomy in the morbidly obese. Author(s): Department of Surgery, Loyola University Medical Center, Maywood, IL 60153. Source: Miles, R H Carballo, R E Prinz, R A McMahon, M Pulawski, G Olen, R N Dahlinghaus, D L Surgery. 1992 October; 112(4): 818-22; discussion 822-3 0039-6060

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Laparoscopy-assisted vaginal hysterectomy: report of seventy-five consecutive cases. Author(s): Creighton University School of Medicine, Omaha, Nebraska. Source: Garcia Padial, J Sotolongo, J Casey, M J Johnson, C Osborne, N G J-GynecolSurg. 1992 Summer; 8(2): 81-5 1042-4067

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Laser laparoscopic cholecystectomy in the ambulatory setting. Source: Haicken, B N J-Post-Anesth-Nurs. 1991 February; 6(1): 33-9 0883-9433

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Management of advanced pancreatic cancer: staging laparoscopy and immunochemotherapy--a new treatment strategy. Author(s): First Department of Surgery, Mie University School of Medicine, Japan. Source: Kishiwada, M Kawarada, Y Taoka, H Isaji, S Hepatogastroenterology. 2002 NovDecember; 49(48): 1704-6 0172-6390

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Minimally invasive colon resection (laparoscopic colectomy). Author(s): Laparoscopy and Laser Surgery Institute of Miami, Florida. Source: Jacobs, M Verdeja, J C Goldstein, H S Surg-Laparosc-Endosc. 1991 September; 1(3): 144-50 1051-7200

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Multiple small lesions of hepatocellular carcinoma controlled by percutaneous and laparoscopic ethanol injection--a case report. Author(s): Department of Internal Medicine II, Shimane Medical University, Izumo, Japan. Source: Kinoshita, Y Tokuda, A Akagi, S Watanabe, M Hamamoto, S Tanaka, S Uchida, Y Fukuda, R Kinoshita, Y Hepatogastroenterology. 2000 Mar-April; 47(32): 383-5 01726390

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Operative laparoscopy in assisted reproduction. Author(s): Instituto Materno Infantile, Universita degli Studi di Palermo. Source: Palermo, R Simonaro, C Carlino, L Ubaldi, F Albano, C Acta-Eur-Fertil. 1992 JulAugust; 23(4): 187-9 0587-2421

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Primary laparoscopic placement of peritoneal dialysis catheters in children and young adults. Author(s): Division of Pediatric Surgery, Brown University School of Medicine and Hasbro Children's Hospital, 2 Dudley Street, Providence, RI 02905, USA. Source: Lessin, M S Luks, F I Brem, A S Wesselhoeft, C W Surg-Endosc. 1999 November; 13(11): 1165-7 0930-2794

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Risks and benefits of laparoscopic cholecystectomy in the community hospital setting. Author(s): Saginaw Cooperative Hospitals, Inc., MI. Source: Smith, J F Boysen, D Tschirhart, J Williams, T J-Laparoendosc-Surg. 1991 December; 1(6): 325-32 1052-3901

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Role of laparoscopy in the initial multimodality management of patients with nearobstructing rectal cancer. Author(s): Colorectal Service and the Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. Source: Koea, J B Guillem, J G Conlon, K C Minsky, B Saltz, L Cohen, A J-GastrointestSurg. 2000 Jan-February; 4(1): 105-8 1091-255X

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Safe technique for laparoscopic entry into the abdominal cavity. Author(s): Center for Fertility and Women's Health, NBGH (N-3), 100 Grand Street, New Britain, CT 06050, USA. Source: Roy, G M Bazzurini, L Solima, E Luciano, A A J-Am-Assoc-Gynecol-Laparosc. 2001 November; 8(4): 519-28 1074-3804

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Safety and risks of laparoscopy in pregnancy. Author(s): Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada. Source: Al Fozan, H Tulandi, T Curr-Opin-Obstet-Gynecol. 2002 August; 14(4): 375-9 1040-872X

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Some complications after laparoscopic nonadjustable gastric banding. Author(s): First Surgical Department, Faculty General Hospital, Charles University, Prague, Czech Republic. Source: Kasalicky, M Fried, M Peskova, M Obes-Surg. 1999 October; 9(5): 443-5 09608923

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Splenectomy for idiopathic thrombocytopenic purpura: comparison of laparoscopic and conventional surgery. Author(s): IRCCS San Raffaele, Department of Surgery, University of Milan, Italy. Source: Marassi, A Vignali, A Zuliani, W Biguzzi, E Bergamo, C Gianotti, L Di Carlo, V Surg-Endosc. 1999 January; 13(1): 17-20 0930-2794

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Staged laparoscopic resection for complicated sigmoid diverticulitis. Author(s): Department of Surgery, University of Miami School of Medicine, Florida 33136, USA. Source: Martinez, S A Cheanvechai, V Alasfar, F S Sands, L R Hellinger, M D SurgLaparosc-Endosc-Percutan-Tech. 1999 April; 9(2): 99-105 1530-4515

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The morphine-sparing effect of metoclopramide on postoperative laparoscopic tubal ligation patients. Author(s): Naval Hospital, Keflavik, Iceland. Source: Gibbs, Robin D Movinsky, Beth Ann Pellegrini, Joseph Vacchiano, Charles A AANA-J. 2002 February; 70(1): 27-32 0094-6354

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The role of laparoscopy in the management of common bile duct obstruction in children. Author(s): Section of Pediatric Surgery, University of Tennessee, Memphis, 77 Washington Ave., Suite 220, Memphis, TN 38105, USA. Source: Shah, R S Blakely, M L Lobe, T E Surg-Endosc. 2001 November; 15(11): 1353-5 1432-2218

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The utility of intracorporeal ultrasonography for screening of the bile duct during laparoscopic cholecystectomy. Author(s): Department of Surgery, Washington University School of Medicine, and the Washington University Institute of Minimally Invasive Surgery, St. Louis, MO, USA. Source: Wu, J S Dunnegan, D L Soper, N J J-Gastrointest-Surg. 1998 Jan-February; 2(1): 50-60 1091-255X

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Ultrasonographic prediction of the efficacy of GnRH agonist therapy before laparoscopic myomectomy. Author(s): Department of Gynecologic and Pediatric Sciences, Reggio Calabria University, Catanzaro, Italy. Source: Zullo, F Pellicano, M Di Carlo, C De Stefano, R Marconi, D Zupi, E J-Am-AssocGynecol-Laparosc. 1998 November; 5(4): 361-6 1074-3804

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Use of laparoscopy in the management of mesenteric venous thrombosis. Author(s): Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119 074. Source: Chong, A K So, J B Ti, T K Surg-Endosc. 2001 September; 15(9): 1042 1432-2218

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Vagotomy without gastric drainage laparoscopic or thoracoscopic approach. Author(s): Department of Surgery, Istanbul Medical Faculty, Istanbul University, Turkey. [email protected] Source: Avci, C Ozmen, V Avtan, L Buyukuncu, Y Muslumanoglu, M Hepatogastroenterology. 1999 May-June; 46(27): 1494-9 0172-6390

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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CHAPTER 3. DISSERTATIONS ON LAPAROSCOPY Overview In this chapter, we will give you a bibliography on recent dissertations relating to laparoscopy. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “laparoscopy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on laparoscopy, we have not necessarily excluded nonmedical dissertations in this bibliography.

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

Roux-En-Y Gastric Bypass: Hand-Assisted Laparoscopy and Investigation of the Excluded Stomach by Sundbom, Magnus; PhD from Uppsala Universitet (Sweden), 2003, 62 pages http://wwwlib.umi.com/dissertations/fullcit/f316385

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

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CHAPTER 4. CLINICAL TRIALS AND LAPAROSCOPY Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning laparoscopy.

Recent Trials on Laparoscopy The following is a list of recent trials dedicated to laparoscopy.8 Further information on a trial is available at the Web site indicated. •

Conventional Surgery Compared With Laparoscopic-Assisted Surgery in Treating Patients With Colorectal Cancer Condition(s): Colon Cancer; Rectal Cancer Study Status: This study is currently recruiting patients. Sponsor(s): Medical Research Council Purpose - Excerpt: RATIONALE: Laparoscopic-assisted surgery is a less invasive type of surgery for colorectal cancer and may have fewer side effects and improve recovery. It is not yet known if undergoing conventional surgery is more effective than laparoscopicassisted surgery for colorectal cancer. PURPOSE: Randomizedphase III trial to compare the effectiveness of conventional surgery with that of laparoscopic-assisted surgery in treating patients who have colorectal cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00003354

8

These are listed at www.ClinicalTrials.gov.

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Laparoscopic Surgery or Standard Surgery in Treating Patients With Endometrial Cancer or Cancer of the Uterus Condition(s): stage I endometrial cancer; stage II endometrial cancer; endometrial adenocarcinoma; stage I uterine sarcoma; stage II uterine sarcoma Study Status: This study is currently recruiting patients. Sponsor(s): Gynecologic Oncology Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Laparoscopic surgery is a less invasive type of surgery for cancer of the uterus and may have fewer side effects and improve recovery. It is not known whether laparoscopic surgery is more effective than standard surgery in treating endometrial cancer. PURPOSE: Randomizedphase III trial to compare the effectiveness of laparoscopic surgery with standard surgery in treating patients with endometrial cancer or cancer of the uterus. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002706

•

Laparoscopy to Remove Pancreatic Tumors (Insulinomas) Condition(s): Insulinoma Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: This study will determine if laparoscopy can be used successfully to find and remove insulinomas (insulin-secreting tumors of the pancreas). These tumors are very small and often difficult to locate with magnetic resonance imaging (MRI), computed tomography (CT) or ultrasound. Invasive procedures, such as arteriograms (X-ray imaging using a contrast agent injected into the bloodstream through a catheter) and venous sampling are more successful but involve more patient discomfort and greater risk. This study will test whether laparoscopy can be used to replace some or all of these tests, as well as more extensive surgery. Patients 11 years of age and older with low blood sugar (hypoglycemia) probably caused by an insulinoma may be eligible for this study. Candidates will have their hypoglycemia confirmed (with tests done under NIH protocol 91-DK-0066: Diagnosis and Treatment of Hypoglycemia) and will have CT imaging of the abdomen and MRI and ultrasound tests of the liver and pancreas. Patients whose tumors are not found by these studies will undergo arteriography of the pancreas and hepatic (liver) venous sampling. Patients will then have laparoscopy. This surgical procedure uses a laparoscope-a tube-like device with special cameras and an ultrasound probe attached through which the surgeon can see and operate inside the abdomen. Laparoscopy is commonly done to remove the gallbladder and is also used to remove portions of the pancreas. For the current procedure, the surgeon makes small incisions in the abdomen, inserts tubes, fills the abdomen with gas, and proceeds to explore and operate on the pancreas. The surgeon will try to locate the tumor with the laparoscope. If the tumor is found, the location will be verified by the imaging study results. If it cannot be located by laparoscopy, the results of the imaging studies will be disclosed to enable removal. If the tumor cannot be successfully removed using the laparoscope, standard surgery will then be performed. If the tumor cannot be found though laparoscopy, imaging studies, or traditional surgery, the operation will be

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concluded without removing any of the pancreas. Medical treatment will be initiated and re-evaluation will be recommended after 6 months. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005910 •

Laparoscopic-Assisted Surgery Compared With Open Surgery in Treating Patients With Colon Cancer Condition(s): stage III colon cancer; stage I colon cancer; adenocarcinoma of the colon; stage II colon cancer Study Status: This study is no longer recruiting patients. Sponsor(s): National Cancer Institute (NCI); Southwest Oncology Group; Eastern Cooperative Oncology Group; Radiation Therapy Oncology Group; Cancer and Leukemia Group B; National Cancer Institute of Canada; National Surgical Adjuvant Breast and Bowel Project (NSABP); North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Less invasive types of surgery may help reduce the number of side effects and improve recovery. It is not yet known which type of surgery is more effective for colon cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of laparoscopic-assisted colectomy with open colectomy in treating patients who have colon cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002575

•

Does Tension-Free Herniorrhaphy or Laparoscopic Herniorrhaphy Achieve Equal or Better Recurrence Rates and Lower Costs While Achieving Equivalent Outcomes for Hernia Patients? Condition(s): Hernia Study Status: This study is completed. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Cooperative Studies Program; American College of Surgeons Purpose - Excerpt: Inguinal hernia is one of the most common worldwide afflictions of men. The presence of an inguinal hernia is indication for its repair. Approximately 700,000 hernia repairs are performed in the U.S. each year, and this procedure accounts for 10% of all general surgery procedures in the Veterans Health Administration (VHA) (10,000 inguinal herniorrhaphies performed per year). There are many different techniques currently in use for repairing inguinal hernias and with the advent of laparoscopy, yet another technique is being advocated. Laparoscopic repair has been reported in some studies to be superior to open repair because of less pain and earlier return to work. However, laparoscopic repair requires a general or regional anesthetic and expensive equipment and supplies to perform. There is also evidence that open tension-free mesh repair may have results similar to laparoscopic repair for these patient centered outcome measures. The general acceptance of this procedure, especially in the VHA, has not been uniform. Furthermore, no randomized trial of sufficient size

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and power to be conclusive has been done to set forth the operative "gold standard" for hernia repair. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00032448

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “laparoscopy” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

•

For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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•

For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 5. PATENTS ON LAPAROSCOPY 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.9 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 “laparoscopy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on laparoscopy, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Laparoscopy By performing a patent search focusing on laparoscopy, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted

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

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

Apparatus and method for developing an anatomic space for laparoscopic hernia repair and patch for use therewith Inventor(s): Monfort; Michelle Y. (Los Gatos, CA), Kieturakis; Maciej J. (San Carlos, CA), Mollenauer; Kenneth H. (Santa Clara, CA) Assignee(s): General Surgical Innovations, Inc. (norwalk, Ct) Patent Number: 6,514,272 Date filed: August 11, 1998 Abstract: Laparoscopic apparatus and method for insertion into a space or potential space in a body including an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is provided and is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A tunneling member is mounted on the distal extremity of the tunneling shaft. A balloon assembly is provided which is removably secured to the tunneling shaft. The balloon assembly includes a balloon wrapped about said tunneling shaft. A sheath is provided which encloses the balloon on the tunneling shaft. The sheath has a slit extending longitudinally thereof permitting the sheath to be removed whereby the balloon can be released and inflated. A tubular member is provided which has a balloon inflation lumen thereon and is coupled to the balloon for inflating said balloon. Excerpt(s): This invention relates to an apparatus and method for developing an anatomic space for laparoscopic hernia repair and a patch for use therewith. In the past, in developing spaces and potential spaces within a body, blunt dissectors or soft-tipped dissectors have been utilized to create a dissected space which is parallel to the plane in which the dissectors are introduced into the body tissue. This often may be in an undesired plane, which can lead to bleeding which may obscure the field and make it difficult to identify the body structures. In utilizing such apparatus and methods, attempts have been made to develop anatomic spaces in the anterior, posterior or lateral to the peritoneum. The same is true for plural spaces and other anatomic spaces. Procedures that have been performed in such spaces include varocele dissection, lymph node dissection, sympathectomy and hernia repair. In the past, the inguinal hernia repair has principally been accomplished by the use of an open procedure which involves an incision in the groin to expose the defect in the inguinal floor, remove the hernial sac and subsequently suture the ligaments and fascias together to reinforce the weakness in the abdominal wall. Recently, laparoscopic hernia repairs have been attempted by inserting laparoscopic instruments into the abdominal cavity through the peritoneum and then placing a mesh to cover the hernia defect. Hernia repair using this procedure has a number of disadvantages, principally because the mesh used for hernia repair is in direct contact with the structures in the abdominal cavity, as for example the intestines, so that there is a tendency for adhesions to form in between these structures. Such adhesions are known to be responsible for certain occasionally serious complications. Such a procedure is also undesirable because typically the patch is stapled into the peritoneum, which is a very thin unstable layer covering the inner abdomen. Thus, the stapled patch can tear away from the peritoneum or shift its position. Other laparoscopic approaches involve cutting away the peritoneum and stapling it closed. This is time consuming and involves the risk of inadvertent cutting of important anatomic structures. In addition, such a procedure is undesirable because it

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requires the use of a general anesthesia. There is therefore a need for a new and improved apparatus and method for developing an anatomic space and particularly for accomplishing hernia repair by laparoscopy. In general, it is an object of the present invention to provide an apparatus and method for developing an anatomic space. Web site: http://www.delphion.com/details?pn=US06514272__ •

Applicator for laparoscopic or endoscopic surgery Inventor(s): D'Alessio; Keith R. (Cary, NC), Mainwaring; Lawrence H. (Raleigh, NC) Assignee(s): Closure Medical Corporation (raleigh, Nc) Patent Number: 6,494,896 Date filed: November 30, 1999 Abstract: A hand-held applicator delivers liquid or semi-liquid compositions, such as adhesives, to an internal tissue or organ in an even and controlled manner. The applicator includes a pump, a tubular extension that is thin enough to pass through an endoscopic pathway or trocar, a proximal end of the tubular extension being sealingly connected to the pump, and an applicator tip that attaches to the distal end of the tubular extension. The tip includes the liquid and the pump pumps the liquid to the internal tissue in an even and controlled manner without contact of the liquid by the pump. The pump is preferably a micropipetter that includes a hand-held portion having a hand-actuatable plunger that does not come in direct, physical contact with the liquid to be dispensed. The composition may be an adhesive such as an alpha-cyanoacrylate. The device may further include a wound closure device including at least two closure pins extending from the distal end of the tubular extension. The wound closure device retracts from the applicator device and orients and aligns a wound or incision target tissue site immediately prior to application of the medical composition. The device provides improved control, ergonomics, and convenience. The device is particularly useful in the field of surgery, especially in the field of laparoscopic or endoscopic surgery, where an even and controlled amount of a medically-acceptable adhesive is to be applied to a target site on an internal tissue or organ. Excerpt(s): This invention relates to the field of surgery and wound closure. More particularly, this invention relates to devices for applying medically-acceptable adhesives, such as 1,1-disubstituted ethylene monomers, to surgical sites. Medical adhesives are used as alternates and/or adjuncts to sutures and staples as wound closure devices. As used herein, "wound" encompasses all disruptions of animal tissue, regardless of manner inflicted, and includes, for example, wounds that are inflicted unintentionally, through surgery, and through natural causes (e.g., degeneration of tissue, infection, etc.) One group of medical adhesives is the monomeric forms of 1,1disubstituted ethylene monomers, such as.alpha.-cyanoacrylates. Members of this group are disclosed in, for example, U.S. Pat. Nos. 5,328,687 to Leung et al; U.S. Pat. No. 3,527,841 to Wicker et al.; U.S. Pat. No. 3,722,599 to Robertson et al.; U.S. Pat. No. 3,995,641 to Kronenthal et al.; and U.S. Pat. No. 3,940,362 to Overhults. Applying medically acceptable adhesives to surgical sites for wound closure requires that the adhesive be dispensed in a precise and controlled manner to the site. Medical practitioners have encountered problems in applying this type of adhesive to internal organs and other deep tissues due to the current limited ability to evenly and controllably dispense an appropriate and accurate amount of the desired adhesive to the site to be closed. Although devices for delivering substances to wound sites are known

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in the art, none of the devices provide an adequate means for delivering a predetermined amount of adhesive to the site in a controlled and even manner. Web site: http://www.delphion.com/details?pn=US06494896__ •

Automated laparoscopic lens cleaner Inventor(s): Kato; Daniel T. (1160 Carlos Privada, Mountain View, CA 94040) Assignee(s): None Reported Patent Number: 6,354,992 Date filed: November 8, 1999 Abstract: An apparatus and method for cleaning the objective lens of a laparoscope, endoscope, or coeloscope during surgery and also removing the solution and debris during and after the cleaning. The result is obtained by using a rigid hollow split sheath for the scope. The split sheath has two separate channels. One channel is for irrigation and the cleaning fluid flows through this channel to be directed onto the lens. The other channel is for suction to remove the solution and debris during and after the cleaning. Control buttons located at the operator's end activate the irrigation and suction functions. The control buttons for irrigation and suction are fabricated into an existing valve type device which can regulate either of these functions. In addition, two ports, one for irrigation and one for suction emerge from the operator's end to connect to the appropriate tubing for irrigation and suction. A rubber ring device screws down at the operator's end allowing the surgeon to secure the sheath to the scope and prevent any leakage of the standard carbon dioxide gas used to distend the abdomen for operative laparoscopy in the patient. Excerpt(s): The present invention relates to an apparatus and method for cleaning and protecting the objective lens of a laparoscope, endoscope, or coeloscope. In particular, the invention relates to an apparatus and method for cleaning and protecting the objective lens of the laparoscope, endoscope or coeloscope while the scope is in use within a body cavity through an irrigation channel and suction channel within the apparatus. Minimally invasive procedures, such as operative laparoscopy, have replaced simple and moderately complex surgical procedures that in the past have been done with large incisions, such as cholycystectomy, hysterectomy, and various gynecologic surgeries. Laparoscopic surgery is now recognized in most instances to substantially reduce patient care costs by decreasing post-operative patient discomfort and reducing hospitalization time. Ever more complex surgical procedures, such as intestinal resections, retroperitoneal lymph-node dissections, radical hysterectomy, spleenectomy, and nephrectomy for instance, are now being successfully accomplished by a laparoscopic surgical approach. Indeed, as longer and more complex surgical procedures are undertaken laparoscopically, laparoscopic surgeons rely on surgical techniques and novel laparasocopic instruments to facilitate laparoscopic surgery, reduce procedure time, and minimize the frustration which can be encountered when such techniques and instruments are not available. As used herein, the term scope is meant to describe a laparoscope, endoscope, coeloscope or optical device used for observation within a body cavity and/or procedures being performed within a body cavity. Such scopes usually consist in part of a rigid or relatively rigid rod or shaft of approximately 300-500 mm length, with an outer diameter of 5 mm to 11 mm, having an objective lens at one end and an eyepiece at the other end. The rod or shaft of the scope contains light-transmitting glass fibres and/or rod lenses. In order to use such scopes, the body cavity must be illuminated with clear, bright light. Therefore, the scope also

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has a connection, adjacent to the eyepiece, for the attachment of an external light source which provides illumination, via light-transmitting fibres within the scope, of the features within the body cavity. Web site: http://www.delphion.com/details?pn=US06354992__ •

Device for lifting the abdominal wall for laparoscopy Inventor(s): Bacher; Uwe (Tuttlingen, DE), Keckstein; Jorg (Villach, DE), Lehmann; Markus (Wurmlingen, DE) Assignee(s): Karl Storz Gmbh & Co., KG (de) Patent Number: 6,221,008 Date filed: March 29, 1999 Abstract: Disclosed is a device for lifting the abdominal wall for laparoscopy, whereby the device can be inserted into the abdominal cavity through an opening in the abdominal wall, having an instrument shaft, which is provided at its distal end region with at least one, preferably two limbs disposed parallel to the axis of the instrument shaft and the can be folded open laterally to the shaft axis. The invention is distinguished by the limbs being joined to the instrument shaft via a folding mechanism, which rotates the limbs at an angle ranging up to 180.degree. Excerpt(s): The present invention relates to a device for lifting the abdominal wall for laparoscopy, whereby this device can be at least partially inserted into the abdomen through an opening in the abdominal wall. Generic type devices possess an instrument shaft which is provided at its distal end region with at least one, preferably two parallel limbs disposed parallel to the axis of the instrument shaft. The limbs can be folded open laterally to the axis of the shaft. Devices of the above class, employed in the field of endoscopic surgery, for laparoscopy respectively laparoscopic treatment, are also known under the term "elevation instruments" Instruments of this type are inserted into the abdominal cavity through a narrow opening and, by folding the holding supports open laterally, provide a wide fan support in order to be able to lift as large as possible an area of the abdominal wall. In this way, the surgical area required inside the abdominal lumen is created for subsequent laparoscopy as well as endoscopesupported surgery. Web site: http://www.delphion.com/details?pn=US06221008__

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Device for removing anatomical parts by laparoscopy Inventor(s): Bennardo; Roberto (Via B. Latini 20, 20026 Novate Milanese, IT) Assignee(s): None Reported Patent Number: 6,206,889 Date filed: May 25, 1999 Abstract: A device for the removal of anatomical parts by laparoscopy, comprising a bag to be inserted by means of a tube applicator inside the abdominal cavity. A flexible element is provided along the edge of the mouth of the bag, having such resilient characteristics as to spring back to a loop configuration when it is not subjected to a deformation. According to a preferred embodiment, the flexible element is formed by a helicoidal spring with a ring clip slidingly coupled thereto, so that the resilient action of

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the spring keeps the mouth open when the bag is inserted in the abdominal cavity, and by making the clip to slide along the spring it is possible to close again the bag when needed. Excerpt(s): The present invention relates to a device for removing anatomical parts, devised for surgical operations carried out by laparoscopy. In a most specific manner, this device comprises a bag wherein the aforesaid parts are placed back and a tube applicator wherein the bag is arranged for being introduced in an abdominal cavity to be operated; the applicator is also provided with means for ejecting the bag out into the cavity above. In practice the operations herein considered consist of making on the patient's abdomen some apertures or laparatomies, usually at least two and no more than four, having diameter of few millimeters (from 5 to 15 mm) and devised for the insertion into the abdominal cavity of surgical instruments suitably adapted to this purpose; these instruments may be optical waveguide probes, scissors, pliers, suture devices or, like in the case of the present invention, devices for removing anatomical parts to be taken or extirpated. Web site: http://www.delphion.com/details?pn=US06206889__ •

Disposable laparoscopic smoke evacuation system Inventor(s): Smith; Shawn P. (30W181 Oxford Dr., Warrenville, IL 60555-1013), Trudel; Gregory J. (10541 White Pine Dr., Parker, CO 80134-2511) Assignee(s): None Reported Patent Number: 6,544,210 Date filed: October 22, 1998 Abstract: A disposable laparoscopic smoke evacuation system. The system utilizes a small fan unit and filter housed in a single disposable housing adapted to be connected between two laparoscopic surgical instrument assemblies via tubing and powered by batteries or available AC power. Excerpt(s): The invention relates to surgical procedures and, more specifically, to a device and method for obtaining a smoke-free environment within the surgical field during laparoscopy. Laparoscopy is a fast growing surgical modality widely used in the treatment of certain prevalent physical ailments. Laparoscopy entails the introduction of an endoscope, light source and surgical instruments through ports formed in the patient's abdomen. In order to facilitate the procedure, the patient's abdominal cavity is inflated with a suitable gas to give the surgeon additional working area and minimize obstruction. Generally, laparoscopy avoids the risks of laparotomy, which requires the surgeon to open the abdomen and carry out the required procedure by his or her direct viewing. The laparoscopic procedure is designed to avoid the surgical complications involved in a conventional laparotomy by allowing a surgeon to view the target site without opening up the patient's abdominal cavity. In a diagnostic laparoscopic procedure, only one channel is required through the patient's abdominal wall into the patient's abdominal cavity, into which the surgeon positions the laparoscope (laparoscopic camera) needed for viewing the underlying and overlying abdominal tissues and/or potential surgical field. Web site: http://www.delphion.com/details?pn=US06544210__

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Electrode leads for use in laparoscopic surgery Inventor(s): Greenstein; Robert J. (Tenafly, NJ) Assignee(s): Transneuronix, Inc. (mt. Arlington, Nj) Patent Number: 6,510,332 Date filed: August 16, 2000 Abstract: This invention relates to an implant device which is designed and adapted use in laparoscopic surgery. This implant device is especially adapted for electrostimulation and/or electrical monitoring of endo-abdominal tissue or viscera. The implant device has an elongated body having on, or near, its distal end a flexible attachment member which can be folded back on to the elongated body and attached to the elongated body thereby forming a closed loop around the tissue of interest. By "looping" around or through the tissue of interest, the attachment member and the elongated body are securely attached to the tissue and will resisted displacement even in cases where the tissue is subject to vigorous, periodic peristaltic movement within the body (e.g., digestive organs). One preferred implant device of this invention has an elongated body equipped with two or more electric poles that are electrically connected to an electric connection terminal for connection to a power source, mechanism to penetrate the tissue or viscera to be treated, quick-release connecting devices to separate the penetration device from the elongated body, and a locking or attachment device which is capable of folding back and attaching to the elongated body whereby the locking device and the elongated body forms a secure and essentially continuous loop around the tissue or viscera to be treated. Excerpt(s): This invention relates to a medical implant device for electrostimulation and/or electrical monitoring of endo-abdominal tissue or viscera. More specifically, this invention provides a medical implant device having electrode leads which can be attached or affixed to the enteric or endo-abdominal tissue or viscera such that the electrode leads resist detachment in spite of the vigorous and/or periodic action or movement of the enteric or endo-abdominal tissue or viscera. The medical implant device of this invention is especially adapted for location or implantation in the endoabdominal cavity over extended periods of time. It is well known that more than 70% of illnesses affecting the digestive tract are of a functional nature. Today such illnesses are treated predominantly using pharmacological means. Since drugs generally have side effects, particularly when the drugs cure the symptom and not the underlying problem or dysfunction, they must often be administered temporally. Indeed, if the side effects are sufficiently serious, the drug may have to be discontinued before full benefit to the patient is realized; in many cases the underlying illness remains. The important role played by electrophysiology in controlling gastrointestinal activity has become increasingly apparent in recent years. Thus, the possibility exits of correcting dysfunction by means of electrostimulation applied at specific frequencies, sites, and modalities and with regard to the self-regulating electromotor physiology of the gastrointestinal organs or tract. It has recently been shown, for example, that changes occur in the motility and electromotor conduct of the gastric tract in eating disorders (e.g., obesity, thinness, bulimia, anorexia). Disturbances in electromotor activity in diabetic gastroparesis, reflux in the upper digestive tract, and numerous other gastroenterological functional pathologies have also been observed. Web site: http://www.delphion.com/details?pn=US06510332__

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Electrosurgical loop and instrument for laparoscopic surgery Inventor(s): Constant; Camille (Gembloux, BE), Dequesne; Jacques (Lausanne, CH), Moreels; Xavier (Gembloux, BE) Assignee(s): Medsys S.a. (gembloux, Be) Patent Number: 6,176,858 Date filed: January 29, 1999 Abstract: An electrosurgical cutting apparatus for performing laparoscopic section of an organ makes use of an electrical current transporter. The transporter includes a conducting wire, electrical insulation portions around the conducting wire at the first end and at the second end, forming respectively a first and a second insulated end and defining a non-insulated cutting portion between said first insulated end and said second insulated end, and a first fastening device located at the first end of the conducting wire and a second fastening device located at the second end of said conducting wire. The second fastening device is in electrical contact with the conducting wire. Excerpt(s): This invention relates to surgical instruments, and more particularly to electrosurgical instruments for laparoscopic surgery. The invention further relates to a laparoscopic method for performing a section of an organ using an electrosurgical instrument. Some of the potential advantages of this procedure include a shorter operation time, fewer complications and an earlier return to normal activity including sexual function. Web site: http://www.delphion.com/details?pn=US06176858__

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End effector and instrument for endoscopic and general surgery needle control Inventor(s): Klieman; Charles H. (21 Lochmoor La., Newport Beach, CA 92660), Needleman; David (667 Sausalito Blvd., Sausalito, CA 94965), Stiggelbout; John M. (89 Girard Ave., Sausalito, CA 94965) Assignee(s): None Reported Patent Number: 6,270,508 Date filed: October 25, 1999 Abstract: A surgical instrument for use in laparoscopy is provided, comprising a tubular member having a proximal end and a distal end, a first end effector piece pivotably mounted to the tubular member near the distal end of the tubular member, a second end effector piece disposed near the distal end of the tubular member and being slidable relative to the tubular member, wherein a surgical item, such as a suture needle, may be received between the first end effector piece and the second end effector piece and may be rolled substantially axially by axial translation of the second end effector piece with respect to the first end effector piece. In one embodiment, the end effector pieces may be provided with depressions in their face surfaces. In another embodiment, the surgical instrument may also include a handle assembly having a control lever and a rotation actuator. The tubular member may also be rotatably mounted on the handle. In another embodiment, the handle assembly may comprise a number of servomotors for effecting motion in the tubular barrel and the end effector pieces. Excerpt(s): The present invention relates generally to the field of surgical instruments. In particular, it relates to an end effector of a surgical instrument for use in endoscopic

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surgical procedures. Endoscopy is a minimally invasive surgical procedure and includes, among other procedures, laparoscopy, thoracoscopy, and arthroscopy. Endoscopic procedures involve viewing the interior of the body using an illuminated optical instrument, referred to as an endoscope. The endoscope and other surgical instruments for operating on tissue inside the body enter the body through ports placed in small incisions in the skin. Endoscopic procedures are typically conducted using specialized surgical instruments that have been adapted to perform general surgical procedures endoscopically. Endoscopic surgical instrument end effectors often take the form of a scissors, dissectors, or scissoring jaws, attached to the distal end of a rigid shaft. A handle attached to the proximal end of the shaft has a mechanism for operating the end effector. An operating linkage inside the shaft connects the handle to the end effector. The handle may also have a second mechanism for rotating the shaft and end effector. Web site: http://www.delphion.com/details?pn=US06270508__ •

Laparoscopic access tool with gas seal Inventor(s): Peterson; Francis C. (Prescott, WI) Assignee(s): Ethicon Endo-surgey, Inc. (cincinnati, Oh) Patent Number: 6,447,489 Date filed: January 18, 2000 Abstract: A laparoscopic access apparatus enabling the removal of tissue or other debris from a surgical site. A catheter having a longitudinal access is provided with a flexible internal sleeve having distal and proximal ends. The sleeve forms an inner channel through which laparoscopic surgical instruments may be passed. The sleeve is mounted with axial tautness along one side of the catheter, it is provided with a loose, baggy portion elsewhere in the catheter defining an inflatable cavity between the catheter and sleeve. A gas port is positioned to enable gas under pressure from a body cavity to enter the inflatable cavity adjacent the distal end thereof to thereby collapse the sleeve and seal the channel. Excerpt(s): The invention relates to apparatus useful in laparoscopic surgery, and particularly to a device enabling tissue to be withdrawn from a body cavity using laparoscopic surgical tools while maintaining gas pressure within the body cavity. Laparoscopic surgery commonly requires that one or more small openings be made through the tissues of a patient to enable the insertion of laparoscopic surgical instruments. Commonly, the body cavity (the abdomen, the knee capsule, etc.) in which laparoscopic surgery is to be performed is first inflated with a gas such as CO.sub.2 to provide an open, inflated area within which the surgical instruments may be manipulated. A catheter may be provided through the tissue wall bounding the body cavity, and it is through the catheter that the surgical instruments are introduced into the body cavity. Because the body cavity is pressurized, there is a tendency for the pressurizing gas within the body cavity to escape outwardly through the catheter, thereby deflating the cavity. To counter this problem, a number of devices have been proposed to provide a pressure seal within the catheter, but yet enable laparoscopic instruments to be passed inwardly and outwardly of the body cavity through the catheter. One such seal is shown in Mollenauer, et al., U.S. Pat. No. 5,634,937. Another is shown in published UK Patent Application GB 2 275 420 (Gaunt, et al.), and yet another is shown in PCT Intemational Publication No. WO 94/22357 (Yoon). The sealing devices described in the above references by and large relate to inflatable, donut-like devices,

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through the center of which laparoscopic instruments may be passed. Although those portions of laparoscopic instruments that are introduced through a cannula into a body cavity are routinely fairly uniform in size, and thus can be introduced and withdrawn from the catheter with some ease, a problem arises when instruments with diameters much larger or smaller that usual are to be introduced into the body cavity, or particularly when pieces of tissue are severed within the body cavity and are to be withdrawn through the catheter without significant loss of pressure in the body cavity. Particularly in the latter case, the tissue sample may not easily fit through the gas seal that is provided, and in this instance, the tissue sample may in fact have to be painstakingly severed into small pieces in order to be successfully removed. If a large tissue sample is removed with some force, then the seal mechanism may be damaged, resulting in a loss of pressure within the body cavity with easily foreseeable medical problems. Web site: http://www.delphion.com/details?pn=US06447489__ •

Laparoscopic forceps handle Inventor(s): Moran; Peter (Leeds, GB), Moran; Stuart (Leeds, GB), White; Mike (Leeds, GB) Assignee(s): Surgical Innovations Ltd. (leeds, Gb) Patent Number: 6,641,595 Date filed: June 1, 2000 Abstract: A laparoscopic forceps comprising a handle; a tubular housing extending axially from the handle and carrying an actuator rod; a jaws mechanism disposed at the end of the tubular housing remote from the handle engaged to the actuation rod and arranged so that the jaws may be opened or closed by actuation of the handle; wherein the handle comprises left and right bow members pivotally connected to a mounting core in a scissors-like arrangement, and adapted to engage a user's finger and thumb in use;the forceps including a switchable ratchet mechanism moveable between locked and unlocked positions, adapted when locked to allow closure and prevent opening of the jaws, and when unlocked to allow free opening and closing of the jaws. Excerpt(s): This invention relates to laparoscopic forceps, particularly to the handle of such forceps. Laparoscopic forceps conventionally comprise a handle, a tubular housing carrying an actuator mechanism and a forceps jaws mechanism located at the remote end of the tubular housing. Manual actuation of the handle opens or closes the jaws. The shaft and jaws mechanism may be rotated relative to the handle and a ratchet mechanism may be provided to allow clamping of the jaws. A monopolar diathermy connection may be provided to facilitate cauterisation of tissue clamped by the jaws. In conventional laparoscopic forceps the handle comprises a pistol grip arrangement wherein the diathermy connection extends upwardly so that the power cable extends from the handle over a surgeon's hand adjacent the knuckles or thumb. The pistol grip arrangement makes it necessary for a surgeon to raise or lower the elbow in order to rotate the forceps in use. This is inconvenient and can be tiring, particularly as the diathermy cable may pass over the surgeon's elbow. According to the present invention a laparoscopic forceps comprises a handle; a tubular housing extending axially from the handle and carrying an actuator rod; a jaws mechanism disposed at the end of the tubular housing remote from the handle engaged to the actuation rod and arranged so that the jaws may be opened or closed by actuation of the handle; wherein the handle comprises left and right bow members pivotally connected to a mounting core in a

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scissors-like arrangement, and adapted to engage a user's finger and thumb in use; the forceps including a switchable ratchet mechanism moveable between locked and unlocked positions, adapted when locked to allow closure and prevent opening of the jaws, and when unlocked to allow free opening and closing of the jaws. Web site: http://www.delphion.com/details?pn=US06641595__ •

Laparoscopic insertion and deployment device Inventor(s): Blackmore; John (Redwood City, CA), Graham; Greg (Ventura, CA), Haynes; Ronald F. (San Luis Obispo, CA), Oppelt; William G. (Arroyo Grande, CA) Assignee(s): Fziomed, Inc. (san Luis Obispo, Ca) Patent Number: 6,193,731 Date filed: October 27, 1998 Abstract: A device for inserting a substantially square sheet of flexible material through a laparoscopic cannula into an abdominal cavity. The device is an elongate, generally cylindrical member having a proximal end and a distal end and a body portion therebetween. A pair of tines is rigidly affixed to the distal end of the body portion with a slot separating the tines. A handle is affixed to the proximal end of the body portion. The slot defined between the pair of tines is dimensioned to accommodate the sheet thickness therewithin. In a preferred use, the sheet of material is inserted between the tines with diagonal corners of the sheet within the slot. The free corners of the sheet are drawn together with one hand and the handle of the device is rotated to wrap the sheet around the exterior surface of the two tines. The distal end of the body portion is then inserted into a laparoscopic cannula and advanced therethrough with a twisting motion until the distal end of the device emerges from the cannula positioned within the abdominal cavity. At this point, the device is slightly withdrawn to dislodge the film from the receptacle at the base of the tines and the sheet unwinds from around the tines, effectively unfolding the sheet within the target cavity. The sheet is finally released from the slot between the tines when the device is withdrawn from the cannula; the sheet remaining within the abdominal cavity. Excerpt(s): The present invention related to a device for inserting a film or sheet of bioabsorbable material into the abdominal cavity of a patient during laparoscopic surgery. Laparoscopic surgery involves the transcutaneous placement of at least one, and usually two, three or four laparoscopic cannulas through the abdominal wall to provide a conduit into the abdomen. The cannula(s) are inserted by means of a trocar placed against the skin which, in response to pressure, provides a open pathway into abdominal cavity through which the cannula(s) may pass. One of such cannulas is employed to inflate the abdominal cavity with carbon dioxide gas to improve the field of view and accessibility to organs within the abdomen. Others are used for the insertion of specialized surgical instruments. All such cannulas are fitted with a leak-proof valve to prevent gas under pressure from leaking from within the abdominal cavity. Instruments used in laparoscopic surgery are passed through the cannulas and manipulated within the abdominal cavity. One of the cannulas houses a camera which, together with a light source, provides a means for a physician or surgeon to view the field of operation and perform a surgical procedure within the abdominal cavity. It has been difficult in the art to insert sheets of flexible material through such cannulas for deployment within the abdominal cavity. Films or sheets of material which are particularly desirable for such insertion include adhesion barriers, bioabsorbable and biodegradable drug releasing films and the like.

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Web site: http://www.delphion.com/details?pn=US06193731__ •

Laparoscopic instrument sleeve Inventor(s): McGahan; Thomas V. (Memphis, TN), Zdeblick; Thomas (Middletown, WI) Assignee(s): Sdgi Holdings, Inc. (wilmington, De) Patent Number: 6,383,191 Date filed: March 15, 2000 Abstract: Surgical techniques and instruments are provided for performing laparoscopic surgical procedures. The apparatus includes a sleeve having a proximal end, a distal end, and a lumen extending between the proximal and distal ends. The lumen opens at the proximal end and receives an elongated member, such as a cannula or surgical instrument, therethrough. The sleeve is resilient material and conformable to the outer shape of at least a distal portion of the elongate member. In one form the distal end wall includes means for opening the end wall to allow the elongate member to advance therethrough. The sleeve may also be provided with internal ribs and a flange member. Various techniques using various surgical instruments in laparoscopic procedures are also disclosed. Excerpt(s): The present invention relates generally to methods and instruments for performing spinal surgery. Specifically, the invention concerns to a sleeve for use with laparoscopic techniques and instruments in spinal surgeries. Various surgical techniques and instruments have been developed for use in laparoscopic procedures to develop an anatomic space and to permit visualization of the procedures. For example, PCT International Publication No. WO 97/30666 to Zdeblick et al. discloses laparoscopic surgical techniques and instruments for preparing a spinal disc space for implantation of fusion devices or implants. The laparoscopic instrumentation provides a sealed working channel to the disc space through which the disc space is distracted, the vertebral endplates and surrounding discs are reamed, and the vertebral implant inserted, all through a laparoscopic port engaged to the end of the sleeve. In this technique, the instrumentation is placed directly through the tissue through an incision in the skin. One drawback associated with this technique is that the instrumentation has edges, corners or the like that can snag or catch tissue as it is advanced therethrough, increasing tissue trauma and bleeding as a result of the procedure. Another drawback associated with this technique is that although the instrumentation is provided with a sealed working channel, the space between the tissue and the instrument provides an avenue for loss of insufflation pressure. While the above described instruments and procedures represent various approaches over prior surgical instruments and procedures for spinal surgery, the need for improvements remains. In particular, procedures and instruments are needed that minimize trauma to tissue surrounding the surgical site while allowing surgical procedures to be performed. Also needed are instruments and techniques that maintain the sealed environment of the working space during surgical procedures. The present invention is directed to these needs, among others. Web site: http://www.delphion.com/details?pn=US06383191__

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Laparoscopic instrument system for real-time biliary exploration and stone removal Inventor(s): Scott, III; George L. (3103 Diamond A, Roswell, NM 88201), Wenner; Donald E. (3600 Kessler Pl., Roswell, NM 88201) Assignee(s): None Reported Patent Number: 6,440,061 Date filed: March 24, 2000 Abstract: A laparoscopic port adapter assembly 10 for conducting bile duct and related procedures, including a laparoscopic port 11, an introducer sheath 12 and a multiple conduit instrument guide 13. The instrument guide 13 may be inserted into a bile duct 14 to facilitate concurrent introduction of multiple instruments directly into the bile duct 14 without need for forceps manipulation of instruments through additional laparoscopic ports. The procedure may be conducted and viewed in real-time video to improve procedural efficiency and safety. Inventive related useful instruments and procedures are included to complement use and flexibility of the laparoscopic port adapter assembly 10. A preferred embodiment may include use of a three-conduit instrument guide 13 and concurrent introduction of a lithotripter 32, choledochoscope 31 and irrigative catheter 34 directly in the bile duct 14. Excerpt(s): The present invention relates generally to medical equipment and more particularly to laparoscopic surgical instruments of the type used in biliary tract procedures. The surgical instruments described herein facilitate common bile duct exploration and the removal of physiologic calculi, generally referred to as stones. The invention provides enhancements related to systematic insertion, deployment and manipulation of various instruments including a choledochoscope for concurrent realtime viewing of the laparoscopic surgical process. Many patients develop stones within their gall bladder, which may pass through the cystic duct to become lodged in the common bile duct, a condition known as choledocholithiasis. Stones are typically variable in size from 1.00-20.00 mm. These stones may block the common bile duct, the hepatic duct or intrahepatic ducts, and if untreated may result in obstructive jaundice that may result in cholangitis (infection within the biliary tract) and severe discomfort to the patient, or death due to sepsis or liver dysfunction. Solitary or multiple stones may be loose within the common bile duct or otherwise embedded into the common bile duct wall, or impacted at the Papilla of Vater. This condition typically requires concurrent surgical removal of the gall bladder along with removal of the stones from the common bile duct. This surgical procedure is referred to as cholecystectomy with common bile duct exploration. The presence of stones in a patient's biliary tract is confirmed using typical diagnostic methods, such as cystic duct cholangiography or ultrasonography. Stones are also often discovered during laparoscopic cholecystectomy, a procedure for removal of the gall bladder. Common bile duct stones may also be anticipated preoperatively due to physical symptoms including jaundice, or from blood tests that indicates liver function abnormality. This condition is typically confirmed intraoperatively during cholecystectomy with cholangiography or by ultrasound. Web site: http://www.delphion.com/details?pn=US06440061__

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Laparoscopic instrument with a detachable tip Inventor(s): DeGuillebon; Henri F. (Manchester-by-the-Sea, MA) Assignee(s): Microline, Inc. (beverly, Ma) Patent Number: 6,595,984 Date filed: March 28, 2000 Abstract: A laparoscopic assembly includes a body, an elongated shaft, and optionally, a removable or non-removable surgical tip. The body includes a casing manually manipulating tip actuating means, a tip actuating rod, a collet, a collet closer, and one or more collet detent members. The shaft is operably and removably gripped by the body and extends from the body to interconnect the body with a surgical tip. The collet closer is shaped and sized to, on tightening of the collet closet, radially compress the collet to grip the sheath. Each collet detent member is disposed in one collet radial bore, and is shaped and sized to permit only partial entry into the collet axial bored to engage the sheath depression during assembly, and be freely movable radially within the collet radial bore in response to urging inwardly by the tightening of the collet closer, or outwardly by the sheath depression wall when the collet closer is loosened. Excerpt(s): The present invention relates to a laparoscopic instrument, and more particularly to a laparoscopic instrument having a manually operable tip, such as cutting blades, forceps, or the like, and to a removable shaft therefor. A wide variety of medical instruments for laparoscopic surgery are presently known. Such instruments are used to access, e.g., the peritoneal cavity of a patient through a small incision in the abdominal wall. An endoscope normally is inserted into the cavity through a second incision in the abdominal wall for viewing of the operation of the instrument by the surgeon. Typical of such laparoscopic instruments are those having a tip end including, e.g., cutting blades, forceps, or other surgical device to be inserted into the cavity to perform the surgery; an external end from which the surgeon may manually manipulate the tip device from a position external to the abdominal wall; and an elongated shaft operably connecting the tip end and the external end. Many such laparoscopic instruments have permanently attached tips. However, in recent years instruments have been developed having disposable tips. Thus, a worn cutting blade may be replaced or one type of tip may be replaced with another, interchangeable type. Because of the high cost of such laparoscopic instruments, reuse of each instrument, or part of each instrument, would be advantageous in controlling the cost of laparoscopic surgery. However, such reuse requires instruments of rugged construction which may be readily cleaned and sterilized. Known laparoscopic instruments, even those with removable tips, can be difficult to clean due to their length and complex internal structure. Web site: http://www.delphion.com/details?pn=US06595984__

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Laparoscopic instruments and trocar systems for trans-umbilical laproscopic surgery Inventor(s): Piskun; Gregory (434 Shady Ave., Apt. 18, Pittsburg, PA 15206) Assignee(s): None Reported Patent Number: 6,454,783 Date filed: September 15, 1999 Abstract: Laparoscopic instruments and trocars are provided for performing laparoscopic procedures entirely through the umbilicus. A generally C-shaped trocar

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provides increased work space between the hands of the surgeon as well as S-shaped laparoscopic instruments placed through the trocar when laparoscopic instrumenttrocar units are placed through the umbilicus. In order to facilitate retraction of intraabdominal structures during a laparoscopic procedure, an angulated needle and thread with either one or two sharp ends is provided. Alternatively, an inflatable unit having at least one generally C-shaped trocar incorporated within the unit's walls can be placed through the umbilicus following a single incision. Generally S-shaped laparoscopic instruments may be placed through the generally C-shaped trocars to facilitate access to intra-abdominal structures. Excerpt(s): The present invention relates to surgical instruments, and particularly to laparoscopic instruments which facilitate the performance of laparoscopic procedures entirely through the umbilicus. Abdominal laparoscopic surgery gained popularity in the late 1980's, when benefits of laparoscopic removal of the gallbladder over traditional (open) operation became evident. Reduced post-operative recovery time, markedly decreased post-operative pain and wound infection, and improved cosmetic outcome are well established benefits of laparoscopic surgery, derived mainly from the ability of laparoscopic surgeons to perform an operation utilizing smaller incisions of the body cavity wall. Laparoscopic procedures generally involve insufflation of the abdominal cavity with CO.sub.2 gas to a pressure of around 15 mm Hg. The abdominal wall is pierced and a 5-10 mm in diameter straight tubular cannula or trocar is then inserted into the abdominal cavity. A laparoscopic telescope connected to an operating room monitor is used to visualize the operative field, and is placed through one of the trocars. Laparoscopic instruments (graspers, dissectors, scissors, retractors, etc.) are placed through two or more additional trocars for the manipulations by the surgeon and surgical assistant(s). Web site: http://www.delphion.com/details?pn=US06454783__ •

Laparoscopic needle introducer device Inventor(s): Valtchev; Konstantin L. (600 Sherbourne St., Suite 507, Toronto Ontario, CA M4X 1W4) Assignee(s): None Reported Patent Number: 6,527,793 Date filed: September 18, 2000 Abstract: A device (10) for introducing and removing a laparoscopic needle (200) through an incision (301) in a wall (302) of a body cavity (300) wherein the device (10) comprises a rod unit (11) including an elongated rod member (20) having a proximal (21) and a distal (22) end segment disposed on the opposite ends of an interior chamber (34) provided with an elongated slot (33) dimensioned to receive a curved laparoscopic needle (200) and a handle member (40) for manipulating the position of the laparoscopic needle (200) within the body cavity (300). In one version of the preferred embodiment, the curved needle (200) is releasably engaged between the tubular proximal end segment (21") and distal end (51) of the elongated slot (33') of the rod member (20'). Excerpt(s): The present invention relates to the field of surgical implements in general, and in particular to a surgical implement used to introduce a curved needle into the peritoneal cavity during laparoscopic surgery. There is currently no specialized instrument for the introduction of a curved needle into the peritoneal cavity. Presently, such needles can be introduced through a trocar sleeve with an interior diameter larger

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than 11 mm. A method developed by Dr. H. Reich enables the surgeon to introduce any size curved needle into the peritoneal cavity through a 5 mm lower quadrant incision. The disadvantage of this method are that insertion of the needle into the abdominal wall, after the removal of the trocar sleeve makes, it is difficult for the surgeon to find the original incision resulting in additional damage as he attempts to follow the original path. Also, the unprotected needle damages the soft tissue through which it is traveling. As a consequence of the foregoing situation, there has existed a longstanding need among surgeons for a new and improved device for introducing a curved laparoscopic needle into a body cavity in as non-invasive a manner as possible with full control over the positional placement of the needle within the body cavity, and the provision of such a device is a stated objective of the present invention. Web site: http://www.delphion.com/details?pn=US06527793__ •

Laparoscopic retractor Inventor(s): Adler; Jonathan (Upper Brookville, NY), Ascher; Bernd (Islip Terrace, NY), Coraci, Jr.; Leonard (Selden, NY) Assignee(s): Flexbar Machine Corp. (islandia, Ny) Patent Number: 6,248,062 Date filed: November 9, 2000 Abstract: A laparoscopic retractor comprises a shaft having a distal end, a proximal end and a channel extending longitudinally from the distal end to the proximal end, and a handle connected to the proximal end of the shaft and having a longitudinal channel therethrough. There are a plurality of links pivotally connected in a linear arrangement, with one of the links connected to the distal end of the shaft. Each link has a longitudinal channel therethrough. The shaft and links form a continuous line terminating in a tip formed by an end link. There is a cable extending from the tip through the channels in the links, shaft and handle and an adjustment mechanism connected to the handle opposite the shaft and connected to the cable. There is spring mounted between the handle and adjustment mechanism to bias movement of the adjustment mechanism relative to the handle. The adjustment mechanism can be locked in a biased position wherein the cable is extended and the links rest in a straight line for insertion through a cannula, and can be released so that the cable is retracted an pulls the links into a curved arrangement for use during surgery. There is also a flush port for internal cleaning. Excerpt(s): This invention relates to a retractor for use in laparoscopic surgery. In particular, the invention relates to a retractor that can be easily moved from a locked, straight position for insertion through a cannula, to an unlocked, self-forming curved or rounded position after the retractor is within the body. In laparoscopic surgery, the surgery is performed by making a small incision in the body and placing a cannula through the incision to the area to be operated on. The surgical instruments are then inserted through the cannula an manipulated from outside the body. Consequently, all of the instruments used in laparoscopic surgery must be small enough to fit through the cannula. It is often necessary during the surgery to move tissues or organs out of the way with a retractor. With large organs such as the liver, a retractor with a large surface area is needed. However, given the small diameter of the cannula, it is difficult to insert a suitable retractor into the surgical site. There have been many attempts to devise a retractor that is suitable for laparoscopic or arthroscopic use. For example, U.S. Pat. No. 5,685,826 to Bonutti discloses a retractor having a mechanically expandible end portion.

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After the retractor is inserted into the surgical area, the tip of the retractor is pulled back, causing the side walls to fold outward, forming a plurality of radial arms. Web site: http://www.delphion.com/details?pn=US06248062__ •

Laparoscopic sealant applicator Inventor(s): Trumbull; Horace R. (Skillman, NJ) Assignee(s): Bristol-myers Squibb Company (new York, Ny) Patent Number: 6,228,051 Date filed: March 27, 1998 Abstract: A laparoscopic applicator device for the selective directional application of one or more liquids to a surgical site is disclosed. The device comprises a handle with liquid inlets at one end, discrete channels within one or more tubes connecting with said inlet and exteding through said handle to a nozzle, and a dual injection shaft at the nozzle end for inserting the shaft and nozzle through a surgical trocar. The dual shaft comprises s rigid portion immediately adjacent the handle and a flexible portion near the nozzle tip. Means are provided, preferably within the handle, for the controlled articulation of the flexible shaft/nozzle assembly, thereby providing application of the liquids in a desired direction. The present invention is particularly useful in the application of surgical sealants, e.g., fibrin sealants. Methods of applying such components are also a part of the invention. Excerpt(s): This invention relates to a laparoscopic sealant applicator wherein a multilumen tubing, in fluid communication with a source of sealant, extends a suitable distance beyond a handle so that the tubing can be laparoscopically inserted and articulated in a desired direction to a desired site. Sealants would also be useful in laparoscopic procedures. In accordance with the present invention a laparoscopic applicator device for the selective directional application of one or more liquids to a surgical site is disclosed. The device comprises a handle with liquid inlets at one end, discrete channels within one or more tubes connecting with said inlets and extending through said handle to a nozzle, and a dual insertion shaft at the nozzle end for inserting the shaft and nozzle through a surgical trocar. The dual shaft comprises s rigid portion immediately adjacent the handle and a flexible portion near the nozzle tip. Means are provided, preferably within the handle, for the controlled articulation of the flexible shaft/nozzle assembly, thereby providing application of the liquids in a desired direction. The present invention is particularly useful in the application of surgical sealants, e.g., fibrin sealants. Methods of applying such components are also a part of the invention. Web site: http://www.delphion.com/details?pn=US06228051__

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Laparoscopy cannula adapter and assembly Inventor(s): Ternamian; Artin (Toronto, CA) Assignee(s): Ternamian; Artin M. (toronto, Ca) Patent Number: 6,638,265 Date filed: June 8, 2000

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Abstract: An adapter for use on an external surface of a laparoscopy cannula and a laparoscopy cannula assembly are disclosed wherein the adapter body has an inner surface for grasping the external surface of the cannula and has an outer surface for aiding in radial spreading of a body entrance and snugly engaging body tissue. The outer surface of the adapter body may be threaded or grooved and the inner surface of the adapter body coapts with the external surface of the cannula. An adapter fabricated in whole or in part from an elastomeric material that assists in snugly engaging the external surface of a cannula is also disclosed. Further, a method for aiding in the radial spreading of a body entrance opening during laparoscopy, and a method of maintaining the position of a cannula during laparoscopy is disclosed. Excerpt(s): This invention relates generally to instruments designed for accessing body cavities. More specifically, this invention relates to an adapter for a laparoscopy cannula and assembly. Cannula assemblies traditionally have been used in laparoscopic surgery for several decades. In laparoscopy, a small incision is required to access an area where a wide range of surgical procedures can be performed with minimal traumna to the tissues. Until the invention described in this inventor's prior U.S. Pat. No. 5,478,329 and its division, U.S. Pat. No. 5,630,805, the disclosures of which are incorporated herein by reference, a surgeon would use a trocar assembly to gain access to the peritoneal cavity during a laparoscopic procedure. The trocar assembly included a trocar (also called an obturator) and a cannula, a tube through which the trocar is guided. Because the cannula end is blunt, in order to access the peritoneal cavity, the trocar would be used to pierce the layers of the anterior abdominal wall. One such prior art trocar assembly is disclosed in U.S. Pat. No. 5,226,890. This trocar assembly includes a tissue engaging member, a guide tube member, and a collet for locking the tubular guide member to the externally smooth cannula. The conical tissue engager is helically threaded on its external surface so that it can be rotated into an incision to engage the tissue. Once the tissue engager is positioned, the trocar cannula is inserted into the bore of the tissue engager and is locked into place using the collet. Web site: http://www.delphion.com/details?pn=US06638265__ •

Method and apparatus for attaching or locking an implant to an anatomic vessel or hollow organ wall Inventor(s): Swanstrom; Lee L. (1405 NW. 24th Street, Portland, OR 97210) Assignee(s): None Reported Patent Number: 6,626,919 Date filed: July 21, 1998 Abstract: An attachment or locking apparatus which can effectively secure an implant, such as a stent or stent graft, to a vessel or hollow organ wall and which allows minimally-invasive techniques, such as laparoscopy, to be used to attach the implant. The locking element is inserted through an anatomic vessel or hollow organ wall and the implant from outside of the vessel or hollow organ. The locking element preferably is composed of a thin retaining element and a clamping element joined flexibly at one end of the retaining element. A fixing element is secured in position on the retaining element to secure or attach the implant in place. A positioning device, including a thin cannula with an attached locking element, may be inserted into the patient's body, such that the cannula penetrates both the vascular or hollow organ wall and the implant deployed within the vascular wall. The clamping element, held within the cannula, is then ejected into the vessel or hollow organ. The locking element is pulled tight, and

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pressure-distribution and/or pressure elements are then slid down the locking element toward the vessel wall or hollow organ. A fixing element is then slid against the pressure-distribution and/or pressure elements, and secured into place. The free end of the locking element may then be cut off near the fixing element. Excerpt(s): The present invention relates to an apparatus and a method for repairing an anatomic vessel wall or the wall of a hollow organ, such as the esophagus, particularly in the human body. In particular, the present invention relates to an attaching or locking element for attaching an implant, such as stent or stent graft, to a vascular or hollow organ wall from the outside of the wall, as well as an instrument for positioning and inserting the attaching or locking element into the body. The present invention also encompasses a method for attaching or locking an implant to a vessel or hollow organ wall. An Abdominal Aortic Aneurysm ("AAA") is a weakening of the wall of the aorta in the abdominal area. AAAs pose a significant health problem and over 160,000 AAAs are diagnosed annually in the United States. A full 25% of AAAs will go on to eventually rupture; in spite of numerous advances in acute medical care, medical transport and resuscitation, ruptured AAAs continue to have a 50% mortality rate. When inserting implants, such as stents or stent grafts, into vessels or hollow organs, in particular when repairing an aneurysm using a stent graft, it is necessary that the stent introduced into the vessel or hollow organ be attached at both its distal and proximal ends tightly and permanently to the vessel wall surrounding the stent, in order to ensure that the stent does not migrate in the vessel and to ensure that the stent seals off the aneurysm, thus reinforcing the weakness in the vessel. Prior art stents used for repair of AAAs have used a variety of mechanisms for attaching the stent to the vessel wall. One mechanism used to attach a stent to a vessel wall is hook-shaped projections at the proximal and distal ends of the stent, which hook-shaped projections are pressed against the vascular wall from the inside of the vessel. The hook-shaped projections mechanically grip the vessel walls to secure the stent or stent graft to the vessel wall. In a similar attachment method, disclosed in U.S. Pat. No. 5,527,355, the stent or stent graft is secured in position against the vessel wall from the inside using hook-shaped retaining elements; these hook-shaped retaining elements are inserted into bands and surround the vessel externally. Web site: http://www.delphion.com/details?pn=US06626919__ •

Multifunctional handpiece for use in open and laparoscopic laser surgery and electrosurgery Inventor(s): Cosmescu; Ioan (1449 N. 22nd St., Phoenix, AZ 85022) Assignee(s): None Reported Patent Number: 6,635,034 Date filed: June 30, 2000 Abstract: A manual and automatic fluid control system and method for use in open and laparoscopic laser surgery and electrosurgery is disclosed. The system includes a manual mode along with several automatic modes which can effectuate both suction and irrigation, either individually or simultaneously. In the various automatic modes, the suction and/or irrigation is automatically activated during activation of a medical apparatus for laser surgery or electrosurgery without requiring separate activation from the surgeon or operating room staff. Several safety features for monitoring the fluid control system are also incorporated within the system such as fluid sensors for detecting the absence of irrigation fluid, pressure sensors and vacuum systems for

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monitoring fluid pressure, fluid sensors for monitoring fluid volume, and warning signals for detecting empty containers. All of the safety features are designed to automatically deactivate suction and/or irrigation means contained within the fluid control system upon detection of unsafe levels. Finally, specially designed suction/irrigation hand pieces are disclosed for use in connection with the fluid control system. Excerpt(s): The present invention relates generally to an automatic fluid control system and method and suction/irrigation hand pieces which are designed to be used in conjunction with the automatic fluid control system and method. More particularly, the present invention relates to an automatic fluid control system and method which can effectuate both suction and irrigation, either individually or simultaneously, and which has a re-useable pump that can deliver high pressure and high flow suction and irrigation which are required during open and laparoscopic laser surgery and electrosurgery procedures. In the past, suction/irrigation units have functioned by applying air pressure on water containers, wherein the water is being used for fluid irrigation, in order to force the water to be pressurized. A trumpet valve was used to release the water under relative pressure for laparoscopic procedures. These devices operated under low pressure due to the risk of exploding the irrigation containers in the event that too much pressure was applied. Consequently, both the water pressure and water flow associated with those devices were low. Further, the trumpet valve associated with these devices is relatively hard to handle because of the strong springs that are necessary to enable the valves to function. Another suction/irrigation device has been designed to include a disposable electric pump. This design is an improved version of the previously described design but is very expensive in that the pump is disposable. Further, the pump is battery operated and very small, thereby resulting in inadequate flow and pressure to obtain good irrigation during hydro-dissection. A modified version of the trumpet valve is also used, but it is hard to handle and expensive. Web site: http://www.delphion.com/details?pn=US06635034__ •

Portable laparoscopic trainer Inventor(s): Aumann; Robert J. (Mason, OH), Brahm; David R. (Cincinnati, OH) Assignee(s): 3-d Technical Services, Inc. (franklin, Oh) Patent Number: 6,659,776 Date filed: December 28, 2000 Abstract: Disclosed herein is a portable device designed to be used for the training and practice of video-laparoscopic surgical techniques. The device permits practicing surgical techniques that closely simulate actual surgical situations by capturing the surgical work area on a self-contained video camera or digital imaging device and transmitting the captured image to a television monitor, LCD screen or computer, thus allowing the surgical technique to be viewed remotely as well as permitting the procedure to be recorded, and viewed and critiqued later. Excerpt(s): This disclosure relates generally to a device or apparatus to facilitate the practice of surgical techniques on simulated tissue. More specifically, the disclosed device is designed to approximate a laparoscopic surgical theater and to allow the surgical instructor or trainee to demonstrate or practice a variety of laparoscopic techniques while having said techniques recorded and transmitted for viewing by the

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practitioner and/or a broad viewing audience. Laparoscopic surgical simulators are well-known and accepted by practitioners in the art, and these devices are wellrepresented in the patent literature. For instance, U.S. Pat. No. 5,403,191, issued Apr. 4, 1995 to Tuason discloses a rather elaborate apparatus employing an endoscopic video monitoring system and a pair of reflecting mirrors affixed to the upper rim of the device to provide additional perspectives and dimensions to the endoscopic image. Notwithstanding the practical functionality and professional acceptance accorded training devices such as those described, supra, the desire for the apparent contradiction of pairing a simpler design with more sophisticated laparoscopic training capability has prompted the development of the presently disclosed device, which can succinctly be described as follows: A portable surgical training device, ideally suited for teaching and learning laparoscopic surgical techniques comprises essentially an enclosed box or container having at least a pair of portals for inserting and manipulating surgical instruments. Within the box is a work area for the placement of simulated tissue samples for the practice and perfection of surgical techniques by the manipulator of the surgical instruments. Also within the confines of the enclosed box is a video camera situated to focus on the simulated tissue on the work area so that it can capture, record and transmit the activity transpiring on the work area to a remote viewing means. Web site: http://www.delphion.com/details?pn=US06659776__ •

System of laparoscopic-endoscopic surgery Inventor(s): Giannadakis; Emmanuil (4-6 Makrinitsis St., Athens 115 22, GR) Assignee(s): None Reported Patent Number: 6,706,050 Date filed: February 3, 2000 Abstract: An apparatus for laparoscopic-endoscopic surgery is arranged to accommodate a plurality of different surgical instruments and to penetrate the abdominal wall through a single hole. The apparatus includes a piercing laparoscopic cylinder (1), equipped at its external orifice with a multi-instrument base (11, 12, 13) provided with a plurality of holes (14, 15) for receiving said surgical instruments. The piercing laparoscopic cylinder is transversely extendible, the multi-instrument base (12, 12, 13) is elongate and comprises longitudinal ducts registering with holes (14, 15). The apparatus also has a reducer (2) capable of introduction into the piercing laparoscopic cylinder and a number of dividers (3) of variable form and size adapted to be detachably introduced and fitted into the reducer. Excerpt(s): The invention pertains to a laparoscopic surgical system designed to make possible the entry of various laparoscopic instruments into the human body. The present system provides the possibility of simultaneous use of more than one instruments from one and only one hole of the wall over the (intervent) area under surgery, and also of modified currently available laparoscopic-endoscopic instruments as well as the introduction of other surgical instruments. The entry of laparoscopic instruments into the human body has until now been obtained by means of the insertion through a single aperture of a special type piercing laparoscopic cylinder or port ("TROCAR") which may be equipped with reducers. The currently existing laparoscopic TROCARS with a single hole have certain disadvantages in spite of their wide use. For example, they afford a limited space for easy manipulation, necessitate larger and numerous incisions and consequently a larger numbers of scars as well as miore time, preclude the use of curved instruments as well as increase the possibility of leakage of

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inflatory gas and therefore overburden the entire surgical operation. Further more the existing laparoscopic instruments hinder the easy and effective grasping of viscera. The present invention is designed to introduce a laparoscopic surgical system capable of making a larger number of manipulations and of facilitating the use of various instruments, the ultimate result being the reduction of operation time, anesthesia time (thus reducing cost) an improved post operational condition for the patient (less morbidity and hospital time) and better aesthetic result. Web site: http://www.delphion.com/details?pn=US06706050__ •

Technique for depth of field viewing of images using an aspherical lens Inventor(s): Loth; Stanislaw (44 Normandy Village, Apt. 14, Nanuet, NY 10954), Petitto; Tony (346 N. Palm Dr., Beverly Hills, CA 90210) Assignee(s): None Reported Patent Number: 6,313,946 Date filed: February 10, 2000 Abstract: A screen is disclosed for viewing depth of field images. The screen includes a prismatic screen mounted between a flat image and a viewer. Additional optical elements may be provided to enlarge a viewed image. A light hood may be provided to reduce glare and other effects of ambient light. Coating the screen with an anti-reflective coating may provide further protection from ambient light. Restructuring the image into smaller image elements provides image quality for a video image or the like. An aspherical lens may be used to minimize or remove distortion of the image perceived by a viewer to the side, above or below the center viewing axis of the screen. The present invention may find particular application in computer monitor systems, medical and obstetric imaging such as sonograms, musculo-skeletal imaging, vascular imaging, angiograms, angioplasty, dental probes, catheter probes, ear probes, endoscopy, laparoscopy, pelviscopy and arthroscopy. Excerpt(s): Depth of field viewing, as described in U.S. Pat. No. 5,400,177, is accomplished by enhancing depth cues which are present in every flat image, whether photographed or recorded electronically, without the requirement of special glasses, eye shutters or similar devices used in front of the viewers eyes. The depth cues are enhanced by a specially designed prismatic screen that separates the viewer's eye focus and convergence. The separation triggers the brain of the viewer to disregard convergence information indicating that the screen is flat, and to interpret the image depth cues as real. To strengthen the focus and convergence separation and add additional image magnification, the preferred embodiment of the present invention utilizes a specially designed magnifying lens as a supplement to the prismatic screen. The lens helps trigger the eye focus and convergence separation--making it stronger when combined with a prismatic screen such as is disclosed in U.S. patent application Ser. No. 08/155,748, filed Nov. 23, 1993, now U.S. Pat. No. 5,400,177. In addition, depending upon the particular design of the lens, the viewed image may magnified from 1.25.times. to 2.times., and at the same time is cleared (cleaned) from the magnified raster of the video scanning lines. The clearing (cleaning) of the viewed image from the magnified raster is accomplished with the prismatic screen, as described in the parent application. With particular reference to FIGS. 29 to 36 of that application, the prismatic screen PR preferably includes three miniature prisms for each video scan line. As a result, each raster video scan line is divided two or three times, thereby providing a significant reduction in the visibility of the raster lines. In accordance with the present

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invention, as described in greater detail below, the prismatic screen may be either a flat or curved structure, depending upon the choice of additional optical elements in the system. A number of designs on how to magnify a video small screen image to a larger screen image are described in patent literature. For example U.S. Pat. No. 2,449,886 and U.S. Pat. No. 5,061,052 disclose such systems. Each of these designs are based on using a positive lens, or a lens combined with a Fresnel lens, and each technique places the optical system near the front of the video monitor screen. The lenses are designed with a short focal length which may cause distortion, because the magnification of the image is not equal in the center and on the edges. Additionally, the Fresnel lens, which is a concentric design of a magnifying lens, may cause image degradation by lowering the image resolution. According to U.S. Pat. No. 5,061,052, the described system is intended to allow individuals of limited means to enjoy the entertainment and education provided by large screen television images, without the necessity of purchasing a large television set. However, such prior art television magnification of a small screen image to a larger screen image may cause distortion and a poor image, particularly since these systems magnify the raster of scanned video lines which make up the image. When the lines are magnified, the image is degraded and becomes distorted, and eyestrain may result. These and other disadvantages of the prior art are overcome by the present invention. Web site: http://www.delphion.com/details?pn=US06313946__ •

Tool for use at laparoscopic surgery at uterus Inventor(s): Engman; Mikael (Sodertalje, SE) Assignee(s): Endolink AB (sodertalje, Se) Patent Number: 6,174,317 Date filed: March 15, 1999 Abstract: An instrument for use in uterine laparoscopic surgery, said instrument including a tubular element which is adapted for insertion into the vagina with the front end-part of the instrument, as seen in the insertion direction, receiving the cervix, wherewith the edge of the front part of said tubular element is shaped to support against the top wall of the vagina, and wherewith the instrument includes a sealing ring which embraces the tubular element and functions to provide a seal between said element and said vaginal wall. The edge portion of the front part of the tubular element is constructed so that the top wall of the vagina will be supported around the full periphery of said edge portion when the tubular element is positioned in the vagina. The instrument includes end closure means detachably fastened to the tubular element and the rear end-part of the tubular element is adapted to provide an anchorage for a suture which is anchored through the cervix. The rear end of the tubular element, as seen in the insertion direction, carries the end closure means which functions to pressure-seal the passageway passing through said tubular element. Excerpt(s): The present invention relates to an instrument for laparoscopic uterine surgery of the kind having a tubular element which is adapted for insertion into the vagina with the front end-part of the instrument, as seen in the insertion direction, receiving the cervix, the edge of the front part of the tubular element being shaped to support against the top wall of the vagina, and the instrument including a sealing ring which embraces the tubular element and functions to provide a seal between the element and the vaginal wall. It is known in the performance of an hysterectomy to use a tubular element which is inserted into the vagina such as to bear against the cervix,

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wherewith the front part of the tubular element supports against the top wall of the vagina so as to raise and support the same, e.g. in the manner of a "pitched tent"; cf WO 94/10926 for instance. A probe is passed through the tubular element, through the neck of the uterus and into the body of the uterus. The probe has an external thread by means of which it can be screwed firmly to the neck of the uterus, or cervix. One drawback with this known instrument is that the probe blocks the cervical canal. Web site: http://www.delphion.com/details?pn=US06174317__ •

Transvaginal tube as an aid to laparoscopic surgery Inventor(s): McCartney; Anthony John (Swanbourne, AU) Assignee(s): Gynetech Pty Ltd. (au) Patent Number: 6,572,631 Date filed: November 19, 1999 Abstract: A transvaginal tube adapted for insertion into the vaginal tract of a patient for use during performance of a laparoscopic hysterectomy or other laparoscopic surgery on the patient. The tube has a diameter greater than the patient's cervix opening and has a distal end and a proximal end. The proximal end is cut in a plane non-normal to its tubular axis being adapted to define the patient's cervico-vaginal junction. The tube further includes a sealing structure capable of forming a seal at the distal end of the tube during the surgery. The tube is capable of maintaining the pneumoperitoneum when inserted into the vaginal tract of the patient with the seal formed at the distal end of the tube. Excerpt(s): This invention relates to transvaginal tube which is particularly useful in laparoscopic surgery, and also to a procedure for the use of such a tube. Modern advances in laparoscopic surgical equipment have meant that surgeons are able to remove the uterus and/or ovaries laparoscopically, removing the need for a long abdominal incision. A laparoscopic radical hysterectomy for cancer has evolved from the efforts of a few oncology centres with an interest in minimising invasive surgery. The operative technique is analogous to a modification of the operation originally described by Wertheim and Meigs. The laparoscope surgeon passes a 10 mm laparoscope trans-abdominally through a sub-umbilical incision after establishing a pneumoperitineum. Using two lateral portals the ovarian pedicles are divided down to the level of the uterine arteries. The ureter is isolated and protected and the uterine vessels and parametrium are divided after mobilising the bladder. The next stage is to remove the uterus and close the vaginal vault so the pneumoperitoneum can be reestablished for the lymphadenectomy. The lymph nodes are removed by plucking them from their bed and dragging them out of the abdomen through the trans-abdominal wall port used for the grasping forceps. Web site: http://www.delphion.com/details?pn=US06572631__

Patents 101

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Use of ligands specific to major histocompatibility complex-class I antigens for diagnosing endometriosis Inventor(s): Lachapelle; Marie-Helene (Laval, CA), Miron; Pierre (Laval, CA), Roy; Denis-Claude (Laval, CA) Assignee(s): Procrea Biosciences Inc. (ville Mont-royal, Ca) Patent Number: 6,376,201 Date filed: March 2, 1999 Abstract: It is an object of the present invention to provide the clinicians with a new application for ligands specific to MHC-class I antigens, especially HLA-ABC antigens, this new application residing in the detection and diagnosis of endometriosis. It is also an object of the present invention to provide a method and a test kit for diagnosing endometriosis, preferably by immunohistochemistry, using a monoclonal anti- HLAABC antibody as a preferred ligand or diagnostic reagent. This new method is noninvasive and is more reliable as a screening test than the conventionally used laparoscopy. When the endometrium of a woman tests negatively with the claimed method, it prevents the use of laparoscopy which is an invasive method for detecting endometriosis. This method can be practised on a specimen obtained from the endometrium of a patient and does not require a specimen sampled directly from the endometriotic foci. Excerpt(s): This invention relates to the use of ligands specific to a Major Histocompatibility Complex (MHC)- class I antigen, especially an HLA-ABC surface antigen, which is normally exposed at the surface of cell membranes, and which is therefore present in or on endometrial cell, for the diagnosis of endometriosis. The detection of this antigen is carried out according to a process comprising the reaction of a ligand, preferably an antibody, which is normally used to detect the presence of a MHC-class I antigen at the surface of all cells expressing it. This invention also relates to a method for the diagnosis of endometriosis using the same ligand(s). Endometriosis is one of the most common disorders encountered in the field of gynaecology, affecting the health of an estimated 10 to 15% of women during their reproductive years. Although not life threatening, endometriosis is often associated with severe pelvic pain and infertility. Web site: http://www.delphion.com/details?pn=US06376201__

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Uterine cannula and pelvic support for gynecological laparoscopy Inventor(s): Hall; Stuart (PO Box 292, Bentley WA 6982, AU), Singh; Jiwan Steven (231 Timberlane Drive, Woodvale WA 6026, AU) Assignee(s): None Reported Patent Number: 6,423,075 Date filed: August 15, 2000 Abstract: The instrument 10 for gynecological laparoscopy includes a cervical funnel 12 and an intra-uterine cannula 14 disposed axially within the funnel 12. Funnel 12 includes a hollow tube 16 having a proximal end 18 adapted to be inserted into the vagina of a patient. A hollow cone-shaped member 20 is provided at the proximal end 18. The cannula 14 has an outer sheath 58 provided at one end with a threaded cone 60 that threadingly engages the cervix to seal the uterus. An inner manipulation shaft 62

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passes through the sheath 58 and cone 60 to allow manipulation of the uterus. The instrument 10 is supported by a support 92 that would be typically attached to an operating table or bed 96. Support 92 allows the position of the instrument 10 to be varied at will by the surgeon thus alleviating the need of the surgeon or a pelvic assistant to physically support the instrument 10. Seal 192 in the shape of a conical frustum is placed over the cone-shaped member 20 prior to insertion into the vagina. The seal 192 forms a seal about end 196 against the vaginal wall and about end 194 on the tube 16 to prevent loss of pneumoperitoneum during surgery. Excerpt(s): This application claims priority to and hereby incorporates by reference Australian Patent Application No. 36354/00, filed May 22, 2000. The present invention relates to a uterine cannula and pelvic support for gynecological laparoscopy. Gynecological laparoscopic surgery requires a pelvic assistant to hold and manipulate uterine cannulas at the command of the gynecologist. Web site: http://www.delphion.com/details?pn=US06423075__

Patent Applications on Laparoscopy As of December 2000, U.S. patent applications are open to public viewing.10 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 laparoscopy: •

Apparatus and methods for developing an anatomic space for laparoscopic hernia repair and patch for use therewith Inventor(s): Kieturakis, Maciej J.; (San Carlos, CA), Mollenauer, Kenneth H.; (Santa Clara, CA), Monfort, Michelle Y.; (Los Gatos, CA) Correspondence: Lyon & Lyon Llp; 633 West Fifth Street; Suite 4700; Los Angeles; CA; 90071; US Patent Application Number: 20010053919 Date filed: August 17, 2001 Abstract: Laparoscopic apparatus and method for insertion into a space or potential space in a body comprising an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is provided and is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A tunneling member is mounted on the distal extremity of the tunneling shaft. A balloon assembly is provided which is removably secured to the tunneling shaft. The balloon assembly includes a balloon wrapped about said tunneling shaft. A sheath is provided which encloses the balloon on the tunneling shaft. The sheath has a slit extending longitudinally thereof permitting the sheath to be removed whereby the balloon can be released and inflated. A tubular member is provided which has a balloon inflation lumen thereon and is coupled to the balloon for inflating said balloon. Excerpt(s): This invention relates to an apparatus and method for developing an anatomic space for laparoscopic hernia repair and a patch for use therewith. In the past, in developing spaces and potential spaces within a body, blunt dissectors or soft-tipped

10

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

Patents 103

dissectors have been utilized to create a dissected space which is parallel to the plane in which the dissectors are introduced into the body tissue. This often may be in an undesired plane, which can lead to bleeding which may obscure the field and make it difficult to identify the body structures. In utilizing such apparatus and methods, attempts have been made to develop anatomic spaces in the anterior, posterior or lateral to the peritoneum. The same is true for plural spaces and other anatomic spaces. Procedures that have been performed in such spaces include varocele dissection, lymph node dissection, sympathectomy and hernia repair. In the past, the inguinal hernia repair has principally been accomplished by the use of an open procedure which involves an incision in the groin to expose the defect in the inguinal floor, remove the hernial sac and subsequently suture the ligaments and fascias together to reinforce the weakness in the abdominal wall. Recently, laparoscopic hernia repairs have been attempted by inserting laparoscopic instruments into the abdominal cavity through the peritoneum and then placing a mesh to cover the hernia defect. Hernia repair using this procedure has a number of disadvantages, principally because the mesh used for hernia repair is in direct contact with the structures in the abdominal cavity, as for example the intestines, so that there is a tendency for adhesions to form in between these structures. Such adhesions are known to be responsible for certain occasionally serious complications. Such a procedure is also undesirable because typically the patch is stapled into the peritoneum, which is a very thin unstable layer covering the inner abdomen. Thus, the stapled patch can tear away from the peritoneum or shift its position. Other laparoscopic approaches involve cutting away the peritoneum and stapling it closed. This is time consuming and involves the risk of inadvertent cutting of important anatomic structures. In addition, such a procedure is undesirable because it requires the use of a general anesthesia. There is therefore a need for a new and improved apparatus and method for developing an anatomic space and particularly for accomplishing hernia repair by laparoscopy. In general, it is an object of the present invention to provide an apparatus and method for developing an anatomic space. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Clutch for stabilizing and adjusting a probe in laparoscopic surgery Inventor(s): Caputo, Jimmy; (Carlsbad, CA), Doyle, Mark; (San Diego, CA) Correspondence: Knobbe Martens Olson & Bear Llp; 2040 Main Street; Fourteenth Floor; Irvine; CA; 92614; US Patent Application Number: 20040024383 Date filed: July 31, 2002 Abstract: Disclosed is a clutch for a surgical device comprising a housing having an interior wall defining a hollow interior; a shaft, the shaft being capable of moving axially and rotationally within the hollow interior of the housing; at least one clutch element connected with the shaft; and an activator; where the surgical device is a laparoscopic surgical tool. Excerpt(s): The present invention relates to a clutch device to be used for coarse adjustment of the position of a device. In one embodiment, the clutch is used to stabilize and adjust the position of a laparoscopic surgical tool during laparoscopic surgery. Current laparoscopic surgical tools are limited in accessibility of certain regions of the human body. Existing tools can perform invasive surgery without making a substantial incision, but these tools are incapable of bending within the body to reach, for example, the backside of the human heart. In addition, after being placed in the desired position,

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current tools are capable of very small movements at the tip of the tool. If the surgeon desires to move the tip a substantial distance, or reposition the tool, the surgeon must move the entire tool, often with both hands, at which point, the surgeon will not be able to operate the tip of the tool during the movement, and the tool will not be in a stable position during the movement. Consequently, there exists a need in the art to provide a device by which the surgeon can reposition the surgical tool with only one hand while still operating the tip of the tool with the other hand, and while the device remains stable during and after the movement. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Device for assisting laparoscopic surgery Inventor(s): Menon-Johansson, Anatole; (London, GB) Correspondence: William M. Lee, JR.; Lee, Mann, Smith, Mcwilliams, Sweeney & Ohlson; P.O.BOX 2786; Chicago; IL; 60690-2786; US Patent Application Number: 20030212425 Date filed: May 8, 2002 Abstract: A tool is described which is adapted to be attached to the foremost end of a laparoscopic instrument. The tool has a ring at its foremost end adapted to be pushed into contact with the abdomen wall at a point where a trocar is to be inserted, for supporting the abdominal wall around the entry point of the trocar. To assist its use the plane of the ring is angled relative to the lengthwise axis of the instrument, and advantageously the diameter of the ring is selected so that it will admit the tip of the trocar but is too small to allow the trocar to pass completely therethrough. Thus by pushing the ring against the peritoneum, the trocar will be prevented from penetrating significantly into the abdominal cavity. A clamp or stop prevents the tool from leaving the instrument. The instrument may be a laparoscopic telescope, or a probe which is inserted through another incision for viewing by a telescope. A method of controlling the insertion of a trocar through the abdomen of a patient is described using a laparoscopic instrument fitted with such a tool wherein the trocar is first pushed gently against the abdomen where an incision is to be made, the region is viewed from within using a laparoscopic telescope, the ring is positioned against the peritoneum so that the ring surrounds the protrusion in the peritoneum caused by the pressure of the trocar against the external surface of the abdomen wall, and thereafter the pressure of the trocar on the skin is increased and the trocar rotated in known manner to form an incision, whilst firmly pressing the ring in the opposite sense to resist inward movement of the trocar beyond that permitted by the ring. Typically the tool is mounted on the telescope and the combination is pushed through a first incision and used to view and support the peritoneum, while a second incision is made by the trocar. Excerpt(s): This invention concerns a device and method to assist in the insertion of laparoscopic trocars. Minimally invasive surgery creates significant benefits for the patient and the health care delivery service. Patients have fewer post-operative complications plus a speedier discharge following such procedures, whilst hospitals are able to safely increase their turnover of patients because of these shorter hospital stays. Laparoscopic surgery is being used to treat an increasing number of conditions in a range of specialties, including (Gynaecology, General surgery, Cardio-thoracic surgery and Orthopaedics. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Device for laparoscopic tubal ligation Inventor(s): Berky, Craig B.; (Milford, OH), Christy, William J.; (Oviedo, FL), Keller, George; (Columbus, OH), Ward, Thomas J.; (Columbus, OH), Wells, Timothy N.; (Ridgefield, CT), Williamson, Warren P. IV; (Loveland, OH) Correspondence: Kevin G. Rooney; Wood, Herron & Evans, L.L.P.; 2700 Carew Tower; 441 Vine Street; Cincinnati; OH; 45202-2917; US Patent Application Number: 20030216752 Date filed: May 12, 2003 Abstract: The present disclosure relates to a ligating instrument and end effector assemblies for use in laparoscopic tubal ligation procedures. The ligating instrument includes an integral grasping assembly and an integral end effector actuator and is configured to perform a ligating procedure by operation of a single hand of a user. The ligating instrument includes an integral grasper assembly for grasping a tubular tissue section and removable end effector or suture deployment mechanism for holding open a suture to be positioned about the tubular section. The grasper is configured to draw the tubular section into the open loop of suture material and cinch the suture material about the tubular tissue section. A rotator knob may be provided to orient grasper members associated with the grasper assembly relative to the tissue section. An alternative end effector is provided to removably mount on the distal end of the ligating instrument and to cut that part of the tubular tissue section which needs to be removed after the tubular tissue section has been ligated. A relatively soft over mold section may be provided to at least partially enclose the handle of the ligating instrument in order to provide comfort and facilitate a surer grip of the instrument. Excerpt(s): The present disclosure claims priority to U.S. Provisional Application Serial No. 60/248,436, filed Nov. 14, 2000, and entitled, "Device for Laparoscopic Tubal Ligation". The present invention relates to surgical devices and methods and, more particularly, to devices and methods for grasping a tissue segment and delivering a loop of suture material to the tissue segment with a single, one hand operable ligating instrument for the purpose of ligation. Modern surgical techniques often entail the use of endosurgery, wherein large incisions are avoided, and, instead, elongated instruments are inserted into and manipulated through trocars. Typically the surgical site, such as the peritoneum, is viewed remotely, and the surgeon works while watching a monitor. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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ELECTROSURGICAL PROCEDURES

APPARATUS

FOR

LAPAROSCOPIC

AND

LIKE

Inventor(s): BOYLE, DON R.; (BOULDER, CO), EMERLING, PAUL H.; (NEDERLAND, CO), NEWTON, DAVID W.; (BOULDER, CO), ODELL, ROGER C.; (LOUISVILLE, CO), STEINWAY, ROBERT C.; (BOULDER, CO) Correspondence: Nixon Peabody, Llp; 8180 Greensboro Drive; Suite 800; Mclean; VA; 22102; US Patent Application Number: 20010056279 Date filed: June 23, 1998

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Abstract: An electrosurgical instrument having a safety shield for use in laparoscopic or like electrosurgical procedures designed to receive a plurality of electrosurgical instrument inserts. The electrosurgical inserts are designed so as to provide quick and easy attachment to the electrosurgical apparatus while still providing enhanced resistance to rotation forces encountered during an electrosurgical procedure, and to distribute actuation forces occurring during use. The safety shield includes a crimped portion for transferring forces that occur during operation of an articulating instrument inserted therein to a handle assembly of the electrosurgical instrument. The electrosurgical instrument has a seal that reduces or prevents electrical current from flowing between the active electrode and shield assemblies. The electrosurgical instrument further includes a connector assembly for receiving a mating cable connector and providing a fail-safe interconnection therewith. A second preferred embodiment of the electrosurgical instrument is adapted to be removably connected with a replaceable shield/connector assembly through which the instrument is inserted. Furthermore, position of the shield with respect to the electrosurgical instrument can easily be accomplished. Excerpt(s): This invention relates to electrosurgical apparatus and in particular to such apparatus for performing laparoscopic, pelvoscopic, arthroscopic, thoroscopic and the like surgical procedures. Procedures of the foregoing type are experiencing explosive growth in that incisions are kept to a minimum size and thus such procedures facilitate shorter hospital stays and lower costs., For example, with laparoscopic surgery, a patient can return to normal activity within about one week, whereas with procedures where a large incision is made, about a month for full recovery may be required. It is to be understood that hereinafter and in the claims, whenever the term "laparoscopic" is employed, similar procedures such as pelvoscopic, arthroscopic, thoroscopic, and the like where small incisions of the foregoing type are made are also encompassed by this term. Prior art electrosurgical laparoscopic apparatus typically include an active electrode probe that is removably insertable through a trocar sheath and that includes an electrode having an insulative coating thereon. The tip of the probe may be of different conventional shapes such as needle-shape, hook-shape, spatula-shape, graspers, scissors, etc. and serve various conventional functions such as suction, coagulation, irrigation, pressurized gas, cutting, etc. There are, however, various problems which may arise with respect to the use of such a prior art apparatus when used in laparoscopic or like procedures. A first problem may arise if the insulation on the active electrode is damaged thereby allowing active current (possibly in the form of arcing) to pass therethrough directly to the patient's tissue (possibly the bowel or colon) whereby peritonitis may set in within several days. A second problem which can arise with prior art apparatus is caused by a capacitive effect where one electrode of the capacitance is the active electrode and the other electrode of the capacitance is a metallic trocar sheath and the dielectric between these elements is the insulation on the active electrode. Current from the active electrode will be capacitively coupled to the trocar sheath and then returned through the body and the return electrode to the generator. If this current becomes concentrated, for example, between the trocar sheath and an organ such as the bowel, the capacitive current can cause a burn to the organ. A third potential problem occurs if the active electrode contacts another instrument within the peritoneal cavity such as metallic graspers or the like. The above-mentioned capacitive effect also arises in this situation where the first electrode is the active electrode and the second electrode is the metallic graspers or the like. Thus, where the grippers contact a unintended site, injury may occur. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 107

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Endometriosis-related markers and uses thereof Inventor(s): Baban, Soheyl; (Montreal, CA), Bernard, Monique; (Boucherville, CA), Cherry, Elana; (Montreal, CA), Gosselin, Diane; (Pointe Calumet, CA), Hugo, Patrice; (Sainte Dorothee, Laval, CA), Malette, Brigitte; (Montreal, CA), Miron, Pierre; (Laval, CA), Prive, Charles; (Montreal, CA), Shazand, Kamran; (Lle des Soeurs, Verdun, CA) Correspondence: Myers Bigel Sibley & Sajovec, L.L.P.; Suite 250; 111 Corning Road; Cary; NC; 27511; US Patent Application Number: 20020127555 Date filed: February 26, 2001 Abstract: The present invention relates to markers of endometriosis which are differentially expressed in the endometrial cells of females with endometriosis compared to endometriosis-free females. The invention also relates to methods for determining likelihood of endometriosis in female subjects, to methods for grading endometriosis in females suffering from endometriosis and to methods for treating this disease. The invention is also concerned with polynucleotides, probes, primers and kits useful for reducing into practice the above-mentioned methods which are more rapid, non invasive, much less complicated and much less costly than laparoscopy. Excerpt(s): This is a non-provisional application of U.S. provisional application No. 60/185,063 filed on Feb. 25, 2000 and No. 60/225,063 filed on Aug. 17, 2000. The present invention relates to markers of endometriosis and more particularly to methods for determining likelihood of endometriosis in female subjects, to methods for grading endometriosis in females suffering from endometriosis and to methods for treating this disease. The invention is also concerned with polynucleotides, probes, primers and kits useful for reducing into practice the above-mentioned methods. Endometriosis is one of the most common gynecological disorders, affecting up to 10-15% of women of reproductive age. It is mainly associated with severe pelvic pain and/or infertility, but also with dysmenorrhea, dyspareunia, and several other symptoms such as intraperitoneal bleeding, back pain, constipation and/or diarrhea. Endometriosis is characterized by the implantation and growth of endometrial cells (which normally constitute the lining of the uterus) in extra-uterine sites, most frequently in the peritoneal cavity. The severity of the disease can be graded. According the American Society of Reproductive Medicine (ASRM), the disease is classified in four stages, namely, minimal (stage I), mild (stage II), moderate (stage III), and severe (stage IV). Although the etiology and pathogenesis of endometriosis remain unclear, the theory of retrograde menstruation is the most widely accepted to explain the presence of endometrial cells in ectopic sites. However, retrograde menstruation occurs in most women. Thus, a certain genetic potential or predisposition, present in the endometrial cells, might be responsible for the presence of the disease. Initially, this genetic potential may relate to mutations in the genome, but in addition, it may also lead to subsequent altered gene expression. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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ENDOSCOPIC BALLOON FOR SPILL-PROOF LAPAROSCOPIC OVARIAN CYSTECTOMY Inventor(s): Q. Vu, Dinh; (Palo Alto, CA) Correspondence: Knobbe Martens Olson & Bear Llp; 2040 Main Street; Fourteenth Floor; Irvine; CA; 92614; US Patent Application Number: 20030216611 Date filed: May 15, 2002 Abstract: An endoscopic balloon device and method of using in a laparoscopic surgical procedure such as a cystectomy is disclosed. An intact organ such as an ovary is encapsulated with the endoscopic balloon while the organ remains attached to the body. By inserting instruments into the bag, a surgical procedure is then performed within the bag, for example, a cyst may be removed from an ovary. After cyst removal, the bag is irrigated to remove leakage before withdrawal of the cyst within the bag. Excerpt(s): The invention relates in one embodiment to a method of performing an ovarian cystectomy by laparoscopy using a spill-proof endoscopic device. A spill-proof endoscopic device is also disclosed. Within the context of one embodiment of the present invention, ovarian cystectomy refers to the removal of a cyst from an ovary. Laparotomy refers to the traditional method of opening up the abdomen by making a large incision, typically about 12-14 cm in length. Oophorectomy is defined as the removal of the entire ovary. Laparoscopy is a method of performing intra-abdominal surgery via very small incisions, often 1 cm or less in length. Laparoscopic ovarian cystectomy is the removal of a cyst from the ovary using the technique of laparoscopy. Ovarian cystectomy is a commonly performed procedure in gynecology. An attendant risk to this procedure, especially if done via laparoscopy, is the accidental leakage of the cyst content into the peritoneal cavity, which occurs most often during the separation of the cyst from the ovary. This can worsen the prognosis if the cyst turns out to be malignant or can lead to peritonitis if the cyst is a dermoid or mucinous cyst. Because of this hazard, ovarian cystectomy by laparoscopy requires more skill, time, and effort than that done via laparotomy if the cyst is to be removed without spillage. Consequently, many surgeons will opt to go directly to a laparotomy or perform a laparoscopic oophorectomy (which has a much lower risk of cyst leakage because the cyst is not separated from the ovary) instead of a laparoscopic cystectomy if he or she is uncertain about the nature of the cyst. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Filter for use in medical procedures Inventor(s): Booth, Charles S.; (Livonia, MI) Correspondence: Leydig Voit & Mayer, Ltd; 700 Thirteenth ST. NW; Suite 300; Washington; DC; 20005-3960; US Patent Application Number: 20030200738 Date filed: May 8, 2003 Abstract: A filter device for use in medical procedures such as laparoscopy is disclosed. Preferably, the device comprises a filter arrangement and a filter housing having first and second side walls, wherein at least a portion of each of the first and second side walls is flexible and porous.

Patents 109

Excerpt(s): This patent application is a continuation of U.S. patent application Ser. No. 09/856,977, filed on Aug. 10, 2001, which is a 371 of International Patent Application No. PCT/US99/28204 filed Nov. 22, 1999. This application claims the benefit of U.S. provisional patent applications No. 60/110,229, filed Nov. 30, 1998, and No. 60/137,497, filed Jun. 4, 1999, which are incorporated by reference. This invention relates to a filter for use in medical procedures, more particularly, for use in laparoscopic or endoscopic surgery. During some medical procedures, e.g., laparoscopic and endoscopic surgery, a suitable gas is introduced into the abdominal cavity to inflate the abdomen. The inflation of the abdomen tends to separate the interior organs and to provide an enlarged cavity within which to perform the surgery. For example, one or more trocars can be used to puncture the abdomen, and insufflation gas can be passed through at least one of the trocar(s) to inflate the abdomen. One or more instruments involved in the surgery, e.g., a laparoscope, scalpel, laser and/or electrocautery device, can be inserted through the appropriate trocar(s) as needed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Instrument for closing, by subcutaneous suturing, an orifice made in the abdominal wall of a patient Inventor(s): Domergue, Jacques; (Montpellier, FR), Navarro, Francis; (Nimes, FR) Correspondence: William R. Evans; Ladas & Parry; 26 West 61 Street; New York; NY; 10023; US Patent Application Number: 20030028201 Date filed: May 1, 2002 Abstract: The present invention relates to an instrument for closing, by subcutaneous suturing, an orifice made in the abdominal wall of a patient.The instrument is characterized in that it comprises in particular a piston rod (5) whose end acts on a flexible support strip (8) for needles (7), thus causing them to emerge at the exterior of the lower part (4) of the cannula (3) of the instrument underneath the abdominal wall (2), so that the needle can then penetrate into a thick part of this wall.The invention can be used for suturing of orifices after a surgical operation by laparoscopy. Excerpt(s): The present invention relates to an instrument for closing, by subcutaneous suturing, an orifice made in the abdominal wall of a patient. It also relates to a procedure for closing such an orifice by subcutaneous suturing. When a surgical operation is performed by laparoscopy, the patient's abdomen is inflated by a gas and the surgeon uses trocars for the surgical procedure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Laparoscopic anesthetic sprayer system Inventor(s): Moore, Mark; (Tallahassee, FL) Correspondence: Innovation Park; 1673 W. Paul Dirac Drive; Tallahassee; FL; 323103763; US Patent Application Number: 20020151873 Date filed: April 17, 2001

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Abstract: The present invention is a tool for use with laparoscopic surgery. The tool includes a hollow member having a first end and a second end. Each end is open and the first end is adapted to receive a conventional vile or syringe housing anesthetic medicine. The second end includes a sprayer head for enabling the housed anesthetic medicine to be dispensed via the sprayer head. Excerpt(s): The present invention relates generally to a laparoscopic anesthetic sprayer system for use in a laparoscopic surgical case and more particularly to a laparoscopic anesthetic sprayer system having a unique sprayer head that allows physicians to adequately and efficiently inject a specific dose of local anesthetic over a specified time period to internal membranes where it is easily absorbed during laparoscopic surgeries and to inherently reduce post operative pain. Local anesthetics are used in the majority of open surgical cases. The patient benefits of local anesthetics in open surgical cases include a reduction in post-operative pain, smoother emergence from the surgery, lower narcotic needs, earlier discharge, less cardiovascular volatitlity, and less nausea and vomiting. As such, it is seen that currently there is no effective or efficient manner to inject local anesthetics during laparoscopic surgeries. The present invention allows the surgeon to give the same quality of care and benefits to their laparoscopic cases as to their open surgical patients. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Laparoscopic applicator Inventor(s): Almond, Edward; (Leeds, GB), Gilbert, Jean-Marie; (Sur Seine, FR), McMahon, Michael; (Leeds, GB), Moran, Peter; (Leeds, GB), Moran, Stuart; (Leeds, GB) Correspondence: Beyer Weaver & Thomas Llp; P.O. Box 778; Berkeley; CA; 94704-0778; US Patent Application Number: 20020082588 Date filed: May 22, 2001 Abstract: A laparoscopic apparatus for inserting and applying a sheet of surgical material comprising:a handle;a sleeve extending forwardly of the handle;a divided spindle comprising a plurality of elongate members forming jaws which are moveable between an open position in which a sheet of surgical material may be placed between or removed from the jaws and a closed position wherein te sheet may be engaged between the jaws and furled on the spindle, the members being biassed towards the open position;the elongate members extending through said sleeve, and be slidably within sleeve md the elongate members be urged into te closed position as the spindle is withdrawn into the sleeve;the sleeve and the elongate members extending hugh a protective outer tube so that the elongate members and a sheet furled there may be reversibly withdrawn into a forward end of the outer tube. Excerpt(s): This invention relates to apparatus for inserting and applying sheets of surgical material for example absorbable adhesion barrier sheet, in laparoscopic surgery. This invention also relates to a method of use of such apparatus and to the use of the apparatus in application of sheets of surgical material. Adhesion barriers are moisture sensitive and must be protected from contact with moist surfaces during application A surgical instrument for application of adhesion barrier sheets is disclosed in WO92/06638 which discloses a rod around which the sheet may be furled for insertion through a trocar sleeve into the body cavity. EP-A-535506 discloses an instrument wherein a rod-like carrier has a slit to receive the barrier sheet, and a

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cylindrical sleeve into which the rod and furled sheet may be stowed during insertion into the body cavity. WO97/36622 discloses apparatus for endoscopic insertion of a sheet wherein the sheet is engaged by pivotal jaws which may fit inside: a bore during insertion into the body cavity. the sleeve and the elongate members extending through a protective outer tube so that the elongate members and a sheet furled thereon may be reversibly withdrawn into a forward end of the outer tube. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Laparoscopic bipolar electrosurgical instrument Inventor(s): Buysse, Steven P.; (Longmont, CO), Couture, Gary M.; (Longmont, CO), Johnson, Kristin D.; (Louisville, CO), Lands, Michael J.; (Louisville, CO), Lawes, Kate R.; (Superior, CO), Lukianow, S. Wade; (Boulder, CO), Nguyen, Lap P.; (Longmont, CO), Schmaltz, Dale F.; (Fort Collins, CO) Correspondence: Douglas E. Denninger, ESQ.; United States Surgical; A Division OF Tyco Healthcare Group LP; 150 Glover Avenue; Norwalk; CT; 06856; US Patent Application Number: 20030014052 Date filed: June 6, 2002 Abstract: A laparoscopic bipolar electrosurgical instrument for sealing tissue includes a handle having an elongated tube affixed thereto. The tube includes first and second jaw members having electrically conductive sealing surfaces attached to a distal end thereof which are movable from a first position for approximating tissue to a second position for grasping tissue therebetween. The handle includes a fixed handle and a handle which is movable relative to the fixed handle to effect movement of the jaw members from the first position to the second position for grasping tissue. The jaw members connect to a source of electrosurgical energy such that the opposable sealing surfaces are capable of conducting electrosurgical energy through tissue held therebetween. A stop is included for maintaining a minimum separation distance between opposing sealing surfaces. A ratchet is also included to maintain a closure force in the range of about 7 kg/cm.sup.2 to about 13 kg/cm.sup.2 between opposing sealing surfaces. Excerpt(s): This application is a continuation-in-part of U.S. application Ser. No. 09/591,330 filed on Jun. 9, 2000 by Lands et al. entitled "LAPAROSCOPIC BIPOLAR ELECTROSURGICAL INSTRUMENT" which is a continuation of U.S. application Ser. No. 08/970,472 filed on Nov. 14, 1997 by Lands et al. entitled "LAPAROSCOPIC BIPOLAR ELECTROSURGICAL INSTRUMENT", the entire contents of both of these applications are incorporated by reference herein in their entirety. This disclosure relates to an electrosurgical instrument for performing laparoscopic surgical procedures, and more particularly to a laparoscopic electrosurgical instrument that is capable of grasping vessels and vascular tissue with sufficient force between two bipolar jaws to seal the vessel or vascular tissue. Laparoscopic surgical instruments are used to perform surgical operation without making large incisions in the patient. The laparoscopic instruments are inserted into the patient through a cannula, or port, that has been made with a trocar. Typical sizes for cannulas range from three millimeters to twelve millimeters. Smaller cannulas are usually preferred, and this presents a design challenge to instrument manufacturers who must find ways to make surgical instruments that fit through the cannulas. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Laparoscopic instruments and trocar systems and related surgical method Inventor(s): Piskun, Gregory; (Brooklyn, NY) Correspondence: R. Neil Sudol; Coleman Sudol Sapone, P.C.; 714 Colorado Avenue; Bridgeport; CT; 06605-1601; US Patent Application Number: 20030028179 Date filed: September 24, 2002 Abstract: Laparoscopic instruments and trocars are provided for performing laparoscopic procedures entirely through the umbilicus. A generally C-shaped trocar provides increased work space between the hands of the surgeon as well as S-shaped laparoscopic instruments placed through the trocar when laparoscopic instrument-trocar units are placed through the umbilicus. In order to facilitate retraction of intraabdominal structures during a laparoscopic procedure, an angulated needle and thread with either one-or two sharp ends is provided. Alternatively, an inflatable unit having at least one generally C-shaped trocar incorporated within the unit's walls can be placed through the umbilicus following a single incision. Generally S-shaped laparoscopic instruments may be placed through the generally C-shaped trocars to facilitate access to intra-abdominal structures. Excerpt(s): This application is a continuation in part of application Ser. No. 09/397,630 filed Sep. 15, 1999. The present invention relates to surgical instruments, and particularly to laparoscopic instruments, which facilitate the performance of laparoscopic procedures entirely through the umbilicus. Abdominal laparoscopic surgery gained popularity in the late 1980's, when benefits of laparoscopic removal of the gallbladder over traditional (open) operation became evident. Reduced postoperative recovery time, markedly decreased post-operative pain and wound infection, and improved cosmetic outcome are well established benefits of laparoscopic surgery, derived mainly from the ability of laparoscopic surgeons to perform an operation utilizing smaller incisions of the body cavity wall. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Laparoscopic port site fascial closure device Inventor(s): Kerr, Stephen; (Manhattan Beach, CA) Correspondence: Baymond A. Miller; Pepper Hamilton Llp; One Mellon Center, 50th Floorr; 500 Grant Street; Pittsburgh; PA; 15219; US Patent Application Number: 20030167063 Date filed: March 1, 2002 Abstract: A laparoscopic fascial closure device for fashioning a secure closure about a laparoscopic puncture site. The device comprises an elongate cannula having proximal and distal ends. A needle suture complex is selectively deployed from the distal end of the device that is operative to deploy a suture across the puncture site from within the body and draw the free ends of the suture outwardly from the body via the laparoscopic port site. The device is configured to be utilized through a ten millimeter or larger laparoscopic port, and is operative to position the suture at the puncture site such that the suture extends in a diametrically-opposed configuration at least 1.0 cm or greater across opposed sides of the puncture site.

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Excerpt(s): Laparoscopic surgery is a well-known, widely utilized surgical technique that advantageously reduces patient recovery time due to its minimal tissue damage, which consequently permits the patient to return to normal activity in a shorter period of time. Generally, laparoscopic surgery relies upon the formation of one or more trocar puncture wounds through which are deployed surgical instruments and a rod-like telescope with a light source to enable the surgeon to view the organs and conduct the surgery. Notwithstanding the tremendous advantages afforded by laparoscopic surgery, such technique still presents substantial clinical problems. More specifically, the puncture wounds created within the body by the surgeon to gain access to the surgical site are often difficult and time-consuming to close, and can place great demands on the surgeon. Such task is made even more difficult when laparoscopic surgery is performed upon obese patients where there is a relatively deep puncture wound formed through a relatively small puncture site or incision. Indeed, the puncture site frequently needs to be enlarged following the laparoscopic procedure to ensure that the site is closed at the interior abdominal wall. Ironically, the need to enlarge the puncture site in order to adequately close the same partially negates the primary advantages of laparoscopic surgery; however, such practice is essential insofar as failure to properly close the puncture wound can lead to serious medical complications. To address such shortcomings, numerous attempts have been made to develop instruments capable of quickly and effectively forming a closure of a laparoscopic fascial defect or puncture site. Exemplary of such attempts include those devices disclosed in U.S. Pat. No. 5,741,279, issued to Gordon et al., on Apr. 21, 1998, entitled ENDOSCOPIC SUTURE SYSTEM; U.S. Pat. No. 5,374,275, issued to Bradley et al., on Dec. 20, 1994, entitled SURGICAL SUTURING DEVICE AND METHOD OF USE; U.S. Pat. No. 5,964,773, issued to Greenstein on Oct. 12, 1999, entitled LAPAROSCOPIC SUTURING DEVICE AND SUTURE NEEDLES; U.S. Pat. No. 5,403,329, issued to Flinchcliffe on Apr. 4, 1995; and U.S. Pat. No. 5,507,757, issued to Sauer et al. on Apr. 16, 1996, entitled METHOD OF CLOSING PUNCTURE WOUNDS, the teachings of all of which are expressly incorporated herein by reference. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Laparoscopic porting Inventor(s): Gaskill, Harold V. III; ( San Antonio, TX), Gaskill, Harold V. IV; (San Antonio, TX) Correspondence: Charles Hieken; Fish & Richardson PC; 225 Franklin ST; Boston; MA; 02110; US Patent Application Number: 20030149443 Date filed: December 20, 2001 Abstract: A retaining collar for laparoscopic surgery includes a compressible and elastic body that has an inner periphery and an outer periphery where the inner periphery forms a conduit for receiving and securing a tubular device. The retaining collar also includes a rigid portion attached to the compressible and elastic body. The rigid portion has an inner periphery, an outer periphery and a cam lock where the inner periphery forms an aperture that aligns with the conduit and the cam lock receives and retains a suture. Excerpt(s): This invention relates to laparoscopic surgery and in particular to laparoscopic porting. Laparoscopic surgical methods require that a portal of entry be created in an abdominal wall. This portal of entry is used to introduce an inert gas, such

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as carbon dioxide, into an abdominal cavity in a process called insufflation. By blowingup the abdominal cavity like a balloon, a space is created inside the abdominal cavity that allows the surgeon to easily view and access the operative field. This portal of entry is also used for the sequential introduction and removal of surgical instruments such as video imaging devices, scissors, graspers, and devices for suctioning and irrigation of the abdominal cavity. Methods of placing these portals are well known to surgeons. One method is to make an incision in the skin of the abdominal wall with a knife or other cutting instrument. This incision is carried down to a fascia or an inner fibrous layer of the abdomen. An opening is then created in the fascia large enough to accommodate a cannula or a port device. Surgical sutures are then placed in the edges of the opening of the fascia. The cannula or port device is then inserted through the incision in the skin, through the hole in the fascia, and into the abdominal cavity. The sutures are then wrapped or tied around the port device to retain it during the operation. The port device then acts as a conduit for surgical instruments as described above. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

LAPAROSCOPIC SAC HOLDER ASSEMBLY Inventor(s): HARRINGTON, FRANK; (CATONSVILLE, MD), MCCLELLAN, WALTHER M.; (GAITHERSBERG, MD) Correspondence: Knobbe Martens Olson & Bear Llp; 620 Newport Center Drive; Sixteenth Floor; Newport Beach; CA; 92660; US Patent Application Number: 20020019594 Date filed: August 5, 1999 Abstract: This invention relates to a surgical device and methods for accessing and retrieving a tissue mass from a body cavity through a minimally invasive laparoscopic procedure. The device consists of a handle comprising an inner rod, which is rotatably engaged within a tubular member, and a loop adapted to hold a surgical bag. The loop comprises first and second bowed leaf elements, wherein the first bowed leaf element is attached to the inner rod and the second bowed leaf element is attached to the tubular member. The device further has a rotatable articulation, such as a hinge, joining the first and second bowed leaf elements, wherein rotation of the inner rod causes the first bowed leaf element to rotate about the articulation, such that the surgical bag may be opened and closed by rotation of the inner rod. Excerpt(s): This invention relates to a surgical device and methods for accessing and retrieving tissue from a body cavity through minimally invasive endoscopic procedures. In recent years, the applications for endoscopic surgery, and in particular, laparoscopic surgery, have -expanded to include many different procedures. A benefit of laparoscopic operations is the relatively quick recovery period experienced by patients, due to the small incisions that are made in the body. These incisions reduce the trauma and the required healing compared to traditional surgery. Laparoscopic tubes and sleeves with diameters on the order of about 5 to 15 millimeters are inserted through the incisions to aid in accessing the tissue in the body cavity. Various instruments and video camera are typically directed through the laparoscopic sleeves for performing and monitoring the surgical steps. A particular concern in laparoscopic surgery is the transporting of tissues and other mass that are cut away or retrieved during the surgery. While moving, manipulating or morcellating the mass within the body cavity, pieces of infected or cancerous mass, blood, bile, and other liquids may escape and pose infection problems or other complications. It is desirable to contain these materials in a bag or

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similar enclosure within the body cavity before removal to minimize the risk of infection or other complications. Thus, while it is important that the bag possess sufficient stability and impermeability, particularly during mechanical morcellation, it is also desirable that containment of the materials be accomplished as quickly as possible with minimal disturbance to the surgical site. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Laparoscopic sealed access device Inventor(s): Bonadio, Frank; (Bray, IE), Cushieri, Alfred; (Fife, GB), McManus, Ronan Bernard; (Bray, IE), Reid, Alan; (Clontarf, IE), Young, Derek William; (Blackrock, IE) Correspondence: Finnegan, Henderson, Farabow, Garrett &; Dunner Llp; 1300 I Street, NW; Washington; DC; 20005; US Patent Application Number: 20020072762 Date filed: March 13, 2001 Abstract: A hand access device for use in hand assisted laparoscopic surgery comprises a substantially tubular inflatable sleeve of pliable gas tight material having a twisted inner sleeve section and an outer sleeve section. The device has an inner O-ring for insertion through a wound opening in the abdominal wall and an outer O-ring for location outside of the wound opening. On insertion of a surgeon's arm the sleeve everts while monitoring a reduced lumen seal to the arm and a seal to the wound openings. Excerpt(s): The invention relates to a medical device particularly for use in surgery to provide surgical access to the abdomen and maintain a gas-tight seal around the arm or an instrument during surgery. Surgery of this type is referred to as hand-assisted laparoscopic surgery or hand-access surgery. Conventional abdominal surgery requires the creation of an incision in the abdominal wall to allow access to, and visuaiisation of the internal organs and other anatomical structures. These incisions must be large enough to accommodate the surgeons hands and any instruments to be utilised by the surgeon during the surgery. Traditionally the size of these incisions has been dictated by the need to see, retract and palpate internal bodily structures. While a large incision will provide access to the interior of the abdomen they are associated with longer healing times, are more susceptible to infection and result in unsightly scars. Alternatives to open surgery exist in the form of endoscopic or laparoscopic surgery. In this method of surgery, the surgeon operates through small incisions using remotely actuated instruments. The instruments pass through the abdominal wall using devices called trocars. These working channels typically have a diameter ranging from 5 to 25 milimeters. Vision is provided using a laparoscope which is typically 20 to 25 centimeters long and uses fibre-optic technology or a CCD camera to provide the operator with a picture of the interior of the abdomen. The abdomen must be insufflated with a gas such as carbon dioxide or nitrogen to maintain a bubble effect and provide a viable working space for the operator to perform the surgery unhindered by the lack of space. This insufflation creates a working space known as the pneumoperitoneum. Trocars through which instruments are inserted are constructed to prevent loss of the gas through them resulting in collapse of the pneumoperitoneum. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Laparoscopic specimen extraction port Inventor(s): Shimm, Peter; (Chevy Chase, MD) Correspondence: Pillsbury Winthrop, Llp; P.O. Box 10500; Mclean; VA; 22102; US Patent Application Number: 20030199915 Date filed: April 19, 2002 Abstract: A laparoscopic surgical extraction port (LSEP) includes a port having a radially-enlarged distal end. A sheath having a plurality of circumferentially-spaced prongs is slidingly mounted onto the port. With the prongs contracted radially-inwardly and the LSEP in its contracted position, a surgeon inserts the LSEP into a patient's abdominal cavity through an incision. The surgeon then expands the LSEP by pulling the port rearwardly such that the radially-enlarged distal end expands the prongs radially-outwardly. The surgeon then positions a specimen and endo-bag in the funnel formed by the expanded prongs. The specimen, endo-bag, and prongs are thereafter simultaneously extracted through the incision. A radially-inward force that is applied to the prongs by the incision substantially prevents the specimen from bunching or rupturing during the extraction process. Excerpt(s): The present invention relates generally to laparoscopic trocars/ports, and more specifically to laparoscopic specimen extraction ports (LSEPs) that prevent the extracted specimen from bunching up in an endoscopic specimen retrieval bag prior to removal through the abdominal wall, for example. The surgical instruments that are inserted through the laparoscopic port 30 typically include a video camera that enables the surgeon to visualize the surgical procedure. Variously sized surgical ports 30 are designed to be used with variously sized instruments. Typical instruments require surgical ports 30 with axial holes 26 having 5 mm inside diameters. As is discussed in greater detail below, endoscopic specimen retrieval bags ("endo-bags.TM.") typically are inserted through ports 30 that have holes 26 with 10 mm inside diameters and 12 mm outside diameters. During laparoscopic surgery, the abdomen is insufflated with carbon dioxide to distend the abdominal cavity 40 (creating pneumoperitoneum) and allow for better visualization of the surgical operation. Each port 30 includes a flapper valve 45 (see FIGS. 15 and 16) that opens to allow the surgeon to insert an instrument therethrough and automatically closes when the instrument is removed so as to prevent the loss of pneumoperitoneum. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Laparoscopic spray device and method of use Inventor(s): Epstein, Gordon; (Fremont, CA), Spero, Richard; (Brentwood, CA), Yardimci, Atif; (Northbrook, IL) Correspondence: Oppenheimer Wolff & Donnelly Llp; 840 Newport Center Drive; Suite 700; Newport Beach; CA; 92660; US Patent Application Number: 20030069537 Date filed: October 5, 2001 Abstract: A laparoscopic spray device for selectively applying a multiple component material dispensed from a multiple component material applicator to a surgical site in vivo is disclosed. The device comprises an interface member capable of engaging a multiple component applicator, a body having at least two lumens therein, and a

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detachable spray tip in fluid communication with the body. The detachable spray tip includes a mixing chamber having at least one flexible mixing member positioned therein which is capable of creating a turbulent flow within a mixing chamber. In addition, the at least one mixing member prevents a back flow of material from the mixing chamber to the at least two lumens. The present invention is particularly useful in remotely applying multiple component tissue adhesives to an internal incision. Excerpt(s): In recent years, minimally invasive surgical techniques have emerged as an alternative to conventional surgical techniques to perform a plurality of surgical procedures. Minimally invasive procedures differ from conventional surgical procedures in that a plurality of devices may be introduced into the body through a small incision. As a result, trauma to the body is greatly reduced, thereby decreasing the recovery time of the patient. One example of a common minimally invasive surgery involves laparoscopic surgical procedures. Laparoscopic procedures may be used to treat hernias, colon dysfunctions, gastroesophageal reflux disease, and gallbladder disorders. Typically, the patient undergoing the procedures will return home hours after undergoing surgery. Generally, laparoscopic procedures require making at least one small incision in the patient's abdomen near the area of interest. A cannula or trocar may be inserted into to the incision to limit blood loss and reduce the likelihood of infection. Thereafter, various surgical instruments are introduced into the patient's body through the incision. Generally, these instruments enable the surgeon to visualize the inside of the patient's body and access the internal organs of the patient. Current laparoscopic surgical instruments include cameras, scissors, dissectors, graspers and retractors. Generally, these instruments include a handle attached to an elongated body having a distal tip used to execute the particular procedure. The handle, which remains outside the patient's body, is used by the surgeon to control the operation of the instrument during the procedure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Laparoscopic tool and method Inventor(s): Peterson, Francis C.; (Prescott, WI) Correspondence: Crawford Pllc; 1270 Northland Drive, Suite 390; ST. Paul; MN; 55120; US Patent Application Number: 20010029353 Date filed: March 1, 2001 Abstract: The present invention is directed to an apparatus for use in internal surgical procedures and is particularly advantageous for use in laparoscopic surgical procedures. An example implementation is directed to a tool having a depth-adjustable cannula having an upper portion that rests on the body, and having an automaticallysealing channel that readily accepts the insertion and removal of surgical instruments without permitting gases to pass. In one particular embodiment, the tool includes a lowprofile platform for stabilizing the tool on a body layer, a projection channel with a flexible sleeve for maintaining the channel closed, and an adjustable member for setting the penetration depth of the tool. The flexible sleeve is sufficiently elastic to close the inner channel in response to pressurization between the outside of the flexible sleeve and the inner surface of the hollow channel. The low-profile platform and the adjustable member permit use of the same tool for different body-wall thicknesses.

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Excerpt(s): This is a continuation application of U.S. patent application Ser. No. 09/246,228, filed on Feb. 8, 1999 (PHIL.110PA), which is related to U.S. patent application entitled, "Choker-Catheter," Ser. No. 08/988,157, filed on Dec. 12, 1997 (now U.S. Pat. No. 6,004,303), and assigned to the instant assignee and incorporated herein in its entirety, to which priority is claimed. The present invention relates to an apparatus for use in laparoscopic surgery and, more particularly, to an apparatus for providing a seal or valve structure within a cannula which effectively and cost efficiently prevents inert gas from escaping while allowing the repeated insertion and removal of surgical instruments through the cannula. Recent advancements in surgical techniques and instruments have permitted for incisions of reduced size for a variety of surgical procedures. For example, surgical procedures which only a few years ago required an incision six or seven inches in length are today performed through incisions requiring less than one inch in length. Among other advancements, one type of surgical instrument that has been significant in this regard is the trocar. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Laparoscopic-assisted endovascular/endoluminal graft placement Inventor(s): Swanstrom, Lee L.; (Portland, OR) Correspondence: Harris Zimmerman, ESQ.; Suite 710; 1330 Broadway; Oakland; CA; 94612; US Patent Application Number: 20030135269 Date filed: January 16, 2002 Abstract: A method and apparatus for repair of AAA uses a graft that is introduced intraluminally and secured through laparoscopic and percutaneous access to the repair site. The arterial graft is a flexible, tubular sleeve that is free of any stent structure. A catheter assembly for delivering the graft includes a removable mechanical expansion assembly that is temporarily expanded to impinge the graft ends against the arterial wall to enable fixation of the graft ends. The fastener assembly for securing the graft includes an inner retention member and a pair of deformable wires extending from the inner retention member. The inner retention member is inserted via needle through the arterial wall and the graft and tension is applied to the wires and the inner retention member pulls the graft end into close impingement with the intimal surface of the vessel. Excerpt(s): The present invention relates to an apparatus and method for repairing an anatomic vessel wall or the wall of a hollow organ or duct, such as the esophagus or aorta, particularly in the human body. More specifically, the invention relates to devices and methods for delivering a vessel graft or other graft endovascularly or endoluminally to a placement site, and thereafter securing the graft using laparoscopic or percutaneous techniques. A notable use for the present invention is with regard to an abdominal aortic aneurysm (hereinafter, "AAA". AAA is a weakening of the wall of the aorta in the abdominal area. Over 160,000 AAAs are diagnosed annually in the United States; one-quarter of AAAs will eventually rupture and, despite many advances in acute medical care, medical transport, and resuscitation, ruptured AAAs continue to have a 50% mortality rate. Thus AAAs comprise a serious health problem for which, arguably, effective treatment has yet to be developed. Because of the negative aspects of the otherwise effective open surgical procedure, alternative techniques have been developed in the prior art. An early attempt, transfemoral intraluminal graft implantation for AAA, involved inserting a stent graft through the femoral artery and

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guiding it to the aneurysm site. Upon proper positioning of the stent graft, the stent was deployed and grafted to the vascular walls of the aorta. The use of stent grafts has decreased patient morbidity and, because of the less invasive nature of the technique used to introduce, deploy, and secure the graft, has significantly reduced the problems involved with the open surgical techniques traditionally used for AAA repair. That is, there is less blood loss, less operative pain, a shorter hospital stay, and quicker healing of the smaller incisions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Magnetic positioning system for trocarless laparoscopic instruments Inventor(s): Baker, Linda A.; (Southlake, TX), Bergs, Richard; (Rowlett, TX), Cadeddu, Jeffrey A.; (Dallas, TX) Correspondence: Edwin S. Flores; Gardere Wynne Sewell Llp; 3000 Thanksgiving Tower; 1601 Elm Street, Suite 3000; Dallas; TX; 75201-4767; US Patent Application Number: 20030114731 Date filed: December 14, 2001 Abstract: The present invention relates to methods and apparatuses for performing surgery, and in particular to devices employing magnetic fields to position and orient medical instruments inside a human body. To provide for greater flexibility of endoscopic viewing and instrument usage and to reduce morbidity, the inventors have developed of a novel laparoscopic system that allows for intra-abdominal movement of an endoscopic camera and surgical instruments without additional port sites. A set of one or more magnets located external to the patient's body are used to position, orient, and/or secure instruments located internal to the patient's body. Excerpt(s): The present invention relates to a method and apparatus for performing surgery, and in particular to employing magnetic fields to position and orient medical instruments inside a human body. Many surgical procedures are now being performed with the use of trocars and cannulas. Originally these devices were used for making a puncture and leaving a tube to drain fluids. As technology and surgical techniques have advanced, it is now possible to insert surgical instruments through the cannulas and perform invasive procedures through openings less than half an inch in diameter. These surgical procedures previously required incisions of many inches. By minimizing the incision, the stress and loss of blood suffered by a patient is reduced and the patient's recovery time is dramatically reduced. Surgical trocars are most commonly used in laparoscopic surgery. Prior to use of the trocar, the surgeon will usually introduce a Veress needle into the patient's abdominal cavity. The Veress needle has a stylet, which permits the introduction of gas into the abdominal cavity. After the Veress needle is properly inserted, it is connected to a gas source and the abdominal cavity is insufflated to an approximate abdominal pressure of 15 mm Hg. By insufflating the abdominal cavity, pneumoperitoneum is created separating the wall of the body cavity from the internal organs. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Methods and instruments for laparoscopic spinal surgery Inventor(s): DeRidder, Steven D.; (Bartlett, TN), McGahan, Thomas V.; (Memphis, TN), Zdeblick, Thomas; (Middletown, WI) Correspondence: Woodard, Emhardt, Naughton,; Moriarty And Mcnett Llp; Bank One Center/tower; 111 Monument Circle, Suite 3700; Indianapolis; IN; 46204-5137; US Patent Application Number: 20030083666 Date filed: December 4, 2002 Abstract: Surgical techniques and instruments are provided for performing surgical procedures in a disc space. The instrument includes a sleeve having a distal end and an opposite proximal end and a working channel extending therebetween. The working channel includes a first portion and an adjacent second portion configured to receive surgical instruments therethrough. A cap member is secured to the sleeve at the proximal end. The cap member has a sealable access port substantially aligned with a corresponding one of the first or second portions. The cap member is movable with respect to the sleeve to substantially align the access port with the other of the first and second portions while the working channel remains sealed. Various techniques using various surgical instruments in laparoscopic procedures are also disclosed. Excerpt(s): This application is a divisional of U.S. patent application Ser. No. 09/525,972 filed in Mar. 15, 2000, which is incorporated herein by reference in its entirety. The present invention relates generally to methods and instruments for performing spinal surgery. Specifically, the invention concerns laparoscopic techniques and instruments to perform spinal surgeries. The use of surgical techniques to correct the causes of low back pain, such as spinal injuries and deformities, has steadily increased over the last several years. One common procedure for relieving pain from the above-described problems is a discectomy, or surgical removal of a portion or all of an intervertebral disc, followed by implantation of a device between the adjacent vertebrae, such as a vertebral implant or fusion device. Typically, implantation of such a device is intended to promote bony fusion between the adjacent vertebral bodies. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Precision endoscopic imaging system Inventor(s): Chen, Min; (Brookline, MA) Correspondence: Stephen G. Matzuk; P. O. Box 767; Boston; MA; 02102; US Patent Application Number: 20030202630 Date filed: September 6, 2002 Abstract: An imaging system is disclosed for use in low-light environments or environments where low-levels of such radiation is desirable. Examples of such environments are endoscopy, laparoscopy, mammography and night photography. In the case of radiation that is other than visible light, a radiation converter and method for fabricating same is disclosed. The radiation converter comprises a film of heavy scintillator (e.g. CdWO.sub.4) coated on a fiber optical window to efficiently convert the radiation into visible light. The visible light is passed into a signal amplifier employing a focussing electron-bombarded charge-couple device (FEBCCD) or a focussing electronbombarded complementary metal-oxide semiconductor (FEBCMOS) to amplify the

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signal. Novel methods of performing three-dimension imaging using this system as well as removing the effects of high-speed movement are also disclosed. Excerpt(s): This application is a Continuation-In-Part of U.S. patent application Ser. No. 09/245,959, PCT/US96/19213, incorporated by reference. The present invention relates generally to precision imaging systems. More particularly, the invention relates to precision endoscopic (and other, e.g. mammographic) imaging systems that operate at low levels of radiation to form a high-resolution image. In endoscopic imaging systems, high image resolution and high sensitivity (or low radiation) is an important system characteristic. This is particularly true in medical imaging through where the clarity and contrasts within an image directly affect the diagnostic capabilities of a physician. That is, the higher the resolution and the higher the sensitivity, the earlier and easier the detection of abnormalities is. Likewise, industrial uses such as quality control of product components operate in much the same manner and lack of detection of abnormalities can have similarly disastrous results. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System and method for releasably holding a surgical instrument Inventor(s): Hill, John W.; (Palo Alto, CA), Jensen, Joel F.; (Redwood City, CA) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20030130648 Date filed: October 4, 2002 Abstract: The invention is directed to a system and method for releasably holding a surgical instrument (14), such as an endoscopic instrument configured for delivery through a small percutaneous penetration in a patient. The instrument comprises an elongate shaft (100) with a pair of mounting pins (116) laterally extending from the shaft between its proximal and distal ends. An instrument holder comprises a support having a central bore (202) and an axially extending slot (204) for receiving the instrument shaft and the mounting pins. A pair of locking slots (206) are cut into the support transversely to and in communication with the axial slot so that the mounting pins can be rotated within the locking slots. The instrument support further includes a latch assembly for automatically locking the mounting pins within the locking slots to releasably couple the instrument to the instrument holder. With this twist-lock motion, the surgeon can rapidly engage and disengage various instruments from the holder during a surgical procedure, such as open surgery, laparoscopy or thoracoscopy. Excerpt(s): This invention relates to surgical manipulators and more particularly to robotic assisted apparatus for use in surgery. In standard laparoscopic surgery, a patient's abdomen is insufflated with gas, and trocar sleeves are passed through small (approximately 1/2 inch) incisions to provide entry ports for laparoscopic surgical instruments. The laparoscopic surgical instruments generally include a laparoscope for viewing the surgical field, and working tools such as clamps, graspers, scissors, staplers, and needle holders. The working tools are similar to those used in conventional (open) surgery, except that the working end of each tool is separated from its handle by an approximately 12-inch long extension tube. To perform surgical procedures, the surgeon passes instruments through the trocar sleeves and manipulates them inside the abdomen by sliding them in and out through the sleeves, rotating them in the sleeves, levering (e.g., pivoting) the sleeves in the abdominal wall, and actuating end effectors on

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the distal end of the instruments. In robotically-assisted and telerobotic surgery (both open surgery and endoscopic procedures), the position of the surgical instruments is controlled by servo motors rather than directly by hand or with fixed clamps. The servo motors follow the motions of a surgeon's hands as he/she manipulates input control devices at a location that may be remote from the patient. Position, force, and tactile feedback sensors may be employed to transmit position, force, and tactile sensations from the surgical instrument back to the surgeon's hands as he/she operates the telerobotic system. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Trocar assembly Inventor(s): McFarlane, Richard H.; (Riviera Beach, FL) Correspondence: Malloy & Malloy, P.A.; 2800 S.W. Third Avenue; Historic Coral Way; Miami; FL; 33129; US Patent Application Number: 20020019609 Date filed: May 30, 2001 Abstract: A trocar assembly structured to regulate fluid flow as well as the introduction of predetermined medical instrumentation into and out of a body cavity of a patient during a surgical procedure such as, but not limited to laparoscopy, endoscopy, etc. The trocar assembly includes a housing having a hollow interior secured at one end to an elongated open ended sleeve through which fluid flow and medical instrumentation passes. A valve assembly includes a valve member disposed within the hollow interior and a valve structure including a valve seat rotatably connected to the housing such that the valve seat is selectively rotatable relative to the valve member and into and out of fluid sealing engagement therewith so as to respectively define a valve-closed position and a valve-open position. The valve assembly may be rotated between the aforementioned open and closed positions utilizing one hand of the person operating the trocar assembly, wherein the valve assembly will automatically remain either in an open or closed position, without continuous pressure being exerted thereon by the personnel operating the trocar assembly. Excerpt(s): The present application is based on and a claim to priority is made under 35 U.S.C. Section 119(e) to provisional patent application currently pending in the U.S. Patent and Trademark Office having Serial No. 60/208,351 and a filing date of May 31, 2000. This invention relates to a trocar assembly structured to facilitate access to internal body cavities of a patient for purposes of performing laparoscopic, arthroscopic, endoscopic or other surgical procedures, wherein inflation and deflation of the body cavity is facilitated by a valve assembly incorporated in the trocar assembly. The valve assembly is selectively positionable between a valve-open and a valve-closed position utilizing a single hand of the operator of the trocar assembly by rotating an externally accessible portion of the valve assembly, wherein the valve assembly is maintained in the preferred open or closed position without external pressure being maintained thereon. In the medical field, the trocar assembly is recognized as an instrument of primary importance when an intended surgical procedure only requires the formation of a small incision to provide access to an internal body cavity or one or more organs located therein. The popularity of modern day trocar assemblies is based in part on technical advances in the medical profession which have reduced the need of surgical procedures involving the forming of substantially large incisions through the body wall or outer bodily tissue, in order to provide access to internal body cavities. It is well

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recognized, that the forming of large incisions utilized in open surgical procedures are traumatic in nature and significantly increase the time required of a patient to completely recover from a surgical procedure, as well as add to the pain and discomfort during such recuperative period. As a result, laparoscopic, arthroscopic, endoscopic and other surgical procedures involve the formation of one or more small openings in the outer body wall utilizing an appropriate penetrating instrument or obturator, in combination with a trocar assembly. 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 laparoscopy, 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 “laparoscopy” (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 laparoscopy. You can also use this procedure to view pending patent applications concerning laparoscopy. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON LAPAROSCOPY Overview This chapter provides bibliographic book references relating to laparoscopy. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on laparoscopy include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “laparoscopy” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on laparoscopy: •

Laparoscopy in Children Source: Heidelberg, Germany: Springer-Verlag. 2003. 147 p. Contact: Available from Springer-Verlag. Tiergartenstr. 17, D-69121 Heidelberg, Germany. (49)6221-487-0. Website: www.springer.de. E-mail: [email protected]. PRICE: $69.95 plus shipping and handling. ISBN: 3540429751. Summary: Most surgeons are familiar with the techniques of laparoscopic surgery, however, in children there are variations in size and technical approach. This book describes the differences and characteristic aspects of laparoscopy in small children. The book is an atlas of numerous drawings, accompanied by textual descriptions. Technical guidelines are given on how to perform laparoscopy safely, even in small children. Topics include patient selection, anesthesia, insufflation, trocar insertion, instruments, ligating, needle insertion, suturing, adhesiolysis, appendectomy, cholecystectomy (gallbladder removal), cryptorchidism, fundoplication, inguinal hernia, intussusception,

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liver biopsy, Meckel's diverticulum, ovary, pyloromyotomy, sigmoid resection, splenectomy, varicocele, thoracoscopy, and postoperative care. The aim of the book is to provide surgeons with the knowledge to extend their expertise in adult laparoscopy to children. A subject index concludes the textbook. •

Essentials of Laparoscopy Source: St. Louis, MO: Quality Medical Publishing, Inc. 1994. 285 p. Contact: Available from Quality Medical Publishing, Inc. 11970 Borman Drive, Suite 222, St. Louis, MO 63146. (800) 348-7808 or, in Missouri, (314) 878-7808. Fax (314) 878-9937. PRICE: $40. ISBN: 0942219538. Summary: This book is intended to prepare the surgeon for performing laparoscopy. The authors concentrate on the basic techniques, instrumentation, and complications unique to laparoscopy in a practice, straightforward, step-by-step manner. Topics include patient selection and preparation; room set-up and patient positioning; anesthetic considerations; establishing the pneumoperitoneum; abdominal access; laparoscopic examination of the abdomen and pelvis; laparoscopic suturing and knot tying; laparoscopic clips and staples; exiting the abdomen; postoperative care; complications of laparoscopy; strategies for prevention and treatment; and pediatric applications of laparoscopy. More than 250 original line drawings clarify each laparoscopic principle. The book is designed to fit within the pocket of a laboratory coat and has a special lay-flat binding and large, easy-to-read print. (AA-M).

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Guide to Laparoscopic Surgery Source: Malden, MA: Blackwell Science, Inc. 1998. 169 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail: [email protected]. Website: www.blackwell-science.com. PRICE: $54.95. ISBN: 086542649X. Summary: This book reviews the important aspects of laparoscopy that every surgeon needs to know. The authors address the needs of trainees in all surgical disciplines, as well as the concerns of qualified surgeons, urologists, and gynecologists. The emphasis is on procedures and practical approaches; four sections are included. In the introduction, the authors review the advantages and disadvantages of laparoscopy, risk factors, combined laparoscopy and open surgery, physiological changes during laparoscopy, anesthesia during the procedures, and postoperative management. The second section on equipment, instruments, basic techniques, problems and solutions includes: imaging and viewing, sterilization and maintenance of optics and the camera, creation of the pneumoperitoneum access, gasless laparoscopy, Veress needle procedures, primary cannula insertion, open cannulation (Hasson's technique), secondary cannula, extraperitoneal laparoscopy, instruments for dissection, diathermy and electrocautery, hemostasis, laser, ultrasound, high velocity water jet, ligation and suturing, and specimen extraction. The section on setting up in the operating theater covers hand instruments, equipment, patient position and preparation, and setting up for the procedure. The final section on laparoscopic procedures themselves, covers diagnostic laparoscopy, laparoscopic ultrasonography, adhesiolysis, cholecystectomy (gallbladder removal), management of common bile duct stones, appendectomy, laparoscopic Nissen's fundoplication, gastroenterostomy, truncal vagotomy, laparoscopy for perforated duodenal ulcer, splenectomy, laparoscopy for undescended testicles, varicocele, laparoscopic simple nephrectomy (kidney removal), and inguinal

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hernia repair. The book is illustrated with numerous line drawings of the equipment and procedures being discussed. A subject index concludes the book. •

Laparoscopic Urology Source: St. Louis, MO: Quality Medical Publishing, Inc. 1993. 450 p. Contact: Available from Quality Medical Publishing, Inc. 11970 Borman Drive, Suite 222, St. Louis, MO 63146. (800) 348-7808 or, in Missouri, (314) 878-7808. Fax (314) 878-9937. PRICE: $90. ISBN: 0942219414. Summary: This book, written by experts in the field of urology, contains the information essential to urologists and general surgeons performing urologic laparoscopic surgery. The book guides readers step-by-step through the basics, including patient selection and preparation, room set-up, patient positioning, trocar placement, and knot tying; and through the surgical techniques used to treat urologic disorders, including lymphadenectomy, varicocelectomy, nephrectomy, nephroureterectomy, and retroperitoneoscopy. Postlaparoscopic patient management and complications of laparoscopic surgery are also addressed. Appendices cover instrumentation, a patient education booklet, codes for urologic procedures performed with laparoscopy, informed consent, and a periprocedural order sheet. 402 figures. (AA-M).

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Laparoscopy in Urology Source: Oxford, England: Blackwell Science, Inc. 1994. 162 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail: [email protected]. PRICE: $99.95. ISBN: 0632036648. Summary: This medical textbook provides readers with an update of the use of laparoscopy in urology. Twenty chapters cover topics including the history of laparoscopy, instrumentation, general laparoscopic techniques, anesthesia for laparoscopy, complications of laparoscopy, the metabolic response to operative laparoscopy, laparoscopy for the nonpalpable testicle, and the laparoscopic approach to the following procedures: varicocelectomy, herniorrhaphy, appendicectomy, pelvic lymphadenectomy, para-aortic lymphadenectomy, retroperitoneal surgery, transperitoneal nephrectomy, colposuspension, bladder-dome transection, ileal conduit diversion, partial cystectomy, and lymphocele drainage. The book is illustrated throughout with medical drawings and full color photographs of laparoscopic procedures. A subject index concludes the text.

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Surgical Laparoscopy Source: St. Louis, MO: Quality Medical Publishing, Inc. 1991. 359 p. Contact: Available from Quality Medical Publishing, Inc. 2086 Craigshire Drive, St. Louis, MO 63146. (314) 878-7808. PRICE: $110, shipping and handling free with prepaid orders. ISBN: 094221921X. Summary: This textbook is a guide to the burgeoning field of surgical laparoscopy. It is intended to introduce surgeons to the principles of laparoscopic surgery and to familiarize those already performing laparoscopic cholecystectomy with the newer procedures and instruments that have been developed. Seventeen chapters cover topics including the history of laparoscopy, laparoscopic equipment and instrumentation, practical anesthesia, open laparoscopy, and clinical applications, including those for

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preoperative diagnosis and staging for gastrointestinal cancers, for gallstone disease, cholecystectomy, cholangiography and management of choledocholithiasis, appendectomy, pelvic lymphadenectomy, truncal and selective vagotomy, inguinal hernia repair, and intestinal surgery. Two final chapters cover the complications of laparoscopic general surgery and training and credentialing for laparoscopic surgery. One appendix provides a partial listing of manufacturers of surgical laparoscopy equipment. A detailed subject index concludes the volume.

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

A Guide to Laparoscopic Surgery by Azad Najmaldin, Pierre J. Guillou; ISBN: 086542649X; http://www.amazon.com/exec/obidos/ASIN/086542649X/icongroupinterna

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A Manual of Clinical Laparoscopy by Michael P. Diamond, Valle; ISBN: 1850706409; http://www.amazon.com/exec/obidos/ASIN/1850706409/icongroupinterna

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A Practical Manual of Laparoscopy: A Clinical Cookbook by Resad Pasic (Editor), et al; ISBN: 1842140779; http://www.amazon.com/exec/obidos/ASIN/1842140779/icongroupinterna

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A Slide Atlas of Laser Operative Laparoscopy and Hysteroscopy by J. Donnez, M. Nisolle; ISBN: 1850706492; http://www.amazon.com/exec/obidos/ASIN/1850706492/icongroupinterna

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A Slide Atlas of Major Surgical Procedures Using Laparoscopy by Ermelando V. Cosmi (Editor); ISBN: 1850707901; http://www.amazon.com/exec/obidos/ASIN/1850707901/icongroupinterna

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Abdominal Access in Open and Laparoscopic Surgery by Edmund K. M. Tsoi (Editor), Claude H. Organ (Editor); ISBN: 0471133523; http://www.amazon.com/exec/obidos/ASIN/0471133523/icongroupinterna

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Advanced Gynecologic Laparoscopy: A Practical Guide by P. G. Cusumano (Editor), J. A. Deprest (Editor); ISBN: 1850706557; http://www.amazon.com/exec/obidos/ASIN/1850706557/icongroupinterna

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Advanced Laparoscopic Surgery: Techniques and Tips by Namir Katkhouda, et al; ISBN: 0702020397; http://www.amazon.com/exec/obidos/ASIN/0702020397/icongroupinterna

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Advanced Techniques in Gasless Laparoscopic Surgery: Abdominal Wall Lifting With Subcutaneous Wiring by D. Hashimoto, et al; ISBN: 9810222084; http://www.amazon.com/exec/obidos/ASIN/9810222084/icongroupinterna

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An Atlas of Gynecologic Endoscopy: Laparoscopy, Hysteroscopy and Fetoscopy by J. Donnez, M. Nisolle; ISBN: 1850700079; http://www.amazon.com/exec/obidos/ASIN/1850700079/icongroupinterna

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An Atlas of Laser Operative Laparoscopy and Hysteroscopy (Encyclopedia of Visual Medicine Series) by J. Donnez, M. Nisolle; ISBN: 1850704643; http://www.amazon.com/exec/obidos/ASIN/1850704643/icongroupinterna

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An Atlas of Operative Laparoscopy and Hysteroscopy, Second Edition on CD-ROM by Jacques Donnez, M. Nisolle; ISBN: 184214197X; http://www.amazon.com/exec/obidos/ASIN/184214197X/icongroupinterna

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Animal laparoscopy; ISBN: 0683038818; http://www.amazon.com/exec/obidos/ASIN/0683038818/icongroupinterna

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Applications in Mini-Laparoscopy for General Surgeons_
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Atlas of Gasless Laparoscopy by Daniel Kruschinski, Daniel Druschinski; ISBN: 184214118X; http://www.amazon.com/exec/obidos/ASIN/184214118X/icongroupinterna

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Atlas of gynecologic laparoscopy and hysteroscopy by K. Semm; ISBN: 0721680631; http://www.amazon.com/exec/obidos/ASIN/0721680631/icongroupinterna

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Atlas of Laparoscopic Pelvic Surgery by Nicholas Kadar, Marco A. Pelosi; ISBN: 0865424179; http://www.amazon.com/exec/obidos/ASIN/0865424179/icongroupinterna

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Atlas of Laparoscopic Surgery by Eddie Joe Reddick (Editor), et al; ISBN: 0881679321; http://www.amazon.com/exec/obidos/ASIN/0881679321/icongroupinterna

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Atlas of Laparoscopic Technique for Gynecologists by T. Tulandi (Editor); ISBN: 0702019143; http://www.amazon.com/exec/obidos/ASIN/0702019143/icongroupinterna

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Atlas of laparoscopy and biopsy of the liver by Miquel Bruguera; ISBN: 0721621821; http://www.amazon.com/exec/obidos/ASIN/0721621821/icongroupinterna

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Atlas of Surgery: The Esophagus, the Stomach, the Duodenum, the Spleen, Laparoscopic Cholecystectomy by John L. Cameron, Corinne Sandone (Illustrator); ISBN: 1556642520; http://www.amazon.com/exec/obidos/ASIN/1556642520/icongroupinterna

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Basic Urologic Laparoscopy by Arthur I., M.D. Sagalowsky, Glenn M., M.D. Preminger; ISBN: 0879935634; http://www.amazon.com/exec/obidos/ASIN/0879935634/icongroupinterna

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Clinical Anatomy for Laparoscopic and Thoracoscopic Surgery by Raghu Savalgi, et al; ISBN: 1857750705; http://www.amazon.com/exec/obidos/ASIN/1857750705/icongroupinterna

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Clinical Laparoscopy by Giorgio Dagnini; ISBN: 8821207463; http://www.amazon.com/exec/obidos/ASIN/8821207463/icongroupinterna

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Color Atlas of Diagnostic Laparoscopy by Harald Henning, et al; ISBN: 0865772894; http://www.amazon.com/exec/obidos/ASIN/0865772894/icongroupinterna

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Color Atlas of Laparoscopic Surgery; ISBN: 3137919010; http://www.amazon.com/exec/obidos/ASIN/3137919010/icongroupinterna

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Color Atlas of Laparoscopy by Kurt Beck; ISBN: 0721616127; http://www.amazon.com/exec/obidos/ASIN/0721616127/icongroupinterna

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Color Atlas/Text of Advanced Laparoscopy for Surgeons by Barry A. Salky (Editor); ISBN: 089640224X; http://www.amazon.com/exec/obidos/ASIN/089640224X/icongroupinterna

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Color atlas/text of advanced laparoscopy for surgeons; ISBN: 4260142240; http://www.amazon.com/exec/obidos/ASIN/4260142240/icongroupinterna

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Complications of Laparoscopic Surgery by Robert W. Bailey; ISBN: 0942219473; http://www.amazon.com/exec/obidos/ASIN/0942219473/icongroupinterna

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Complications of Laparoscopy and Flexible Endoscopy: Postgraduate Course of the Annual Meeting of the Society of American Gastrointestinal Endoscopic by Inc Medical Support Systems (Editor); ISBN: 0387142193; http://www.amazon.com/exec/obidos/ASIN/0387142193/icongroupinterna

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Complications of Laparoscopy and Hysteroscopy by Randle S. Corfman (Editor), et al; ISBN: 0865425078; http://www.amazon.com/exec/obidos/ASIN/0865425078/icongroupinterna

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Current Review Laparoscopy 2/E: Skin, Sft Tiss, Bone/Jnt Infec by David C. Brooks, Ann Saydlowski (Illustrator); ISBN: 187813261X; http://www.amazon.com/exec/obidos/ASIN/187813261X/icongroupinterna

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Current Techniques in Laparoscopy by David C. Brooks (Editor), Larry Ward (Illustrator); ISBN: 1878132059; http://www.amazon.com/exec/obidos/ASIN/1878132059/icongroupinterna

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Endoscopic and Laparoscopic Ultrasonography for Surgeons: Colon, Rectum, and Anus by Jeffrey W. Milsom, et al; ISBN: 0896403386; http://www.amazon.com/exec/obidos/ASIN/0896403386/icongroupinterna

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Equine Diagnostic and Surgical Laparoscopy by A. T. Fischer Jr. (Editor), Hackett Fischer; ISBN: 0721679250; http://www.amazon.com/exec/obidos/ASIN/0721679250/icongroupinterna

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Essential Urologic Laparoscopy: The Complete Clinical Guide by Stephen Y., Md. Nakada (Editor); ISBN: 1588291545; http://www.amazon.com/exec/obidos/ASIN/1588291545/icongroupinterna

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Essentials of Laparoscopy by Randall R., M.D. Odem, et al; ISBN: 0942219538; http://www.amazon.com/exec/obidos/ASIN/0942219538/icongroupinterna

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Extra-Peritoneal Laparoscopic Surgery by Christopher G. Eden (Editor); ISBN: 0865426236; http://www.amazon.com/exec/obidos/ASIN/0865426236/icongroupinterna

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Female sterilization by minilaparotomy or open laparoscopy by A. Jefferson Penfield; ISBN: 0806715413; http://www.amazon.com/exec/obidos/ASIN/0806715413/icongroupinterna

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Gallstones and laparoscopic cholecystectomy : Janaury 1989 through August 1992 : 683 citations (SuDoc HE 20.3615/2:92-4) by Peggie S. Tillman; ISBN: B00010BAQM; http://www.amazon.com/exec/obidos/ASIN/B00010BAQM/icongroupinterna

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Gasless Laparoscopy in General Surgery and Gynecology: Diagnostic and Operative Procedures by Vittorio Paolucci; ISBN: 3131022310; http://www.amazon.com/exec/obidos/ASIN/3131022310/icongroupinterna

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Gasless Laparoscopy With Conventional Instruments: The Next Phase in Minimally Invasive Surgery by Stephen R., M.D. Smith, Claude H., Jr., M.D. Organ; ISBN: 0930405617; http://www.amazon.com/exec/obidos/ASIN/0930405617/icongroupinterna

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Gynecologic laparoscopy : diagnostic and operatory by Luis A. Cibils; ISBN: 0812105230; http://www.amazon.com/exec/obidos/ASIN/0812105230/icongroupinterna

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Gynecological laparoscopy, principles and techniques : selected papers and discussion from the First International Congress of the American Association of Gynecological Laparoscopists in New Orleans, Louisiana; ISBN: 0883720736; http://www.amazon.com/exec/obidos/ASIN/0883720736/icongroupinterna

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Hernia Repair: The Laparoscopic Approach by David C. Dunn, Donald Menzies; ISBN: 0865429081; http://www.amazon.com/exec/obidos/ASIN/0865429081/icongroupinterna

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Highlights in the history of laparoscopy : the development of laparoscopic techniques-- a cumulative effort of internists, gynecologists, and surgeons by Grzegorz S. Litynski; ISBN: 3980474062; http://www.amazon.com/exec/obidos/ASIN/3980474062/icongroupinterna

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Intraoperative and Laparoscopic Ultrasonography by O. James Garden (Editor), James D. Greig; ISBN: 0632035536; http://www.amazon.com/exec/obidos/ASIN/0632035536/icongroupinterna

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Intraoperative, Laparoscopic, and Endoluminal Ultrasound by Robert A. Kane (Editor), Stephanie Donley (Editor); ISBN: 0443079986; http://www.amazon.com/exec/obidos/ASIN/0443079986/icongroupinterna

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Introduction of laparoscopic technique in Bangladesh; ISBN: 9848227024; http://www.amazon.com/exec/obidos/ASIN/9848227024/icongroupinterna

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Laparoscopic Abdominal Surgery by D. Hickok (Editor), et al; ISBN: 0070239894; http://www.amazon.com/exec/obidos/ASIN/0070239894/icongroupinterna

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Laparoscopic and Thoracoscopic Surgery by Constantine T. Frantzides; ISBN: 0815132905; http://www.amazon.com/exec/obidos/ASIN/0815132905/icongroupinterna

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Laparoscopic Appearance of Endometriosis; ISBN: 0685349721; http://www.amazon.com/exec/obidos/ASIN/0685349721/icongroupinterna

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Laparoscopic Cholecystectomy (Digestive Surgery) by J.J. Jakimowicz (Editor), T.J.M. Ruers (Editor); ISBN: 3805554397; http://www.amazon.com/exec/obidos/ASIN/3805554397/icongroupinterna

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Laparoscopic cholecystectomy : a discussion paper by N. A. Hirsch; ISBN: 0642158304; http://www.amazon.com/exec/obidos/ASIN/0642158304/icongroupinterna

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Laparoscopic Cholecystectomy and New Techniques in Biliary Stone Disease by Warren S. Grundfest; ISBN: 007025088X; http://www.amazon.com/exec/obidos/ASIN/007025088X/icongroupinterna

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Laparoscopic Cholecystectomy: Featuring Advanced Biliary Procedures by Medascend; ISBN: 1888829036; http://www.amazon.com/exec/obidos/ASIN/1888829036/icongroupinterna

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Laparoscopic Complications; ISBN: 0941158373; http://www.amazon.com/exec/obidos/ASIN/0941158373/icongroupinterna

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Laparoscopic Hysterectomy by Ray Garry (Editor), Harry Reich (Editor); ISBN: 0632034653; http://www.amazon.com/exec/obidos/ASIN/0632034653/icongroupinterna

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Laparoscopic Hysterectomy and Pelvic Floor Reconstruction (Minimally Invasive Gynecology Series) by C. Y., Md. Liu (Editor); ISBN: 0865423830; http://www.amazon.com/exec/obidos/ASIN/0865423830/icongroupinterna

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Laparoscopic Inguinal Hernia Repair by Ara Darzi (Editor), et al; ISBN: 1899066012; http://www.amazon.com/exec/obidos/ASIN/1899066012/icongroupinterna

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Laparoscopic Surgery by Garth H. Ballantyne, et al; ISBN: 0721666485; http://www.amazon.com/exec/obidos/ASIN/0721666485/icongroupinterna

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Laparoscopic Surgery by Moises Jacobs, et al; ISBN: 0071364811; http://www.amazon.com/exec/obidos/ASIN/0071364811/icongroupinterna

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Laparoscopic Surgery of the Abdomen by Bruce V., Jr. Macfadyen (Editor), et al; ISBN: 0387984682; http://www.amazon.com/exec/obidos/ASIN/0387984682/icongroupinterna

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Laparoscopic Surgery: An Atlas for General Surgeons by Gary C. Vitale, et al; ISBN: 0397512686; http://www.amazon.com/exec/obidos/ASIN/0397512686/icongroupinterna

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Laparoscopic Surgery: the Implications of Changing Practice by Michael Hobsley (Editor), et al; ISBN: 0340607602; http://www.amazon.com/exec/obidos/ASIN/0340607602/icongroupinterna

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Laparoscopic Urologic Oncology (Current Clinical Urology) by Jeffrey A. Cadeddu (Editor); ISBN: 1592594255; http://www.amazon.com/exec/obidos/ASIN/1592594255/icongroupinterna

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Laparoscopic Urologic Surgery by Leonard G. Gomella, et al; ISBN: 0781700442; http://www.amazon.com/exec/obidos/ASIN/0781700442/icongroupinterna

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Laparoscopy by Jean W. Saleh, Jean N. Saleh; ISBN: 0721621260; http://www.amazon.com/exec/obidos/ASIN/0721621260/icongroupinterna

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Laparoscopy; ISBN: 0683068768; http://www.amazon.com/exec/obidos/ASIN/0683068768/icongroupinterna

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Laparoscopy and Culdoscopy in Gynecology: Textbook and Atlas by Hans Frangenheim; ISBN: 0407901000; http://www.amazon.com/exec/obidos/ASIN/0407901000/icongroupinterna

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Laparoscopy and Hysteroscopy in Gynecologic Practice by Victor Gomel; ISBN: 0815138431; http://www.amazon.com/exec/obidos/ASIN/0815138431/icongroupinterna

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Laparoscopy and imaging techniques by Giorgio Dagnini; ISBN: 3540509992; http://www.amazon.com/exec/obidos/ASIN/3540509992/icongroupinterna

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Laparoscopy for sterilization : a manual of self instruction for physicians, nurses, and hospital operating staff by Edwin S. Bronstein; ISBN: 0815112750; http://www.amazon.com/exec/obidos/ASIN/0815112750/icongroupinterna

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Laparoscopy for Surgeons by Barry A. Salky, George Berci; ISBN: 0896401669; http://www.amazon.com/exec/obidos/ASIN/0896401669/icongroupinterna

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Laparoscopy in Children by Felix Schier; ISBN: 3540429751; http://www.amazon.com/exec/obidos/ASIN/3540429751/icongroupinterna

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Laparoscopy in endocrine and genetic disorders of the gonads : a cytogenetic endocrine and endoscopic approach to differential diagnosis : report of cases and atlas; ISBN: 8774941127; http://www.amazon.com/exec/obidos/ASIN/8774941127/icongroupinterna

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Laparoscopy in Urology by Malcolm J. Coptcoat, Adrian D. Joyce; ISBN: 0632036648; http://www.amazon.com/exec/obidos/ASIN/0632036648/icongroupinterna

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Laparoscopy, culdoscopy and gynecograpy; technique and atlas by Melvin R. Cohen; ISBN: 0721626505; http://www.amazon.com/exec/obidos/ASIN/0721626505/icongroupinterna

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Metabolic and Systemic Responses Following Interventional Laparoscopy (Medical Intelligence Unit) by Ricardo Vitor Cohen, Lenilson Moreira Filho; ISBN: 1570591512; http://www.amazon.com/exec/obidos/ASIN/1570591512/icongroupinterna

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Metabolic Effects of Laparoscopy by Ricardo Cohen; ISBN: 1587061805; http://www.amazon.com/exec/obidos/ASIN/1587061805/icongroupinterna

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Minimally Invasive Therapy: Laparoscopic and Thoracic Surgery by Karl Kremer (Editor), et al; ISBN: 0865776393; http://www.amazon.com/exec/obidos/ASIN/0865776393/icongroupinterna

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New Applications of Laparoscopy (Medical Intelligence Unit (Unnumbered).) by David W., M.D. Easter; ISBN: 1879702096; http://www.amazon.com/exec/obidos/ASIN/1879702096/icongroupinterna

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New Challenges in Laparoscopic Urologic Surgery (Recent Advances in Endourology, 5) by Seiji Naito, et al; ISBN: 4431012192; http://www.amazon.com/exec/obidos/ASIN/4431012192/icongroupinterna

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Operative Gynecologic Laparoscopy: Principles and Techniques by Camran Nezhat (Editor), et al; ISBN: 0071054316; http://www.amazon.com/exec/obidos/ASIN/0071054316/icongroupinterna

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Operative Laparoscopy by Richard M., M.D. Soderstrom (Editor), Richard M. Saderstrom (Editor); ISBN: 0397517971; http://www.amazon.com/exec/obidos/ASIN/0397517971/icongroupinterna

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Operative Laparoscopy and Hysteroscopy by Stephen M. Cohen (Editor); ISBN: 0443089507; http://www.amazon.com/exec/obidos/ASIN/0443089507/icongroupinterna

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Operative Laparoscopy and Thoracoscopy by Bruce V. MacFadyen (Editor), et al; ISBN: 0781702798; http://www.amazon.com/exec/obidos/ASIN/0781702798/icongroupinterna

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Operative Laparoscopy for Gynecologists by Jorge Garcia Padial, et al; ISBN: 1880906058; http://www.amazon.com/exec/obidos/ASIN/1880906058/icongroupinterna

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Operative Laparoscopy in Gynecologic Oncology by Boike; ISBN: 1850706328; http://www.amazon.com/exec/obidos/ASIN/1850706328/icongroupinterna

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Operative Manual for Endoscopic Abdominal Surgery: Operative Pelviscopy, Operative Laparoscopy by K. Semm; ISBN: 0815177135; http://www.amazon.com/exec/obidos/ASIN/0815177135/icongroupinterna

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Pediatric Laparoscopy by Thom E. Lobe; ISBN: 1570596387; http://www.amazon.com/exec/obidos/ASIN/1570596387/icongroupinterna

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Pediatric Laparoscopy and Thoracoscopy by Thom E., M.D. Lobe, Kurt P., M.D. Schropp; ISBN: 0721646107; http://www.amazon.com/exec/obidos/ASIN/0721646107/icongroupinterna

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Practical Laparoscopic Surgery for General Surgeons by Iain M. C. MacIntyre (Editor); ISBN: 0750607424; http://www.amazon.com/exec/obidos/ASIN/0750607424/icongroupinterna

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Practical Laparoscopy by A. Cuschieri, George Berci; ISBN: 0702011320; http://www.amazon.com/exec/obidos/ASIN/0702011320/icongroupinterna

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Practical manual of laparoscopy by Alan G. Gordon; ISBN: 0632037091; http://www.amazon.com/exec/obidos/ASIN/0632037091/icongroupinterna

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Practical Manual of Operative Laparoscopy and Hysteroscopy; ISBN: 354097749X; http://www.amazon.com/exec/obidos/ASIN/354097749X/icongroupinterna

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Practical Manual of Operative Laparoscopy and Hysteroscopy by Ricardo Azziz (Editor), et al; ISBN: 0387946969; http://www.amazon.com/exec/obidos/ASIN/0387946969/icongroupinterna

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Principles and Practices of Surgical Laparoscopy by Paterson, et al; ISBN: 0702017124; http://www.amazon.com/exec/obidos/ASIN/0702017124/icongroupinterna

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Proceedings of: Lasers in Urology, Laparoscopy, and General Surgery 21 -23 January 1991 (Spie Volume 1421) by Grahm M. Watson, et al; ISBN: 0819405116; http://www.amazon.com/exec/obidos/ASIN/0819405116/icongroupinterna

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Retroperitonescopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology by Paolo Caione, et al; ISBN: 8847001722; http://www.amazon.com/exec/obidos/ASIN/8847001722/icongroupinterna

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Slide Atlas of Total Laparoscopic Hysterectomy by Ray Garry FRCOG MD, Harry Reich FACOG MD; ISBN: 0865429812; http://www.amazon.com/exec/obidos/ASIN/0865429812/icongroupinterna

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Staging Laparoscopy by P. Hohenberger (Editor), et al; ISBN: 3540656324; http://www.amazon.com/exec/obidos/ASIN/3540656324/icongroupinterna

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Surgical laparoscopy; ISBN: 068314510X; http://www.amazon.com/exec/obidos/ASIN/068314510X/icongroupinterna

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Surgical Laparoscopy by Karl A. Zucker (Editor), et al; ISBN: 0683306707; http://www.amazon.com/exec/obidos/ASIN/0683306707/icongroupinterna

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Surgical Laparoscopy Update by Karl A. Zucker, et al; ISBN: 0942219260; http://www.amazon.com/exec/obidos/ASIN/0942219260/icongroupinterna

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Surgical Laparoscopy, Endoscopy & Percutaneous Techniques by Carol E. H. ScottConner; ISBN: 0015344908; http://www.amazon.com/exec/obidos/ASIN/0015344908/icongroupinterna

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Textbook of Laparoscopy by Jaroslav F., Md Hulka, Harry, MD Reich; ISBN: 0721636438; http://www.amazon.com/exec/obidos/ASIN/0721636438/icongroupinterna

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The Sages Manual: Fundamentals of Laparoscopy and Gi Endoscopy by Carol E. H. Scott-Conner (Editor); ISBN: 0387984968; http://www.amazon.com/exec/obidos/ASIN/0387984968/icongroupinterna

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The Sages Manual: Fundamentals of Laparoscopy and GI Endoscopy (CD-ROM for PDAs) by Skyscape; ISBN: 1592250092; http://www.amazon.com/exec/obidos/ASIN/1592250092/icongroupinterna

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Tulandi Mccomb Atlas Laparoscopic Technique; ISBN: 0702017981; http://www.amazon.com/exec/obidos/ASIN/0702017981/icongroupinterna

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Understanding Laparoscopy; ISBN: 9998471974; http://www.amazon.com/exec/obidos/ASIN/9998471974/icongroupinterna

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Urologic Laparoscopic Surgery by Raul O. Parra (Editor), John A. Boullier (Editor); ISBN: 0070485801; http://www.amazon.com/exec/obidos/ASIN/0070485801/icongroupinterna

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Urologic Laparoscopy by Sakti Das (Editor), E. David Crawford (Editor); ISBN: 0721637663; http://www.amazon.com/exec/obidos/ASIN/0721637663/icongroupinterna

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Urologic Laparoscopy by Osamu Yoshida (Editor), et al; ISBN: 4431702520; http://www.amazon.com/exec/obidos/ASIN/4431702520/icongroupinterna

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

Laparoscopic Herniorrhaphy Source: in Hernia. 4th ed. Philadelphia, PA: Lippincott-Raven Publishers. 1995. p. 253268. Contact: Available from Lippincott-Raven Publishers. 1185 Avenue of the Americas, New York, NY 10036. (212) 930-9500. Fax (212) 869-3495. PRICE: $149 (as of 1995). ISBN: 0397512864. Summary: This chapter on laparoscopic herniorrhaphy is from a medical textbook on the diagnosis and treatment of hernia. Topics include the history of laparoscopic herniorrhaphy; materials used for hernia repair; intraperitoneal landmarks of the anatomy of the inguinal canal; operative exposures for laparoscopic herniorrhaphy, including intraperitoneal inlay prosthesis, transabdominal preperitoneal prosthetic repair, and the preperitoneal approach; complications of laparoscopic herniorrhaphy; and cost factors. The chapter concludes with eight pages of comments on specific

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aspects covered within the text, each with its own references. 6 figures. 5 tables. 63 references. •

Laparoscopically Assisted Bowel Resection Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 453-455. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on laparoscopically assisted bowel resection is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and Ulcerative Colitis (UC), together known as inflammatory bowel disease (IBD). Laparoscopic resection for inflammation makes good sense, but has inherent technical challenges. The most common indications for bowel resection related to inflammation are diverticulitis and inflammatory bowel disease (IBD). Inflammation can make dissection difficult and potentially dangerous. Acute indications include bleeding, obstruction, and, rarely, perforation. More chronic indications include fistulization, chronic obstruction, and perianal abscess. Since societal costs can be significant in terms of insurance expenditure for an in patient and time lost to business, a laparoscopically assisted approach may benefit some patients with Crohn's disease (and their health care provider). This approach is appropriate for virtually all patients with Crohn's disease. The only exceptions are those with known phlegmons, multiple strictures, or complex fistulae (abnormal passageways). However, the procedure is safe only if the surgeon is willing to convert to a standard surgical technique when difficulty is encountered or when the dissection becomes potentially dangerous. Obviously, no rules can be offered in this regard, since it depends upon the individual combination of the patient's diseased bowel state, the surgeon's skill level, and the sophistication of the surgeon's tools. In general, a laparoscopically assisted procedure is appropriate for nutritionally sound patients who have obstruction or intractable disease without complications. 7 references.

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CHAPTER 7. MULTIMEDIA ON LAPAROSCOPY Overview In this chapter, we show you how to keep current on multimedia sources of information on laparoscopy. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on laparoscopy is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “laparoscopy” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “laparoscopy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on laparoscopy: •

Laparoscopic Fundoplication: Correction of Acid Reflux by Laparoscopy Source: Camp Hill, PA: Chek-Med Systems, Inc. 1994. (videocassette). Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797 or (717) 761-1170. Fax (717) 761-0216. PRICE: $120.00 each; $215.00 for two in series of 3; $295.00 for whole series. Summary: This patient education videotape provides a brief overview of the use of laparoscopic fundoplication for the correction of acid reflux disease of the esophagus. The videotape features a general introduction to the procedure of laparoscopy, noting that it usually results in less patient discomfort, a quicker recovery time, and lower cost. The program shows a series of patients expressing their concerns and the results they obtained with laparoscopy. The program then defines gastroesophageal reflux disease (GERD) and discusses why it occurs, typical symptoms, the course of the disease, and diagnostic considerations. After mention of the conservative treatment options, including lifestyle changes, medications, and diet therapy, the program discusses the

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advantages, risk factors and patient selection issues of laparoscopic fundoplication. The program then uses graphics to show how the actual laparoscopic procedure is conducted. The program concludes by showing one patient's postoperative recovery period. The program features Dr. Paul Kunkel. •

Pediatric Laparoscopy as an Adjunct to the Surgical Management of the Non-Palpable Testes Source: Purchase, NY: P.C. Communication, Inc. 1990. Contact: Available from VideoUrology Times. 270 Madison Avenue, New York, NY 10016. (800) 342-8244. (One of six video presentations comprising a videocassette program representing Program 1 of Volume 3 of VideoUrology). PRICE: $59.95 for 6title set; $150 for 24-title set. Summary: This program, from a video journal on urology, demonstrates the use of laparoscopy for non-palpable testes to help plan further treatment. (AA-M).

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Video Perspectives in Surgical Laparoscopy Source: St. Louis, MO: Quality Medical Publishing, Inc. 199x. Contact: Available from Quality Medical Publishing, Inc. 11970 Borman Drive, Suite 222, St. Louis, MO 63146. (800) 348-7808 or, in Missouri, (314) 878-7808. Fax (314) 878-9937. PRICE: $59 or $89 for 1/2 in NTSC; $84 or $114 for PAL, SECAM, and 3/4 in formats. Summary: This series of instructional videotapes is designed to take viewers into the operating room for a firsthand look at new laparoscopic procedures. Programs are available on: laparoscopic highly selective vagotomy; laparoscopic appendectomy; laparoscopic herniorrhaphy; laparoscopic cholecystectomy using laser; laparoscopic cholecystectomy using electrocautery; common bile duct exploration; laparoscopic suturing; laparoscopic pelvic lymphadenectomy; open laparoscopy for the general surgeon; practice guidelines for the OR nurse; laparoscopic management of acute and complicated cholecystitis; diagnostic and therapeutic thoracoscopy; patient education for laparoscopic biliary tract surgery; laparoscopic colon resection; laparoscopic splenectomy; thoracoscopic esophageal myotomy; laparoscopic Nissen fundoplication; diagnostic and therapeutic thoracoscopy; laparoscopic adrenalectomy; and inguinal anatomy for laparoscopic hernia repair. The individuals demonstrating these various laparoscopic techniques are internationally recognized for their pioneering work and expertise in this area. (AA-M).

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Laparoscopic Surgery in Evolution Source: Bellaire, TX: American Urological Association (AUA) Office of Education. 1993. (videocassette). Contact: Available from Karol Media. 350 North Pennsylvania Avenue, P.O. Box 7600, Wilkes-Barre, PA 18773-7600. (800) 608-0096. Fax (717) 822-8226. PRICE: $20.00. Item number 919-2068. Summary: This videocassette program, one of a series from the American Urological Association, presents six laparoscopic techniques. Techniques featured are laparoscopic partial nephrectomy in an animal model; laparoscopic ureterolysis; laparoscopic orchiectomy; laparoscopic varicocele ligation; and laparoscopic ileal loop conduit. The program begins with a group discussion of clinical experiences with laparoscopic nephrectomy. The video also features interviews with five of the urologists, who

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describe patient indications, details of the procedures they performed, and potential complications. •

Technique of Laparoscopic Live Donor Nephrectomy: The Five Year Johns Hopkins University Experience Source: Houston, TX: American Urological Association (AUA) Office of Education. 2000. (videocassette). Contact: Available from AUA Office of Education. 2425 West Loop South, Suite 333, Houston, Texas 77027. (800) 282-7077. Fax: (713) 622-2898. PRICE: $20.00. Item number HV2250. Summary: This videotape program demonstrates the technique of laparoscopic donor nephrectomy (removal of the kidney from a living kidney donor with a laparoscope, an illuminated tube that permits transcutaneous, or through the skin, surgery). The program first reviews the patient preparation and trocar placement (how and where on the abdomen the laparoscopes are placed), then details the operative technique used. Each step of the surgery is shown live, with graphics interspersed and overlaid to help visualize the goals of each procedure. The program is narrated by Dr. Li-Ming Su, who concludes by briefly discussing the reduction in postoperative complications in patients undergoing this procedure compared to patients undergoing open nephrectomy.

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Inguinal Anatomy for Laparoscopic Hernia Repair Source: St. Louis, MO: Quality Medical Publishing, Inc. 1994. Contact: Available from Quality Medical Publishing, Inc. 11970 Borman Drive, Suite 222, St. Louis, MO 63146. (800) 348-7808 or, in Missouri, (314) 878-7808. Fax (314) 878-9937. PRICE: $59 for 1/2 in NTSC; $84 for PAL, SECAM, and 3/4 in formats. Summary: This videotape program is from a series of instructional videotapes designed to take viewers into the operating room for a firsthand look at laparoscopic procedures. This program focuses on documenting the anatomy of the inguinal region for laparoscopic hernia repair. A cadaver demonstration and live laparoscopic footage are used to define this anatomical region for safer hernia repairs. (AA-M).

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CHAPTER 8. PERIODICALS AND NEWS ON LAPAROSCOPY Overview In this chapter, we suggest a number of news sources and present various periodicals that cover laparoscopy.

News Services and Press Releases One of the simplest ways of tracking press releases on laparoscopy is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “laparoscopy” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to laparoscopy. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “laparoscopy” (or synonyms). The following was recently listed in this archive for laparoscopy: •

Laparoscopic surgery better than conventional Source: Reuters Health eLine Date: December 22, 2003

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Laparoscopic adhesiolysis not recommended for abdominal pain Source: Reuters Industry Breifing Date: April 10, 2003

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Laparoscopy may provide long-term survival benefit to colon cancer patients Source: Reuters Medical News Date: June 28, 2002

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Laparoscopic perforated ulcer repair can improve postoperative outcomes Source: Reuters Industry Breifing Date: April 08, 2002

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Utility of staging laparoscopy depends on diagnosis Source: Reuters Medical News Date: January 28, 2002

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Quality of life impaired many years after bile duct injury during laparoscopy Source: Reuters Medical News Date: December 27, 2001

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Laparoscopic pyloromyotomy more expensive than open procedure Source: Reuters Medical News Date: October 23, 2001

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Laparoscopic pancreatic resection can be safe and effective Source: Reuters Medical News Date: September 21, 2001

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Remote laparoscopic cholecystectomy looks promising in pilot trial Source: Reuters Industry Breifing Date: August 07, 2001

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Applied Medical gets FDA okay for laparoscopy port device Source: Reuters Industry Breifing Date: June 05, 2001

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Incidence of abscess high in subset of patients after laparoscopic appendectomy Source: Reuters Medical News Date: May 11, 2001

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Thoracoscopy/laparoscopy is feasible for esophageal cancer staging Source: Reuters Medical News Date: May 07, 2001

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Laparoscopic method improves outcomes of appendectomy Source: Reuters Medical News Date: March 02, 2001

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No need to remove normal-looking appendix during diagnostic laparoscopy Source: Reuters Medical News Date: February 27, 2001

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Laparoscopy contributes to staging of potentially unresectable pancreatic cancer Source: Reuters Medical News Date: December 11, 2000

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Hand-assisted laparoscopic surgery an option for upper urinary tract cancers Source: Reuters Medical News Date: December 08, 2000

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Robotically assisted laparoscopy feasible for tubal reanastomosis Source: Reuters Medical News Date: December 04, 2000

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Hand-assisted laparoscopy facilitates gastroplasty for severe obesity Source: Reuters Medical News Date: July 14, 2000

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Safety shields do not decrease risk of visceral injuries during laparoscopy Source: Reuters Medical News Date: May 23, 2000

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Device facilitates hand-assisted laparoscopy for complex procedures Source: Reuters Medical News Date: May 18, 2000

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Laparoscopy permits more precise dissection during radical prostatectomy Source: Reuters Medical News Date: May 12, 2000

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Recurrence associated with laparoscopic repair of large type III hiatal hernia Source: Reuters Medical News Date: May 10, 2000

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Hand-assisted laparoscopy shortens hospital stay following aortic bypass surgery Source: Reuters Medical News Date: May 09, 2000

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Laparoscopy reduces unnecessary interventions for patients with pancreatic cancer Source: Reuters Medical News Date: April 18, 2000

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Preexisting factors affect pregnancy rates after laparoscopic infertility treatment Source: Reuters Medical News Date: March 13, 2000

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Laparoscopy for repair of groin hernia debated Source: Reuters Health eLine Date: July 19, 1999

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Laparoscopic repair of groin hernia called risky for nonspecialists Source: Reuters Medical News Date: July 16, 1999

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Cholecystectomy: risks of laparoscopy, protective effects of cholangiography documented Source: Reuters Medical News Date: April 13, 1999

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Laparoscopic management of adnexal masses "successful" in broad group of women Source: Reuters Medical News Date: February 11, 1999

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Laparoscopic surgery for ectopic pregnancy results in higher fertility rate than laparotomy Source: Reuters Medical News Date: October 29, 1998

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Data needed to prove benefits of laparoscopic surgery Source: Reuters Medical News Date: October 28, 1998

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Laparoscopy called "procedure of choice" for reversal of tubal sterilization Source: Reuters Medical News Date: October 07, 1998

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Colorectal cancer: laparoscopic techniques "promising alternative" to conventional surgery Source: Reuters Medical News Date: July 20, 1998

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Laparoscopy may help reduce unnecessary laparotomies for cervical cancer Source: Reuters Medical News Date: June 08, 1998

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First laparoscopic endorectal pull-through for colonic aganglionosis in a neonate performed Source: Reuters Medical News Date: June 01, 1998

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Vaginal Tubal Ligation Has Advantages Over Laparoscopic Approach Source: Reuters Medical News Date: October 23, 1997

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Laparoscopic Surgery Safe in Early Pregnancy Source: Reuters Medical News Date: October 20, 1997

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Laparoscopic No Better Than Open Surgery In Routine Appendectomy Source: Reuters Medical News Date: July 25, 1997

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Laparoscopic Hernia Repair Shown Superior To Open Repair Source: Reuters Medical News Date: May 29, 1997

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Laparoscopic Hernia Repair Benefits Source: Reuters Health eLine Date: May 28, 1997

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Laparoscopy Recommended For Patients With Diffuse Abdominal Pain Source: Reuters Medical News Date: April 17, 1996

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Robot-Assisted Laparoscopy: A Preliminary Report Source: Reuters Medical News Date: December 12, 1995

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Laparoscopic Cholecystectomy May Disseminate In Situ Gallbladder Carcinoma Source: Reuters Medical News Date: December 11, 1995

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Diagnostic Laparoscopy Recommended For Evaluation Of Acute And Chronic Liver Disease Source: Reuters Medical News Date: August 24, 1995

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Laparoscopic Appendectomy May Become The New 'Gold Standard' Source: Reuters Medical News Date: August 02, 1995

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “laparoscopy” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “laparoscopy” (or synonyms). If you know the name of a company that is relevant to laparoscopy, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “laparoscopy” (or synonyms).

Newsletters on Laparoscopy Find newsletters on laparoscopy using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following

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hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “laparoscopy.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “laparoscopy” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

New Surgical Approaches in Laparoscopy Developing Rapidly Source: Urology Times. 22(3): 11. March 1994. Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This brief professional newsletter article brings readers up-to-date on new surgical approaches in laparoscopy in the field of urology. Topics include retroperitoneoscopy and extraperitoneoscopy, two surgical approaches that offer ready access to the kidneys, ureter, and bladder. The article discusses the indications, contraindications, history, patient selection and preparation, and ongoing refinements of each procedure. 2 figures.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “laparoscopy” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on laparoscopy: •

FDA Approves Adjustable Stomach Band to Treat Severe Obesity Source: WIN Notes. p. 7. Winter 2001/2002. Contact: Weight-control Information Network, 1 WIN Way, Bethesda, MD 20992-3665. (202) 828-1025. [email protected]. Summary: In June 2001, the United States Food and Drug Administration (FDA) approved a new surgical device for the treatment of severe obesity. The device, called the Lap-Band Adjustable Gastric Banding System, provides some advantages over traditional gastric bypass surgery, but may not be as effective. The Lap-Band is inserted via laparoscopy, a procedure less invasive than some types of obesity surgeries. Researchers at the Medical College of Virginia of the Virginia Commonwealth University (VCU) in Richmond, one of eight centers performing the procedure during FDA's clinical trial, did not find the Lap-Band to be effective for the surgical treatment of morbid obesity and recommended further studies to determine its long-term efficacy. VCU patients lost an average of 38 percent of their excess weight over 3 years, which is about half the amount of weight usually lost after more traditional gastric bypass surgery.

•

Endopyelotomy Procedures Present Wealth of Options Source: Urology Times. 23(4): 9. April 1995.

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Contact: Available from Urology Times. 131 West First Street, Duluth, MN 55802-2065. Summary: In this article, from a professional urology newspaper, the author reports on the wealth of choices now available for endopyelotomy, used for treating ureteropelvic junction (UPJ) obstruction. Reporting on information from the 12th World Congress of Endourology and SWL, held in St. Louis in 1994, the author covers options including traditional open pyeloplasty, percutaneous endopyelotomy, and several modalities of retrograde endopyelotomy, including incision through a ureteroscopy, a ureteroresectoscope laparoscopy, and a balloon cutting catheter. One of the conference presenters stresses that it is now possible to choose a modality according to the patient's clinical situation and condition. Other topics include advantages and disadvantages of each method; the use of prestenting; vessels adjacent to the UPJ; and the value of imaging technologies. 1 figure. •

Gallbladder Surgery: A Second Look at a First-Line Treatment Source: Harvard Health Letter. 22(1): 6-8. November 1996. Contact: Available from Harvard Health Letter. P.O. Box 420300, Palm Coast, FL 321420300. (800) 829-9045. Summary: This newsletter article reviews the differences between laparoscopy and open surgery for treating gallbladder disease. Unlike open gallbladder surgery, in which the surgeon makes an incision in the abdomen, the laparoscopic method requires only several tiny punctures in the belly to allow for the insertion of a small video camera and surgical instruments. The author reports results of a recent British study of 200 patients that showed that laparoscopic cholecystectomy (gallbladder removal) takes longer to do than mini-incision open surgery and offers no added benefit in recovery time, length of hospital stay, and time back to work. These results were in contrast to earlier evidence showing that people who undergo laparoscopy recover more quickly and with less pain and scarring than those treated with conventional open surgery. The author discusses the incidence of gallstones, the indications for cholecystectomy, rising rates of gallbladder removal, malpractice claims for bile duct injuries from laparoscopic cholecystectomy, and the differential diagnosis of gallbladder disease. The author stresses that the decision to have surgery is an individual one. People with infrequent gallstone attacks may be able to live with the prospect of having another down the road, while those whose episodes are more common or severe may find that laparoscopic cholecystectomy greatly improves the quality of their lives. 1 figure.

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

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periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

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/

11

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

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•

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

•

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/

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

•

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

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

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

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

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

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

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

•

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

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

•

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

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

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

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

•

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

•

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

•

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

•

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

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

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

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

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

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

•

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

12

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

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•

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

•

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

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “laparoscopy” (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 35004 1577 203 57 12 36853

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “laparoscopy” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

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

15

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). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

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 Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

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/.

19 Adapted 20

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. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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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 laparoscopy 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 laparoscopy. 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 laparoscopy. 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 “laparoscopy”:

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Other guides Colorectal Cancer http://www.nlm.nih.gov/medlineplus/colorectalcancer.html Endometriosis http://www.nlm.nih.gov/medlineplus/endometriosis.html Gallbladder Diseases http://www.nlm.nih.gov/medlineplus/gallbladderdiseases.html Infertility http://www.nlm.nih.gov/medlineplus/infertility.html Ovarian Cysts http://www.nlm.nih.gov/medlineplus/ovariancysts.html Uterine Diseases http://www.nlm.nih.gov/medlineplus/uterinediseases.html Weight Loss Surgery http://www.nlm.nih.gov/medlineplus/weightlosssurgery.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on laparoscopy. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Laparoscopic Colon Surgery: Using Smaller Incisions for Less Pain and a Faster Recovery Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. PRICE: $1.95 plus shipping and handling; bulk copies available. Order number 11109. Summary: This brochure outlines the use of laparoscopy for colon surgery. With laparoscopy, the doctor makes a few small incisions rather than a single large one. A laparoscope (a thin, telescope like tube) is then placed into one of the small incisions. This allows the doctor to view the colon on a video monitor. Surgical tools are placed into the other incisions. The benefits of a laparoscopic approach over open surgery include less scarring, less pain, faster recovery, shorter hospital stay, and quicker return

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to normal activity. The brochure reviews the anatomy and physiology of the colon, then summarizes common colon problems, including large polyps, diverticulosis and diverticulitis, inflammatory bowel disease (IBD), and colon cancer. Diagnostic tests that may be used to evaluate and diagnose colon problems include the medical history, physical exam, barium enema, endoscopy, and sigmoidoscopy. The brochure details the preoperative steps that patients should follow before laparoscopic treatment and what patients can expect during and immediately after the surgical procedure. Common laparoscopic procedures include segmental resection, right hemicolectomy, left hemicolectomy, sigmoid colectomy, and colostomy surgery; each type is illustrated. The brochure also reviews postoperative care in the hospital and at home. The brochure concludes with a reminder of the steps toward long term colon health, including good nutrition and physical activity. The brochure is illustrated with full color line drawings. 30 figures. •

Laparoscopy Source: Waco, TX: Health Edco. 1991. 2 p. Contact: Available from Health Edco. P.O. Box 21207, Waco, TX 76702-1207. (800) 2993366, ext. 295. Fax (817) 751-0221. PRICE: $.59 for 1-99 copies; discounts available for larger quantities. Order number EU38051. Summary: This brochure provides information for patients about to undergo a diagnostic laparoscopy on an outpatient basis. Topics include diagnostic tests done before the laparoscopy; preoperative instructions; what to expect on the day of surgery; how the laparoscope is used; what the patient can expect during the procedure; postoperative care; and postprocedure care at home. The brochure includes a checklist of do's and don'ts for patients to follow. The brochure features full color illustrations of the female digestive and reproductive systems and the laparoscopic procedure.

•

What Is Laparoscopic Surgery? Source: Chicago, IL: American College of Surgeons. 1996. 18 p. Contact: Available from American College of Surgeons. 55 East Erie Street, Chicago, IL 60611. (312) 664-4050. PRICE: Single copy free; bulk copies available. Item number PI-22. Summary: This brochure tells readers about one type of endoscope, the laparoscope, and how surgeons are using it to perform a variety of abdominal operations. Topics include a description of how laparoscopy is performed; laparoscopic cholecystectomy (gallbladder removal); esophageal reflux disease; appendectomy; hernia repair; laparoscopic colon procedures; surgery of the female organs; other procedures; and the future of laparoscopic surgery. The brochure concludes with a glossary of related terms. The National Guideline Clearinghouse™

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

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Guideline for diagnostic laparoscopy Source: Society of American Gastrointestinal Endoscopic Surgeons - Medical Specialty Society; 1998 April; 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1861&nbr=1087&a mp;string=laparoscopy

•

Guidelines for the clinical application of laparoscopic biliary tract surgery Source: Society of American Gastrointestinal Endoscopic Surgeons - Medical Specialty Society; 1990 (updated 1999); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1865&nbr=1091&a mp;string=laparoscopy

•

SAGES guidelines for laparoscopic surgery during pregnancy Source: Society of American Gastrointestinal Endoscopic Surgeons - Medical Specialty Society; 1996 February (revised 2000 Oct); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3146&nbr=2372&a mp;string=laparoscopy 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 laparoscopy. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

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

•

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

•

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

•

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

•

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

•

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

•

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

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Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to laparoscopy. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with laparoscopy. 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 laparoscopy. 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 “laparoscopy” (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 “laparoscopy”. 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 “laparoscopy” (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 “laparoscopy” (or a synonym) into the search box, and click “Submit Query.”

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

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22

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

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

22

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

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •

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

•

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

•

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

•

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

•

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

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

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California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

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

•

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

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

•

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/

23

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

Finding Medical Libraries 165

•

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

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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

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

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

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

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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 167

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

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

•

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

169

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

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LAPAROSCOPY 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] Abdominal fat: Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] 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] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acute tubular: A severe form of acute renal failure that develops in people with severe illnesses like infections or with low blood pressure. Patients may need dialysis. Kidney function often improves if the underlying disease is successfully treated. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adhesives: Substances that cause the adherence of two surfaces. They include glues (properly collagen-derived adhesives), mucilages, sticky pastes, gums, resins, or latex. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU]

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Adjuvant Therapy: Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, or hormone therapy. [NIH]

Adnexa: The appendages of the eye, as the lacrimal apparatus, the eyelids, and the extraocular muscles. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] 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] Allantois: An embryonic diverticulum of the hindgut of reptiles, birds, and mammals; in man its blood vessels give rise to those of the umbilical cord. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may

Dictionary 173

occur. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] 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] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgenic: Producing masculine characteristics. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]

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Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] 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] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anovulation: Suspension or cessation of ovulation in animals and humans. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

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] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antrectomy: An operation to remove the upper portion of the stomach, called the antrum.

Dictionary 175

This operation helps reduce the amount of stomach acid. It is used when a person has complications from ulcers. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Appendectomy: An operation to remove the appendix. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Argon: A noble gas with the atomic symbol Ar, atomic number 18, and atomic weight 39.948. It is used in fluorescent tubes and wherever an inert atmosphere is desired and nitrogen cannot be used. [NIH] Aromatase: An enzyme which converts androgens to estrogens by desaturating ring A of the steroid. This enzyme complex is located in the endoplasmic reticulum of estrogenproducing cells including ovaries, placenta, testicular Sertoli and Leydig cells, adipose, and brain tissues. The enzyme complex has two components, one of which is the CYP19 gene product, the aromatase cytochrome P-450. The other component is NADPH-cytochrome P450 reductase which transfers reducing equivalents to P-450(arom). EC 1.14.13.-. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriography: A procedure to x-ray arteries. The arteries can be seen because of an injection of a dye that outlines the vessels on an x-ray. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arthroscopy: Endoscopic examination, therapy and surgery of the joint. [NIH] Articular: Of or pertaining to a joint. [EU] Articulation: The relationship of two bodies by means of a moveable joint. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the

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thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Barium enema: A procedure in which a liquid with barium in it is put into the rectum and colon by way of the anus. Barium is a silver-white metallic compound that helps to show the image of the lower gastrointestinal tract on an x-ray. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Atresia: Atresia of the biliary tract, most commonly of the extrahepatic bile ducts. [NIH]

Biliary Tract: The gallbladder and its ducts. [NIH] Biliopancreatic Diversion: A surgical procedure which diverts pancreatobiliary secretions via the duodenum and the jejunum into the colon, the remaining small intestine being anastomosed to the stomach after antrectomy. The procedure produces less diarrhea than does jejunoileal bypass. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH]

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Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopsy specimen: Tissue removed from the body and examined under a microscope to determine whether disease is present. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a

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neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchial: Pertaining to one or more bronchi. [EU] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cadaver: A dead body, usually a human body. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] 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]

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Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] 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] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Cefoxitin: Semisynthetic cephamycin antibiotic resistant to beta-lactamase. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Ceramide: A type of fat produced in the body. It may cause some types of cells to die, and is being studied in cancer treatment. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Angiography: Radiography of the vascular system of the brain after injection of a contrast medium. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] 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] Chemoembolization: A procedure in which the blood supply to the tumor is blocked surgically or mechanically, and anticancer drugs are administered directly into the tumor. This permits a higher concentration of drug to be in contact with the tumor for a longer period of time. [NIH]

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Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chlamydia: A genus of the family Chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is Chlamydia trachomatis. [NIH] Cholangiography: Radiographic examination of the bile ducts. [NIH] Cholangitis: Inflammation of a bile duct. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Choledocholithiasis: Gallstones in the bile ducts. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Circadian: Repeated more or less daily, i. e. on a 23- to 25-hour cycle. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which

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causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] 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] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Colorectal Surgery: A surgical specialty concerned with the diagnosis and treatment of disorders and abnormalities of the colon, rectum, and anal canal. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Common Bile Duct: The largest biliary duct. It is formed by the junction of the cystic duct and the hepatic duct. [NIH] Common Bile Duct Obstruction: A blockage of the common bile duct, often caused by gallstones. [NIH] Competency: The capacity of the bacterium to take up DNA from its surroundings. [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.

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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] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Concentric: Having a common center of curvature or symmetry. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells,

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adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast Media: Substances used in radiography that allow visualization of certain tissues. [NIH]

Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Convalescence: The period of recovery following an illness. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Cryptorchidism: A condition in which one or both testicles fail to move from the abdomen, where they develop before birth, into the scrotum. Cryptorchidism may increase the risk for development of testicular cancer. Also called undescended testicles. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to

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which a subject has learned to respond. [NIH] Culdoscopy: Endoscopic examination, therapy or surgery of the female pelvic viscera by means of an endoscope introduced into the pelvic cavity through the posterior vaginal fornix. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyanide: An extremely toxic class of compounds that can be lethal on inhaling of ingesting in minute quantities. [NIH] Cyanoacrylates: A group of compounds having the general formula CH2=C(CN)-COOR; it polymerizes on contact with moisture; used as tissue adhesive; higher homologs have hemostatic and antibacterial properties. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cystectomy: Used for excision of the urinary bladder. [NIH] Cystic Duct: The tube that carries bile from the gallbladder into the common bile duct and the small intestine. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH]

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Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermoid: A benign mixed tumor, usually congenital, containing teeth, hairs, skin glands, fibrous tissue, and other skin elements, rarely found in the limbal region of the eye and orbit. [NIH] Dermoid Cyst: A benign mixed tumor, usually congenital, containing teeth, hairs, skin glands, fibrous tissue, and other skin elements, rarely found in the limbal region of the eye and orbit. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diathermy: The induction of local hyperthermia by either short radio waves or highfrequency sound waves. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dissection: Cutting up of an organism for study. [NIH]

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Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] 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] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]

Duodenum: The first part of the small intestine. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dyspnea: Difficult or labored breathing. [NIH] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus. [NIH]

Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding

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ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolytes: Substances that break up into ions (electrically charged particles) when they are dissolved in body fluids or water. Some examples are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells, and the movement of wastes out of cells. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Embryogenesis: The process of embryo or embryoid formation, whether by sexual (zygotic) or asexual means. In asexual embryogenesis embryoids arise directly from the explant or on intermediary callus tissue. In some cases they arise from individual cells (somatic cell embryoge). [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]

Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

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Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopic retrograde cholangiopancreatography: ERCP. A procedure to x-ray the pancreatic duct, hepatic duct, common bile duct, duodenal papilla, and gallbladder. In this procedure, a thin, lighted tube (endoscope) is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and an x-ray is taken. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs. [NIH] Enterostomal Therapy: A nurse who cares for patients with an ostomy. [NIH] Enucleation: Removal of the nucleus from an eucaryiotic cell. [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]

Environmental Pollutants: Substances which pollute the environment. Use environmental pollutants in general or for which there is no specific heading. [NIH]

for

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophilic: A condition found primarily in grinding workers caused by a reaction of the pulmonary tissue, in particular the eosinophilic cells, to dust that has entered the lung. [NIH] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum

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epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Ergonomics: Study of the relationships between man and machines; adjusting the design of machines to the need and capacities of man; study of the effect of machines on man's behavior. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Achalasia: Disorder of lower esophagogastric motility due to failure of the lower esophageal sphincter to relax with swallowing. It is sometimes caused by degeneration of the ganglion cells of the myenteric plexus or of the vagal motor nuclei. [NIH] Esophageal Manometry: A test to measure muscle tone inthe esophagus. [NIH] Esophageal Stricture: A narrowing of the esophagus often caused by acid flowing back from the stomach. This condition may require surgery. [NIH] Esophageal Ulcer: A sore in the esophagus. Caused by long-term inflammation or damage from the residue of pills. The ulcer may cause chest pain. [NIH] 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]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excisional: The surgical procedure of removing a tumor by cutting it out. The biopsy is then examined under a microscope. [NIH]

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Excisional biopsy: A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extraocular: External to or outside of the eye. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Fallopian Tubes: Two long muscular tubes that transport ova from the ovaries to the uterus. They extend from the horn of the uterus to the ovaries and consist of an ampulla, an infundibulum, an isthmus, two ostia, and a pars uterina. The walls of the tubes are composed of three layers: mucosal, muscular, and serosal. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fatty Liver: The buildup of fat in liver cells. The most common cause is alcoholism. Other causes include obesity, diabetes, and pregnancy. Also called steatosis. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetal Blood: Blood of the fetus. Exchange of nutrients and waste between the fetal and maternal blood occurs via the placenta. The cord blood is blood contained in the umbilical vessels at the time of delivery. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas

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fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fine-needle aspiration: The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatus: Gas passed through the rectum. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] Fold: A plication or doubling of various parts of the body. [NIH] Follicles: Shafts through which hair grows. [NIH] Follicular Fluid: A fluid consisting of sex steroid hormones, plasma proteins, mucopolysaccharides, and electrolytes that is present in the vesicular ovarian follicle (Graafian follicle) surrounding the ovum. [NIH] Follicular Phase: The period of the menstrual cycle that begins with menstruation and ends with ovulation. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Fornix: A bundle of nerves connected to the hippocampus. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Gadolinium: An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH]

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Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] 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] Gastrectomy: An operation to remove all or part of the stomach. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric banding: Surgery to limit the amount of food the stomach can hold by closing part of it off. A band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness. [NIH]

Gastric Bypass: Surgical procedure in which the stomach is transected high on the body. The resulting proximal remnant is joined to a loop of the jejunum in an end-to-side anastomosis. This procedure is used frequently in the treatment of morbid obesity. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterostomy: Surgical construction of a channel between the stomach and intestines. [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] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gastroplasty: Surgical treatment of the stomach or lower esophagus used to decrease the size of the stomach. The procedure is used mainly in the treatment of morbid obesity and to

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correct defects in the lower esophagus or the stomach. Different procedures employed include vertical (mesh) banded gastroplasty, silicone elastomer ring vertical gastroplasty and horizontal banded gastroplasty. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genital: Pertaining to the genitalia. [EU] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Ginger: Deciduous plant rich in volatile oil (oils, volatile). It is used as a flavoring agent and has many other uses both internally and topically. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glare: Scatter from bright light that decreases vision. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadorelin: A decapeptide hormone released by the hypothalamus. It stimulates the synthesis and secretion of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. [NIH] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are

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different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [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] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Gynaecological: Pertaining to gynaecology. [EU] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels

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of 9 percent or more. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Hepatic Duct, Common: Predominantly extrahepatic bile duct which is formed by the junction of the right and left hepatic ducts, which are predominantly intrahepatic, and, in turn, joins the cystic duct to form the common bile duct. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocellular carcinoma: A type of adenocarcinoma, the most common type of liver tumor. [NIH] Hepatocyte: A liver cell. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Herniorrhaphy: An operation to repair a hernia. [NIH] Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Hirsutism: Excess hair in females and children with an adult male pattern of distribution. The concept does not include hypertrichosis, which is localized or generalized excess hair. [NIH]

Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histamine Agonists: Drugs that bind to and activate histamine receptors. Although they have been suggested for a variety of clinical applications histamine agonists have so far been more widely used in research than therapeutically. [NIH] Histamine Antagonists: Drugs that bind to but do not activate histamine receptors, thereby blocking the actions of histamine or histamine agonists. Classical antihistaminics block the histamine H1 receptors only. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU]

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Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [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] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hydration: Combining with water. [NIH] Hydrochloric Acid: A strong corrosive acid that is commonly used as a laboratory reagent. It is formed by dissolving hydrogen chloride in water. Gastric acid is the hydrochloric acid component of gastric juice. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hyperandrogenism: A state characterized or caused by an excessive secretion of androgens by the adrenal cortex, ovaries, or testes. The clinical significance in males is negligible, so the term is used most commonly with reference to the female. The common manifestations in women are hirsutism and virilism. It is often caused by ovarian disease (particularly the polycystic ovary syndrome) and by adrenal diseases (particularly adrenal gland hyperfunction). [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercarbia: Excess of carbon dioxide in the blood. [NIH] Hypersecretion: Excessive secretion. [EU] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hysterectomy: Excision of the uterus. [NIH] Hysterosalpingography: Radiography of the uterus and fallopian tubes after the injection of

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a contrast medium. [NIH] Hysteroscopy: Endoscopic examination, therapy or surgery of the interior of the uterus. [NIH]

Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH] Ileus: Obstruction of the intestines. [EU] Iliac Artery: Either of two large arteries originating from the abdominal aorta; they supply blood to the pelvis, abdominal wall and legs. [NIH] Imaging procedures: Methods of producing pictures of areas inside the body. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU]

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In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incisional: The removal of a sample of tissue for examination under a microscope. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] 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]

Inferior vena cava: A large vein that empties into the heart. It carries blood from the legs and feet, and from organs in the abdomen and pelvis. [NIH] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires

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surgery. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. [NIH] Intrahepatic: Within the liver. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intramuscular injection: IM. Injection into a muscle. [NIH] Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [NIH] Intravenous: IV. Into a vein. [NIH] 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] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin

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or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Involution: 1. A rolling or turning inward. 2. One of the movements involved in the gastrulation of many animals. 3. A retrograde change of the entire body or in a particular organ, as the retrograde changes in the female genital organs that result in normal size after delivery. 4. The progressive degeneration occurring naturally with advancing age, resulting in shrivelling of organs or tissues. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoflurane: A stable, non-explosive inhalation anesthetic, relatively free from significant side effects. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Jejunoileal Bypass: A surgical procedure consisting of the anastomosis of the proximal part of the jejunum to the distal portion of the ileum, so as to bypass the nutrient-absorptive segment of the small intestine, to treat morbid obesity. [NIH] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (receptors, NMethyl-D-Aspartate) and may interact with sigma receptors. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH]

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Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Lacrimal: Pertaining to the tears. [EU] Lacrimal Apparatus: The tear-forming and tear-conducting system which includes the lacrimal glands, eyelid margins, conjunctival sac, and the tear drainage system. [NIH] Laparoscopes: Endoscopes for examining the interior of the abdomen. [NIH] Laparoscopic-assisted colectomy: Surgery done with the aid of a laparoscope (a thin, lighted tube) to remove part or all of the colon through small incisions made in the wall of the abdomen. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] 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] 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] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Leuprolide: A potent and long acting analog of naturally occurring gonadotropin-releasing hormone (gonadorelin). Its action is similar to gonadorelin, which regulates the synthesis and release of pituitary gonadotropins. [NIH] Levonorgestrel: A progestational hormone with actions similar to those of progesterone and about twice as potent as its racemic or (+-)-isomer (norgestrel). It is used for contraception, control of menstrual disorders, and treatment of endometriosis. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lincomycin:

(2S-trans)-Methyl

6,8-dideoxy-6-(((1-methyl-4-propyl-2-

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pyrrolidinyl)carbonyl)amino)-1-thio-D-erythro-alpha-D-galacto-octopyranoside. An antibiotic produced by Streptomyces lincolnensis var. lincolnensis. It has been used in the treatment of staphylococcal, streptococcal, and Bacteroides fragilis infections. [NIH] Linkage: 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] Lipid: Fat. [NIH] Lipolysis: The hydrolysis of lipids. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Lithotomy: A position in which the patient lies on his back with legs flexed and his thighs on his abdomen and abducted. [NIH] Lithotomy position: A position in which the patient lies on his back with legs flexed and his thighs on his abdomen and abducted. [NIH] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is laser lithotripsy. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] 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]

Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. Also called lymph node dissection. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph

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nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocele: Cystic mass containing lymph from diseased lymphatic channels or following surgical trauma or other injury. [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 Angiography: Non-invasive method of vascular imaging and determination of internal anatomy without injection of contrast media or radiation exposure. The technique is used especially in cerebral angiography as well as for studies of other vascular structures. [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] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammography: Radiographic examination of the breast. [NIH] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Maternal-Fetal Exchange: Exchange of substances between the maternal blood and the fetal blood through the placental barrier. It excludes microbial or viral transmission. [NIH] Mechanoreceptors: Cells specialized to transduce mechanical stimuli and relay that information centrally in the nervous system. Mechanoreceptors include hair cells, which mediate hearing and balance, and the various somatosensory receptors, often with nonneural accessory structures. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH]

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Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Methylene Blue: A compound consisting of dark green crystals or crystalline powder, having a bronze-like luster. Solutions in water or alcohol have a deep blue color. Methylene blue is used as a bacteriologic stain and as an indicator. It inhibits Guanylate cyclase, and has been used to treat cyanide poisoning and to lower levels of methemoglobin. [NIH] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] 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] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the

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second trimester. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucopurulent: Containing both mucus and pus. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiple Organ Failure: A progressive condition usually characterized by combined failure of several organs such as the lungs, liver, kidney, along with some clotting mechanisms, usually postinjury or postoperative. [NIH] Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myenteric: On stimulation of an intestinal segment, the segment above contracts and that below relaxes. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle

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known as cardiac muscle. [NIH] Nafarelin: 6-(3-(2-Naphthalenyl)-D-alanine)luteinizing hormone-releasing factor (pig). A gonadorelin analog agonist. It has been used in the treatment of central precocious puberty and endometriosis. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Necrotizing Enterocolitis: A condition in which part of the tissue in the intestines is destroyed. Occurs mainly in under-weight newborn babies. A temporary ileostomy may be necessary. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needle biopsy: The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] 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] Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]

Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are

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unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonmalignant: Not cancerous. [NIH] Norethindrone: A synthetic progestational hormone with actions similar to those of progesterone but functioning as a more potent inhibitor of ovulation. It has weak estrogenic and androgenic properties. The hormone has been used in treating amenorrhea, functional uterine bleeding, endometriosis, and for contraception. [NIH] Norgestrel: (+-)-13-Ethyl-17-hydroxy-18,19-dinorpregn-4-en-20-yn-3-one. A progestational agent with actions similar to those of progesterone. This racemic or (+-)-form has about half the potency of the levo form (levonorgestrel). Norgestrel is used as a contraceptive and ovulation inhibitor and for the control of menstrual disorders and endometriosis. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Oncology: The study of cancer. [NIH] Oocytes: Female germ cells in stages between the prophase of the first maturation division and the completion of the second maturation division. [NIH] Oophorectomy: Surgery to remove one or both ovaries. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver

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somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Optic Nerve Diseases: Conditions which produce injury or dysfunction of the second cranial or optic nerve, which is generally considered a component of the central nervous system. Damage to optic nerve fibers may occur at or near their origin in the retina, at the optic disk, or in the nerve, optic chiasm, optic tract, or lateral geniculate nuclei. Clinical manifestations may include decreased visual acuity and contrast sensitivity, impaired color vision, and an afferent pupillary defect. [NIH] Orbit: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] Orchiectomy: The surgical removal of one or both testicles. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovarian Follicle: Spheroidal cell aggregation in the ovary containing an ovum. It consists of an external fibro-vascular coat, an internal coat of nucleated cells, and a transparent, albuminous fluid in which the ovum is suspended. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overall survival: The percentage of subjects in a study who have survived for a defined period of time. Usually reported as time since diagnosis or treatment. Often called the survival rate. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovulation Induction: Techniques for the artifical induction of ovulation. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor

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molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxygenase: Enzyme which breaks down heme, the iron-containing oxygen-carrying constituent of the red blood cells. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatectomy: Surgery to remove the pancreas. In a total pancreatectomy, a portion of the stomach, the duodenum, common bile duct, gallbladder, spleen, and nearby lymph nodes also are removed. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Ducts: Ducts that collect pancreatic juice from the pancreas and supply it to the duodenum. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Papilla: A small nipple-shaped elevation. [NIH] Papilledema: Swelling around the optic disk. [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU]

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Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] 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] Perforated Ulcer: An ulcer that breaks through the wall of the stomach or the duodenum. Causes stomach contents to leak into the abdominal cavity. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [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] Perianal: Located around the anus. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peristalsis: The rippling motion of muscles in the intestine or other tubular organs

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characterized by the alternate contraction and relaxation of the muscles that propel the contents onward. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a

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fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumothorax: Accumulation of air or gas in the space between the lung and chest wall, resulting in partial or complete collapse of the lung. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polychlorinated Biphenyls: Industrial products consisting of a mixture of chlorinated biphenyl congeners and isomers. These compounds are highly lipophilic and tend to accumulate in fat stores of animals. Many of these compounds are considered toxic and potential environmental pollutants. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH]

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Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Postoperative Period: The period following a surgical operation. [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] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progestogen: A term applied to any substance possessing progestational activity. [EU] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Progressive disease: Cancer that is increasing in scope or severity. [NIH] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH]

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Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Propofol: A widely used anesthetic. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Proton Pump: Integral membrane proteins that transport protons across a membrane against a concentration gradient. This transport is driven by hydrolysis of ATP by H(+)transporting ATP synthase. [NIH] Proton Pump Inhibitors: Medicines that stop the stomach's acid pump. Examples are omeprazole (oh-MEH-prah-zol) (Prilosec) and lansoprazole (lan-SOH-prah-zol) (Prevacid). [NIH]

Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pseudotumor Cerebri: A condition marked by raised intracranial pressure and characterized clinically by headaches; nausea; papilledema, peripheral constriction of the visual fields, transient visual obscurations, and pulsatile tinnitus. Obesity is frequently associated with this condition, which primarily affects women between 20 and 44 years of age. Chronic papilledema may lead to optic nerve injury (optic nerve diseases) and visual loss (blindness). [NIH]

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Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radical prostatectomy: Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy and perineal prostatectomy. [NIH] Radio Waves: That portion of the electromagnetic spectrum beyond the microwaves, with wavelengths as high as 30 KM. They are used in communications, including television. Short Wave or HF (high frequency), UHF (ultrahigh frequency) and VHF (very high frequency) waves are used in citizen's band communication. [NIH] Radioactive: Giving off radiation. [NIH]

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Radiofrequency ablation: The use of electrical current to destroy tissue. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptivity: The condition of the reproductive organs of a female flower that permits effective pollination. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectal Prolapse: Protrusion of the rectal mucous membrane through the anus. There are various degrees: incomplete with no displacement of the anal sphincter muscle; complete with displacement of the anal sphincter muscle; complete with no displacement of the anal sphincter muscle but with herniation of the bowel; and internal complete with rectosigmoid or upper rectum intussusception into the lower rectum. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH]

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Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflective: Capable of throwing back light, images, sound waves : reflecting. [EU] 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] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Mechanics: The physical or mechanical action of the lungs, diaphragm, ribs, and chest wall during respiration. It includes airflow, lung volume, neural and reflex controls, mechanoreceptors, breathing patterns, etc. [NIH]

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Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retractor: An instrument designed for pulling aside tissues to improve exposure at operation; an instrument for drawing back the edge of a wound. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Reverse Transcriptase Polymerase Chain Reaction: A variation of the PCR technique in which cDNA is made from RNA via reverse transcription. The resultant cDNA is then amplified using standard PCR protocols. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rotator: A muscle by which a part can be turned circularly. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH]

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Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salpingitis: 1. Inflammation of the uterine tube. 2. Inflammation of the auditory tube. [EU] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Scalpel: A small pointed knife with a convex edge. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [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] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the 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]

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Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] 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] Sleep Deprivation: The state of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH]

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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] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [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] Spinal Injuries: Injuries involving the vertebral column. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splenectomy: An operation to remove the spleen. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Sprayer: A device for converting a medicated liquid into a vapor for inhalation; an instrument for applying a spray which is a jet of fine medicated vapor used either as an application to a diseased part or to charge the air of a room with a disinfectant. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Standard therapy: A currently accepted and widely used treatment for a certain type of cancer, based on the results of past research. [NIH] Steatosis: Fatty degeneration. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this

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group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] 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] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stromal Cells: Connective tissue cells of an organ found in the loose connective tissue. These are most often associated with the uterine mucosa and the ovary as well as the hematopoietic system and elsewhere. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

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] Superior Mesenteric Artery Syndrome: Duodenal obstruction caused by compression of the third part of the duodenum by the root of the intestinal mesentery which contains the superior mesenteric artery, vein, and nerve. [NIH]

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Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Surgical Equipment: Nonexpendable apparatus used during surgical procedures. They are differentiated from surgical instruments, usually hand-held and used in the immediate operative field. [NIH] Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sympathectomy: The removal or interruption of some part of the sympathetic nervous system for therapeutic or research purposes. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Systemic: Affecting the entire body. [NIH] Systemic therapy: Treatment that uses substances that travel through the bloodstream, reaching and affecting cells all over the body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thinness: A state of insufficient flesh on the body usually defined as having a body weight less than skeletal and physical standards. [NIH] Thoracic: Having to do with the chest. [NIH] Thoracic Surgery: A surgical specialty concerned with diagnosis and treatment of disorders of the heart, lungs, and esophagus. Two major types of thoracic surgery are classified as pulmonary and cardiovascular. [NIH] Thoracoscopy: Endoscopic examination, therapy or surgery of the pleural cavity. [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

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intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] 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] Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Adhesives: Substances used to cause adherence of tissue to tissue or tissue to nontissue surfaces, as for prostheses. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Topical: On the surface of the body. [NIH] Total pancreatectomy: Surgery to remove the entire pancreas. [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] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

Tracer: A substance (such as a radioisotope) used in imaging procedures. [NIH] Traction: The act of pulling. [NIH] Transcutaneous: Transdermal. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is

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analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Troglitazone: A drug used in diabetes treatment that is being studied for its effect on reducing the risk of cancer cell growth in fat tissue. [NIH] Truncal: The bilateral dissection of the abdominal branches of the vagus nerve. [NIH] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Ultrasound test: A test that bounces sound waves off tissues and internal organs and changes the echoes into pictures (sonograms). [NIH] Umbilical Cord: The flexible structure, giving passage to the umbilical arteries and vein, which connects the embryo or fetus to the placenta. [NIH] Umbilicus: The pit in the center of the abdominal wall marking the point where the umbilical cord entered in the fetus. [NIH] Uncompensated Care: Medical services for which no payment is received. Uncompensated care includes charity care and bad debts. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the

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"personal unconscious". [NIH] Unresectable: Unable to be surgically removed. [NIH] Urachal Cyst: Cyst occurring in a persistent portion of the urachus, presenting as an extraperitoneal mass in the umbilical region. It is characterized by abdominal pain, and fever if infected. It may rupture, leading to peritonitis, or it may drain through the umbilicus. [NIH] Urachus: The urinary canal of the fetus; postnatally it is usually a fibrous cord but occasionally persists as a vesicoumbilical fistula. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Ureteroscopy: Endoscopic examination, therapy or surgery of the ureter. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urethritis: Inflammation of the urethra. [EU] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urolithiasis: Stones in the urinary system. [NIH] Urologic Surgical Procedures: Surgery performed on the urinary tract or its parts in the male or female. For surgery of the male genitalia,male urologic surgical procedures are available. [NIH] Urologist: A doctor who specializes in diseases of the urinary organs in females and the urinary and sex organs in males. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH]

Dictionary 227

Vagal: Pertaining to the vagus nerve. [EU] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vaginosis: A condition caused by the overgrowth of anaerobic bacteria (e. g., Gardnerella vaginalis), resulting in vaginal irritation and discharge. [NIH] Vagotomy: The interruption or removal of any part of the vagus (10th cranial) nerve. Vagotomy may be performed for research or for therapeutic purposes. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Varices: Stretched veins such as those that form in the esophagus from cirrhosis. [NIH] Varicocele: A complex of dilated veins which surround the testicle, usually on the left side. [NIH]

Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular endothelial growth factor: VEGF. A substance made by cells that stimulates new blood vessel formation. [NIH] Vasculitis: Inflammation of a blood vessel. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Vena: A vessel conducting blood from the capillary bed to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] 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] Vertebral: Of or pertaining to a vertebra. [EU] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virilism: Development of masculine traits in the female. [NIH]

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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] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral fat: One of the three compartments of abdominal fat. Retroperitoneal and subcutaneous are the other two compartments. [NIH] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Zygote: The fertilized ovum. [NIH]

229

INDEX A Abdominal fat, 171, 228 Abdominal Pain, 58, 141, 144, 171, 211, 226 Aberrant, 29, 171 Ablation, 31, 41, 171 Abscess, 7, 40, 136, 142, 171 Acetylcholine, 171, 207 Acidosis, 39, 171 Acrylonitrile, 171, 218 Acute renal, 171, 195 Acute tubular, 20, 171 Adaptability, 171, 179 Adenocarcinoma, 64, 72, 73, 171, 195 Adhesions, 7, 37, 78, 103, 171 Adhesives, 79, 171 Adipose Tissue, 22, 35, 171 Adjustment, 92, 103, 171 Adjuvant, 32, 73, 171, 172 Adjuvant Therapy, 32, 172 Adnexa, 50, 55, 172 Adrenal Cortex, 172, 183, 189, 196, 213 Adverse Effect, 172, 220 Affinity, 172, 202 Age of Onset, 172, 225 Agonist, 25, 38, 66, 172, 186, 206 Alanine, 172, 206 Algorithms, 35, 172, 177 Alimentary, 172 Alkaline, 171, 172, 176, 178 Alkaloid, 172, 205 Allantois, 10, 172 Allograft, 4, 8, 13, 172 Alpha Particles, 172, 215 Alternative medicine, 145, 172 Amebiasis, 172, 204 Amenorrhea, 173, 207 Amine, 173, 195 Amino Acids, 173, 189, 210, 214, 218, 225, 226 Ampulla, 173, 188, 190 Anaerobic, 173, 227 Anaesthesia, 42, 46, 47, 53, 54, 57, 173, 198 Anaesthetic, 42, 173 Anal, 173, 181, 188, 191, 205, 216 Analgesic, 173, 205, 208 Analog, 38, 173, 180, 201, 206, 207 Analogous, 100, 173, 225

Anaphylatoxins, 173, 182 Anastomosis, 8, 10, 60, 173, 192, 200 Anatomical, 12, 36, 81, 82, 115, 139, 173, 197 Androgenic, 173, 207 Androgens, 172, 173, 175, 196 Anemia, 62, 173 Anesthesia, 5, 17, 47, 52, 56, 79, 98, 103, 125, 126, 127, 173, 174, 187, 200, 213 Anesthetics, 110, 174 Aneurysm, 95, 119, 174, 175 Angioplasty, 98, 174 Animal model, 28, 36, 61, 138, 174 Anomalies, 7, 10, 27, 174 Anorexia, 83, 174, 226 Anovulation, 21, 174 Antibacterial, 174, 180, 184, 221 Antibiotic, 33, 174, 175, 178, 179, 189, 202, 221 Antibodies, 174, 197, 203, 216 Antibody, 54, 101, 172, 174, 181, 184, 197, 198, 205, 215, 216, 220 Antiemetic, 174, 204 Antigen, 101, 172, 174, 182, 197, 198, 220 Antigen-Antibody Complex, 174, 182 Antimicrobial, 33, 174 Antioxidant, 28, 174 Antrectomy, 174, 176 Anus, 130, 173, 175, 176, 177, 188, 210, 216 Aorta, 95, 118, 175, 197, 227 Aortic Aneurysm, 50, 62, 64, 95, 118, 175 Aperture, 97, 113, 175, 215 Appendectomy, 6, 7, 11, 41, 60, 61, 62, 125, 126, 128, 138, 142, 144, 159, 175 Appendicitis, 7, 44, 55, 61, 175 Applicability, 47, 175 Approximate, 96, 119, 175 Aqueous, 175, 176, 184, 187, 201 Arginine, 173, 175, 207 Argon, 61, 175 Aromatase, 25, 29, 175 Arrhythmia, 39, 175 Arterial, 7, 12, 26, 34, 118, 175, 196, 214, 223 Arteries, 7, 12, 100, 175, 177, 183, 197, 204, 225 Arteriography, 72, 175 Arterioles, 175, 177

230

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Arthroscopy, 85, 98, 175 Articular, 175 Articulation, 93, 114, 175 Assay, 175, 197 Asymptomatic, 12, 172, 175, 209 Auditory, 175, 219, 227 Autodigestion, 175, 209 Autonomic, 47, 171, 175, 223 Azithromycin, 33, 175 B Back Pain, 107, 175 Bacteria, 174, 176, 187, 189, 190, 192, 194, 204, 212, 219, 221, 226, 227 Bactericidal, 176, 189 Bacterium, 23, 176, 181, 195 Barium, 13, 159, 176 Barium enema, 159, 176 Base, 87, 97, 176, 200, 226 Benign, 3, 11, 16, 52, 64, 176, 185, 192, 206, 216 Bilateral, 45, 176, 225 Bile, 17, 26, 66, 89, 114, 142, 147, 176, 180, 181, 184, 188, 191, 192, 195, 200, 202, 222 Bile Acids, 176, 192, 222 Bile Acids and Salts, 176 Bile Ducts, 176, 180, 191 Bile Pigments, 176, 200 Biliary, 17, 27, 89, 131, 138, 160, 176, 178, 181, 195, 209 Biliary Atresia, 27, 176 Biliary Tract, 89, 138, 160, 176, 178, 209 Biliopancreatic Diversion, 22, 176 Bilirubin, 176, 191, 196 Biochemical, 14, 176 Biological Transport, 176, 185 Biopsy, 14, 28, 32, 38, 51, 126, 129, 177, 189, 210 Biopsy specimen, 28, 177 Biosynthesis, 25, 177 Biotechnology, 40, 42, 145, 153, 177 Bladder, 10, 11, 53, 89, 100, 127, 146, 177, 184, 198, 202, 214, 218, 226 Blastocyst, 177, 182, 187, 211 Bloating, 36, 177, 192 Blood Glucose, 177, 194, 199 Blood pressure, 171, 177, 178, 196, 205 Blood transfusion, 5, 177 Body Composition, 21, 177 Body Fluids, 177, 178, 186, 187 Body Mass Index, 177, 208 Bone Marrow, 177, 197, 202, 203, 222 Bowel Movement, 177, 185

Brachytherapy, 177, 199, 215 Bradykinin, 177, 207, 212 Branch, 167, 178, 203, 209, 215, 221 Breakdown, 178, 185, 192 Breeding, 38, 178 Broad-spectrum, 33, 178 Bronchial, 178, 195 Bulimia, 83, 178 Bupivacaine, 43, 178, 201 Bypass, 5, 17, 24, 143, 146, 178, 200 C Cadaver, 139, 178 Calcium, 178, 181, 187 Calculi, 15, 89, 178 Callus, 178, 187 Cannula, 86, 87, 88, 91, 92, 93, 94, 101, 102, 109, 111, 112, 114, 117, 118, 126, 178 Carbohydrates, 178, 179 Carbon Dioxide, 39, 46, 80, 87, 114, 115, 116, 178, 184, 191, 192, 196, 211, 217 Carcinogen, 178, 204 Carcinogenic, 178, 222 Carcinoma, 12, 56, 144, 178 Cardiac, 178, 187, 201, 206, 209, 218, 222 Cardiovascular, 5, 22, 45, 50, 110, 178, 223 Cardiovascular disease, 22, 178 Case report, 50, 57, 63, 65, 178, 179, 180 Case series, 24, 179, 180 Catheterization, 174, 179, 199 Catheters, 40, 65, 179, 197, 199 Caudal, 179, 213 Causal, 179, 188 Cause of Death, 31, 35, 179 Cecum, 51, 179, 201 Cefoxitin, 41, 179 Cell Death, 30, 179, 206 Cell membrane, 101, 176, 179, 211 Ceramide, 32, 179 Cerebral, 179, 189, 203 Cerebral Angiography, 179, 203 Cerebrospinal, 179, 220 Cerebrospinal fluid, 179, 220 Cerebrovascular, 178, 179 Cervical, 23, 100, 101, 144, 179 Cervix, 99, 100, 101, 179, 217 Chemoembolization, 26, 179 Chemotactic Factors, 180, 182 Chemotherapy, 12, 172, 180 Chest Pain, 3, 180, 189 Chest wall, 180, 212, 217 Chlamydia, 23, 33, 35, 54, 180 Cholangiography, 17, 18, 89, 128, 143, 180

Index 231

Cholangitis, 89, 180 Cholecystitis, 138, 180 Choledocholithiasis, 89, 128, 180 Cholelithiasis, 17, 180 Cholesterol, 176, 180, 183, 191, 222 Chromosomal, 180, 212 Chromosome, 180, 202 Chronic Disease, 24, 180 Chronic renal, 180, 212, 226 Circadian, 37, 180 Clamp, 104, 180 Clear cell carcinoma, 180, 185 Clindamycin, 41, 180 Clinical study, 180, 183 Clinical trial, 20, 25, 26, 27, 28, 33, 38, 71, 74, 146, 153, 180, 205, 210, 214, 216 Cloning, 177, 180 Coagulation, 14, 106, 178, 180, 195, 201, 212, 224 Cohort Studies, 181, 188 Colectomy, 5, 6, 15, 18, 43, 60, 61, 65, 73, 159, 181 Colitis, 136, 181, 198 Collagen, 171, 181, 212 Collapse, 85, 115, 178, 181, 212 Colonoscopy, 42, 181 Colorectal, 14, 16, 19, 43, 48, 60, 62, 65, 71, 144, 158, 181 Colorectal Cancer, 71, 158, 181 Colorectal Surgery, 14, 19, 60, 181 Colostomy, 20, 159, 181 Common Bile Duct, 16, 17, 26, 66, 89, 126, 138, 181, 184, 195, 209 Common Bile Duct Obstruction, 66, 181 Competency, 33, 181 Complement, 89, 173, 181, 203, 212 Complete remission, 182, 217 Compress, 90, 182 Computational Biology, 153, 182 Computed tomography, 31, 72, 182 Computerized axial tomography, 182 Computerized tomography, 182 Concentric, 99, 182 Conception, 48, 182, 183, 190, 213, 221 Concretion, 178, 182 Cone, 101, 182 Connective Tissue, 36, 177, 181, 182, 202, 219, 222 Connective Tissue Cells, 182 Consciousness, 173, 183, 218 Constipation, 107, 183, 211 Constriction, 183, 200, 214

Contraception, 183, 201, 207 Contraindications, ii, 17, 146, 183 Contrast Media, 183, 203 Controlled clinical trial, 26, 183 Convalescence, 8, 10, 16, 183 Coronary, 178, 183, 204 Coronary heart disease, 178, 183 Coronary Thrombosis, 183, 204 Corpus, 183, 210, 213 Corpus Luteum, 183, 213 Cortex, 183, 189 Cortisol, 37, 183 Cranial, 183, 199, 208, 227 Credentialing, 128, 183 Cross-Sectional Studies, 183, 188 Cryptorchidism, 125, 183 Cryptosporidiosis, 175, 183 Cues, 98, 183 Culdoscopy, 132, 133, 184 Curative, 14, 16, 32, 36, 184 Cyanide, 184, 204 Cyanoacrylates, 79, 184 Cyclic, 184, 194, 207 Cyst, 5, 11, 52, 108, 184, 226 Cystectomy, 108, 127, 184 Cystic Duct, 17, 89, 181, 184, 195 Cytochrome, 175, 184 Cytokines, 34, 184 Cytoplasm, 179, 184, 188, 218 Cytotoxic, 184, 216 D Databases, Bibliographic, 153, 184 Decarboxylation, 184, 195 Degenerative, 184, 195 Delivery of Health Care, 184, 194 Deprivation, 37, 185 Dermoid, 45, 108, 185 Dermoid Cyst, 45, 185 DES, 107, 173, 185 Diabetes Mellitus, 185, 194, 207 Diagnostic Imaging, 185, 215 Diagnostic procedure, 31, 77, 145, 185 Diaphragm, 51, 185, 195, 212, 217 Diarrhea, 107, 172, 176, 183, 185 Diastolic, 185, 196 Diathermy, 21, 86, 126, 185 Diffusion, 39, 176, 185, 198 Digestion, 172, 176, 177, 185, 192, 199, 202, 210, 222 Digestive system, 75, 185, 192 Digestive tract, 83, 185, 220 Dilatation, 3, 174, 185, 213

232

Laparoscopy

Dilation, 4, 177, 185 Direct, iii, 11, 18, 26, 37, 40, 78, 79, 82, 103, 185, 186, 193, 196, 213, 217 Disease Progression, 16, 25, 185 Disinfectant, 185, 189, 221 Dissection, 6, 7, 9, 10, 11, 12, 17, 18, 78, 96, 103, 126, 136, 143, 185, 202, 225 Diverticula, 186 Diverticulitis, 61, 64, 66, 136, 159, 186 Diverticulum, 49, 50, 62, 64, 126, 172, 186 Dopamine, 186, 204 Dorsal, 186, 213 Drive, ii, vi, 6, 15, 17, 18, 31, 59, 101, 126, 127, 138, 139, 186 Drug Tolerance, 186, 224 Duodenal Ulcer, 126, 186 Duodenum, 129, 176, 186, 188, 192, 200, 209, 210, 222 Dysmenorrhea, 107, 186 Dyspareunia, 107, 186 Dysphagia, 3, 11, 13, 15, 36, 186 Dyspnea, 15, 186 E Eating Disorders, 83, 186 Ectopic, 25, 35, 107, 143, 186 Ectopic Pregnancy, 143, 186 Effector, 84, 105, 171, 181, 186 Efficacy, 4, 8, 9, 13, 19, 22, 24, 25, 26, 29, 31, 33, 36, 37, 38, 40, 41, 56, 66, 146, 186 Elective, 7, 35, 45, 61, 186 Electrocoagulation, 181, 186 Electrode, 83, 106, 187 Electrolytes, 176, 187, 191, 200 Electrons, 174, 176, 187, 200, 209, 215, 216 Embolism, 17, 187 Embolus, 15, 187, 198 Embryo, 177, 187, 198, 213, 221, 225 Embryo Transfer, 187, 213 Embryogenesis, 33, 187 Emulsion, 187, 191 Encapsulated, 108, 187 Endarterectomy, 174, 187 Endocrine System, 187 Endocrinology, 39, 66, 187, 194 Endometrial, 23, 25, 35, 36, 49, 57, 72, 101, 107, 187, 188 Endometriosis, 24, 25, 29, 36, 37, 44, 45, 46, 101, 107, 131, 158, 188, 201, 206, 207 Endometrium, 25, 30, 101, 187, 188, 204 Endoscope, 80, 81, 82, 85, 90, 159, 184, 188 Endoscopic retrograde cholangiopancreatography, 26, 188

Endothelium, 188, 207 Endothelium-derived, 188, 207 Endotoxins, 182, 188 End-stage renal, 53, 180, 188, 212 Enema, 188 Energy balance, 35, 188 Enterostomal Therapy, 19, 188 Enucleation, 63, 188 Environmental Health, 152, 154, 188 Environmental Pollutants, 188, 212 Enzymatic, 178, 182, 188, 195, 218 Enzyme, 30, 175, 186, 188, 194, 209, 210, 212, 214, 217, 224, 228 Eosinophilic, 50, 188 Epidemiologic Studies, 23, 188 Epidermis, 188, 215 Epigastric, 55, 189, 209 Epithelial, 25, 171, 176, 189 Equipment and Supplies, 73, 189 Ergonomics, 79, 189 Erythrocytes, 173, 177, 189, 217 Erythromycin, 175, 189 Esophageal, 3, 11, 13, 15, 36, 62, 138, 142, 159, 189, 192 Esophageal Achalasia, 62, 189 Esophageal Manometry, 11, 189 Esophageal Stricture, 13, 189 Esophageal Ulcer, 4, 189 Esophagitis, 13, 15, 16, 19, 189, 192 Estradiol, 25, 30, 189 Estrogen, 25, 30, 175, 189 Estrogen receptor, 25, 189 Ethanol, 65, 189 Evacuation, 82, 183, 189, 192 Evoke, 21, 189, 222 Excisional, 14, 189, 190 Excisional biopsy, 14, 190 Exocrine, 190, 209 Exogenous, 25, 38, 190, 225 External-beam radiation, 190, 215 Extracellular, 31, 182, 190 Extracellular Matrix, 182, 190 Extracorporeal, 15, 51, 190 Extraction, 18, 20, 116, 126, 190 Extraocular, 172, 190 Extremity, 78, 102, 190 F Fallopian Tubes, 190, 196, 217, 225 Family Planning, 153, 190 Fat, 7, 15, 34, 171, 176, 177, 179, 183, 187, 190, 202, 208, 212, 220, 225 Fatty acids, 35, 190

Index 233

Fatty Liver, 22, 190 Feces, 183, 190 Femoral, 118, 190 Femoral Artery, 118, 190 Femur, 190 Fertilization in Vitro, 190, 213 Fetal Blood, 190, 203 Fetus, 29, 39, 190, 211, 221, 222, 225, 226 Fibrin, 14, 93, 190, 211, 224 Fibrinogen, 190, 212, 224 Fine-needle aspiration, 191, 206 Fistula, 191, 207, 226 Fixation, 118, 191 Flatus, 191, 192 Fluorescence, 31, 191 Fluoroscopy, 36, 46, 191 Flush, 92, 191 Fold, 27, 93, 191, 204 Follicles, 33, 191 Follicular Fluid, 21, 191 Follicular Phase, 25, 191 Foramen, 191, 211 Fornix, 184, 191 Fovea, 191 G Gadolinium, 6, 7, 191 Gallstones, 17, 46, 130, 147, 176, 180, 181, 191 Gamma Rays, 192, 215, 216 Ganglion, 189, 192, 208 Gas exchange, 39, 192 Gastrectomy, 22, 51, 192 Gastric Acid, 19, 192 Gastric banding, 60, 63, 66, 192 Gastric Bypass, 22, 24, 60, 69, 146, 192 Gastric Emptying, 192 Gastric Juices, 192, 210 Gastrin, 192, 196 Gastroenterologist, 36, 192 Gastroenterostomy, 126, 192 Gastroesophageal Reflux, 4, 5, 6, 13, 16, 17, 26, 117, 137, 192 Gastroesophageal Reflux Disease, 6, 13, 14, 16, 17, 26, 117, 137, 192 Gastrointestinal, 5, 6, 17, 18, 19, 26, 46, 83, 128, 130, 160, 176, 177, 189, 192, 220, 221, 222 Gastrointestinal tract, 5, 176, 189, 192, 220, 221 Gastroparesis, 83, 192 Gastroplasty, 13, 62, 143, 192 Gene, 22, 25, 27, 34, 107, 175, 177, 193

Gene Expression, 22, 25, 27, 34, 107, 193 Generator, 106, 193 Genital, 23, 33, 180, 193, 194, 200, 226 Germ Cells, 193, 207, 208, 223 Gestation, 23, 35, 193, 210, 211, 221 Giardiasis, 193, 204 Ginger, 56, 193 Gland, 172, 193, 196, 202, 206, 209, 214, 219, 222 Glare, 98, 193 Glomerular, 193, 217 Glucose, 21, 177, 185, 193, 194, 199, 219 Glycogen, 180, 193 Gonad, 193 Gonadal, 9, 193, 222 Gonadorelin, 193, 201, 206 Gonadotropin, 25, 38, 193, 201 Gonorrhea, 23, 33, 193 Governing Board, 193, 213 Grade, 193, 194 Grading, 107, 193, 194 Graft, 5, 7, 8, 13, 20, 94, 95, 118, 194, 196, 197 Graft Rejection, 194, 197 Grafting, 194, 197 Gram-negative, 180, 194 Groin, 78, 103, 143, 194, 198 Growth, 106, 107, 173, 174, 179, 194, 203, 206, 207, 208, 211, 219, 220, 225 Guanylate Cyclase, 194, 207 Gynaecological, 42, 194 Gynecology, 29, 35, 37, 42, 43, 46, 48, 49, 50, 52, 56, 57, 60, 61, 66, 108, 130, 132, 194 H Health Care Costs, 26, 29, 194 Health Expenditures, 194 Heart attack, 178, 194 Heartburn, 4, 13, 15, 194, 195 Heme, 176, 184, 194, 209 Hemoglobin, 173, 189, 194 Hemolytic, 62, 195 Hemorrhage, 4, 186, 195, 215, 222 Hemostasis, 126, 195 Hepatic, 22, 34, 72, 89, 181, 188, 195 Hepatic Duct, Common, 188, 195 Hepatitis, 18, 28, 47, 195 Hepatobiliary, 17, 195 Hepatocellular, 26, 65, 195 Hepatocellular carcinoma, 26, 65, 195 Hepatocyte, 22, 195 Heredity, 193, 195

234

Laparoscopy

Hernia, 5, 15, 17, 20, 45, 64, 73, 78, 102, 131, 135, 138, 139, 143, 144, 159, 195 Herniorrhaphy, 10, 73, 127, 135, 138, 195 Hiatal Hernia, 5, 15, 19, 143, 195 Hirsutism, 195, 196 Histamine, 16, 173, 195 Histamine Agonists, 195 Histamine Antagonists, 16, 195 Histidine, 195 Histology, 22, 39, 195 Hormonal, 30, 32, 38, 195, 196 Hormonal therapy, 38, 196 Hormone, 21, 24, 38, 172, 183, 185, 189, 192, 193, 195, 196, 199, 201, 204, 206, 207, 213, 220 Hormone therapy, 24, 172, 196 Hospital Charges, 13, 196 Hospital Costs, 28, 196 Host, 196, 197 Hydration, 20, 196 Hydrochloric Acid, 34, 196 Hydrogen, 171, 173, 176, 178, 196, 205, 206, 208, 214 Hydrolysis, 196, 202, 214 Hyperandrogenism, 21, 196 Hyperbilirubinemia, 196, 200 Hypercarbia, 4, 196 Hypersecretion, 21, 196 Hypertension, 17, 22, 24, 178, 196, 207, 224, 226 Hyperthermia, 185, 196 Hypoglycemia, 63, 72, 196 Hysterectomy, 41, 51, 56, 65, 80, 99, 100, 132, 134, 196 Hysterosalpingography, 55, 196 Hysteroscopy, 43, 55, 128, 129, 130, 132, 133, 134, 197 I Id, 67, 146, 160, 166, 168, 197 Idiopathic, 23, 62, 66, 197 Ileal, 127, 138, 197 Ileostomy, 197, 206 Ileum, 179, 197, 200 Ileus, 18, 19, 197 Iliac Artery, 190, 197 Imaging procedures, 197, 224 Immune response, 171, 174, 194, 197, 203, 222, 228 Immune system, 197, 203, 226, 228 Immunization, 197 Immunoassay, 39, 197 Immunoglobulin, 174, 197, 205

Immunohistochemistry, 39, 101, 197 Immunologic, 180, 197, 216 Immunology, 54, 171, 172, 197 Immunosuppressive, 197 Immunosuppressive therapy, 197 Immunotherapy, 12, 197 Impairment, 35, 197, 204 Implant radiation, 197, 199, 215 Implantation, 30, 83, 88, 107, 118, 120, 182, 197 In vitro, 31, 187, 198, 220, 224 In vivo, 25, 27, 28, 30, 31, 32, 116, 198 Incisional, 64, 198 Incompetence, 192, 198 Incontinence, 198 Indicative, 29, 128, 198, 209, 227 Induction, 38, 173, 185, 198, 200, 208 Infancy, 63, 198 Infarction, 183, 198, 204, 217 Infection, 20, 23, 47, 79, 89, 114, 115, 117, 172, 180, 183, 193, 198, 202, 203, 222, 224, 225, 228 Inferior vena cava, 12, 198 Infertility, 24, 25, 29, 32, 33, 39, 45, 48, 66, 101, 107, 143, 158, 198, 226 Infiltration, 34, 198, 213 Inflammation, 7, 17, 33, 136, 175, 180, 181, 186, 189, 195, 198, 209, 211, 219, 226, 227 Inflammatory bowel disease, 136, 159, 198 Informed Consent, 24, 127, 198 Infusion, 34, 198, 225 Ingestion, 191, 198, 212 Inguinal, 16, 41, 57, 73, 78, 103, 125, 126, 128, 132, 135, 138, 139, 198 Inguinal Hernia, 16, 41, 57, 73, 78, 103, 125, 127, 128, 132, 198 Inhalation, 199, 200, 212, 221 Inlay, 135, 199, 218 Insufflation, 17, 37, 39, 88, 91, 109, 114, 115, 125, 199 Insulin, 21, 22, 24, 72, 199, 225 Insulin-dependent diabetes mellitus, 22, 199 Intermittent, 60, 199, 211 Internal Medicine, 65, 187, 199 Internal radiation, 199, 215 Interstitial, 43, 177, 199, 217 Intervertebral, 120, 199, 202 Intervertebral Disk Displacement, 199, 202 Intestinal, 19, 47, 56, 80, 128, 183, 199, 205, 222

Index 235

Intestine, 176, 177, 181, 199, 201, 210, 228 Intoxication, 199, 228 Intracellular, 198, 199, 204, 207 Intracranial Pressure, 199, 214 Intrahepatic, 89, 195, 199 Intramuscular, 60, 199 Intramuscular injection, 60, 199 Intraperitoneal, 43, 107, 135, 199 Intravenous, 34, 47, 198, 199 Intubation, 54, 179, 199 Intussusception, 125, 199, 216 Involuntary, 200, 205, 217, 220, 222 Involution, 10, 200 Ionizing, 172, 200, 216 Ions, 176, 187, 196, 200 Irrigation, 80, 95, 96, 106, 114, 200 Ischemia, 28, 39, 200, 217 Isoflurane, 47, 200 J Jaundice, 17, 89, 196, 200 Jejunoileal Bypass, 176, 200 Jejunum, 176, 192, 200 Joint, 175, 200, 221, 223 K Kb, 152, 200 Ketamine, 57, 200 Kidney Disease, 5, 72, 75, 152, 200 Kidney Failure, 188, 200 Kidney Pelvis, 200, 226 Kidney Transplantation, 8, 200 L Labile, 181, 201 Laceration, 4, 201 Lacrimal, 172, 201 Lacrimal Apparatus, 172, 201 Laparoscopes, 139, 201 Laparoscopic-assisted colectomy, 14, 73, 181, 201 Laparotomy, 7, 14, 27, 35, 45, 50, 52, 53, 82, 108, 143, 201 Large Intestine, 179, 181, 185, 199, 201, 216, 220, 228 Laser Surgery, 65, 95, 96, 201 Latent, 201, 213 Length of Stay, 16, 54, 201 Lens, 80, 98, 201 Lesion, 201, 202, 225 Leukocytes, 177, 180, 184, 201 Leukocytosis, 34, 201 Leuprolide, 38, 201 Levonorgestrel, 38, 201, 207 Library Services, 166, 201

Lidocaine, 43, 201 Ligament, 201, 214, 221 Ligands, 101, 201 Ligation, 9, 11, 34, 105, 126, 138, 144, 201 Lincomycin, 180, 201 Linkage, 85, 202 Lipid, 199, 202, 225 Lipolysis, 34, 202 Lipophilic, 202, 212 Lithotomy, 9, 202 Lithotomy position, 9, 202 Lithotripsy, 15, 18, 202 Liver Transplantation, 22, 202 Localization, 197, 202 Localized, 6, 7, 171, 187, 191, 195, 198, 202, 211, 225 Loop, 81, 83, 84, 105, 114, 138, 139, 192, 195, 197, 202 Low Back Pain, 120, 202 Lower Esophageal Sphincter, 3, 16, 19, 189, 192, 202 Lumbar, 176, 199, 202 Lumen, 78, 81, 88, 93, 102, 115, 178, 202 Lymph, 6, 9, 11, 32, 78, 80, 100, 103, 179, 188, 202, 203, 206, 209 Lymph node, 6, 9, 11, 32, 78, 100, 103, 179, 202, 203, 206, 209 Lymphadenectomy, 6, 100, 127, 128, 138, 202 Lymphatic, 188, 198, 202, 203, 212, 221 Lymphatic system, 202, 203, 221 Lymphocele, 127, 203 Lymphocyte, 174, 203 Lymphoid, 51, 174, 203 Lymphoma, 51, 203 Lymphoproliferative, 43, 203 M Magnetic Resonance Angiography, 6, 7, 203 Magnetic Resonance Imaging, 44, 56, 72, 203 Major Histocompatibility Complex, 101, 203 Malignancy, 19, 203 Malignant, 5, 10, 16, 17, 19, 31, 108, 171, 203, 206, 216, 219 Mammography, 120, 203 Manometry, 13, 15, 36, 203 Maternal-Fetal Exchange, 39, 203 Mechanoreceptors, 203, 217 Medial, 9, 203 Medical Records, 7, 203, 218

236

Laparoscopy

MEDLINE, 153, 203 Membrane, 179, 182, 188, 190, 194, 204, 205, 210, 211, 212, 214, 216, 218 Membrane Proteins, 204, 214 Memory, 174, 204 Menstrual Cycle, 29, 191, 204, 213 Menstruation, 25, 107, 173, 186, 191, 204 Mental Disorders, 75, 204, 215 Mental Health, iv, 20, 75, 152, 154, 204, 215 Mentors, 28, 204 Mesenteric, 9, 54, 67, 204, 222 Mesentery, 204, 211, 222 Metabolite, 32, 204 Metastasis, 52, 61, 204 Methylene Blue, 48, 204 Metoclopramide, 66, 204 Metronidazole, 41, 204 MI, 65, 108, 169, 204 Microorganism, 204, 209, 228 Millimeter, 112, 204 Miscarriage, 23, 30, 35, 204 Mitochondrial Swelling, 205, 206 Mobility, 37, 205 Mobilization, 12, 205 Modification, 56, 100, 205 Molecular, 29, 153, 155, 173, 177, 182, 190, 205, 218 Molecule, 174, 176, 182, 186, 188, 196, 205, 208, 212, 216 Monitor, 4, 91, 96, 98, 99, 105, 158, 205, 207 Monoclonal, 101, 205, 215 Morphine, 60, 66, 205, 206, 208 Morphology, 21, 205 Motility, 19, 83, 189, 205 Motion Sickness, 205, 206 Mucinous, 108, 192, 205 Mucopurulent, 23, 205 Mucosa, 51, 205, 222 Mucus, 205 Multicenter study, 9, 205 Multiple Organ Failure, 28, 205 Multivariate Analysis, 51, 205 Mydriatic, 185, 205 Myenteric, 189, 205 Myocardium, 204, 205 N Nafarelin, 25, 206 Narcosis, 206 Narcotic, 8, 110, 205, 206 Nausea, 47, 56, 110, 174, 192, 206, 214, 226 NCI, 1, 72, 73, 74, 151, 206

Necrosis, 20, 40, 198, 204, 206, 217 Necrotizing Enterocolitis, 27, 206 Needle biopsy, 18, 191, 206 Neonatal, 27, 48, 206 Neoplasm, 64, 206, 219 Neoplastic, 203, 206 Nephrectomy, 4, 7, 8, 11, 12, 13, 20, 48, 53, 62, 64, 80, 126, 127, 138, 139, 206 Nephropathy, 13, 200, 206 Nerve, 10, 41, 56, 173, 192, 206, 208, 213, 222, 224, 227 Nervous System, 171, 172, 192, 203, 205, 206, 208, 220, 222, 223 Neural, 203, 206, 217 Neurosurgery, 31, 206 Neutrons, 172, 206, 215 Nitric Oxide, 39, 207 Nitrogen, 115, 172, 173, 175, 191, 207 Nonmalignant, 62, 207 Norethindrone, 38, 207 Norgestrel, 201, 207 Nuclear, 187, 191, 192, 206, 207 Nuclei, 172, 187, 189, 203, 206, 207, 208, 214 Nucleic acid, 207 Nucleus, 184, 188, 192, 199, 207, 214 O Occult, 49, 207 Octreotide, 61, 207 Oncology, 48, 49, 53, 55, 56, 72, 73, 100, 132, 133, 207 Oocytes, 32, 207 Oophorectomy, 31, 108, 207 Ophthalmology, 191, 207 Opium, 205, 207 Optic Nerve, 208, 214, 218 Optic Nerve Diseases, 208, 214 Orbit, 185, 208 Orchiectomy, 138, 208 Organ Culture, 208, 224 Orthostatic, 207, 208 Ostomy, 19, 20, 188, 208 Outpatient, 56, 159, 208 Ovarian Follicle, 183, 191, 208 Ovariectomy, 25, 208 Ovaries, 31, 32, 45, 100, 175, 190, 196, 207, 208, 217, 225 Ovary, 21, 33, 38, 51, 108, 126, 183, 189, 193, 196, 208, 222 Overall survival, 16, 31, 208 Overweight, 22, 67, 208 Ovulation, 21, 30, 38, 174, 191, 207, 208

Index 237

Ovulation Induction, 38, 208 Ovum, 183, 191, 193, 208, 213, 228 Oxidation, 174, 184, 208 Oxygenase, 30, 209 Oxygenation, 56, 209 P Pacemaker, 37, 209 Paediatric, 50, 60, 209 Palliative, 5, 209 Pancreas, 72, 171, 185, 199, 209, 220, 224 Pancreatectomy, 63, 209 Pancreatic, 5, 40, 56, 61, 65, 72, 142, 143, 188, 192, 209 Pancreatic cancer, 61, 65, 142, 143, 209 Pancreatic Ducts, 188, 209 Pancreatic Juice, 192, 209 Pancreatitis, 40, 209 Papilla, 89, 188, 209 Papilledema, 209, 214 Parietal, 209, 211, 212 Partial remission, 209, 217 Patch, 78, 102, 209 Pathogen, 23, 209 Pathogenesis, 25, 107, 209 Pathologic, 171, 177, 183, 196, 209, 213 Pathologies, 39, 83, 210 Pathophysiology, 25, 37, 210 Patient Education, 127, 137, 138, 158, 164, 166, 169, 210 Patient Satisfaction, 13, 210 Patient Selection, 4, 11, 18, 19, 20, 125, 126, 127, 138, 146, 210 Pelvic inflammatory disease, 33, 210 Penis, 210, 211, 217 Pepsin, 210 Peptic, 5, 210 Peptic Ulcer, 5, 210 Peptide, 210, 214 Perception, 182, 210, 219 Percutaneous, 5, 14, 15, 28, 40, 45, 46, 49, 52, 54, 55, 57, 65, 118, 121, 134, 147, 202, 210 Perforated Ulcer, 142, 210 Perforation, 7, 53, 136, 175, 191, 210, 228 Perfusion, 39, 210 Perianal, 136, 210 Perinatal, 23, 29, 210 Perineal, 20, 210, 215 Perineum, 210 Perioperative, 14, 210 Peristalsis, 15, 210

Peritoneal, 9, 25, 27, 39, 41, 65, 90, 91, 94, 106, 107, 108, 130, 199, 211 Peritoneal Cavity, 25, 39, 90, 91, 94, 106, 107, 108, 199, 211 Peritoneal Dialysis, 65, 211 Peritoneum, 39, 44, 78, 103, 104, 105, 204, 211, 218 Peritonitis, 7, 56, 106, 108, 211, 226, 228 Phallic, 191, 211 Pharmacologic, 173, 211, 224 Pharynx, 192, 211, 227 Phospholipids, 190, 211 Photocoagulation, 181, 211 Physical Examination, 7, 211 Physiologic, 16, 29, 37, 39, 89, 172, 177, 185, 204, 211, 216 Physiology, 5, 18, 37, 83, 159, 187, 194, 211 Pilot study, 48, 211 Placenta, 175, 189, 190, 211, 213, 225 Plants, 172, 178, 193, 205, 211, 219, 224, 225 Plaque, 174, 211 Plasma, 39, 52, 172, 174, 179, 190, 191, 194, 195, 200, 212, 219 Plasma protein, 191, 212 Plasmid, 27, 212 Platelet Aggregation, 173, 207, 212 Platelets, 207, 212, 224 Platinum, 202, 212 Pleural, 212, 223 Pleural cavity, 212, 223 Plexus, 189, 212 Pneumothorax, 8, 212 Poisoning, 199, 204, 206, 212 Polychlorinated Biphenyls, 29, 212 Polycystic, 5, 21, 196, 212 Polyposis, 181, 212 Polysaccharide, 174, 212 Port, 12, 52, 55, 60, 61, 85, 88, 89, 92, 97, 100, 111, 112, 114, 116, 119, 120, 142, 212 Port-a-cath, 212 Posterior, 4, 63, 78, 103, 173, 175, 184, 186, 209, 213 Postoperative, 4, 8, 9, 11, 13, 14, 15, 20, 36, 37, 42, 66, 112, 126, 138, 139, 142, 159, 205, 213 Postoperative Complications, 11, 15, 139, 213 Postoperative Period, 20, 213 Practice Guidelines, 138, 154, 159, 213 Precancerous, 213 Precursor, 186, 188, 213

238

Laparoscopy

Predisposition, 107, 213 Pregnancy Outcome, 23, 213 Premalignant, 31, 213 Prevalence, 22, 29, 213 Probe, 72, 100, 103, 104, 106, 213 Procaine, 201, 213 Progesterone, 25, 30, 201, 207, 213, 222 Progestogen, 38, 213 Progression, 18, 26, 174, 213 Progressive, 17, 180, 186, 194, 200, 205, 206, 213, 217 Progressive disease, 18, 213 Projection, 117, 208, 213 Prophase, 207, 214 Propofol, 47, 214 Prospective study, 12, 29, 41, 61, 214 Prostate, 6, 10, 11, 32, 214, 215, 217, 218, 225 Prostate gland, 32, 214 Prostatectomy, 10, 32, 54, 214, 215 Prosthesis, 63, 135, 214 Protein S, 177, 189, 214, 218 Proteins, 34, 173, 174, 179, 181, 184, 189, 204, 205, 207, 210, 212, 214, 220, 224 Proteolytic, 182, 191, 214 Protocol, 22, 24, 35, 41, 72, 214 Proton Pump, 11, 13, 16, 19, 26, 214 Proton Pump Inhibitors, 11, 13, 16, 26, 214 Protons, 172, 196, 200, 214, 215 Proximal, 78, 79, 84, 85, 87, 88, 91, 92, 95, 100, 101, 102, 112, 120, 121, 186, 192, 200, 214 Pseudotumor Cerebri, 24, 214 Psychiatric, 204, 215, 220 Psychiatry, 191, 215, 222 Puberty, 206, 215 Public Health, 24, 29, 34, 36, 154, 215 Public Policy, 37, 153, 215 Publishing, 8, 17, 40, 126, 127, 138, 139, 215 Pulmonary, 5, 15, 19, 39, 177, 188, 200, 215, 223, 227 Pulse, 22, 205, 215 Punctures, 147, 215 Pupil, 185, 205, 215 Purpura, 62, 66, 215 Purulent, 215, 227 R Race, 201, 207, 215 Radiation, 32, 73, 120, 121, 172, 190, 191, 192, 196, 199, 200, 203, 204, 215, 216, 228 Radiation therapy, 32, 172, 190, 199, 215

Radical prostatectomy, 10, 32, 54, 143, 215 Radio Waves, 185, 215 Radioactive, 196, 197, 199, 207, 215, 216 Radiofrequency ablation, 26, 216 Radioimmunotherapy, 216 Radioisotope, 216, 224 Radiolabeled, 215, 216 Radiological, 26, 210, 216 Radiology, 32, 62, 216 Radiopharmaceutical, 32, 193, 216 Radiotherapy, 33, 177, 215, 216 Random Allocation, 216 Randomization, 38, 216 Randomized, 24, 26, 33, 40, 41, 43, 45, 73, 186, 216 Reagent, 101, 196, 216 Receptivity, 25, 216 Receptor, 30, 174, 182, 186, 216 Rectal, 5, 60, 64, 65, 71, 216 Rectal Prolapse, 5, 64, 216 Rectum, 14, 130, 175, 176, 177, 181, 185, 191, 192, 198, 201, 214, 216, 220 Recurrence, 8, 10, 16, 25, 32, 38, 52, 73, 143, 217 Red blood cells, 189, 195, 209, 217, 219 Reductase, 175, 217 Refer, 1, 181, 191, 202, 207, 216, 217 Reflective, 98, 217 Reflex, 217 Reflux, 15, 17, 19, 26, 36, 62, 83, 137, 159, 192, 217 Refraction, 217, 221 Regimen, 33, 38, 186, 217 Regurgitation, 3, 13, 15, 192, 194, 217 Remission, 24, 217 Renal failure, 53, 217 Reperfusion, 28, 217 Reperfusion Injury, 217 Reproduction Techniques, 213, 217 Reproductive system, 159, 214, 217 Research Design, 24, 217 Resection, 5, 7, 9, 12, 19, 45, 51, 60, 62, 64, 65, 66, 126, 136, 138, 142, 159, 217, 225 Respiration, 178, 205, 217, 218 Respiratory Mechanics, 56, 217 Restoration, 217, 218 Resuscitation, 95, 118, 218 Retina, 201, 208, 218 Retinal, 182, 208, 218 Retractor, 92, 218 Retrograde, 107, 147, 200, 218

Index 239

Retroperitoneal, 14, 15, 40, 46, 52, 63, 80, 127, 218, 228 Retropubic, 214, 215, 218 Retropubic prostatectomy, 215, 218 Retrospective, 7, 23, 35, 45, 218 Retrospective study, 45, 218 Reverse Transcriptase Polymerase Chain Reaction, 39, 218 Ribosome, 218, 225 Risk factor, 4, 23, 126, 138, 188, 214, 218 Rod, 80, 86, 90, 91, 109, 110, 113, 114, 176, 180, 218 Rotator, 105, 218 Rubber, 80, 171, 218 S Saliva, 218, 219 Salivary, 37, 185, 209, 218, 219 Salivary glands, 185, 218, 219 Salpingitis, 23, 219 Saponins, 219, 222 Sarcoma, 52, 72, 219 Scalpel, 109, 219 Schizoid, 219, 228 Schizophrenia, 219, 228 Schizotypal Personality Disorder, 219, 228 Screening, 6, 31, 66, 101, 180, 219 Scrotum, 183, 219, 223 Secondary tumor, 204, 219 Secretion, 21, 193, 195, 196, 199, 205, 207, 219 Segmental, 159, 219 Segmentation, 219 Semen, 214, 219 Semisynthetic, 179, 180, 219 Sensibility, 173, 219 Sensor, 32, 219 Sepsis, 34, 89, 219 Serologic, 197, 220 Serology, 35, 220 Serum, 31, 173, 181, 193, 211, 220 Shock, 15, 202, 220, 225 Shunt, 10, 220 Side effect, 25, 32, 71, 72, 73, 83, 172, 200, 220, 224 Sigmoid, 9, 43, 61, 64, 66, 126, 159, 220 Sigmoid Colon, 9, 220 Sigmoidoscopy, 159, 220 Signs and Symptoms, 217, 220, 226 Skeletal, 98, 173, 180, 220, 223 Skeleton, 190, 200, 220 Sleep Deprivation, 37, 220

Small intestine, 176, 179, 184, 186, 188, 193, 196, 197, 198, 199, 200, 220 Smooth muscle, 173, 183, 195, 205, 220, 222 Sneezing, 220, 222 Soft tissue, 92, 177, 220 Solvent, 189, 220 Somatic, 187, 220, 227 Somatostatin, 207, 220 Sound wave, 185, 217, 220, 225 Specialist, 161, 185, 221 Species, 38, 180, 205, 215, 221, 222, 225, 228 Spectrum, 18, 215, 221 Sperm, 173, 180, 221, 223 Sphincter, 19, 37, 216, 221 Spinal cord, 179, 180, 192, 206, 217, 221, 223 Spinal Injuries, 120, 221 Spleen, 129, 202, 203, 209, 221 Splenectomy, 52, 61, 62, 66, 126, 138, 221 Spontaneous Abortion, 213, 221 Sprains and Strains, 202, 221 Sprayer, 109, 110, 221 Staging, 6, 43, 52, 55, 56, 65, 128, 134, 142, 221 Standard therapy, 17, 221 Steatosis, 190, 221 Steel, 180, 221 Stent, 94, 95, 118, 208, 221 Sterility, 44, 51, 198, 221 Sterilization, 126, 130, 132, 144, 221 Steroid, 25, 30, 175, 176, 183, 191, 219, 221 Stillbirth, 213, 222 Stimulant, 195, 222 Stimulus, 186, 187, 217, 222, 224 Stoma, 208, 222 Stress, 5, 11, 16, 18, 24, 28, 32, 36, 52, 119, 183, 206, 213, 218, 222 Stress incontinence, 24, 222 Stroke, 75, 152, 178, 222 Stromal, 25, 188, 222 Stromal Cells, 25, 222 Stupor, 206, 222 Styrene, 218, 222 Subacute, 50, 198, 222 Subclinical, 33, 198, 222 Subcutaneous, 34, 109, 128, 222, 228 Subspecies, 221, 222 Substance P, 189, 204, 213, 219, 222 Suction, 80, 95, 96, 106, 222

240

Laparoscopy

Superior Mesenteric Artery Syndrome, 63, 222 Suppression, 19, 25, 223 Surgical Equipment, 100, 223 Survival Rate, 8, 208, 223 Sympathectomy, 78, 103, 223 Sympathetic Nervous System, 206, 223 Symphysis, 214, 223 Symptomatic, 6, 10, 13, 17, 49, 209, 223 Systemic, 12, 33, 34, 39, 133, 175, 177, 198, 215, 223 Systemic therapy, 12, 223 Systolic, 196, 223 T Tachycardia, 39, 223 Testicles, 126, 183, 208, 219, 223 Testicular, 175, 183, 223 Testis, 10, 54, 189, 223 Thigh, 190, 194, 223 Thinness, 83, 223 Thoracic, 61, 104, 133, 176, 185, 223 Thoracic Surgery, 61, 104, 133, 223 Thoracoscopy, 85, 121, 126, 133, 134, 138, 142, 223 Thorax, 171, 202, 223, 227 Threshold, 38, 196, 223 Thrombin, 190, 212, 224 Thrombosis, 12, 52, 214, 222, 224 Thrombus, 183, 198, 212, 224, 227 Tidal Volume, 56, 224 Tinnitus, 214, 224 Tissue Adhesives, 117, 224 Tissue Culture, 31, 224 Tolerance, 8, 28, 171, 224 Tomography, 32, 224 Topical, 189, 224 Total pancreatectomy, 209, 224 Toxic, iv, 184, 212, 222, 224 Toxicology, 154, 224 Toxins, 174, 188, 198, 216, 224 Toxoplasmosis, 175, 224 Tracer, 35, 224 Traction, 180, 224 Transcutaneous, 87, 139, 224 Transfection, 177, 224 Transfusion, 225 Translation, 54, 84, 189, 225 Transplantation, 4, 6, 8, 12, 13, 20, 180, 187, 197, 203, 225 Transurethral, 214, 225 Transurethral Resection of Prostate, 214, 225

Trauma, 18, 28, 45, 50, 57, 88, 114, 117, 189, 203, 206, 209, 224, 225, 228 Trees, 218, 225 Trichomoniasis, 204, 225 Triglyceride, 22, 225 Troglitazone, 21, 225 Truncal, 6, 63, 126, 128, 225 Tubal ligation, 41, 66, 105, 225 Tuberculosis, 42, 44, 225 Type 2 diabetes, 24, 225 U Ulcer, 6, 186, 189, 210, 225 Ulceration, 210, 225 Ultrasonography, 66, 89, 126, 130, 131, 225 Ultrasound test, 72, 225 Umbilical Cord, 172, 225 Umbilicus, 10, 90, 91, 112, 225, 226 Uncompensated Care, 196, 225 Unconscious, 174, 197, 225 Unresectable, 142, 226 Urachal Cyst, 10, 226 Urachus, 10, 226 Uraemia, 209, 226 Uremia, 200, 217, 226 Ureter, 9, 20, 100, 146, 200, 202, 226 Ureteroscopy, 15, 147, 226 Urethra, 210, 214, 225, 226 Urethritis, 23, 226 Urinary, 8, 15, 17, 142, 178, 184, 198, 214, 218, 226 Urinary tract, 8, 15, 17, 142, 226 Urinary tract infection, 9, 226 Urine, 177, 198, 222, 226 Urogenital, 193, 226 Urolithiasis, 14, 15, 226 Urologic Surgical Procedures, 9, 226 Urologist, 6, 226 Urology, 4, 5, 6, 8, 9, 10, 12, 44, 48, 49, 50, 53, 54, 58, 127, 132, 133, 134, 138, 146, 147, 226 Uterus, 38, 72, 99, 100, 101, 107, 179, 183, 186, 187, 188, 190, 196, 197, 204, 208, 213, 217, 225, 226, 227 V Vaccine, 171, 214, 226 Vagal, 189, 227 Vagina, 99, 101, 179, 185, 204, 217, 227 Vaginal, 41, 51, 56, 65, 99, 100, 102, 144, 184, 227 Vaginitis, 33, 227 Vaginosis, 33, 227 Vagotomy, 6, 61, 63, 67, 126, 128, 138, 227

Index 241

Vagus Nerve, 225, 227 Valves, 96, 227 Varices, 11, 227 Varicocele, 126, 138, 227 Vascular endothelial growth factor, 25, 227 Vasculitis, 209, 227 Vasoactive, 39, 227 Vasodilator, 177, 186, 195, 227 Vein, 5, 9, 52, 174, 198, 199, 207, 222, 225, 227 Vena, 227 Venous, 5, 7, 54, 67, 72, 214, 227 Venous Thrombosis, 5, 54, 67, 227 Ventral, 17, 45, 64, 227 Ventricle, 215, 223, 227 Venules, 177, 227 Vertebrae, 120, 199, 221, 227 Vertebral, 88, 120, 221, 227 Vesicular, 191, 227 Veterinary Medicine, 153, 227

Viral, 203, 227 Virilism, 196, 227 Virus, 28, 47, 211, 227, 228 Viscera, 83, 98, 184, 204, 220, 228 Visceral, 35, 61, 143, 211, 227, 228 Visceral fat, 35, 228 Visual field, 214, 228 Vitro, 228 Vivo, 27, 32, 228 Volvulus, 43, 228 W White blood cell, 174, 201, 203, 205, 228 Withdrawal, 108, 228 Womb, 217, 226, 228 Wound Infection, 14, 17, 91, 112, 228 X Xenograft, 33, 174, 228 X-ray, 72, 175, 176, 182, 188, 191, 192, 207, 215, 216, 228 Z Zygote, 182, 228

242

Laparoscopy

Index 243

244

Laparoscopy