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

USCLE PASMS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N...

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USCLE PASMS 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., 1960Muscle Spasms: 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: 0-597-84508-5 1. Muscle Spasms-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 muscle spasms. 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 MUSCLE SPASMS ....................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Muscle Spasms.............................................................................. 7 E-Journals: PubMed Central ....................................................................................................... 10 The National Library of Medicine: PubMed ................................................................................ 10 CHAPTER 2. NUTRITION AND MUSCLE SPASMS ............................................................................. 25 Overview...................................................................................................................................... 25 Finding Nutrition Studies on Muscle Spasms ............................................................................ 25 Federal Resources on Nutrition ................................................................................................... 26 Additional Web Resources ........................................................................................................... 26 CHAPTER 3. DISSERTATIONS ON MUSCLE SPASMS ......................................................................... 29 Overview...................................................................................................................................... 29 Dissertations on Muscle Spasms ................................................................................................. 29 Keeping Current .......................................................................................................................... 29 CHAPTER 4. CLINICAL TRIALS AND MUSCLE SPASMS ................................................................... 31 Overview...................................................................................................................................... 31 Recent Trials on Muscle Spasms ................................................................................................. 31 Keeping Current on Clinical Trials ............................................................................................. 32 CHAPTER 5. PATENTS ON MUSCLE SPASMS.................................................................................... 35 Overview...................................................................................................................................... 35 Patents on Muscle Spasms........................................................................................................... 35 Patent Applications on Muscle Spasms....................................................................................... 48 Keeping Current .......................................................................................................................... 55 CHAPTER 6. BOOKS ON MUSCLE SPASMS ....................................................................................... 57 Overview...................................................................................................................................... 57 Book Summaries: Federal Agencies.............................................................................................. 57 Book Summaries: Online Booksellers........................................................................................... 58 Chapters on Muscle Spasms ........................................................................................................ 58 CHAPTER 7. MULTIMEDIA ON MUSCLE SPASMS ............................................................................ 61 Overview...................................................................................................................................... 61 Video Recordings ......................................................................................................................... 61 CHAPTER 8. PERIODICALS AND NEWS ON MUSCLE SPASMS ......................................................... 63 Overview...................................................................................................................................... 63 News Services and Press Releases................................................................................................ 63 Newsletter Articles ...................................................................................................................... 65 Academic Periodicals covering Muscle Spasms........................................................................... 65 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................... 67 Overview...................................................................................................................................... 67 U.S. Pharmacopeia....................................................................................................................... 67 Commercial Databases ................................................................................................................. 68 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 73 Overview...................................................................................................................................... 73 NIH Guidelines............................................................................................................................ 73 NIH Databases............................................................................................................................. 75 Other Commercial Databases....................................................................................................... 77 The Genome Project and Muscle Spasms .................................................................................... 77 APPENDIX B. PATIENT RESOURCES ................................................................................................. 81 Overview...................................................................................................................................... 81 Patient Guideline Sources............................................................................................................ 81

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Finding Associations.................................................................................................................... 89 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 91 Overview...................................................................................................................................... 91 Preparation................................................................................................................................... 91 Finding a Local Medical Library.................................................................................................. 91 Medical Libraries in the U.S. and Canada ................................................................................... 91 ONLINE GLOSSARIES.................................................................................................................. 97 Online Dictionary Directories ..................................................................................................... 99 MUSCLE SPASMS DICTIONARY ............................................................................................ 101 INDEX .............................................................................................................................................. 151

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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 muscle spasms 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 muscle spasms, 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 muscle spasms, 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 muscle spasms. 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 muscle spasms, 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 muscle spasms. 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 MUSCLE SPASMS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on muscle spasms.

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

Understanding Diverticular Disease Source: Ostomy Quarterly. 39(2): 56-57. Winter 2002. Contact: Available from Ostomy Quarterly. 36 Executive Park, Suite 120, Irvine, CA 92614-6744. (800) 826-0826 or (714) 660-8624. Summary: Diverticular disease is a condition where the diverticula form in the colon; it is associated with abdominal pain and disturbed bowel habits. The symptoms are caused by intestinal muscle spasms, not from an inflammation of the diverticula. Diverticulosis is the presence of diverticula in the colon with no symptoms. This newsletter article helps readers with ostomies understand diverticular disease. Diverticular disease is very common in the United States; roughly half of Americans develop diverticula by the age of 60 and nearly all of those over 80 do. Most people with

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diverticula have no complications. Unless a diverticulum becomes inflamed, it will produce no symptoms (including pain). The article considers the causes of diverticular disease, the symptoms, the causes of diverticulitis (inflammation), treatment strategies for diverticulitis, and the prevention of diverticular disease. A diet high in fiber may prevent the development of diverticula within the colon and may lessen the symptoms associated with diverticular disease. Most cases of diverticulitis respond to medical treatment. Surgery is reserved for patients with recurrent bouts of diverticulitis or when complications arise. 2 figures. •

Pathophysiology of GERD: Esophageal Body Function Source: Practical Gastroenterology. 23(12): 12-15. December 1999. 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: Esophageal peristalsis (the muscle spasms that move food through the esophagus) plays an important role in the clearance of refluxed material (primarily stomach acid) from the esophagus. This article considers the role of esophageal motility abnormalities in the pathophysiology of gastroesophageal reflux disease (GERD). Clearance is a two step process: bolus clearance and acid neutralization. When a bolus of acid is instilled into the esophagus, it is cleared by a peristaltic contraction that is responsible for eliminating most of an individual bolus; the small amount of acid not cleared by a swallow will be neutralized by saliva transported through the esophagus during a swallow. It normally takes 7 to 10 swallows to return esophageal pH to baseline after a reflux episode. Disruption of normal esophageal peristalsis with development of an esophageal motility abnormality results in delayed esophageal clearance, increasing the potential for development of erosive esophagitis. Achalasia, the only true primary motility disorder documented with certainty, is not seen in GERD and will not be discussed here. The other abnormalities include incoordinated motility, hypercontractile motility and nutcracker esophagus, and hypocontractile motility, a category that includes hypotensive LES and ineffective esophageal motility (IEM). The latter represents a reclassification of the large category formerly termed nonspecific esophageal motility disorders. The author reviews each of these abnormalities and considers their impact in GERD. The author concludes that esophageal manometry should be performed in patients in whom antireflux surgery is being considered to ensure that effective (normal) esophageal peristalsis is present. 1 figure. 2 tables. 10 references.

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Implant-Stabilized Complete Mandibular Denture for a Patient with Cerebral Palsy Source: Dental Update. 22(1): 23-26. January-February 1995. Summary: People with cerebral palsy (CP) often have difficulty in chewing, speaking, and swallowing because of the involuntary muscle spasms caused by CP. This problem also makes it very difficult or even impossible for them to wear complete mandibular dentures. This article describes a person with CP who was successfully fitted with a complete lower denture stabilized by osseointegrated implants. The author first provides a brief overview of CP, including how it is classified. The case report describes a 64-year-old edentulous woman with cerebral palsy who was having difficulty retaining her complete lower denture. The problems related to her CP included involuntary movements of the mandible, tongue, and lips. The author reports that the patient also had major problems in controlling her legs and to a lesser extent her arms. The author describes the care given and the followup; the patient was provided with the

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Astra overdenture system with magnetic retention of the denture. At initial review, the patient's speech had improved, she was eating with enjoyment, and she experienced no discomfort or other problems. The lower denture needed some additional shaping to support wide mouth opening when the patient was excited. The choice of magnets demanded precise alignment of the implant fixtures and produced easier insertion and removal than that created by stud anchorage. The simple flat surface of the keeper is easily cleaned by the caregiver. 5 figures. 4 references. (AA-M). •

Avoiding a Trip to the Sidelines Source: Diabetes Forecast. 52(9): 29-31. September 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article provides guidelines for avoiding injury while exercising. Many sports-related injuries are associated with overtraining, also known as overuse syndrome. The symptoms of overtraining include sudden weight loss, an increase in the morning resting pulse rate, chronic muscle and generalized fatigue and soreness, depressive symptoms and lack of concentration, loss of appetite, and a strong aversion to exercising. Although overtraining responds to rest, the process may put a person's exercise regimen on hold for 6 to 12 weeks. The most frequent injury associated with overtraining is a strained muscle; however, sprained ligaments are also common. Overtraining that leads to an actual injury can be treated with the RICE principal, that is, resting, icing the swollen, painful sites on the body, compressing the injury lightly with an elastic bandage to reduce swelling, and elevating the affected limb above the heart to reduce pooling of blood and subsequent swelling. Although heat may reduce muscle spasms and soreness, it should not be applied for more than 15 to 20 minutes on injuries caused by overuse. The article includes a checklist that a person can use prior to beginning an exercise program.

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Effects of Botulinum Toxin on Pathophysiology in Spasmodic Dysphonia Source: Annals of Otology, Rhinology and Laryngology. 109(2): 194-203. February 2000. Contact: Available from Annals Publishing Company. 4507 Laclede Avenue, St. Louis, MO 63108. Summary: This article reports on a study undertaken to determine the mechanism of symptom relief with treatment by botulinum toxin injection in persons with adductor spasmodic dysphonia (ADSD). ADSD is characterized by a strained speech quality with pitch and phonatory breaks coincident with muscle spasms during vowels in connected speech. The authors evaluated the effects of unilateral thyroarytenoid muscle injections on both injected and noninjected muscles in 10 subjects with ADSD, using electromyography on both sides of the larynx before and after treatment. The subjects' speech symptoms were reduced 2 weeks following injection, when the electromyographic study occurred. Muscle activation levels and the numbers of spasmodic muscle bursts decreased significantly postinjection in both the injected and noninjected muscles. The reductions in laryngeal muscle bursts correlated with symptom reduction in all muscles. Reductions in laryngeal muscle bursts did not relate to either absolute or normalized levels of muscle activity before or after botulinum toxin injection. The results suggest that changes in the central pathophysiology are responsible for changes in speech symptoms following treatment. 6 figures. 5 tables. 38 references.

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Working With Challenging Skin Source: Massage and Bodywork. 140-141,144. August/September 2003. Summary: This journal article discusses symptoms and considerations when practicing massage therapy on geriatric patients. When working with geriatric patients, massage therapists need to be aware that skin has less collagen and elastic fibers resulting in thinner skin that may tear more easily. The most common skin conditions found in geriatric patients are cellulitis, decubitus ulcers (bedsores), scleroderma, and benign skin tumors. Cellulitis is caused by a bacterial infection and generally affects the extremities and face. As long as the therapist avoids infected areas (to keep the infection from spreading and causing inflammation), massage is appropriate. The massage table should be disinfected afterwards to prevent the spread of infection. Decubitis ulcers form when epidural cells and skin tissue do not receive adequate blood supply. These ulcers appear as black or gray areas on the tissue over the bone. Massage should not be performed on the ulcer itself, but around the area of the ulcer, possibly helping to increase circulation. Scleroderma is a condition in which the connective tissue in the skin, organs, and muscles become hardened and inflamed. Symptoms include joint stiffness, decreased range of motion, and swelling. Massage can help alleviate joint stiffness, edema, and muscle spasms and improve circulation. Benign skin tumors such as moles and skin tags are not contraindications for massage therapy. Massage therapists should note any changes in the appearance of moles or skin tags as they may indicate malignancy. Therapists should avoid using strokes that work deep into the tissue as this may bruise or tear skin. Lighter, fluffing strokes promote circulation and relaxation in the geriatric patient. 5 references.

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Enigma of Whiplash Injury: Current Management Strategies and Controversies Source: Postgraduate Medicine. 109(3): 179-180,183-186. March 2001. Summary: This journal article provides health professionals with information on the current management strategies of and controversies over whiplash injuries. Whiplash is defined as trauma resulting in cervical musculoligamentous sprain or strain. Whiplash injuries are most commonly caused by low velocity rear end collisions. The extensor recoil after a rear end collision is thought to result in a hyperextension cervical injury. However, the pathophysiologic mechanism resulting in pain associated with whiplash is poorly understood. Neck pain is the hallmark symptom of whiplash. The pain can radiate into the occiput, shoulder, or midscapular area. Other common symptoms include headaches, thoracolumbar back pain, and paresthesias of the upper extremities. Plain radiographs should be obtained to exclude fractures or subluxations. Although various abnormalities have been observed on magnetic resonance imaging (MRI) in patients with whiplash injuries, a consistent correlation between MRI changes and symptoms of whiplash has never been well defined. Traditional treatment of whiplash injury involves conservative therapy consisting of rest, analgesic medications, and muscle relaxants for 2 to 4 weeks. In cases of severe pain, oral narcotics may be used for 7 to 10 days. Various factors may be associated with a poor prognosis, including a previous history of neck pain, neck stiffness, presence of thoracolumbar pain, muscle spasms, paresthesias, presence of objective neurologic signs, and an abnormal cervical spine curvature on x ray. Persistent symptoms lead to chronic whiplash syndrome. Most of the controversy surrounding whiplash injury has related to arguments about the validity of chronic cases. Some investigators have concluded that many people who experience chronic syndromes are malingering to obtain the monetary benefits of litigation. However, studies demonstrate that symptom persistence occurs even when litigation issues have been resolved. Thus, it may be more useful to include chronic

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whiplash with a group of disorders referred to as the functional somatic syndromes. Research suggests that some patients with chronic symptoms may be better served by trying cognitive behavioral therapy as opposed to continuing ineffective traditional medical treatments. 2 figures and 19 references.

Federally Funded Research on Muscle Spasms The U.S. Government supports a variety of research studies relating to muscle spasms. 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 muscle spasms. 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 muscle spasms. The following is typical of the type of information found when searching the CRISP database for muscle spasms: •

Project Title: IDENTIFICATION OF A GENE UNDERLYING DYSTONIA Principal Investigator & Institution: Patel, Pragna; Professor; Neurology; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2004 Summary: (provided by applicant): The dystonias are a common clinically and genetically heterogeneous group of movement disorders. They are characterized by involuntary, sustained, repetitive and patterned muscle contractions, affecting one or more sites of the body, frequently causing twisting and repetitive movements, or abnormal postures. Dystonia may be caused by CNS structural lesions, medications, be "idiopathic" or demonstrate obvious genetic inheritance. At least ten loci for inherited forms of dystonia have been mapped and genes have been identified at four of these loci. Our long-term goal is to dissect the pathophysiology of various movement disorders by identifying the underlying genes, and studying the regulation of these genes in the normal and disease state and to develop treatment regimens based on these findings. We have recently identified a large family demonstrating a variant form of dystonia that appears to segregate with tremor and paroxysmal muscle spasms. Based on phenotypic evaluation of members of this extended family, we hypothesize that this family is segregating a hitherto undescribed type of dystonia and thus, provides an opportunity to identify a new gene. Simulation analysis indicates sufficient power to detect linkage in this family. We propose to (i) examine all relevant known loci for association by linkage analysis of 20 affected and selected unaffected members that have already been sampled (ii) conduct genome-wide linkage analysis to map the dystonia locus if known loci are excluded, and (iii) identify candidate genes and conduct

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

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mutation analysis in order to identify the dystoma gene. Linkage analysis will be conducted by parametric and non-parametric approaches. Candidate genes will be prioritized by bioinformatics and molecular approaches including a novel custom microarray approach. Mutation analysis of selected candidate genes and validation in the family will identify the dystoma gene. Future studies will aim to dissect the biochemistry and cell biology of the gene product, and to develop an animal model for this form of dystonia. Our studies will add to the repertoire of knowledge about dystonia that should enable design of better diagnostic and treatment strategies for dystoma in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MUSCLE FUNCTION IN HUMAN CERVICAL SPINAL CORD INJURY Principal Investigator & Institution: Thomas, Christine K.; Associate Professor; Miami Project to Cure Paralysis; University of Miami-Medical Box 248293 Coral Gables, Fl 33124 Timing: Fiscal Year 2002; Project Start 01-JAN-1994; Project End 31-MAR-2006 Summary: Our long-term objective is to characterize the physiological processes that underlie involuntary muscle contractions, weakness and excessive fatiguability, major problems encountered in skeletal muscles paralyzed by injury or disease. In this proposal we will test the novel hypothesis that ongoing spontaneous motor unit activity, spasticity and muscle spasms preserve muscle contractile properties in the same way that exercise enhances muscle performance in uninjured people. In individuals with skeletal muscles paralyzed (not under voluntary control) or partially paralyzed by spinal cord injury, our Specific Aims are: 1) to characterize the patterns of involuntary muscle activity during spasms, contractions triggered by trivial - inputs such as light touch a few weeks post injury; 2) to compare the patterns, amount and duration of involuntary muscle activity recorded in the laboratory and over 24 hour periods with muscle contractile properties (strength, speed, fatigability) and measures of spasticity (eg. Ashworth scale); 3) to evaluate motor unit recruitment and rate modulation during spasms in relation to motor unit contractile properties measured by intraneural motor axon stimulation and/or spike-triggered averaging. Motoneuron excitability will be assessed from F- waves; 4) to describe the patterns of ongoing, spontaneous motor unit activity commonly seen in paralyzed muscles to discern whether it reflects changes in motoneuron properties and/or synaptic inputs; 5) to follow the time course over which involuntary muscle contractions develop and the changes in muscle strength, speed and fatigability that occur during the first year post injury (acute to chronic transition). Data from spinal cord injured people who do or do not take anti-spasm medication will be compared to that obtained from able-bodied controls during evoked and voluntary contractions. These data will improve our understanding of muscle spasms, the most debilitating aspect of the spasticity that is so prevalent after spinal cord injury and other neuromuscular disorders. The information obtained will also provide a rationale for the design of new rehabilitation that will aim to dampen involuntary muscle activity or to use it effectively to perform functional tasks. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEURAL MECHANISMS OF HEMIFACIAL SPASM Principal Investigator & Institution: Kassem, Iris S.; Neurobiology and Behavior; State University New York Stony Brook Stony Brook, Ny 11794

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Timing: Fiscal Year 2002; Project Start 17-AUG-2002 Summary: (provided by applicant): Hemifacial spasm generally begins as involuntary muscle spasms in the eyelids and then progresses to the entire distribution of the facial nerve. This disease is thought to be due to a compression of the facial nerve at its root entry zone by one of several arteries in the region. The underlying neural mechanisms of the hemifacial spasm are still controversial. Arterial compression of the nerve can modify the facial nerve, facial motoneurons, and the trigeminal nucleus. This proposal investigates the role of each of these modifications in producing the symptoms of hemifacial spasm. Hemifacial spasm patients will used to identify changes in the trigeminal system. An animal model isolating the different mechanisms will be created to characterize the causes of symptom development resulting from motoneuron and trigeminal modifications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF OSTEOPENIA IN CHILDREN WITH CEREBRAL PALSY Principal Investigator & Institution: Henderson, Richard C.; Professor; Orthopaedics; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 25-SEP-2002; Project End 29-SEP-2004 Summary: (provided by applicant): Osteopenia resulting in fractures with minimal trauma is a common problem in many pediatric conditions such as osteogenesis imperfecta, juvenile idiopathic osteoporosis, muscular dystrophy, and myelodysplasia (spina bifida). As part of the North American Growth in Cerebral Palsy Project (NAGCePP) we have extensively studied one such group of children, those with cerebral palsy (CP), to better define the prevalence, causes, and consequences of osteopenia in this condition. Bisphosphonates are a group of medications utilized to treat osteoporosis in elderly adults. There are published reports of these agents used in assorted pediatric conditions, but with rare exception these are anecdotal, uncontrolled case reports involving at most a few children. We have recently completed a small placebo-controlled Pilot Trial to assess the safety and efficacy of intravenous bisphosphonates to treat low bone density in children with severe CP. At the conclusion of the 18-month study period bone density in the distal femur had increased 89% + 21% (mean + SE) compared to 9% + 6% in controls. No clinically significant adverse effects were identified. The Pilot Trial raises many questions with regards to dosing (frequency, duration, amount, route of administration), indications for treatment, long-term risks and benefits including the effect on fracture rate. The results of the Pilot Trial provide the justification for a larger scale Future Clinical Trial to answer these many questions. The purpose of this application is to support the Clinical Trial Planning Project, a process critical to the successful implementation and completion of the Future Clinical Trial. The Clinical Trial Planning Project will focus on building from both the Pilot Trial and the existing NAGCeP collaboration in several areas. Subjects: Develop additional recruiting strategies for larger numbers of subjects and further refine criteria for inclusion based on analysis of fracture risk data. Intervention: Select alternative drugs and dosing regimens that are more practical. Outcomes: Further evaluate and adapt DXA technology to this population with contractures, scoliosis, metallic implants, involuntary muscle spasms, retardation, and other characteristics that present unique challenges. Collaborative Resources & Infrastructure: Adapt and expand our existing NAGCePP network (eg database, safety monitoring) to incorporate the Future Clinical Trial.

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Muscle Spasms

Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

Acute muscle spasm. by Rush P.; 2001 Jul 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81227

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 muscle spasms, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “muscle spasms” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for muscle spasms (hyperlinks lead to article summaries): •

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A 57-year-old man with muscle spasms. Author(s): Somerson SW. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 1991 August; 17(4): 257-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1865624

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

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

Studies

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A controlled clinical trial of chlormezanone, orphenadrine, orphenadrine/paracetamol and placebo in the treatment of painful skeletal muscle spasms. Author(s): Valtonen EJ. Source: Ann Clin Res. 1975 April; 7(2): 85-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1103709

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A novel method of inducing muscle cramps using repetitive magnetic stimulation. Author(s): Caress JB, Bastings EP, Hammond GL, Walker FO. Source: Muscle & Nerve. 2000 January; 23(1): 126-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10590418

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A randomized controlled trial of quinidine in the treatment of cirrhotic patients with muscle cramps. Author(s): Lee FY, Lee SD, Tsai YT, Lai KH, Chao Y, Lin HC, Wang SS, Lo KJ. Source: Journal of Hepatology. 1991 March; 12(2): 236-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2051002

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A simple alternative to quinine for nocturnal muscle cramps. Author(s): Miller JM. Source: Md Med J. 1996 May; 45(5): 383. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8935851

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A young woman with muscle cramps and periodontal disease. Author(s): Seitzinger DB, Nahman NS Jr, Hedrick SW. Source: Hosp Pract (Off Ed). 1985 February 15; 20(2): 48E, 48F. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3918063

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Activation of renin-angiotensin system does not cause skeletal muscle cramps during hemodialysis. Author(s): Piergies AA, Atkinson AJ Jr, Hubler GL, del Greco F. Source: Int J Clin Pharmacol Ther Toxicol. 1990 October; 28(10): 405-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2258248

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Acupuncture for the relief of painful muscle spasms in dystonic cerebral palsy. Author(s): Sanner C, Sundequist U. Source: Developmental Medicine and Child Neurology. 1981 August; 23(4): 544-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7274598

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Afterdischarge activity in neuropathic patients with frequent muscle cramps. Author(s): Parisi L, Serrao M, Rossi P, Valente G, Fattapposta F, Pierelli F, Amabile G. Source: Acta Neurologica Scandinavica. 2000 December; 102(6): 359-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11125750

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Muscle Spasms

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Alcohol ingestion and muscle spasms. Author(s): Blank NK. Source: Jama : the Journal of the American Medical Association. 1979 April 13; 241(15): 1574. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=430705

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An elderly man with muscle cramps. Author(s): Younis N, Casson IF. Source: Postgraduate Medical Journal. 2000 November; 76(901): 721, 731-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11060159

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Are muscle cramps in Isaacs' syndrome triggered by human immunoglobulin? Author(s): Van Engelen BG, Benders AA, Gabreels FJ, Veerkamp JH. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1995 March; 58(3): 393. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7755748

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Axillary injection of botulinum A toxin in a patient with muscle cramps associated with severe axillary hyperhidrosis. Author(s): Filosto M, Bertolasi L, Fincati E, Priori A, Tomelleri G, Chieregato G, Rizzuto N. Source: Acta Neurol Belg. 2001 June; 101(2): 121-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11486559

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Botulinum toxin A for spasticity, muscle spasms, and rigidity. Author(s): Grazko MA, Polo KB, Jabbari B. Source: Neurology. 1995 April; 45(4): 712-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7723960

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Botulinum toxin A improves muscle spasms and rigidity in stiff-person syndrome. Author(s): Liguori R, Cordivari C, Lugaresi E, Montagna P. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 1997 November; 12(6): 1060-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9399238

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Botulinum toxin treatment of muscle cramps: a clinical and neurophysiological study. Author(s): Bertolasi L, Priori A, Tomelleri G, Bongiovanni LG, Fincati E, Simonati A, De Grandis D, Rizzuto N. Source: Annals of Neurology. 1997 February; 41(2): 181-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9029067

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Botulinum-A toxin in the treatment of craniocervical muscle spasms: short- and longterm, local and systemic effects. Author(s): Dutton JJ. Source: Survey of Ophthalmology. 1996 July-August; 41(1): 51-65. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8827930

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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 1-2002. A 24-year-old woman with paresthesias and muscle cramps after a stay in Africa. Author(s): Nutman TB, Kradin RL. Source: The New England Journal of Medicine. 2002 January 10; 346(2): 115-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11784879

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Charcot-Marie-Tooth disease type 1A presenting as calf hypertrophy and muscle cramps. Author(s): Krampitz DE, Wolfe GI, Fleckenstein JL, Barohn RJ. Source: Neurology. 1998 November; 51(5): 1508-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9818900

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Chloroquine phosphate reduces the frequency of muscle cramps during maintenance hemodialysis. Author(s): Sever MS, Kocak N. Source: Nephron. 1990; 56(4): 443. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2080007

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Cirrhosis and muscle cramps: evidence of a causal relationship. Author(s): Angeli P, Albino G, Carraro P, Dalla Pria M, Merkel C, Caregaro L, De Bei E, Bortoluzzi A, Plebani M, Gatta A. Source: Hepatology (Baltimore, Md.). 1996 February; 23(2): 264-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8591851

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Cisplatin-induced peripheral neuropathy. Frequent off-therapy deterioration, demyelinating syndromes, and muscle cramps. Author(s): Siegal T, Haim N. Source: Cancer. 1990 September 15; 66(6): 1117-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2169332

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Comparison of 50% dextrose water, 25% mannitol, and 23.5% saline for the treatment of hemodialysis-associated muscle cramps. Author(s): Canzanello VJ, Hylander-Rossner B, Sands RE, Morgan TM, Jordan J, Burkart JM. Source: Asaio Trans. 1991 October-December; 37(4): 649-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1768504

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Creatine monohydrate treatment alleviates muscle cramps associated with haemodialysis. Author(s): Chang CT, Wu CH, Yang CW, Huang JY, Wu MS. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2002 November; 17(11): 1978-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12401856

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Dantrolene, pelvic neoplasm, and muscle spasms: report of a case. Author(s): Myers A. Source: Jama : the Journal of the American Medical Association. 1977 May 30; 237(22): 2378. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=576933

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Distinct patterns of motor unit behavior during muscle spasms in spinal cord injured subjects. Author(s): Thomas CK, Ross BH. Source: Journal of Neurophysiology. 1997 May; 77(5): 2847-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9163400

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Effect of muscle spasms on blood gases and acid-base status in tetanus patients. Author(s): Elegbeleye OO. Source: European Journal of Clinical Investigation. 1978 December; 8(6): 423-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=105916

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Effect of niuche-shen-qi-wan on painful muscle cramps in patients with liver cirrhosis: a preliminary report. Author(s): Motoo Y, Taga H, Yamaguchi Y, Watanabe H, Okai T, Sawabu N. Source: The American Journal of Chinese Medicine. 1997; 25(1): 97-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9167002

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Effect of orally administered shao-yao-gan-cao-tang (Shakuyaku-kanzo-to) on muscle cramps in maintenance hemodialysis patients: a preliminary study. Author(s): Hinoshita F, Ogura Y, Suzuki Y, Hara S, Yamada A, Tanaka N, Yamashita A, Marumo F. Source: The American Journal of Chinese Medicine. 2003; 31(3): 445-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943175

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Effectiveness of quinine in treating muscle cramps: a double-blind, placebocontrolled, parallel-group, multicentre trial. Author(s): Diener HC, Dethlefsen U, Dethlefsen-Gruber S, Verbeek P. Source: Int J Clin Pract. 2002 May; 56(4): 243-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12074203

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Exercise-induced, persistent and generalized muscle cramps. A case report. Author(s): Dickhuth HH, Rocker K, Niess A, Horstmann T, Mayer F, Striegel H. Source: The Journal of Sports Medicine and Physical Fitness. 2002 March; 42(1): 92-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11832881

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Facial muscle spasms and clonazepam. Author(s): Wieland C. Source: The Medical Journal of Australia. 1985 September 2; 143(5): 222-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4033500

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Facial muscle spasms: an Australian study. Author(s): Kowal L, Davies R, Kiely PM. Source: Australian and New Zealand Journal of Ophthalmology. 1998 May; 26(2): 123-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9630292

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Familial dwarfism and painful muscle spasms. Author(s): Sica RE, Espinoza R, Benavente O, Sanz OP, Molina H. Source: Medicina (B Aires). 1995; 55(2): 111-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7565047

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Gabapentin treatment for muscle cramps: an open-label trial. Author(s): Serrao M, Rossi P, Cardinali P, Valente G, Parisi L, Pierelli F. Source: Clinical Neuropharmacology. 2000 January-February; 23(1): 45-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10682230

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Hydroquinine pharmacokinetics after oral administration in adult patients with muscle cramps. Author(s): van Kan HJ, Jansen PH, Tuinte C, Smits P, Verbeek AL. Source: European Journal of Clinical Pharmacology. 2000 June; 56(3): 263-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10952483

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Hypertension and muscle spasms; a clinical pathologic conference. Author(s): Reiss E, Pirani CL. Source: Chic Med Sch Q. 1966 Spring; 26(1): 39-52. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5930862

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Intrathecal baclofen and homeopathy for the treatment of painful muscle spasms associated with malignant spinal cord compression. Author(s): Thompson E, Hicks F. Source: Palliative Medicine. 1998 March; 12(2): 119-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9616449

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Is taurine effective for treatment of painful muscle cramps in liver cirrhosis? Author(s): Matsuzaki Y, Tanaka N, Osuga T. Source: The American Journal of Gastroenterology. 1993 September; 88(9): 1466-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8362861

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Low-dose prazosin in patients with muscle cramps during hemodialysis. Author(s): Sidhom OA, Odeh YK, Krumlovsky FA, Budris WA, Wang Z, Pospisil PA, Atkinson AJ Jr. Source: Clinical Pharmacology and Therapeutics. 1994 October; 56(4): 445-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7955806

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Muscle cramp as a feature of neuromuscular disease. Five neuromuscular disorders, accompanied by frequent muscle cramps. Author(s): Jansen PH, Joosten EM, Vingerhoets HM. Source: Acta Neurol Belg. 1992; 92(3): 138-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1636371

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Muscle cramps and creatine kinase elevations in hemodialysis patients. Author(s): Mattana J, Ayer S. Source: Nephron. 1991; 58(3): 380. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1896113

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Muscle cramps and elevated serum creatine phosphokinase levels induced by betaadrenoceptor blockers. Author(s): Imai Y, Watanabe N, Hashimoto J, Nishiyama A, Sakuma H, Sekino H, Omata K, Abe K. Source: European Journal of Clinical Pharmacology. 1995; 48(1): 29-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7621844

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Muscle cramps and magnesium deficiency: case reports. Author(s): Bilbey DL, Prabhakaran VM. Source: Can Fam Physician. 1996 July; 42: 1348-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8754704

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Muscle cramps associated with vincristine therapy. Author(s): Haim N, Barron SA, Robinson E. Source: Acta Oncologica (Stockholm, Sweden). 1991; 30(6): 707-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1659838

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Muscle cramps during hemodialysis. Author(s): Mujais SK. Source: Int J Artif Organs. 1994 November; 17(11): 570-2. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7744514

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Muscle cramps during prednisolone treatment. Author(s): Mcligeyo SO. Source: Bmj (Clinical Research Ed.). 1993 September 25; 307(6907): 802-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8219969

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Muscle cramps in cancer patients. Author(s): Steiner I, Siegal T. Source: Cancer. 1989 February 1; 63(3): 574-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2912532

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Muscle cramps in chronic liver diseases and treatment with antispastic agent (eperisone hydrochloride) Author(s): Kobayashi Y, Kawasaki T, Yoshimi T, Nakajima T, Kanai K. Source: Digestive Diseases and Sciences. 1992 July; 37(7): 1145-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1618065

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Muscle cramps in patients with cirrhosis. Author(s): Abrams GA, Concato J, Fallon MB. Source: The American Journal of Gastroenterology. 1996 July; 91(7): 1363-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8677996

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Muscle cramps in the calf as presenting symptom of sarcoidosis. Author(s): Janssen M, Dijkmans BA, Eulderink F. Source: Annals of the Rheumatic Diseases. 1991 January; 50(1): 51-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1994868

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Muscle cramps in the cancer patient: causes and treatment. Author(s): Siegal T. Source: Journal of Pain and Symptom Management. 1991 February; 6(2): 84-91. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2007796

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Muscle cramps induced by beta-blockers with intrinsic sympathomimetic activity properties: a hint of a possible mechanism. Author(s): Zimlichman R, Krauss S, Paran E. Source: Archives of Internal Medicine. 1991 May; 151(5): 1021. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2025129

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Muscle cramps or RSI? Author(s): Elvey R. Source: The Medical Journal of Australia. 1986 March 17; 144(6): 334-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3713630

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Muscle cramps or RSI? Author(s): Sinclair D. Source: The Medical Journal of Australia. 1985 November 11; 143(10): 480. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4088118

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Muscle cramps related to corticosteroids. Author(s): Lear J, Daniels RG. Source: Bmj (Clinical Research Ed.). 1993 May 1; 306(6886): 1169. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8499821

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Muscle cramps. Author(s): Chandira AR. Source: J Indian Med Assoc. 2002 March; 100(3): 203. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12408290

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Muscle cramps. Author(s): Simchak AC, Pascuzzi RM. Source: Seminars in Neurology. 1991 September; 11(3): 281-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1947491

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Muscle cramps. Author(s): McGee SR. Source: Archives of Internal Medicine. 1990 March; 150(3): 511-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2178579

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Muscle cramps: a cause of elevated creatine kinase levels in hemodialysis patients. Author(s): Hernando P, Caramelo C, Lopez Garcia D, Hernando L. Source: Nephron. 1990; 55(2): 231-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2362646

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Muscle cramps: a 'complication' of cirrhosis. Author(s): Marotta PJ, Graziadei IW, Ghent CN. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2000 November; 14 Suppl D: 21D-25D. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11110608

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Muscle spasms and creatine phosphokinase elevation following salbutamol administration. Author(s): Lisi DM. Source: The European Respiratory Journal : Official Journal of the European Society for Clinical Respiratory Physiology. 1989 January; 2(1): 98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2707408

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Muscle spasms and long Q-T interval. Author(s): Hancock EW. Source: Hosp Pract (Off Ed). 1988 February 15; 23(2): 121, 124. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3125189

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Muscle spasms and stiffness that progressed for four years. Author(s): Bhutani MS, Mathews T, Akuthota P. Source: Hosp Pract (Off Ed). 1992 May 30; 27(5A): 131-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1583088

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Muscle spasms and trismus in an alcoholic. Author(s): Patel A, Masood A, Kim J. Source: Hosp Pract (Off Ed). 1991 May 15; 26(5): 151-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2030116

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Muscle spasms associated with intrathecal morphine therapy: treatment with midazolam. Author(s): Littrell RA, Kennedy LD, Birmingham WE, Leak WD. Source: Clin Pharm. 1992 January; 11(1): 57-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1730179

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Muscle spasms associated with Sudeck's atrophy after injury. Author(s): Jessop J. Source: British Medical Journal (Clinical Research Ed.). 1984 February 25; 288(6417): 644. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6199073

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Muscle spasms associated with Sudeck's atrophy after injury. Author(s): Marsden CD, Obeso JA, Traub MM, Rothwell JC, Kranz H, La Cruz F. Source: British Medical Journal (Clinical Research Ed.). 1984 January 21; 288(6412): 173-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6198018

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Myotonia congenita with painful muscle cramps. Author(s): Sunohara N, Tomi H, Nakamura A, Arahata K, Nonaka I. Source: Intern Med. 1996 June; 35(6): 507-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8835606

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Night muscle cramps. Author(s): Kiveloff B. Source: Journal of the American Geriatrics Society. 1989 October; 37(10): 1004. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2794313

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On the myofascial origin of muscle cramps. Author(s): Simons DG. Source: Muscle & Nerve. 1995 July; 18(7): 787. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7783772

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Pain, muscle spasms and twitching fingers following brachial plexus avulsion. Report of three cases relieved by dorsal root entry zone coagulation. Author(s): Pagni CA, Canavero S. Source: Journal of Neurology. 1993 September; 240(8): 468-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8263551

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Painful muscle cramps. A symptom of liver cirrhosis? Author(s): Konikoff F, Theodor E. Source: Journal of Clinical Gastroenterology. 1986 December; 8(6): 669-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3805668

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Painful muscle spasms complicating algodystrophy: central or peripheral disease? Author(s): Robberecht W, Van Hees J, Adriaensen H, Carton H. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1988 April; 51(4): 563-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3379430

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Past and current understanding of the pathophysiology of muscle cramps: why treatment of varicose veins does not relieve leg cramps. Author(s): Jansen PH, Lecluse RG, Verbeek AL. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 1999 May; 12(3): 222-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10461641

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Persistent motor neuron discharges of central origin present in the resting state. A case report of alcohol-induced muscle spasms. Author(s): Blank NK, Meerschaert JR, Rieder MJ. Source: Neurology. 1974 March; 24(3): 277-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4855954

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Plasma taurine in liver cirrhosis with painful muscle cramps. Author(s): Yamamoto S. Source: Advances in Experimental Medicine and Biology. 1996; 403: 597-600. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8915399

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Postexercise increase in nitric oxide in football players with muscle cramps. Author(s): Noakes TD. Source: The American Journal of Sports Medicine. 1999 September-October; 27(5): 688-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10496591

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Postexercise increase in nitric oxide in football players with muscle cramps. Author(s): Maddali S, Rodeo SA, Barnes R, Warren RF, Murrell GA. Source: The American Journal of Sports Medicine. 1998 November-December; 26(6): 8204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9850785

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Preliminary observation: oral zinc sulfate replacement is effective in treating muscle cramps in cirrhotic patients. Author(s): Kugelmas M. Source: Journal of the American College of Nutrition. 2000 February; 19(1): 13-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10682870

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Prevalence and characteristics of muscle cramps in patients with varicose veins. Author(s): Hirai M. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 2000 November; 29(4): 269-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11141650

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Randomised controlled trial of hydroquinine in muscle cramps. Author(s): Fowler AW. Source: Lancet. 1997 May 3; 349(9061): 1325-6; Author Reply 1326. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9142089

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Randomised controlled trial of hydroquinine in muscle cramps. Author(s): Roffe C, Sills S, Crome P. Source: Lancet. 1997 May 3; 349(9061): 1325; Author Reply 1326. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9142088

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Randomised controlled trial of hydroquinine in muscle cramps. Author(s): Curtis JR. Source: Lancet. 1997 May 3; 349(9061): 1325; Author Reply 1326. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9142087

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Randomised controlled trial of hydroquinine in muscle cramps. Author(s): Jansen PH, Veenhuizen KC, Wesseling AI, de Boo T, Verbeek AL. Source: Lancet. 1997 February 22; 349(9051): 528-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9048790

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Recurrent muscle spasms of central origin. Author(s): Satoyoshi E. Source: Trans Am Neurol Assoc. 1967; 92: 153-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5634016

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Recurrent muscle spasms of central origin. A report of two cases. Author(s): Satoyoshi E, Yamada K. Source: Archives of Neurology. 1967 March; 16(3): 254-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6018875

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Reducing muscle spasms in a child with cerebral palsy. Author(s): Hawley D, Reiser DW. Source: The American Journal of Nursing. 1978 July; 78(7): 1214-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=249236

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Reversible muscle spasms in hyperthyroidism. Author(s): Alting van Geusau RB, Howeller DH. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1986 November; 49(11): 1322-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3794741

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Rigidity and painful muscle spasms in a patient with probable myelitis. Author(s): Cannas A, Tacconi P, Pinna L, Congia S, Costa B, Fiaschi A. Source: Italian Journal of Neurological Sciences. 1991 December; 12(6): 587-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1783538

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Severe muscle spasms after visualization of a subarachnoid catheter. Author(s): Feingold A, Elam JO, Dobben GD. Source: Jama : the Journal of the American Medical Association. 1970 May 4; 212(5): 87980. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5467385

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Severe muscle spasms: an unusual manifestation of hypothyroidism. Author(s): Margolis J, Margolis DA. Source: Southern Medical Journal. 1981 December; 74(12): 1551. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7313757

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Shock and prolonged muscle cramps after intravenous insulin therapy. Author(s): Meyer AH, Kirkman MS. Source: N C Med J. 1992 September; 53(9): 484-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1407029

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The lady who had muscle cramps and developed thrombotic microangiopathy. Author(s): Rabetoy G, Hansen M, Brosnahan G, Hartung L. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2000 September; 15(9): 1464-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10978412

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The use of intrathecal phenol for muscle spasms in multiple sclerosis. A description of two cases. Author(s): Browne RA, Catton DV. Source: Can Anaesth Soc J. 1975 March; 22(2): 208-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1173228

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Three cases of recurrent generalized muscle spasms in China. Author(s): Wang DX, Fu HD. Source: Jpn J Med. 1985 August; 24(3): 263-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4068361

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Tocainide therapy in muscle cramps and spasms due to neuromuscular disease. Author(s): Puniani TS, Bertorini TE. Source: Muscle & Nerve. 1991 March; 14(3): 280-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1904131

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Treatment of muscle spasms with oral dantrolene sodium. Author(s): Christian JM. Source: Oral Surg Oral Med Oral Pathol. 1989 March; 67(3): 268-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2927921

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Vitamin E and cirrhotic muscle cramps. Author(s): Konikoff F, Ben-Amitay G, Halpern Z, Weisman Y, Fishel B, Theodor E, Rattan J, Gilat T. Source: Isr J Med Sci. 1991 April; 27(4): 221-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2010278

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CHAPTER 2. NUTRITION AND MUSCLE SPASMS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and muscle spasms.

Finding Nutrition Studies on Muscle Spasms 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 “muscle spasms” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “muscle spasms” (or a synonym): •

Skeletal muscle-specific immunotoxin for the treatment of focal muscle spasm. Author(s): Biochemistry Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA. Source: Hott, J S Dalakas, M C Sung, C Hallett, M Youle, R J Neurology. 1998 February; 50(2): 485-91 0028-3878

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/

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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The following is a specific Web list relating to muscle spasms; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Riboflavin Source: Integrative Medicine Communications; www.drkoop.com Vitamin B2 (Riboflavin) Source: Integrative Medicine Communications; www.drkoop.com

•

Minerals Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Creatine Source: Integrative Medicine Communications; www.drkoop.com Creatine Monohydrate Source: Healthnotes, Inc.; www.healthnotes.com Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890,00.html Magnesium Hydroxide Source: Healthnotes, Inc.; www.healthnotes.com Phosphocreatine Source: Integrative Medicine Communications; www.drkoop.com Potassium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10086,00.html Potassium-Sparing Diuretics Source: Integrative Medicine Communications; www.drkoop.com

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Muscle Spasms

Food and Diet Athletic Performance Source: Healthnotes, Inc.; www.healthnotes.com Homeopathic Remedies for Athletic Performance Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. DISSERTATIONS ON MUSCLE SPASMS Overview In this chapter, we will give you a bibliography on recent dissertations relating to muscle spasms. 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 “muscle spasms” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on muscle spasms, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Muscle Spasms 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 muscle spasms. 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: •

The Relationship between Dehydration, Electrolyte Imbalance, Environmental Heat, and Local Fatigue with Exercise-Associated Muscle Cramps by Jung, Alan Peter; PhD from The University of Alabama, 2003, 63 pages http://wwwlib.umi.com/dissertations/fullcit/3092360

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 MUSCLE SPASMS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning muscle spasms.

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

Screening Protocol for Patients with Neurologic Disorders with Muscle Stiffness Condition(s): Neurological Disorder; Muscle Cramp Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will evaluate patients with muscle stiffness for possible participation in current or future research studies. It will determine the cause of muscle stiffness or cramps and measure the severity of symptoms. Children and adults with muscle stiffness, cramps or spasticity may be eligible for this study. Participants will provide a medical history and have a physical examination. In addition to the standard neurological examination, patients may be tested on how long it takes to make some movements, such as walking or tapping on a keyboard. To determine the cause of the muscle problem, patients may also undergo blood tests and the following procedures: Magnetic resonance imaging (MRI) - MRI uses a strong magnetic field and radio waves to show structural and chemical changes in tissue. The patient lies on a table in a space enclosed by a metal cylinder (the scanner) for about 45 minutes, lying very still for 10 to 15 minutes at a time. The patient can communicate with the technician at all times during the procedure. Electromyography (EMG) and nerve conduction studies - EMG measures the electrical activity of the muscles. A needle is inserted into a muscle to record its electrical activity. Nerve conduction studies measure the speed with which nerves conduct electrical impulses. A wire is taped on the skin over a nerve to deliver a small electrical stimulus and another wire taped to the skin records the impulses.

8

These are listed at www.ClinicalTrials.gov.

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Patients will also be asked to fill out a health questionnaire no more than once a year. The information will be used to determine their eligibility for new studies. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00015444

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 “muscle spasms” (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/

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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

Clinical Trials 33

•

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 MUSCLE SPASMS 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 “muscle spasms” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on muscle spasms, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Muscle Spasms By performing a patent search focusing on muscle spasms, 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 muscle spasms: •

Anticonvulsant and central nervous system-depressing bis(fluorophenyl)alkylamides and their uses Inventor(s): Artman; Linda D. (Salt Lake City, UT), Balandrin; Manuel F. (Sandy, UT), Moe; Scott T. (Salt Lake City, UT), Mueller; Alan L. (Salt Lake City, UT), Smith; Daryl (Salt Lake City, UT), VanWagenen; Bradford C. (Salt Lake City, UT) Assignee(s): Nps Pharmaceuticals, Inc. (salt Lake City, Ut) Patent Number: 6,617,358 Date filed: June 2, 2000 Abstract: Bis(Fluorophenyl)alkylamides have been chemically synthesized which possess beneficial pharmacological properties (e.g., anticonvulsant activity) useful for the treatment of neurological diseases or disorders, such as, for example, epilepsy, convulsions, and seizure disorders. The preferred compounds of the invention also cause little sedation and have high therapeutic and protective indices in animal models of epilepsy. These compounds further possess long pharmacological half-lives, which, in practical clinical therapeutic application, should translate into once-a-day dosing, of great benefit to patients suffering from these diseases and/or disorders. These compounds may also be of further clinical utility in the treatment of other diseases and disorders of the central and peripheral nervous systems, or diseases or disorders affected by them, including, but not limited to, spasticity, skeletal muscle spasms and pain, restless leg syndrome, anxiety and stress, and bipolar disorder. Excerpt(s): The present invention relates to compounds useful in treating pathological conditions, such as convulsions and spasticity, without producing undesirable excessive sedation or muscle weakness in animal subjects, including humans. More particularly, the invention relates to the preparation, biological activities, and therapeutic uses of 3,3bis(3-fluorophenyl)propionamide and related compounds in patients suffering from pathologies of this nature. The following is a description of relevant art, none of which is admitted to be prior art to the claims. A number of pathological states, diseases, and disorders are characterized by a profound aberration in the normal function of the central nervous system (CNS). Such conditions include multiple sclereosis, strokes, spinal cord injuries, chronic neurodegenerative disorders and diseases such as Parkinson's and Huntington's diseases, Alzheimers disease, amyotrophic lateral sclerosis (ALS; Lou Gehrig disease), and epilepsy. At the clinical level, these states usually only respond to pharmacologic intervention with compounds or substances that possess significant activity at the level of the CNS. Web site: http://www.delphion.com/details?pn=US06617358__

•

Benzodiazepine treatment Inventor(s): Snorrason; Ernir (Stigahlid 80, 105 Reykjav ik, IS) Assignee(s): None Reported Patent Number: 5,589,475 Date filed: August 22, 1994

Patents 37

Abstract: The use of a pharmaceutically acceptable cholinesterase inhibitor or a prodrug therefor for counteracting the sedative, hypnotic or respiratory depressive effects of benzodiazepines, substantially without interfering with the anxiolytic, antipsychotic, anticonvulsant, and muscle relaxant activity of benzodiazepines. When benzodiazepines are used for treatment of diseases where the sedative, hypnotic or respiratory depressive effects are undesirable, such as diseases selected from the group consisting of anxiety, anxiety neurosis, anxiety reactions, panic reactions, schizophrenia, affective or schizoaffective type schizophrenia, borderline psychosis, agitating endogene depressions, hyperactivity in children, and muscle spasms, the cholinesterase inhibitor of the present invention is particularly effective. The invention also is directed to use a pharmaceutically acceptable cholinesterase inhibitor or a prodrug therefor for the treatment of schizophrenia, in particular affective or schizoaffective type schizophrenia. The acetyl cholinesterase is preferably one that acts substantially selectively at nicotinic receptor sites, and which has selectively for acetyl cholinesterase opposed to butyryl cholinesterase, e.g., galanthamine or a galanthamine derivative. Excerpt(s): The present invention relates to the use of cholinesterase inhibitors, such as galanthamine, for the preparation of a pharamceutical composition for counteracting the sedative or hypnotic or respiratory depressive effects of benzodiazepines, substantially without interfering with the anxiolytic, antipsychotic, anticonvulsant, and muscle relaxant activity of benzodiazepines. Expressed in another manner, the invention relates to a method for counteracting the sedative, hypnotic or respiratory depressive effects of benzodiazepines, substantially without interfering with the above-mentioned anxiolytic and other desired properties of benzodiazepines, comprising administering, to a patient in subjected to benzodiazepine therapy, that is, a patient who receives benzodiazepine, an effective amount of a pharmaceutically acceptable cholinesterase inhibitor. An aspect of the invention relates to the treatment of schizophrenia, in particular affective or schizoaffective type of schizophrenia, by administering, to a patient suffering from such a condition, an effective amount of a cholinesterase inhibitor, such as galanthamine. Web site: http://www.delphion.com/details?pn=US05589475__ •

Dosage form for Parkinson's disease, spasticity and muscle spasms Inventor(s): Bhatti; Gurdish K. (Fremont, CA), Carpenter; Howard A. (Palo Alto, CA), Edgren; David E. (El Granada, CA) Assignee(s): Alza Corporation (palo Alto, Ca) Patent Number: 5,128,145 Date filed: August 2, 1991 Abstract: A dosage form is disclosed comprising a drug and a maltodextrin polymer for administering to a patient a drug in need of therapy. Excerpt(s): This invention pertains to an improvement in a dosage form. The dosage form comprises a wall that surrounds a compartment comprising a drug, wherein the improvement comprises a maltodextrin in the compartment that cooperated with the dosage form for delivering the drug from the compartment, while concomitantly permitting the drug to substantially maintain both its chemical integrity and therapeutic activity. Dosage forms for delivering a drug to a biological environment of use are known to the prior art in U.S. Pat. Nos. 3,845,770 and 3,916,899, issued to the patentees Felix Theeuwes and Takeru Higuchi. The dosage forms disclosed in these patents comprise a wall that surrounds an internal compartment containing the drug. The wall

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is permeable to the passage of an external fluid and it is substantially impermeable to the passage of drug. There is at lease one passageway through the wall for delivering the drug from the dosage form. These dosage forms release the drug by fluid being imbibed through the wall into the compartment at a rate determined by the permeability of the wall and the osmotic pressure gradient across the wall to produce an aqueous solution containing drug that is dispensed through the passageway from the dosage form. These dosage forms are extraordinarily effective for delivering an agent that is soluble in fluid imbibed into the dosage form that exhibits and osmotic pressure gradient across the wall against an external fluid. A pioneer advancement in dosage form invention was presented to the drug delivery arts by Richard Cortese and Felix Theeuwes in U.S. Pat. No. 4,327,725. The invention disclosed and claimed in this patent pertained to enhancing the delivery kinetics of the dosage form for delivering drugs with various degrees of solubility in aqueous fluids that are difficult to deliver, by manufacturing the dosage form comprising a hydrogel. The hydrogel in the presence of fluid imbibed into the dosage form, swells and moves from a rested state to an expanded state. The force generated by the expansion of the hydrogel is applied against the drug thereby pushing the beneficial drug through the passageway from the dosage form. Web site: http://www.delphion.com/details?pn=US05128145__ •

Ibuprofen-muscle relaxant combinations Inventor(s): Gates; Thomas N. (Doylestown, PA), Sims; Robert T. (Holicong, PA), Slivka; William (Philadelphia, PA) Assignee(s): Merck & Co., Inc. (rahway, Nj) Patent Number: 5,260,337 Date filed: July 29, 1992 Abstract: This invention relates to pharmaceutical compositions for use in the treatment of pain and inflammation and the treatment of muscle spasms and associated pain, soreness and tightness of muscles in mammalian organism, said composition comprising:(i) an analgesically and anti-inflammatory effective amount of (S)-ibuprofen, or a salt thereof, substantially free of (R)-ibuprofen; and(ii) an amount effective in the treatment of muscle spasms of at least one of the muscle relaxants, or a therapeutically active stereoisomer thereof, substantially free of its other stereoisomers. Excerpt(s): The non-steroidal anti-inflammatory drugs (NSAID) have been utilized in the treatment of pain/inflammation and have been disclosed as useful in the treatment, management and mitigation of cold symptoms and the pain associated therewith. Ibuprofen (2-(4-isobutylphenyl)propionic acid) is a well known and commonly employed NSAID. Recently, it has been found that a faster onset of pain relief and an enhanced analgesic response can be obtained by the utilization of the single enantiomer (S)-ibuprofen in comparison to racemic ibuprofen, (see for example U.S. Pat. No. 4,877,620). Muscle relaxants are useful for the treatment of muscle spasms, and associated muscle pain, soreness and tightness, due to muscle strains, overexertion, and minor injuries of the back and neck. Both ibuprofen and muscle relaxants are also useful in relieving the symptoms associated with menstrual associated disorders, such as cramping. Web site: http://www.delphion.com/details?pn=US05260337__

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Injectable therapy for control of muscle spasms and pain related to muscle spasms Inventor(s): Aoki; Kei Roger (Laguna Hills, CA), Garst; Michael E. (Newport Beach, CA), Wheeler; Larry A. (Irvine, CA) Assignee(s): Allergan (waco, Tx) Patent Number: 5,721,215 Date filed: March 20, 1996 Abstract: A method for administration of botulinum toxin, includes the steps of (a) selecting at least one neuromuscular blocking agent having a duration of activity shorter than neuromuscular blocking activity of botulinum toxin; (b) selecting at least one muscle of a muscle group; (c) intramuscularly injecting the selected agent into the selected muscle; (d) observing muscle relaxation in both the selected muscle and other nonselected muscles in the muscle group to determine spill-over, muscle tone and balance; (e) repeating steps (b)-(d) until a final muscle selection is found; and (f) intramuscularly injecting botulinum toxin into the final muscle selection. Excerpt(s): The present invention relates to an improved method for the administration of botulinum toxin and to the use and selection of neuromuscular blocking agents having a duration of activity shorter than the meuromuscular blocking activity of botulinum toxin. Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum, of which there are seven subtypes: A-G, and has a molecular weight of 150,000. This toxin binds to haemagglutinin and other nontoxic proteins to form a much bigger molecular complex. A bacterial toxin, botulinum toxin, in particular botulinum toxin type A, has been used in the treatment of a number of neuromuscular disorders and conditions involving muscular spasm; for example, strabismus, blepharospasm, spasmodic torticollis (cervical dystonia), oromandibular dystonia and spasmodic dysphonia (laryngeal dystonia). The toxin binds rapidly and strongly to presynaptic cholinergic nerve terminals and inhibits the exocytosis of acetylcholine by decreasing the frequency of acetylcholine release. This results in local paralysis and hence relaxation of the muscle afflicted by spasm. Web site: http://www.delphion.com/details?pn=US05721215__

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Interferential stimulator for applying low frequency alternating current to the body Inventor(s): Reiss; Hans W. (Encinitas, CA) Assignee(s): Medserve Group, Inc. (vista, Ca) Patent Number: 5,324,317 Date filed: September 30, 1992 Abstract: An interferential stimulator for applying two medium frequency alternating currents of slightly differing frequencies to the body of a living being so that they cross and interact to produce a low frequency therapeutic current at a selected point. A fixed frequency is generated and applied to the skin through a first electrode pair. A second frequency, differing from the first by from about 1 to 150Hz is applied through a second electrode pair. The electrodes are arranged to deliver a localized stimulation. At the crossing point of the four electrodes a low frequency beat or pulse is produced by the heterodyne process for specific point stimulation. The stimulator may be operated in any of several modes. First, constant stimulation may be applied at fixed frequency difference between electrodes. Second, the frequency difference can be decreased

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abruptly and returned to the original frequency difference over about 1 second. Third, the frequency difference can be decreased abruptly about 50% and returned over a typically 8 second period. Fourth, a gradual about 50% drop in frequency difference may be accomplished gradually and returned over typically a 10 second period. This device has been found to be useful in reducing pain, and appears to provide benefits in reducing edema and inflammation, increasing blood flow and reducing muscle spasms. Excerpt(s): This invention relates in general to electrotherapy apparatus and, more specifically to an interferential generator for treating a living body with low frequency therapeutic current at a selected point. A wide variety of transcutaneous electrical nerve stimulation (TENS) devices have been developed to deliver electrical current to an area of a living body, typically a human being, to alleviate pain. Typical of these is U.S. Pat. No. 4,989,605 to Rossen, which applies a carrier signal to the skin through an electrode. The signal is in the form of D.C. bursts in the frequency range of 10,000 to 19,000Hz which is modulated on and off at a lower frequency. Other typical TENS type devices include the microprocessor controlled device for applying a low frequency pulse train and a modulated high frequency pulse train to a patient through an electrode as disclosed by Padjen et al in U.S. Pat. No. 4,719,922, a device in which a constant current square wave signal is directed into the body between two electrodes as described by Hudleson et al in U.S. Pat. 4,232,680 and a device in which a high frequency low amperage current is applied to a body through an electrode as described by Liss et al in U.S. Pat. No. 3,902,502. The prior art TENS devices deliver a wide area stimulation, rather than the generally preferable localized stimulation. Also, prior art devices tend to provide a uniform signal throughout a treatment. The body tends to accommodate to the stimulation, lessening its effectiveness over time. While of varying effectiveness, the prior devices are not as effective as would be desired in treating pain and other conditions. Thus, there is a continuing need for electrotherapy devices of improved effectiveness. Web site: http://www.delphion.com/details?pn=US05324317__ •

Intraoral topical anti-inflammatory treatment for relief of migraine, tension-type headache, post-traumatic headache facial pain, and cervical-muscle spasm Inventor(s): Friedman; Mark (5 Forest Ct., Larchmont, NY 10538) Assignee(s): None Reported Patent Number: 6,139,861 Date filed: August 9, 1999 Abstract: An anti-inflammatory, either a NSAID or glucocorticoid steroid in the form of an ointment, cream, lotion, gel, powder, paste, film, tape or adhesive bandage, provided with appropriate vehicle to allow specific adherence to a specific gingival area is applied to the area of maxillary alveolar tenderness located in the maxillary third molar apical area. This intraoral area of tenderness is noted consistently in a number of painful conditions and can be used in this manner including to prevent or relieve migraine, tension-type headache, post-traumatic headache, facial pain and cervical muscle spasm. Excerpt(s): This invention relates to a method for treatment of migraine, tension-type headache, post-traumatic headache, facial pain and cervical muscle spasm. More particularly the invention relates to a method of treatment which is non-invasive, nontoxic and non-sedating. The method of the invention comprises delivering a composition, topically, to a specific intraoral area of tenderness consistently noted in

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patients with headache that appears closely associated with several painful conditions: migraine, tension-type headache, post-traumatic headache, facial pain and cervicalmuscle spasm. The composition comprises at least one member of the group of antiinflammatory agents, NSAIDS or glucocorticoid steroids dissolved, distributed or dispersed in a suitable carrier for topical administration to the intraoral area of tenderness which has been found to be associated with the afore-noted conditions. In preliminary data analysis, 1026/1100 (93.2%) mostly asymptomatic migraine patients exhibited maxillary alveolar tenderness, with laterality and degree of tenderness closely related to laterality and severity of symptoms. This consistent finding has been corroborated by several neurologists. In a pilot study of thirty asymptomatic migraine patients with a unilateral history, blinded, inexperienced examiners selected the symptomatic side in 27/30 (90%) patients, based on the laterality of intraoral palpation findings. Web site: http://www.delphion.com/details?pn=US06139861__ •

Method for pain relief using low power laser light Inventor(s): Wong; Edmund (Honolulu, HI) Assignee(s): Diolase Corporation (berkeley, Ca) Patent Number: 5,640,978 Date filed: November 6, 1991 Abstract: The invention comprises a method for treatment of chronic and referred pain such as chronic headaches and migraine headaches, as well as pain of the upper back, neck and shoulders, and lower back pain using low power laser light. The source of such referred pain involves microscopic and macroscopic tears in the periosteal-osseous junctions of the upper vertebrae, the scapula, and the skull. These lesions stimulate the generation of histamines, kinins, bradykinins, prostaglandin, proteolytic enzymes, seratonin, and other substances which cause numerous localized autonomic reactions, such as muscle spasm, ischemia, local inflammation, edema, as well as generalized reactions such as increased blood pressure, photophobia, nausea, blurred vision, copious mucous flow of the nose and sinus, and the like. The muscle spasms are responsible for transmitting the pain sensation to other portions of the body, and the systemic reactions are often associated with migraine-type headaches. The sites of the periosteal-osseous lesions can be correlated directly with the distant locus of the referred pain sensation. The laser energy is directed to the sites of the lesions to cause an increase in lymphatic circulation at the site of the causative lesion in response to the laser energy. Laser energy delivered to the site results in increased blood circulation and cellular metabolism in the area, which promotes more rapid healing of the lesion. Excerpt(s): Although it is often said that the common cold is the most prevalent disease among humankind, it is also true that chronic pain is an affliction that is almost as prevalent. Chronic headaches, muscle pain, joint pain, and the like are experienced by most individuals, and many persons have such chronic pain on a daily or weekly basis. It is interesting to note that most forms of chronic pain often are not traceable to a specific causative factor. The term "referred pain" has been used to describe pain that is experienced at a locus removed from the cause or lacking an identified cause. From the perspective of a treating physician, this situation leads to skepticism concerning the patient's complaints, and a tendency to dismiss the complaints as psychosomatic, neurological, or imagined. From the perspective of the patient, there is real suffering experienced on a regular basis, and often there is no medical treatment to relieve the

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pain. Frequently, medical treatment consists of drugs such as analgesics or muscle relaxers. These substances are systemic, and can have adverse side effects such as kidney toxicity, liver inflammation, gastrointestinal symptoms, and the like. Alternative treatments consist of chiropractic manipulations, acupuncture, physical therapy, stress relief regimens, and the like. These approaches to treatment have had limited success for most chronic pain sufferers. Research conducted 40 to 50 years ago indicated that referred pain could be emulated in test subjects by injecting hypertonic saline solution into the interspinous ligaments and causing temporary inflammations of the periosteum at the points where muscle tissue extends from the upper spinal vertebrae to the skull and the scapula. Referred pain was produced at various sites remote from the injection points, and was virtually indistinguishable from the sensations described by chronic pain sufferers. Moreover, it was clear that induced inflammation of specific sites along the spinous processes resulted in pain sensation at corresponding specific sites throughout the body far removed from the cause, and that the pain sensation could also be induced in the form of headaches similar to migraine headaches. This research also established that the pain referral mechanism did not involve mere neural transmission. However, this promising early work apparently was not followed, and did not result in effective treatment modalities. Web site: http://www.delphion.com/details?pn=US05640978__ •

Method of treating chronic pain associated with muscle spasms, tendonitis and sciatica Inventor(s): Joseph; William K. (241 Central Park West, #7C, New York, NY 10024) Assignee(s): None Reported Patent Number: 6,048,881 Date filed: February 1, 1999 Abstract: The invention is a method of treating chronic pain associated with muscle spasms, tendonitis and sciatica comprising administering to a human patient an effective amount of niacin. Excerpt(s): The present invention relates to a method for treating chronic pain associated with muscle spasms, tendonitis and sciatica by administering to a human patient an effective amount of niacin. Chronic pain associated with conditions such as muscle spasms, tendonitis and sciatica is not only very painful to the individual, but is usually very difficult to treat. Inadequate treatment of chronic pain can be debilitating to humans. Muscle spasms are violent, involuntary contractions of a muscle or a group of muscles. They affect a large segment of the population and are often very painful. The pain resulting from muscle spasms often is chronic, i.e. lasts for one day or even longer. By contrast, the pain associated with leg cramps, which usually radiates from the calf, and can last from a few seconds up to ten minutes. See for example, Weiner et al., JAMA 244:2332-2333 (1980). Web site: http://www.delphion.com/details?pn=US06048881__

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Patch arrangement for galvanic treatment Inventor(s): Berger; Mario (Gartenstrasse 15, 5788 Winterberg, DE) Assignee(s): None Reported Patent Number: 5,354,321 Date filed: June 10, 1992 Abstract: The invention refers to a patch arrangement for electric elimination of muscle spasms. The invention is based upon the object to employ electrotherapy through stable galvanization without external voltage source to attain high efficiency and to make it overall more practical. In accordance with the invention, the object is attained by arranging a plane electrode of different metals at both sides of the affected area. A further metal electrode is applied onto both of these skin contact electrodes at the other side or body-distant side thereof wherein the metals of these electrodes may correspond to those of both skin electrodes, however, with opposing polarity according to the electrochemical series. Both obtained compact bimetallic electrodes are insulated at their border against electrolytic shorting and attached to the body by means of the electrocardiographic electrode patch which is available in the medical trade. Moreover, by suitably selecting the metals, two additional galvanic elements are obtained upon the skin in series with the galvanic element composed of two different metals and already known in the literature. Excerpt(s): The invention refers to a patch arrangement of electrically connected electrodes of different metals for application upon the human body for electric influence of electrically acting structures of the organism. When experiencing muscle spasms and irritations of the nerve root especially in the area of the spine, electrotherapy is increasingly the preferred treatment. The aversion of employing a respective drug therapy increases. Application of a direct current through the tissue being treated (stable galvanization) is of particular significance. In practice, large stationary devices are used which are also dimensioned for other types of current (so-called stimulating current devices). Smaller portable and battery-operated devices (so called TENS-devices) are commercially available for ambulant or medium-term continuous application. While a longer-term application with stationary devices is not feasible, the still required size of portable devices renders their use still inconvenient. Web site: http://www.delphion.com/details?pn=US05354321__

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Pharmaceutical methods using parabenzoquinone to treat muscle spasms Inventor(s): Ewing; Channing B. (P.O. Box 47, East Lake Weir, FL 32632) Assignee(s): None Reported Patent Number: 4,522,830 Date filed: February 24, 1984 Abstract: Bronchial asthma including bronchial spasms associated therewith are treated with pharmaceutical compositions containing small amounts of parabenzoquinone, for instance 2 milliliters of a one part per million solution of PBQ in sterile isotonic saline solution. This solution is administered to an asthma patient. Typically the same dose is repeated again in a month or so and the asthma symptoms are alleviated. Excerpt(s): This application relates to methods of treating various disease states and more specifically to a method of administering pharmaceutical compositions containing

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highly diluted amounts of parabenzoquinone to a subject in need of such therapy. Parabenzoquinone, or as it is known chemically 1,4-benzoquinone, quinone or chinone, has the formula C.sub.6 H.sub.4 O.sub.2, is a known staple of commerce used in the manufacture of dyes, hydroquinone, fungicides, as an analytical reagent, in photography, and as an oxidizing agent. It appears in the form of yellow crystals and has a rather irritating odor. It is soluble in alcohol, ether and alkaline solutions but only slightly soluble in hot water. It has a specific gravity of 1.307 and a melting point of 115.7.degree. C. Parabenzoquinone, or PBQ as it is sometimes referred to hereinafter, is reported to be toxic when inhaled and a strong irritant to the skin and mucus membrane, with a tolerance value of 0.1 parts per million (ppm) in air; see the Condensed Chemical Dictionary, 10th Edition, Halley, editor (1981) page 879, and also Dangerous Properties Of Industrial Materials, by Sachs, editor, 4th Edition (1975) pp. 1074-1075 which describes quinone as causing severe local damage to skin and mucus membranes by contact with it in the solid state, in solutions or the form of condensed vapors. The art has accepted a criterion for regulating work room concentration of quinone in the air according to personal comfort of the individuals involved as judged by eye irritation. The oral LD.sub.50 in rats is reported to be 130 mg/km. Despite these severe warnings I have surprisingly found, however, that they dilute solutions of parabenzoquinone--of the order of 1 part per million (ppm)--may be used either by injection or in the form of an oral composition, for instance a tablet, for the treatment of various disease states including both the central nervous system and the parasympathetic portion of the autonomic nervous system. Further, I have found that when sterile water is used as the vehicle for diluting the PBQ upon injection severe pain and discomfort results in the subject, but that when isotonic saline is used as the diluent the pain on injection is significantly and substantially reduced to a manageable level. Web site: http://www.delphion.com/details?pn=US04522830__ •

Rotary massaging device and method of using same Inventor(s): Cellers; Warren G. (127 N. Summit, Arkansas City, KS 67005) Assignee(s): None Reported Patent Number: 4,014,324 Date filed: April 26, 1976 Abstract: A rotary massaging device for palpating muscle spasms comprising a variable speed power means having a flexible drive shaft operably connected thereto for transmitting rotary motion to a remotely disposed massaging element. The massaging element includes a rigid shaft having one end thereof connected with the flexible drive shaft, the other shaft end being connected coaxially with a disk having a protruding, rounded knob eccentrically affixed thereto being adapted for kneading contact with a patient's skin. The massaging device includes a handle having a central aperture therethrough within which the shaft is rotatably mounted, and an outer handle surface adapted for grasping by the operator's hand. The operator of the device measures the patient's pulse rate, adjusts the rotational speed of the power means to correspond therewith, and applies the massaging head to the patient's skin in the area of the muscle spasm, thereby relieving the discomfort. Excerpt(s): This invention relates to motor driven appliances for massaging surface portions of the human body and in particular to rotary massaging devices for palpating muscle spasms. The principal objects of the present invention are: to provide a rotary massaging device whose speed may be varied to correspond to the pulse rate of the

Patents 45

patient for improved muscle spasm therapy; to provide such a device having a massaging head which is simple yet effective and efficient in design and which is capable of producing a petrissage action on the deeper muscles and tissues of the body while simultaneously massaging the muscle for increased blood circulation; to provide such a device wherein an inflexible knob is eccentrically affixed to the massaging head and is adapted to contact impressingly the patient's skin and orbitally knead the underlying flesh, whereby the patient is quickly and efficiently treated; and to provide such a device which is economical to manufacture, efficient in use, capable of a long operating life and particularly well adapted for the proposed use. Other objects and advantages of this invention will become apparent from the following description taken in connection with the accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention. Web site: http://www.delphion.com/details?pn=US04014324__ •

Therapeutic bath salts and method of use Inventor(s): McLean; Linsey (4267 S. State Rd., Davison, MI 48423) Assignee(s): None Reported Patent Number: 5,958,462 Date filed: May 23, 1997 Abstract: Therapeutic bath salts for the relaxation of muscles, elimination or reduction of muscle spasms, and for the overall enhancement of a person's mood. The bath salts of the present invention are used as aromatherapy that has both the convenience of a bath and the internal mechanisms of ingested medication. The formula for the composition of the present invention includes a selected amount of magnesium sulfate trihydrate (a hydrated version of epsom salts), lithium chloride, copper gluconate, and essential oils. The oils include rosewood oil, ylang ylang oil, lavender oil and patchouli oil. The oils are provided as scents for use in the prescribed aromatherapy. The user mixes a preselected amount of the crystallized salt or liquid form of the present invention with the bath water. A period of time is allowed to elapse before the user departs the bath. By resting in the tub, the user accrues the combined benefits of external therapy and internal therapy. Excerpt(s): The present invention relates generally to therapeutic bath salts. More particularly, the present invention relates to a composition that includes a magnesium salt, a lithium salt, a copper salt, a carbonate, and, in its preferred form, one or more essential oils. Bath and bathing therapies have been known for centuries. As early as the times of ancient Egypt, wealthy families availed themselves of "scented and anointed waters" to allegedly alleviate a virtual panoply of diseases, from minor muscular discomfort to life-threatening disease. The Romans were well known for their baths which provided both therapeutic treatment and social interaction. The ancient ruins of baths generally are found by hot springs and mineral springs, such as by the ancient city of Carcalla. The user could select from cold, warm or hot springs, and could take advantage of the high mineral content of many of these waters. Modern versions of hot springs may be found, for example, at Hot Springs, Ark. Web site: http://www.delphion.com/details?pn=US05958462__

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Therapeutic copper compositions Inventor(s): Heintze; York (Bochum, DE) Assignee(s): Fischer; Gertrude (east Liverpool, Oh) Patent Number: 4,123,511 Date filed: July 2, 1975 Abstract: Therapeutic copper compositions are described which are adapted to be applied as from an aerosol container to areas of human skin for the treatment of muscle spasms and cramps, mild burns and insect bites and to enhance healing by increasing blood circulation beneath the skin and to normalize the pH of the skin area being treated. The copper is in the form of a copper powder or copper oleate. Excerpt(s): The present invention relates to copper-containing compositions for external application to human skin to stimulate and increase circulation of blood beneath the skin, to enhance healing of mild burns and insect bites and to overcome muscular spasms and cramps. The compositions also have antifungal action against fungal infections such as athlete's foot. The compositions of the invention are in either of two forms suitable for filling into aerosol containers under pressure with a propellant, one of which is termed a copper spray and the other of which is termed a colorless spray. The copper spray is made up of copper powder, 98% of which is 300 mesh, colloidal silica such as silica aerogel and oil of rosemary in isopropyl or ethyl alcohol and methylene chloride. The propellant is CO.sub.2 or preferably a 50:50 or 30:70 mixture of Freon 11 which is trichlorofluoromethane and Freon 12 which is dichlorodifluoromethane. The colorless spray differs primarily from the copper spray in the use of copper oleate (10%). Copper oleate is per se known and is defined as a mixture of 10% copper oxide dissolved in oleic acid and forming a greenish-blue, granular powder soluble in ether. Web site: http://www.delphion.com/details?pn=US04123511__

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Treatment of disorders of inflammation and immunity and disorders associated with smooth muscle spasm and compositions therefor Inventor(s): Horrobin; David F. (P.O. Box 10, Nuns' Island, Montreal, CA), Lieb; Julian (41 Village La., Bethany, CT 06525) Assignee(s): None Reported Patent Number: 4,386,072 Date filed: February 3, 1982 Abstract: A method for the treatment or prophylaxis of disorders of inflammation and immunity and disorders associated with smooth muscle spasm, by administering dihomo-.gamma.-linolenic acid or a bioprecursor thereof conjointly with a physiologically acceptable lithium salt. Vitamin E and related tocopherols may optionally be also administered. Excerpt(s): This invention relates to the treatment of disorders of inflammation and immunity as well as disorders associated with smooth muscle spasm. Defects in the biosynthesis and/or metabolism of prostaglandins are now believed to play an important part in disorders of inflammation and immunity, and those associated with smooth muscle spasm. For example, it has been found that the synovial tissues from patients suffering from rheumatoid arthritis produce larger amounts of prostaglandin

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E2 (PGE2) and prostaglandin F2.alpha. (PGF2.alpha.) compared to the synovial tissues from unaffected subjects. Web site: http://www.delphion.com/details?pn=US04386072__ •

Treatment of migraine, post-traumatic headache, tension-type headaches, atypical facial pain, cervical pain and muscle spasm Inventor(s): Friedman; Mark (5 Forest Ct., Larchmont, NY 10538) Assignee(s): None Reported Patent Number: 6,450,170 Date filed: June 15, 2000 Abstract: A new method of treatment of migraine, tension-type headaches, posttraumatic headache, atypical facial pain as well as cervical pain and muscle spasm is presented, comprising the application of bursts of low power laser light to the area of intra-oral tenderness associated with the above conditions. The zone of tenderness is in the area of the plexus formed by the posterior and middle superior alveolar branches of the ipsilateral maxillary nerve. The intra-oral tenderness associated with migraine, tension-type headaches, post-traumatic headache, atypical facial pain, cervical pain and muscle spasm disappears almost immediately, returning in approximately 3 hours to a few days, With repeated applications, a marked decrease or elimination of the intra-oral tenderness and similar elimination of migraine, tension-type headaches, post-traumatic headache, atypical facial pain, cervical and muscle spasm frequency and intensity was observed. The brief application of bursts of low power laser light (non-cutting 5-60 mW) from a low power Helium-Neon, Gallium Arsenide or Gallium Aluminum Arsenide laser, having a maximum output of 60 mW ,typically utilizing an application time of 215 minutes. Excerpt(s): The present invention relates to a new method for the treatment of migraine, tension-type headaches, atypical facial pain, post-traumatic headache, cervical pain and muscle spasm. In accordance with the invention, the method of treatment for these headaches, atypical facial pain, cervical pain and muscle spasm comprises the application of low power laser light to the area of intra-oral tenderness which has been found by the inventor herein to be associated with the aforesaid conditions. This zone of tenderness and an increased local temperature are in the area of the plexus formed by the posterior superior alveolar branch of the ipsilateral maxillary nerve. The zone of tenderness is located bilaterally when the symptoms are bilateral and unilaterally when the symptoms are one sided. In the case of tension (muscle contraction) headaches in the frontalis or forehead and/or orbital region, the laser emitted radiation can also be applied to the supraorbital nerve as it emerges from the supraorbital notch or foramen over the eye or at the infraorbital foramen beneath the eye, or at the mandibular foramen in the mandible This laser application is performed either separately or in conjunction with the laser treatment directed to the area of intra-oral tenderness. The intra-oral tenderness associated with migraine, tension-type headaches, post-traumatic headache, cervical muscle spasm and atypical facial pain is markedly decreased or disappears immediately after intra-oral laser application, returning in approximately three hours to a few days, but most importantly it has been found that with repeated applications, the tenderness returns to a lesser degree along with a decrease in symptoms. For the above-noted conditions, a marked decrease or elimination of the above noted conditions' frequency and intensity takes place. Immediate relief is often noted when the patient is symptomatic.

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Web site: http://www.delphion.com/details?pn=US06450170__

Patent Applications on Muscle Spasms 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 muscle spasms: •

Aminoadamantane derivatives as therapeutic agents Inventor(s): Larrick, James W.; (Woodside, CA), Lipton, Stuart A.; (Rancho Santa Fe, CA), Stamler, Jonathan S.; (Chapel Hill, NC), Wang, Yuqiang; (Mountain View, CA), Ye, Wenqing; (Fremont, CA) Correspondence: Mintz, Levin, Cohn, Ferris,; Glovsky & Popeo, P.C.; One Financial Center; Boston; MA; 02111; US Patent Application Number: 20030008889 Date filed: July 19, 2002 Abstract: The present invention provides novel aminoadamantane derivatives, methods of making the derivatives, compositions including the novel aminoadamantane derivatives, and methods for the treatment and prevention of neurological diseases using the derivatives and compositions. There are a variety of neurological disorders that can be treated using the present invention, including, for example, the following: neurological disorders arising from trauma, ischemic or hypoxic conditions that can be treated include stroke, hypoglycemia, cerebral ischemia, cardiac arrest, spinal cord trauma, head trauma, perinatal hypoxia, cardiac arrest and hypoglycemic neuronal damage; neurodegenerative disorders such as epilepsy, Alzheimer's disease, Huntington's disease Parkinsonism, and amyotrophic lateral sclerosis; other diseases or disorders such as convulsion, pain, depression, anxiety, schizophrenia, muscle spasms, migraine headaches, urinary incontinence, nicotine withdrawal, opiate tolerance and withdrawal, emesis, brain edema, tardive dyskinesia, AIDS-induced dementia, ocular damage, retinopathy, cognitive disorders, and neuronal injury associated with HIVinfection such as dysfunction in cognition, movement and sensation. Excerpt(s): Certain adamantane derivatives have been used to treat illnesses. Rimantadine (1-(1-aminoethyl)adamantane) is used for the prophylaxis and treatment of influenza in humans. Amantadine has been used for the treatment of both influenza and Parkinson's disease (Schwab et al., J Am. Med. Assoc. (1969) 208:1168). Another derivative, memantine, is currently under clinical investigation for the treatment of various neurodegenerative diseases and has been licensed for the treatment of Parkinson's associated spasticity in Germany (Schneider et al., Dtsch. Med. Wschr. (1984) 109:987). Memantine protects cortical and retinal neuron cultures from the toxicity of glutamate, NMDA and the HIV-1 coat protein gp120 (Dreyer et al., Science (1990) 248:364). Recent studies demonstrate that it prevents quinolinic acid-induced hippocampal damage in rats (Kelhoff and Wolf., Eur. J. Pharmacol. (1992) 219:451). Memantine demonstrates antiphypoxic properties in vitro and in vivo. It is thought that memantine exerts a neuroprotective effect because it is a micromolar antagonist of the NMDA receptor (Bormann J., Eur. J. Pharmacol. (1989) 166:591). While memantine is

10

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

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being used to treat neurological disorders, the variety and severity of neurological diseases presents a need for other neuroprotective agents. The present invention provides novel compounds, compositions and methods for the treatment of neurological diseases. The present invention also provides methods of making the novel compounds. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Anticonvulsant and central alkylamides and their uses

nervous

system-depressing

bis

(fluorophenyl)

Inventor(s): Artman, Linda D.; (Salt Lake City, UT), Balandrin, Manuel F.; (Sandy, UT), Moe, Scott T.; (Boston, MA), Mueller, Alan L.; (Salt Lake City, UT), Smith, Daryl; (Salt Lake City, UT), VanWagenen, Bradford C.; (Salt Lake City, UT) Correspondence: Nps Pharmaceuticals, INC. C/o Foley & Lardner; P.O. Box 80278; San Diego; CA; 92138-0278; US Patent Application Number: 20030199589 Date filed: May 2, 2003 Abstract: Bis(Fluorophenyl)alkylamides have been chemically synthesized which possess beneficial pharmacological properties (e.g., anticonvulsant activity) useful for the treatment of neurological diseases or disorders, such as, for example, epilepsy, convulsions, and seizure disorders. The preferred compounds of the invention also cause little sedation and have high therapeutic and protective indices in animal models of epilepsy. These compounds further possess long pharmacologic half-lives, which, in practical clinical therapeutic application, should translate into once-a-day dosing, of great benefit to patients suffering from these diseases and/or disorders. These compounds may also be of further clinical utility in the treatment of other diseases and disorders of the central and peripheral nervous systems, or diseases or disorders affected by them, including, but not limited to, spasticity, skeletal muscle spasms and pain, restless leg syndrome, anxiety and stress, and bipolar disorder. Excerpt(s): This application is a Continuation of International Application No. PCT/US98/26315, filed Dec. 9, 1998 which claims the benefit of Provisional Application No. 60/069,005, filed Dec. 10, 1997. The present invention relates to compounds useful in treating pathological conditions, such as convulsions and spasticity, without producing undesirable excessive sedation or muscle weakness in animal subjects, including humans. More particularly, the invention relates to the preparation, biological activities, and therapeutic uses of 3,3-bis(3-fluorophenyl)propionamide and related compounds in patients suffering from pathologies of this nature. The following is a description of relevant art, none of which is admitted to be prior art to the claims. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Article and method for self-administered physical therapy to alleviate back pain Inventor(s): Pecora, Ralph R.; (Baltimore, MD) Correspondence: Royal W. Craig; A Professional Corporation; Suite 153; 10 North Calvert Street; Baltimore; MD; 21202; US Patent Application Number: 20020193714 Date filed: June 13, 2002

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Abstract: A therapeutic device for alleviating mid-to-upper back pain. The device comprises a hard cylindrical body wrapped in a cushioning sleeve. The sleeve is sufficiently firm to resist deforming, thereby maintaining its round shape and enabling it to roll easily along the ground. At the same time, the sleeve comfortably supports the user and transfers the force of the hard inner element to the user's back muscles and joints without causing pain or injury. The device can be used by individuals suffering from mid-to-upper back pain associated with muscle spasms, soreness, or injury. The device enables the individual to self-administer therapy to the back muscles and joints to relieve back pain and reduce the likelihood of future incidences of pain. Excerpt(s): The present application derives priority from U.S. Provisional Patent Application 60/297,803, filed: Jun. 13, 2001. The present invention relates to physical therapy devices, and, more particularly, to a therapeutic device for alleviating mid-toupper back pain resulting from muscle spasms or tired, stiff muscles. Worldwide back pain is estimated to afflict 60-80% of the human population at some point in their lives, and it afflicts 2-5% of the population at any given time. Anatomically, the back is divisible into three regions defined by the vertebrae of the spinal column. Beginning at the neck, the first 7 descending vertebrae are the cervical vertebrae. Next, the thoracic region consists of 12 vertebrae, and finally the lumbar region comprises five vertebrae of the lower back. The trapezius and the latissimus dorsi represent two large muscle groups in the back most commonly associated with muscular back pain. The present invention is directed to alleviating the discomfort and debilitating effects of mid-toupper back pain, generally corresponding to regions of the thoracic and cervical vertebrae. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Carbamic acid derivatives Inventor(s): Bleicher, Konrad; (Freiburg, DE), Mutel, Vincent; (Mulhouse, FR), Vieira, Eric; (Allschwil, CH), Wichmann, Jurgen; (Steinen, DE), Woltering, Thomas Johannes; (Weil am Rhein, DE) Correspondence: Hoffmann-la Roche INC.; Patent Law Department; 340 Kingsland Street; Nutley; NJ; 07110 Patent Application Number: 20020091150 Date filed: December 10, 2001 Abstract: The present invention is a compound of formula 1wherein R.sup.1, R.sup.2, R.sup.2', X, A.sup.1/A.sup.2 and B are as defined in the specification.These compounds may be used in the control or prevention of acute and/or chronic neurological disorders such as restricted brain function caused by bypass operations or transplants, poor blood supply to the brain, spinal cord injuries, head injuries, hypoxia caused by pregnancy, cardiac arrest, hypoglycaemia, Alzheimer's disease, Huntington's chorea, ALS, dementia caused by AIDS, eye injuries, retinopathy, cognitive disorders, memory deficits, schizophrenia, idiopathic parkinsonism or parkinsonism caused by medicaments as well as conditions which lead to glutamate deficiency functions, such as e.g. muscle spasms, convulsions, migraine, urinary incontinence, nicotine addiction, psychoses, opiate addiction, anxiety, vomiting, acute and chronic pain, dyskinesia and depression. Excerpt(s): This application is a divisional application of U.S. patent application Ser. No. 09/545,622, filed Apr. 10, 2000. In the central nervous system (CNS) the transmission of stimuli takes place by the interaction of a neurotransmitter, which is sent out by a

Patents 51

neuron, with a neuroreceptor. L-glutamic acid, the most commonly occurring neurotransmitter in the CNS, plays a critical role in a large number of physiological processes. The glutamate-dependent stimulus receptors are divided into two main groups. The first main group forms ligand-controlled ion channels. The metabotropic glutamate receptors (mGluR) belong to the second main group and, furthermore, belong to the family of G-protein-coupled receptors. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Immunotoxin (mAB-RICIN) for the treatment of focal movement disorders Inventor(s): Dalakas, Marinos C.; (Bethesda, MD), Hallett, Mark; (Bethesda, MD), Hott, Jonathan S.; (Birmingham, MI), Youle, Richard J.; (Bethesda, MD) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20020081303 Date filed: November 7, 2001 Abstract: Compositions and methods for treatment of focal muscle spasms. Immunotoxin conjugates comprise a toxin conjugated to an antibody reactive to a muscle specific antigen. Excerpt(s): Compositions comprising a toxin conjugated to an antibody selectively reactive to a muscle specific antigen. Methods of using the immunotoxin conjugates for treatment of focal muscle spasms are also provided. A variety of neurological disorders are characterized by disabling, involuntary muscular spasms. The most successful treatment for focal muscle spasm is intramuscular injection of the botulinum toxin A (BTX), the only pharmaceutical formulation of botulinum toxin currently on the market. Intramuscular injection of BTX weakens the muscles and reduces the symptoms. (Jankovic and Brin, N. Engl. J. Med., (1991) 324:1186-1194; Stell and Moore, History and current applications of botulinum toxin treatment. In: Moore P, ed. Handbook of botulinum toxin treatment. Oxford: Blackwell Science, Inc., 1995:3-1 5; Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: the clinical usefulness of botulinum toxin-a in treating neurologic disorders. Neurology (1990) 40:1332-1336; Coffield et a. The site and mechanism of action of botulinum neurotoxin. In: Jankovic J, Hallett M, eds. Therapy with botulinum toxin. New York: Marcel Dekker, Inc., (1994) 3-14). However, the therapeutic effect of BTX is transient and as the BTX paralytic effects wane, patients usually receive additional injections. For many patients, repeated exposure to BTX has been accompanied with decreasing efficacy and duration of benefit. Collateral sprouts of denervated motor nerve terminals and increasing titers of toxin neutralizing antibodies are two mechanisms of resistance to BTX (Coffield et al., supra, Jankovic and Schwartz, Neurology (1995) 45:1743-1746). As a result, larger and more frequent doses of BTX become necessary for relief of the spasm, increasing the risk of side-effects. Eventually, some patients become completely refractory to treatment. Accordingly, what is needed in the art is a means to treat focal muscle disorders with greater specificity and duration of effect. The present invention provides these and other advantages. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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•

Muscle Spasms

Methods of treating involuntary facial spasms and facial wrinkles Inventor(s): Zhu, Alex; (New York, NY) Correspondence: Mintz, Levin, Cohn, Ferris, Glovsky; And Popeo, P.C.; One Financial Center; Boston; MA; 02111; US Patent Application Number: 20040037895 Date filed: February 12, 2003 Abstract: The invention describes antibiotics, muscle relaxants and plant extracts that have neuromuscular blockade effects as well as methods of use thereof. These compounds can be used in the same clinical settings as botulinum toxin and may be used topically, thereby providing an advantage over botulinum toxin in terms of application and ease of use. The compounds can be used in pharmaceutical compositions for the treatment of involuntary muscle spasms and in cosmetic compositions for the treatment of facial wrinkles. Also provided are kits useful for therapeutic and/or cosmetic applications. Excerpt(s): This application claims priority to U.S. Ser. No. 60/405,779, filed Aug. 23, 2002, which is incorporated herein by reference in its entirety. This invention relates generally to pharmaceutical compositions and methods for chemodenervation using compounds with botulinum toxin-like properties. Several compounds are used to modulate the activity at neuromuscular junctions and display neuromuscular blockade effects. One such compound is botulinum toxin, which blocks the release of acetylcholine from the neuromuscular junction, and has been applied to a variety of therapeutic and cosmetic conditions. These applications include, but are not limited to, ocular disorders; dystonia, bleopharospasm, hemifacial spasm, synkinesis, and the involuntary facial muscle spasms caused by these disorders; gastrointestinal disorders; management of pain; and treatment of facial wrinkles. In all these cases, the toxin needs to be injected in the area where symptoms occur in order to exert a therapeutic effect. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Methods of treating muscle spasms using N-desmethylzopiclone Inventor(s): Bakale, Roger A.; (Shrewsbury, MA), Hong, Yaping; (Framingham, MA), Jerussi, Thomas P.; (Framingham, MA), McConville, Fran A.; (Grafton, MA), Rubin, Paul D.; (Sudbury, MA), Senanayake, Chrisantha H.; (Shrewsbury, MA), Xiang, Tingjian; (Northboro, MA) Correspondence: Pennie & Edmonds Llp; 1667 K Street NW; Suite 1000; Washington; DC; 20006 Patent Application Number: 20020143016 Date filed: January 9, 2002 Abstract: The invention is directed to compositions comprising, and methods of using, racemic N-desmethylzopiclone, optically pure (+)-N-desmethylzopiclone, and optically pure (-)-N-desmethylzopiclone in the treatment and prevention of diseases and conditions in mammals. The invention is further directed to novel methods of preparing N-desmethylzopiclone, optically pure (+)-N-desmethylzopiclone, and optically pure (-)N-desmethylzopiclone. Excerpt(s): The invention relates to compositions and methods for the treatment and prevention of anxiety, convulsive disorders, and other disorders. Zopiclone and some of

Patents 53

its uses are described by U.S. Pat. Nos. 3,862,149 and 4,220,646. Uses of the optically pure (+) and (-) enantiomers of the drug (i.e., (+)-zopiclone and (-)-zopiclone) are described by U.S. Pat. No. 5,786,357 and WO 93/10788, respectively. Zopiclone binds at or near benzodiazepine receptor complexes. Goa, K. L. and Heel, R. C. Drugs, 32:48-65 (1986). These complexes are located both within the central nervous system and peripherally (e.g., in the endocrine system), and contain macromolecular complexes which comprise benzodiazepine and GABA binding sites. Verma, A. and Snyder, S. H., Annu. Rev. Pharmacol. Toxicol. 29:307-22 (1989). Benzodiazepine receptor complexes are further associated with, and interact with, membrane channels for chloride ion transport. Upon binding to a benzodiazepine receptor complex, zopiclone is believed to allosterically modulate the activity of the complex by increasing trans-membrane conductance of chloride ions. This stabilizes neuronal membrane potentials and dampens excitatory input. See Meldrum, B. S., Brit. J. Clin. Pharm. 27(suppl. 1):3S-11S (1989); Goodman & Gilman's The Pharmacological Basis of Therapeutics, Hardman, J. G., et al., eds. p. 365 (9.sup.th ed., 1996). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

PROTEIN KINASE C EPSILON AS MODULATOR OF ANXIETY, ALCOHOL CONSUMPTION AND SELF-ADMINISTRATION OF DRUGS OF ABUSE Inventor(s): HODGE, CLYDE W.; (TIBURON, CA), MESSING, ROBERT O.; (FOSTER CITY, CA) Correspondence: Tom Hunter, J.D., PH.D.; Law Offices OF Jonathan Quine; 2033 Clement Avenue, Suite 200; Alameda; CA; 94501; US Patent Application Number: 20020124272 Date filed: June 25, 1999 Abstract: The present invention is directed to the production of PKC isozyme.epsilon. (PKC.epsilon.)-deficient cells and non-human animals. The present invention is further directed to the identification of PKC.epsilon. as a target for drugs that reduce anxiety. According to the present invention, PKC.epsilon.-inhibiting compounds act in synergy with drugs acting at the GABA.sub.A receptor. The present invention is also directed to the use of modulators of PKC.epsilon. to modulate alcohol consumption, selfadministration of other drugs of abuse, and the effects of alcohol consumption as well as the use of inhibitors of PKC.epsilon., either alone or in conjunction with allosteric agonists of GABA.sub.A receptors, to treat conditions, such as addiction, withdrawal syndrome, skeletal muscle spasms, convulsive seizures, and epilepsy, that are amenable to treatment by allosteric agonists of GABA.sub.A receptors. Additional aspects of the present invention are diagnostic methods for identifying individuals at risk for becoming alcoholics or abusers of other drugs and kits for performing such diagnostic methods.The present invention relates to: cells and non-human animals deficient for the PKC isozyme.epsilon. (PKC.epsilon.); the use of PKC.epsilon. as a target for drugs; the use of inhibitors of PKC.epsilon. in methods of reducing anxiety and treating conditions associated with insufficient activity of the GABA.sub.A receptor; the use of modulators of PKC.epsilon. in methods of modulating alcohol consumption, modulating selfadministration of other drugs of abuse, and altering the effects of alcohol; pharmaceutical compositions comprising inhibitors of PKC.epsilon. and allosteric agonists of GABA.sub.A receptors; and the identification of individuals with enhanced susceptibility to alcoholism or other forms of addiction.

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Excerpt(s): This application is related to U.S. Provisional Application No. 60/091,755, filed Jul. 6, 1998, and U.S. Provisional Application No. 60/125,995, filed Mar. 24, 1999. The present invention relates to: cells and non-human animals deficient for the protein kinase C isozyme.epsilon. (PKC.epsilon.); the use of PKC.epsilon. as a target for drugs; the use of modulators of PKC.epsilon. in methods of reducing anxiety, modulating alcohol consumption and self-administration of other drugs of abuse, altering the effects of alcohol, and treating conditions associated with insufficient activity of the GABA.sub.A receptor; and the identification of individuals with enhanced susceptibility to alcoholism or other forms of addiction. Anxiety is very common sensation that, if severe or persistent, can be quite disabling. Anxiety-related disorders are so prevalent that benzodiazepines, the most frequently prescribed anxiolytic agents, regularly appear in lists of the top 20 or 25 most frequently prescribed drugs. Given the undesirable side effects of benzodiazepines and other anxiety-reducing drugs, there is a need for new treatments for anxiety. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Symptomatic relief of allergic reactions Inventor(s): Keller, Robert H.; (Weston, FL), Wen, Xue-Lan; (Miami, FL) Correspondence: Ronald R. Santucci; Pitney, Hardin, Kipp & Szuch, Llp; 20th Floor; 711 Third Avenue; New York; NY; 10017; US Patent Application Number: 20010000144 Date filed: November 30, 2000 Abstract: The composition disclosed is a unique formulation of Traditional Chinese Medicine (TCM) extracts created to reduce the debilitating symptoms of allergies. It combines a number of organically grown, but, non-organically extracted, standardized formulations of natural ingredients which have been used singly for hundreds of years for symptomatic relief of allergies. These include Ginseng and Gan Cao, which provide a natural anti-inflammatory effect; Bai Gao, which prevent the smooth muscle spasms associated with allergic reactions; Suan Zao ren, which provides an antihistamine effect without the usual sedative effect; and Wu Mai, which reduces the local swelling associated with allergies. Combined, it was unexpectedly found that these ingredients provide a natural, non-drying, non-sedating alternative to antihistamines, without inhibiting the natural healing mechanisms. Excerpt(s): 2. This invention relates to pharmaceutical compositions and methods for the treatment of mammals suffering symptoms of allergic reactions. 4. An allergy is defined as an immune response in a mammal induced by an environmental antigen that has deleterious effects resulting in significant tissue damage and inflammation. Allergies comprise one of the most common medical problems in the twentieth century with some estimates suggesting that as many at 10% of the population may be affected. The antigen (allergen) is a non-parasitic antigen and the immune response is generally a type I hypersensitivity reaction. This reaction, which comprises mast cell or basophil degranulation manifests itself clinically in disorders related to biological effects of mediators released by the degranulation. These mediators are pharmacologically active agents that act on local tissues to increase vascular permeability and inflammation. Primary mediators such as histamine, serotonin, protease, prostaglandins SRS-A and similar substances released during degranulation may actually be more detrimental than beneficial to the comfort and well-being of the affected individual. the biological effects are the symptoms of the hypersensitivity reactions. 5. The classical treatment of

Patents 55

type I hypersensitivity reactions has heretofore comprised administration of, for example, antihistamines or a process termed desensitization. Desensitization involves multiple injections and requires frequent visits to a doctor over a long period of time. Antihistamines are, of course, effective to relieve the symptoms associated with the type I hypersensitivity reaction. Antihistamine treatment suffers from problems including drying of the mucous membranes and sedation as well as manifest side effects of depression and drowsiness. In addition, antihistamines can interact with other medicines. Warnings are given to refrain from operating machinery when antihistamines are administered. Both methods are expensive. 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 muscle spasms, 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 “muscle spasms” (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 muscle spasms. You can also use this procedure to view pending patent applications concerning muscle spasms. 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 MUSCLE SPASMS Overview This chapter provides bibliographic book references relating to muscle spasms. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on muscle spasms 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 “muscle spasms” (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 muscle spasms: •

Your Guide to Living With Ankylosing Spondylitis Source: Sherman Oaks, CA: Spondylitis Association of America. 2000. 32 p. Contact: Available from Spondylitis Association of America. P.O. Box 5827, Sherman Oaks, CA 91413. (800) 777-8189. Website: www.spondylitis.org. Summary: This book discusses ankylosing spondylitis (AS) and provides an overview of spinal anatomy, common symptoms, other affected areas of the body, causes, and genetics. AS is a systemic, rheumatic condition affecting primarily the spine but may also affect the joints of the shoulder, hip, knee, and foot. Treatment for AS includes using medications such as NSAIDs and DMARDs to manage symptoms, undergoing surgery to correct severe flexion deformities, and using massage and movement training to help relieve muscle spasms and pain and to improve flexibility and strength. Patients should talk to their physician before using herbal and food supplements or alternative

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diets. The psychological consequences of being diagnosed with AS are discussed. Coping strategies include accepting the condition, building social and personal support systems, and adapting to the challenges that AS can present. Illustrated exercises to help improve posture and flexibility are included.

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 “muscle spasms” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “muscle spasms” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “muscle spasms” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Back Pain, Painful Syndromes and Muscle Spasms: Current Concepts and Recent Advances: Proceedings by Malcolm I. Jayson (Editor), et al; ISBN: 1850703043; http://www.amazon.com/exec/obidos/ASIN/1850703043/icongroupinterna

•

How to be Pain-Less. A Beginner's Guide to the Self-Treatment of Muscle Spasms by Julie Donnelly B.S. LMT, Julie Donnelly; ISBN: 1929632037; http://www.amazon.com/exec/obidos/ASIN/1929632037/icongroupinterna

•

Muscle Spasm and Pain by M. Emre (Editor), H. Mathies (Editor); ISBN: 1850701490; http://www.amazon.com/exec/obidos/ASIN/1850701490/icongroupinterna

•

Muscle Spasm, Pain & Marijuana Therapy : Testimony from Federal and State Court Proceedings on Marijuana's Medical Use by R.C. Randall (Editor); ISBN: 093648506X; http://www.amazon.com/exec/obidos/ASIN/093648506X/icongroupinterna

•

Speaking of Back-Aches: Advice and Help on Disc Problems, Wear and Tear of the Spinal Column, Muscle Spasm, Sciatica, Headaches and Migraines by Renate Zauner; ISBN: 0832622338; http://www.amazon.com/exec/obidos/ASIN/0832622338/icongroupinterna

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

Books

•

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Osteoarthritis and Paget 's Disease Source: in A Patient's Guide to Paget 's Disease of Bone. New York, NY: The Paget 's Disease Foundation, Inc. 1994. p. 23-24. Contact: Paget Foundation For Paget 's Disease of Bone and Related Disorders. 200 Varick Street, Suite 1004, New York, NY 10014-4810. (212) 229-1582 or FAX (212) 2291502. PRICE: Free. Summary: Paget 's disease ( PD ) can cause osteoarthritis by changing the bone around the joint; the resulting pain is very common in people with PD. Treatment involves a multifaceted program of physical and medicinal measures that include exercise, weight control, devices to alter joint pressures, anti-inflammatory agents, and drugs to reduce muscle spasms. Occasionally, surgical consultation is required. The author cautions that for any treatment to be effective, the person with PD must have an understanding of his or her disease or diseases, the therapy or therapies available, and what can or cannot be expected.

•

Maple Syrup Urine Disease Source: in Complete Directory for Pediatric Disorders. Millerton, NY: Grey House Publishing, Inc. 2002. p. 498-499. Contact: Available from Grey House Publishing, Inc. 185 Millerton Road, Millerton, NY 12546. Website: www.greyhouse.com. PRICE: $165.00 plus shipping and handling. ISBN: 1930956614. Summary: This entry, from a directory of pediatric disorders, describes maple syrup urine disease (MSUD), a metabolic disorder characterized by the deficiency of certain enzymes. There are four basic types of MSUD: classic, intermittent, mild or intermediate MSUD, and thiamine-responsive MSUD. Classic MSUD, the most severe form of this disorder, becomes apparent within the first week of life and is recognizable by a characteristic maple syrup odor of the urine and on the body. Symptoms and physical findings associated with this life-threatening form of MSUD include listlessness, drowsiness, exaggerated muscular tension (hypertonicity) and rigidity with periods of loss of muscle tone (flaccidity), severe muscle spasms, convulsions, and coma. Treatment for classic MSUD includes the removal of leucine, isoleucine, valine, and certain other related elements from the blood by a procedure known as peritoneal dialysis. Subsequent therapy includes a diet low in leucine, isoleucine, and valine (amino acids, the building blocks of protein). MSUD is inherited as an autosomal recessive trait. Approximately one in 200,000 people in the United States is affected by this disorder. The entry concludes with a reference to organizations that may be helpful (listed in the General Resources Section of the book), the addresses of related websites, national associations and support groups, and the citations for related children's books.

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CHAPTER 7. MULTIMEDIA ON MUSCLE SPASMS Overview In this chapter, we show you how to keep current on multimedia sources of information on muscle spasms. 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 muscle spasms is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “muscle spasms” 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 “muscle spasms” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on muscle spasms: •

Pain Control Source: Princeton, NJ: Films for the Humanities and Sciences. 199x. (videocassette). Contact: Available from Films for the Humanities and Sciences. P. O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126; (609) 452-1128. PRICE: $149.00 for purchase; $75.00 for rental. Order Number TF-2368. Summary: This videotape looks at some of the available treatments for the most serious types of pain. The program discusses treatment modalities including injections, infusions, topical sprays, inhalants, pills, acupressure and acupuncture, electromyography, and a number of other ways to relieve muscle spasms. (AA-M).

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

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

Botox treatment for muscle spasms aids well-being Source: Reuters Health eLine Date: August 01, 2001

•

Muscle spasm drug shows promise as headache treatment Source: Reuters Medical News Date: June 21, 2001

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Toxin injection relieves stroke-related muscle spasms Source: Reuters Health eLine Date: October 06, 2000 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 “muscle spasms” (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 “muscle spasms” (or synonyms). If you know the name of a company that is relevant to muscle spasms, 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 “muscle spasms” (or synonyms).

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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 “muscle spasms” (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 muscle spasms: •

Botulinum Toxin: Can A Poison Help? Source: Mayo Clinic Health Letter. 18(6): 6. June 2000. Contact: Available from Mayo Clinic Health Letter. 200 First Street SW, Rochester, MN 55905. (800) 333-9037 or (303) 604-1465. Email: [email protected]. Summary: This newsletter article provides people who have muscular problems with information on the medicinal uses of botulinum toxin. Although botulinum toxin causes muscle paralysis throughout the body when it is ingested, it can halt unwanted movements when injected into specific muscles. Botulinum toxin is currently used to treat spasmodic torticollis; facial tics; eyelid twitching; crossed eyes; muscle spasms associated with cerebral palsy, multiple sclerosis, stroke, and Parkinson's disease; swallowing and speech difficulties; migraines; chronic anal fissures; and vaginal spasms. Injections are usually done in a doctor's office. Several injections are typical, and a few days or weeks may be needed before the toxin becomes fully effective. Treatment usually lasts 3 months or longer before it must be repeated.

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

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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for muscle spasms. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with muscle spasms. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to muscle spasms: Benzodiazepines •

Systemic - U.S. Brands: Alprazolam Intensol; Ativan; Dalmane; Diastat; Diazepam Intensol; Dizac; Doral; Halcion; Klonopin; Librium; Lorazepam Intensol; Paxipam; ProSom; Restoril; Serax; Tranxene T-Tab; Tranxene-SD; Tranxene-SD Half Strength; Valium; Xanax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202084.html

Diphtheria and Tetanus Toxoids and Pertussis Vaccine Adsorbed •

Systemic - U.S. Brands: Acel-Imune; Certiva; Infanrix; Tripedia http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202201.html

Diphtheria and Tetanus Toxoids and Pertussis Vaccine Adsorbed and Haemophilus B Conjugate Vaccine •

Systemic - U.S. Brands: Tetramune http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202911.html

Flavoxate •

Systemic - U.S. Brands: Urispas http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202239.html

Oxybutynin •

Systemic - U.S. Brands: Ditropan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202431.html

Tetanus Immune Globulin •

Systemic - U.S. Brands: BayTet http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202908.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

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PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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

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

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

•

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/

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.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

•

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

•

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

•

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

•

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

•

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

•

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

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 “muscle spasms” (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 5834 52 865 5 193 6949

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 “muscle spasms” (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/.

The Genome Project and Muscle Spasms In the following section, we will discuss databases and references which relate to the Genome Project and muscle spasms. Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).22 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. 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. 22 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

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To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “muscle spasms” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for muscle spasms: •

Dwarfism, Familial, with Muscle Spasms Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=600771 Genes and Disease (NCBI - Map)

The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: •

Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

•

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

•

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

•

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

•

Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html

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•

Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

•

Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez

Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: •

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

•

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

•

Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

•

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

•

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

•

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

•

PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

•

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

•

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

•

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

•

Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

•

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then

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select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “muscle spasms” (or synonyms) into the search box and click “Go.” Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database23 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database24 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “muscle spasms” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

23

Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 24 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.

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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 muscle spasms 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 muscle spasms. 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 muscle spasms. 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 “muscle spasms”:

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Angina http://www.nlm.nih.gov/medlineplus/angina.html Bell's Palsy http://www.nlm.nih.gov/medlineplus/bellspalsy.html Heart Attack http://www.nlm.nih.gov/medlineplus/heartattack.html Heat Illness http://www.nlm.nih.gov/medlineplus/heatillness.html Leg Injuries and Disorders http://www.nlm.nih.gov/medlineplus/leginjuriesanddisorders.html Movement Disorders http://www.nlm.nih.gov/medlineplus/movementdisorders.html Muscle Disorders http://www.nlm.nih.gov/medlineplus/muscledisorders.html Neck Disorders and Injuries http://www.nlm.nih.gov/medlineplus/neckdisordersandinjuries.html Neuromuscular Disorders http://www.nlm.nih.gov/medlineplus/neuromusculardisorders.html

Within the health topic page dedicated to muscle spasms, the following was listed: •

General/Overviews Muscle Cramp Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=270&topcategory=Sport s Muscle Cramp Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00311 Muscle Cramps Source: National Parkinson Foundation, Inc. http://www.parkinson.org/muscramps02.htm

•

Specific Conditions/Aspects Heat Cramps Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=FA00021 Nocturnal Leg Cramps Source: McGraw-Hill Companies http://www.postgradmed.com/issues/2002/02_02/pn_legcramps.htm Stiffness, Cramps and Twitching Source: Muscular Dystrophy Association http://www.mdausa.org/publications/Quest/q73ss.html

Patient Resources

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Children Your Multi-Talented Muscles Source: Nemours Foundation http://kidshealth.org/kid/body/muscles_noSW.html

•

Organizations American Academy of Orthopaedic Surgeons http://www.aaos.org/ National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/

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 muscle spasms. 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: •

Botulinum Toxin Injections: A Treatment for Muscle Spasms Source: American Academy of Family Physicians. February 2003. 2 p. Contact: Available online from American Academy of Family Physicians. Website: http://familydoctor.org. Summary: This fact sheet discusses the use of botulinum toxin to stop muscle spasms that occur in the face, head, or eye. This treatment is used for a number of conditions including spasmodic torticollis and lazy eye. The botulinum toxin is administered by injection in small doses and works by stopping the chemical messages sent from nerves. Soreness at the injection sight may occur after treatment and can be treated with nonprescription medications such as acetaminophen or ibuprofen or with an ice pack. Other short-term side effects may include weakness in the injected muscles, rash, muscle soreness throughout the body, or difficulty swallowing. 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

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located at http://www.guideline.gov/ by using the keyword “muscle spasms” (or synonyms). The following was recently posted: •

1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infar Source: American College of Cardiology Foundation - Medical Specialty Society; 1996 November 1 (revised 1999 Sep); 22 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2006&nbr=1232&a mp;string=muscle+AND+spasm

•

ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Source: American College of Cardiology Foundation - Medical Specialty Society; 2000 (revised online 2002 Mar); 95 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3190&nbr=2416&a mp;string=muscle+AND+spasm

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ACR Appropriateness Criteriatm for suspected cervical spine trauma Source: American College of Radiology - Medical Specialty Society; 1995 (revised 2002); 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3564&nbr=2790&a mp;string=muscle+AND+spasm

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American Gastroenterological Association medical position statement: guidelines on constipation Source: American Gastroenterological Association - Medical Specialty Society; 2000 May 21 (reviewed 2001); 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3061&nbr=2287&a mp;string=muscle+AND+spasm

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Ankle sprain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1997 August (revised 2002 Mar); 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3356&nbr=2582&a mp;string=muscle+AND+spasms

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Assessment and management of acute pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 2000 October (revised 2002 Oct); 74 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3500&nbr=2726&a mp;string=muscle+AND+spasms

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Cancer pain Source: Singapore Ministry of Health - National Government Agency [Non-U.S.]; 2003 March; 88 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3748&nbr=2974&a mp;string=muscle+AND+spasm

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Cardiovascular disease in women: a guide to risk factor screening, prevention and management Source: Brigham and Women's Hospital (Boston) - Hospital/Medical Center; 2002; 15 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3487&nbr=2713&a mp;string=muscle+AND+cramps

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

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Clinical practice guideline (second edition) for the diagnosis, treatment, and management of reflex sympathetic dystrophy/complex regional pain syndrome (RSD/CRPS) Source: Reflex Sympathetic Dystrophy Syndrome Association - Private Nonprofit Organization; 2002 February; 46 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3204&nbr=2430&a mp;string=muscle+AND+spasms

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Clinical practice guideline for the management of postoperative pain Source: Department of Defense - Federal Government Agency [U.S.]; 2001 July (revised 2002 May); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3284&nbr=2510&a mp;string=muscle+AND+spasm

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Clinical practice guidelines for nutrition in chronic renal failure Source: National Kidney Foundation - Disease Specific Society; 2000 June; 121 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2545&nbr=1771&a mp;string=muscle+AND+cramps

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Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient Source: American College of Critical Care Medicine - Professional Association; 1995 (revised 2002); 15 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3170&nbr=2396&a mp;string=muscle+AND+spasms

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Diagnosis and management of foodborne illnesses: a primer for physicians Source: American Medical Association - Medical Specialty Society; Reprint released 2001 January; 88 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2707&nbr=1933&a mp;string=muscle+AND+spasms

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Diagnosis and treatment of adult degenerative joint disease (DJD) of the knee Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 June (revised 2002 May); 42 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3355&nbr=2581&a mp;string=muscle+AND+spasm

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Disorders of the neck and upper back Source: Work Loss Data Institute - Public For Profit Organization; 2003; 109 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3803&nbr=3030&a mp;string=muscle+AND+spasms

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Guidelines for detection of thyroid dysfunction Source: American Thyroid Association - Professional Association; 2000 June 12; 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2361&nbr=1587&a mp;string=muscle+AND+cramps

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Low back Source: Work Loss Data Institute - Public For Profit Organization; 2003; 50 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3802&nbr=3029&a mp;string=muscle+AND+spasms

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

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

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Migraine headache Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1998 November (revised 2002 Jul); 74 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3441&nbr=2667&a mp;string=muscle+AND+cramps

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Oral hygiene care for functionally dependent and cognitively impaired older adults Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 2002 November; 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3611&nbr=2837&a mp;string=muscle+AND+spasms

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Reflex sympathetic dystrophy/complex regional pain syndrome clinical practice guidelines - third edition Source: International Research Foundation for RSD/CRPS - Private Nonprofit Research Organization; 2003 January 1; 48 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4117&nbr=3162&a mp;string=muscle+AND+spasms

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

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The diagnosis and treatment of adult asthma Source: New Zealand Guidelines Group - Private Nonprofit Organization; 2002 September; 101 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3462&nbr=2688&a mp;string=muscle+AND+cramps

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The management of menorrhagia in secondary care Source: Royal College of Obstetricians and Gynaecologists - Medical Specialty Society; 1999 July; 77 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2556&nbr=1782&a mp;string=muscle+AND+cramps

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VHA/DoD clinical practice guideline for the management of substance use disorders Source: Department of Defense - Federal Government Agency [U.S.]; 2001 September; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3169&nbr=2395&a mp;string=muscle+AND+cramps Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

What to Expect During Your EMG Test Summary: This fact sheet provides an overview of EMG (electromyography) testing and explains its usefulness in evaluating the causes of numbness, tingling, pain, weakness, fatigue, and muscle cramping. Source: American Association of Electrodiagnostic Medicine http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4849 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 muscle spasms. 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.

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Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

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

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

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

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

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

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

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

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to muscle spasms. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with muscle spasms. 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 muscle spasms. 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 “muscle spasms” (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

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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 “muscle spasms”. 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 “muscle spasms” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “muscle spasms” (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.25

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

25

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)26: •

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

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

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

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

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

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

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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

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

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

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

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

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

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

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

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

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

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

26

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

Finding Medical Libraries 93

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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

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

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

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

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

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries 95

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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•

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

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

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

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

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on muscle spasms: •

Basic Guidelines for Muscle Spasms Muscle spasmsor cramps Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm

•

Signs & Symptoms for Muscle Spasms Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm Excessive sweating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Excessive urine volume Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003146.htm

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Fasciculations Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003296.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Muscle twitching Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003296.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm •

Diagnostics and Tests for Muscle Spasms Blood flow studies Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003442.htm Electromyography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm Extremity angiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003772.htm Extremity arteriography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003772.htm Myelography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003807.htm Serum calcium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003477.htm Serum sodium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003481.htm Spine CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003787.htm Spine X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003806.htm Thyroid function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003444.htm

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Background Topics for Muscle Spasms Analgesics Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm

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Benign Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002236.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Pain relievers Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Relieved by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002288.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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MUSCLE SPASMS 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 Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [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] Actin: Essential component of the cell skeleton. [NIH] Adamantane: A tricyclo bridged hydrocarbon. [NIH] Adductor: A muscle that draws a part toward the median line. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [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] 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] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular

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quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] 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] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] 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] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [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] Ambulant: Walking or able to walk. [EU] 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 acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Aminoethyl: A protease inhibitor. [NIH] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anchorage: In dentistry, points of retention of fillings and artificial restorations and appliances. [NIH]

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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] Angina: Chest pain that originates in the heart. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [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] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Antibiotics: Substances produced by microorganisms that can inhibit or suppress the growth of 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] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [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] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including

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phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Aqueous: Having to do with water. [NIH] Aqueous fluid: Clear, watery fluid that flows between and nourishes the lens and the cornea; secreted by the ciliary processes. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [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] Arteriolar: Pertaining to or resembling arterioles. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to

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strains of unusual type. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Avulsion: The forcible separation, or tearing away, of a part of an organ. [NIH] Axilla: The underarm or armpit. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Babesiosis: A group of tick-borne diseases of mammals including zoonoses in humans. They are caused by protozoans of the genus babesia, which parasitize erythrocytes, producing hemolysis. In the U.S., the organism's natural host is mice and transmission is by the deer tick ixodes scapularis. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Baclofen: A GABA derivative that is a specific agonist at GABA-B receptors. It is used in the treatment of spasticity, especially that due to spinal cord damage. Its therapeutic effects result from actions at spinal and supraspinal sites, generally the reduction of excitatory transmission. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial toxin: A toxic substance, made by bacteria, that can be modified to kill specific tumor cells without harming normal cells. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [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] Basophil: A type of white blood cell. Basophils are granulocytes. [NIH] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for

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medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [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] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [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] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [NIH] Blepharospasm: Excessive winking; tonic or clonic spasm of the orbicularis oculi muscle. [NIH]

Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [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

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heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [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] Bone Marrow Cells: Cells contained in the bone marrow including fat cells, stromal cells, megakaryocytes, and the immediate precursors of most blood 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] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [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 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] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchial Spasm: Spasmodic contraction of the smooth muscle of the bronchi. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of

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body fluids. [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] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [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] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell 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] Cellular metabolism: The sum of all chemical changes that take place in a cell through which energy and basic components are provided for essential processes, including the synthesis of new molecules and the breakdown and removal of others. [NIH] Cellulitis: An acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions. [NIH] Central Nervous System: The main information-processing organs of the nervous system,

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consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellar Diseases: Diseases that affect the structure or function of the cerebellum. Cardinal manifestations of cerebellar dysfunction include dysmetria, gait ataxia, and muscle hypotonia. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [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] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Cholinesterase Inhibitors: Drugs that inhibit cholinesterases. The neurotransmitter acetylcholine is rapidly hydrolyzed, and thereby inactivated, by cholinesterases. When cholinesterases are inhibited, the action of endogenously released acetylcholine at cholinergic synapses is potentiated. Cholinesterase inhibitors are widely used clinically for their potentiation of cholinergic inputs to the gastrointestinal tract and urinary bladder, the eye, and skeletal muscles; they are also used for their effects on the heart and the central

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nervous system. [NIH] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Chromaffin System: The cells of the body which stain with chromium salts. They occur along the sympathetic nerves, in the adrenal gland, and in various other organs. [NIH] 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 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] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary processes: The extensions or projections of the ciliary body that secrete aqueous humor. [NIH] Cinchona: A genus of rubiaceous South American trees that yields the toxic cinchona alkaloids from their bark; quinine, quinidine, chinconine, cinchonidine and others are used to treat malaria and cardiac arrhythmias. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clinical 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] Clonazepam: An anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. It is seldom effective in generalized tonic-clonic or partial seizures. The mechanism of action appears to involve the enhancement of gaba receptor responses. [NIH] Clonic: Pertaining to or of the nature of clonus. [EU] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot

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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] Coenzymes: Substances that are necessary for the action or enhancement of action of an enzyme. Many vitamins are coenzymes. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] 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] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Congenita: Displacement, subluxation, or malposition of the crystalline lens. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, 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] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH]

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Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Convulsion: A violent involuntary contraction or series of contractions of the voluntary muscles. [EU] Convulsive: Relating or referring to spasm; affected with spasm; characterized by a spasm or spasms. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH]

Creatine Kinase: A transferase that catalyzes formation of phosphocreatine from ATP + creatine. The reaction stores ATP energy as phosphocreatine. Three cytoplasmic isoenzymes have been identified in human tissues: MM from skeletal muscle, MB from myocardial tissue, and BB from nervous tissue as well as a mitochondrial isoenzyme. Macro-creatine

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kinase refers to creatine kinase complexed with other serum proteins. EC 2.7.3.2. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Criterion: A standard by which something may be judged. [EU] Crowns: A prosthetic restoration that reproduces the entire surface anatomy of the visible natural crown of a tooth. It may be partial (covering three or more surfaces of a tooth) or complete (covering all surfaces). It is made of gold or other metal, porcelain, or resin. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] 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] Dantrolene: Skeletal muscle relaxant that acts by interfering with excitation-contraction coupling in the muscle fiber. It is used in spasticity and other neuromuscular abnormalities. Although the mechanism of action is probably not central, dantrolene is usually grouped with the central muscle relaxants. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Decubitus Ulcer: An ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time. The bony prominences of the body are the most frequently affected sites. The ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH]

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Dental Abutments: Natural teeth or teeth roots used as anchorage for a fixed or removable denture or other prosthesis (such as an implant) serving the same purpose. [NIH] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor artificial teeth. [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [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] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dominance: In genetics, the full phenotypic expression of a gene in both heterozygotes and homozygotes. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH]

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Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] 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] Duodenum: The first part of the small intestine. [NIH] Dwarfism: The condition of being undersized as a result of premature arrest of skeletal growth. It may be caused by insufficient secretion of growth hormone (pituitary dwarfism). [NIH]

Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dysphonia: Difficulty or pain in speaking; impairment of the voice. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [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] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elastin: The protein that gives flexibility to tissues. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding 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] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU]

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Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electroshock: Induction of a stress reaction in experimental subjects by means of an electrical shock; applies to either convulsive or non-convulsive states. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]

Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [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] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [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] 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] Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [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]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks

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containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Manometry: A test to measure muscle tone inthe esophagus. [NIH] Esophageal Motility Disorders: Disorders affecting the motor function of the upper or lower esophageal sphincters, the esophageal body, or a combination of these parts. The failure of the sphincters to maintain a tonic pressure may result in the impeding of the passage of food, regurgitation of food, or reflux of gastric acid into the esophagus. [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]

Esotropia: A form of ocular misalignment characterized by an excessive convergence of the visual axes, resulting in a "cross-eye" appearance. An example of this condition occurs when paralysis of the lateral rectus muscle causes an abnormal inward deviation of one eye on attempted gaze. [NIH] Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [NIH] Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [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] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exotropia: A form of ocular misalignment where the visual axes diverge inappropriately. For example, medial rectus muscle weakness may produce this condition as the affected eye will deviate laterally upon attempted forward gaze. An exotropia occurs due to the relatively unopposed force exerted on the eye by the lateral rectus muscle, which pulls the eye in an outward direction. [NIH] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [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] Extrapyramidal: Outside of the pyramidal tracts. [EU]

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Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Eye Injuries: Damage or trauma inflicted to the eye by external means. The concept includes both surface injuries and intraocular injuries. [NIH] Facial: Of or pertaining to the face. [EU] Facial Expression: Observable changes of expression in the face in response to emotional stimuli. [NIH] Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [NIH] Facial Pain: Pain in the facial region including orofacial pain and craniofacial pain. Associated conditions include local inflammatory and neoplastic disorders and neuralgic syndromes involving the trigeminal, facial, and glossopharyngeal nerves. Conditions which feature recurrent or persistent facial pain as the primary manifestation of disease are referred to as facial pain syndromes. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [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] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Flexor: Muscles which flex a joint. [NIH] Food Technology: The application of knowledge to the food industry. [NIH] Foodborne Illness: An acute gastrointestinal infection caused by food that contains harmful bacteria. Symptoms include diarrhea, abdominal pain, fever, and chills. Also called food poisoning. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or

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asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Galanthamine: A cholinesterase inhibitor. It has been used to reverse the muscular effects of gallamine and tubocurarine and has been studied as a treatment for Alzheimer's disease and other central nervous system disorders. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

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] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Giant Cells: Multinucleated masses produced by the fusion of many cells; often associated with viral infections. In AIDS, they are induced when the envelope glycoprotein of the HIV virus binds to the CD4 antigen of uninfected neighboring T4 cells. The resulting syncytium leads to cell death and thus may account for the cytopathic effect of the virus. [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] Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH]

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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] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body. [NIH]

Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [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] Haematemesis: The vomiting of blood. [EU] Haemodialysis: The removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane, e.g., by means of a haemodialyzer. [EU] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level

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may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [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] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterotropia: One in which the angle of squint remains relatively unaltered on conjugate movement of the eyes. [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] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [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] Hydrogenation: Specific method of reduction in which hydrogen is added to a substance by the direct use of gaseous hydrogen. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH]

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Hyperhidrosis: Excessive sweating. In the localized type, the most frequent sites are the palms, soles, axillae, inguinal folds, and the perineal area. Its chief cause is thought to be emotional. Generalized hyperhidrosis may be induced by a hot, humid environment, by fever, or by vigorous exercise. [NIH] Hyperreflexia: Exaggeration of reflexes. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypokinesia: Slow or diminished movement of body musculature. It may be associated with basal ganglia diseases; mental disorders; prolonged inactivity due to illness; experimental protocols used to evaluate the physiologic effects of immobility; and other conditions. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hypoxic: Having too little oxygen. [NIH] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH]

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Idiopathic: Describes a disease of unknown cause. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [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] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunomodulator: New type of drugs mainly using biotechnological methods. Treatment of cancer. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [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] Immunotoxin: An antibody linked to a toxic substance. Some immmunotoxins can bind to cancer cells and kill them. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] 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] 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] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical

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signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [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] 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] Intramuscular: IM. Within or into muscle. [NIH] Intramuscular injection: IM. Injection into a muscle. [NIH] Intraocular: Within the eye. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a

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mechanical deformation. Ion channels which neurotransmitter receptors are not included. [NIH]

are

integral

parts

of

ionotropic

Ion Transport: The movement of ions across energy-transducing cell membranes. Transport can be active or passive. Passive ion transport (facilitated diffusion) derives its energy from the concentration gradient of the ion itself and allows the transport of a single solute in one direction (uniport). Active ion transport is usually coupled to an energy-yielding chemical or photochemical reaction such as ATP hydrolysis. This form of primary active transport is called an ion pump. Secondary active transport utilizes the voltage and ion gradients produced by the primary transport to drive the cotransport of other ions or molecules. These may be transported in the same (symport) or opposite (antiport) direction. [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] Ipsilateral: Having to do with the same side of the body. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Isoleucine: An essential branched-chain amino acid found in many proteins. It is an isomer of LEUCINE. It is important in hemoglobin synthesis and regulation of blood sugar and energy levels. [NIH] Isopropyl: A gene mutation inducer. [NIH] Isotonic: A biological term denoting a solution in which body cells can be bathed without a net flow of water across the semipermeable cell membrane. Also, denoting a solution having the same tonicity as some other solution with which it is compared, such as physiologic salt solution and the blood serum. [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] 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] Kinetic: Pertaining to or producing motion. [EU] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Lacrimal: Pertaining to the tears. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH]

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Laterality: Behavioral manifestations of cerebral dominance in which there is preferential use and superior functioning of either the left or the right side, as in the preferred use of the right hand or right foot. [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] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] 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] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Lithium Chloride: A salt of lithium that has been used experimentally as an immunomodulator. [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 Cirrhosis: Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

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

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] 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]

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Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [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] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malingering: Simulation of symptoms of illness or injury with intent to deceive in order to obtain a goal, e.g., a claim of physical illness to avoid jury duty. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Maple Syrup Urine Disease: A genetic disorder involving deficiency of an enzyme necessary in the metabolism of branched-chain amino acids, and named for the characteristic odor of the urine. [NIH] Masseter Muscle: A masticatory muscle whose action is closing the jaws. [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maxillary Nerve: The intermediate sensory division of the trigeminal (5th cranial) nerve. The maxillary nerve carries general afferents from the intermediate region of the face including the lower eyelid, nose and upper lip, the maxillary teeth, and parts of the dura. [NIH]

Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH]

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Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Memantine: Amantadine derivative that has some dopaminergic effects. It has been proposed as an antiparkinson agent. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Potentials: Ratio of inside versus outside concentration of potassium, sodium, chloride and other ions in diffusible tissues or cells. Also called transmembrane and resting potentials, they are measured by recording electrophysiologic responses in voltagedependent ionic channels of (e.g.) nerve, muscle and blood cells as well as artificial membranes. [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] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menorrhagia: Excessive menstrual flow. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] 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] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metabotropic: A glutamate receptor which triggers an increase in production of 2 intracellular messengers: diacylglycerol and inositol 1, 4, 5-triphosphate. [NIH] Methylene Chloride: A chlorinated hydrocarbon that has been used as an inhalation anesthetic and acts as a narcotic in high concentrations. Its primary use is as a solvent in manufacturing and food technology. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microwaves: That portion of the electromagnetic spectrum lying between UHF (ultrahigh frequency) radio waves and heat (infrared) waves. Microwaves are used to generate heat, especially in some types of diathermy. They may cause heat damage to tissues. [NIH] Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at

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physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and cardiac patients. [NIH]

Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH]

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Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Myalgia: Pain in a muscle or muscles. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myelitis: Inflammation of the spinal cord. Relatively common etiologies include infections; autoimmune diseases; spinal cord; and ischemia (see also spinal cord vascular diseases). Clinical features generally include weakness, sensory loss, localized pain, incontinence, and other signs of autonomic dysfunction. [NIH] Myelodysplasia: Abnormal bone marrow cells that may lead to myelogenous leukemia. [NIH]

Myelogenous: Produced by, or originating in, the bone marrow. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Myotonia: Prolonged failure of muscle relaxation after contraction. This may occur after voluntary contractions, muscle percussion, or electrical stimulation of the muscle. Myotonia is a characteristic feature of myotonic disorders. [NIH] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [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] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] 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] Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [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] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH]

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Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [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] Neurodegenerative Diseases: Hereditary and sporadic conditions which are characterized by progressive nervous system dysfunction. These disorders are often associated with atrophy of the affected central or peripheral nervous system structures. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Blockade: The intentional interruption of transmission at the neuromuscular junction by external agents, usually neuromuscular blocking agents. It is distinguished from nerve block in which nerve conduction is interrupted rather than neuromuscular transmission. Neuromuscular blockade is commonly used to produce muscle relaxation as an adjunct to anesthesia during surgery and other medical procedures. It is also often used as an experimental manipulation in basic research. It is not strictly speaking anesthesia but is grouped here with anesthetic techniques. The failure of neuromuscular transmission as a result of pathological processes is not included here. [NIH] Neuromuscular Blocking Agents: Drugs that interrupt transmission of nerve impulses at the skeletal neuromuscular junction. They can be of two types, competitive, stabilizing blockers (neuromuscular nondepolarizing agents) or noncompetitive, depolarizing agents (neuromuscular depolarizing agents). Both prevent acetylcholine from triggering the muscle contraction and they are used as anesthesia adjuvants, as relaxants during electroshock, in convulsive states, etc. [NIH] Neuromuscular Depolarizing Agents: Drugs that interrupt transmission at the skeletal neuromuscular junction by causing sustained depolarization of the motor end plate. These agents are primarily used as adjuvants in surgical anesthesia to cause skeletal muscle relaxation. [NIH] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuromuscular Nondepolarizing Agents: Drugs that interrupt transmission at the skeletal neuromuscular junction without causing depolarization of the motor end plate. They prevent acetylcholine from triggering muscle contraction and are used as muscle relaxants during electroshock treatments, in convulsive states, and as anesthesia adjuvants. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous

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system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurosecretory Systems: A system of neurons that has the specialized function to produce and secrete hormones, and that constitutes, in whole or in part, an endocrine organ or system. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutralization: An act or process of neutralizing. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] 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]

Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oculi: Globe or ball of the eye. [NIH]

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Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver 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] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Orbicularis: A thin layer of fibers that originates at the posterior lacrimal crest and passes outward and forward, dividing into two slips which surround the canaliculi. [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] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Orofacial: Of or relating to the mouth and face. [EU] Orphenadrine: A muscarinic antagonist used to treat drug-induced parkinsonism and to relieve pain from muscle spasm. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteogenesis: The histogenesis of bone including ossification. It occurs continuously but particularly in the embryo and child and during fracture repair. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Palsy: Disease of the peripheral nervous system occurring usually after many years of

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increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [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] 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]

Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] 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] 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

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and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peristalsis: The rippling motion of muscles in the intestine or other tubular organs 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] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [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

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grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Photophobia: Abnormal sensitivity to light. This may occur as a manifestation of eye diseases; migraine; subarachnoid hemorrhage; meningitis; and other disorders. Photophobia may also occur in association with depression and other mental disorders. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [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]

Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Piloerection: Involuntary erection or bristling of hairs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] 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] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [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] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH]

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Post-traumatic: Occurring as a result of or after injury. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [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] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] 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] Prophylaxis: An attempt to prevent disease. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to

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indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostaglandins D: Physiologically active prostaglandins found in many tissues and organs. They show pressor activity, are mediators of inflammation, and have potential antithrombotic effects. [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] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] 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] 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] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the

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term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] 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]

Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alphaadrenergic neurotransmission. [NIH] Quinine: An alkaloid derived from the bark of the cinchona tree. It is used as an antimalarial drug, and is the active ingredient in extracts of the cinchona that have been used for that purpose since before 1633. Quinine is also a mild antipyretic and analgesic and has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Quinine is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood. [NIH] Quinolinic: It is produced by immune cells and slowly infiltrates the brain tissues after an injury. [NIH] Quinolinic Acid: 2,3-Pyridinedicarboxylic acid. A metabolite of tryptophan with a possible role in neurodegenerative disorders. Elevated CSF levels of quinolinic acid are significantly correlated with the severity of neuropsychological deficits in patients who have AIDS. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Racemic: Optically inactive but resolvable in the way of all racemic compounds. [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] 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]

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Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [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] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [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] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refractory: Not readily yielding to treatment. [EU] 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] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [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] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH]

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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] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones,

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and parotid glands. [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] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Scoliosis: A lateral curvature of the spine. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [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] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensory loss: A disease of the nerves whereby the myelin or insulating sheath of myelin on the nerves does not stay intact and the messages from the brain to the muscles through the nerves are not carried properly. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Determination: The biological characteristics which distinguish human beings as female or male. [NIH]

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Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [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] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] 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] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU]

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Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] 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] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spike: The activation of synapses causes changes in the permeability of the dendritic membrane leading to changes in the membrane potential. This difference of the potential travels along the axon of the neuron and is called spike. [NIH] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Compression: Acute and chronic conditions characterized by external mechanical compression of the spinal cord due to extramedullary neoplasm; epidural abscess; spinal fractures; bony deformities of the vertebral bodies; and other conditions. Clinical manifestations vary with the anatomic site of the lesion and may include localized pain, weakness, sensory loss, incontinence, and impotence. [NIH] Spinal Cord Vascular Diseases: Hypoxic-ischemic and hemorrhagic disorders of the spinal cord. Arteriosclerosis, emboli, and vascular malformations are potential causes of these conditions. [NIH] Spinal Fractures: Broken bones in the vertebral column. [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Spinous: Like a spine or thorn in shape; having spines. [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] Spondylitis: Inflammation of the vertebrae. [EU] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic

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hydrocarbons. [EU] 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] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strabismus: Deviation of the eye which the patient cannot overcome. The visual axes assume a position relative to each other different from that required by the physiological conditions. The various forms of strabismus are spoken of as tropias, their direction being indicated by the appropriate prefix, as cyclo tropia, esotropia, exotropia, hypertropia, and hypotropia. Called also cast, heterotropia, manifest deviation, and squint. [EU] Strained: A stretched condition of a ligament. [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] 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] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [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] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Supraorbital: The branch of the frontal nerve that passes through the supraorbital notch or foramen and is sensory for the upper eyelid, the conjunctiva, the eyebrow, the forehead, and the scalp up to the occipital bone. [NIH] Supraspinal: Above the spinal column or any spine. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [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] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH]

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Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synovial: Of pertaining to, or secreting synovia. [EU] Systemic: Affecting the entire body. [NIH] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Tendonitis: Inflammation of tendons attached to the biceps muscle, i. e. the main flexor muscle of the upper arm. [NIH] Tetani: Causal agent of tetanus. [NIH] Tetanic: Having the characteristics of, or relating to tetanus. [NIH] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by Clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases,

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palliative or curative. [NIH] Thiamine: 3-((4-Amino-2-methyl-5-pyrimidinyl)methyl)-5-(2methylthiazolium chloride. [NIH]

hydroxyethyl)-4-

Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [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] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH]

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Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transcutaneous: Transdermal. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [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] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [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] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Trismus: Spasmodic contraction of the masseter muscle resulting in forceful jaw closure. This may be seen with a variety of diseases, including tetanus, as a complication of radiation therapy, trauma, or in association with neoplastic conditions. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberous Sclerosis: A rare congenital disease in which the essential pathology is the appearance of multiple tumors in the cerebrum and in other organs, such as the heart or kidneys. [NIH] Tubocurarine: A neuromuscular blocker and active ingredient in curare; plant based alkaloid of Menispermaceae. [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] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH]

Dictionary 149

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

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] 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] Valine: A branched-chain essential amino acid that has stimulant activity. It promotes muscle growth and tissue repair. It is a precursor in the penicillin biosynthetic pathway. [NIH]

Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [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] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH]

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Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] 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] 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]

151

INDEX A Abdomen, 101, 107, 124, 126, 134, 135, 144, 145, 147 Abdominal, 3, 101, 118, 134, 135 Abdominal Pain, 3, 101, 118 Abscess, 101, 144 Acetaminophen, 83, 101 Acetylcholine, 39, 52, 101, 109, 131, 132 Actin, 101, 129, 130 Adamantane, 48, 101 Adductor, 5, 101 Adrenergic, 101, 104, 114, 116, 137, 139, 145 Adverse Effect, 9, 101, 143 Aerosol, 46, 101 Afferent, 101, 118, 144 Affinity, 101, 143 Agonist, 101, 105, 114, 132 Akathisia, 101, 104 Algorithms, 102, 106 Alkaline, 44, 102, 108 Alkaloid, 102, 129, 132, 139, 148 Allergen, 54, 102, 114 Alpha Particles, 102, 139 Alpha-1, 102, 137 Alternative medicine, 64, 102 Ambulant, 43, 102 Amine, 102, 121 Amino acid, 59, 102, 103, 104, 112, 120, 121, 125, 126, 127, 134, 137, 138, 142, 148, 149 Amino Acid Sequence, 102, 103 Aminoethyl, 48, 102 Amnestic, 102, 129 Anal, 65, 102 Anal Fissure, 65, 102 Analgesic, 6, 38, 101, 102, 122, 129, 133, 139 Anatomical, 102, 109, 123, 142 Anchorage, 5, 102, 114 Anemia, 79, 103 Anesthesia, 103, 113, 129, 131 Angina, 82, 84, 103 Angiography, 98, 103 Angiotensinogen, 103, 140 Animal model, 8, 9, 36, 49, 103 Anions, 103, 125 Ankle, 84, 103, 149

Antibiotics, 52, 103 Antibodies, 51, 103, 126, 136 Antibody, 51, 101, 103, 121, 123, 127, 139, 144 Anticonvulsant, 36, 37, 49, 103, 110 Antiemetic, 103, 104 Antifungal, 46, 103 Antigen, 51, 54, 101, 103, 119, 121, 122, 123, 127 Antihistamine, 54, 55, 103 Anti-inflammatory, 38, 40, 41, 54, 59, 101, 103, 112, 119, 122 Anti-Inflammatory Agents, 41, 59, 103, 112 Antipsychotic, 37, 103, 131 Antipyretic, 101, 104, 139 Anus, 102, 104, 107, 111 Anxiety, 36, 37, 48, 49, 50, 52, 53, 54, 97, 102, 104, 134 Anxiolytic, 37, 54, 104, 129 Aperture, 44, 104 Aqueous, 38, 104, 105, 110, 126 Aqueous fluid, 38, 104 Arachidonic Acid, 104, 137 Arginine, 104, 132 Arterial, 9, 104, 122, 138 Arteries, 9, 104, 107, 112, 128, 130 Arteriography, 98, 104 Arteriolar, 104, 107, 140 Artery, 104, 112, 134, 139 Articular, 104, 133 Asymptomatic, 41, 104 Ataxia, 78, 79, 104, 109, 146 Atrophy, 19, 78, 104, 131 Atypical, 47, 104 Autoimmune disease, 105, 129, 130 Autonomic, 41, 44, 101, 104, 105, 119, 130, 132, 135, 143, 144, 145 Autonomic Nervous System, 44, 105, 135, 143, 145 Avulsion, 20, 105 Axilla, 105, 107 Axillary, 12, 105 B Babesiosis, 105, 139 Back Pain, 6, 41, 49, 50, 58, 105 Baclofen, 15, 105 Bacteria, 103, 105, 117, 118, 128, 144, 148

152

Muscle Spasms

Bacterial toxin, 39, 105 Bacterium, 39, 105 Basal Ganglia, 104, 105, 110, 122 Basal Ganglia Diseases, 104, 105, 110, 122 Base, 14, 105, 113, 125 Basophil, 54, 105 Baths, 45, 105 Benign, 6, 99, 106, 120, 130 Benzene, 106 Benzodiazepines, 37, 54, 68, 106 Bifida, 106 Bilateral, 47, 106 Bile, 106, 119, 126, 144, 146 Bile Acids, 106, 119, 144, 146 Binding Sites, 53, 106 Biochemical, 106, 133, 142 Biotechnology, 10, 64, 75, 77, 78, 79, 106 Biotransformation, 106 Bipolar Disorder, 36, 49, 106 Bladder, 106, 109, 118, 123, 129, 138, 149 Blepharospasm, 39, 106 Blood Coagulation, 106, 108 Blood Glucose, 106, 120, 122, 124 Blood Platelets, 106, 142 Blood pressure, 41, 106, 109, 122, 143 Blood vessel, 103, 106, 107, 108, 109, 110, 116, 125, 134, 135, 143, 145, 146, 147, 149 Body Fluids, 107, 108, 143 Bolus, 4, 107 Bolus infusion, 107 Bone Density, 9, 107 Bone Marrow, 106, 107, 126, 130 Bone Marrow Cells, 107, 130 Bowel, 3, 102, 107, 114, 124, 135, 145 Bowel Movement, 107, 114, 145 Brachial, 20, 107 Brachial Plexus, 20, 107 Bradykinin, 107, 132 Branch, 47, 95, 107, 134, 143, 145, 146 Breakdown, 107, 108, 114, 119, 133 Bronchi, 107, 116, 148 Bronchial, 43, 107, 121 Bronchial Spasm, 43, 107 Burns, 46, 107 Burns, Electric, 107 Bypass, 50, 107 C Calcium, 27, 98, 108 Capsules, 108, 114 Carcinogenic, 106, 108, 144 Carcinogens, 108, 133

Cardiac, 48, 50, 108, 110, 115, 116, 117, 129, 130, 139, 144 Cardiac arrest, 48, 50, 108 Cardiorespiratory, 108, 129 Cardiovascular, 85, 108, 142, 143 Carotene, 108, 141 Case report, 4, 9, 15, 16, 20, 108, 110 Catheter, 22, 108 Cations, 108, 125 Cauda Equina, 108, 142 Caudal, 108, 122, 136 Causal, 13, 108, 146 Cell Division, 78, 105, 108, 127, 136, 137 Cell membrane, 108, 117, 125 Cellular metabolism, 41, 108 Cellulitis, 6, 108 Central Nervous System, 36, 44, 49, 50, 53, 101, 105, 106, 108, 109, 110, 115, 119, 120, 129, 142 Central Nervous System Infections, 109, 120 Cerebellar, 104, 109, 140, 148 Cerebellar Diseases, 104, 109, 148 Cerebral, 4, 9, 11, 22, 48, 65, 104, 105, 109, 113, 116, 117, 126 Cerebral Cortex, 104, 109, 117 Cerebral Palsy, 4, 9, 11, 22, 65, 109 Cerebrum, 109, 148 Cervical, 6, 39, 40, 47, 50, 84, 107, 109, 130 Cervix, 109, 118 Character, 109, 113 Chemoreceptor, 104, 109 Chin, 109, 128 Chiropractic, 42, 109 Cholesterol, 106, 109, 144 Cholinergic, 39, 104, 109, 132 Cholinesterase Inhibitors, 37, 109 Chorea, 50, 104, 110 Chromaffin System, 110, 116 Chromosome, 110, 126 Chronic renal, 86, 110, 136 Ciliary, 104, 110 Ciliary processes, 104, 110 Cinchona, 110, 139 Circulatory system, 110, 116 Cirrhosis, 13, 17, 18, 110 CIS, 110, 141 Clinical study, 110, 112 Clinical trial, 7, 31, 32, 75, 110, 115, 140 Clonazepam, 15, 110 Clonic, 106, 110 Cloning, 106, 110

Index 153

Coagulation, 20, 106, 110, 121 Coenzymes, 111, 132 Cofactor, 111, 138 Cognition, 48, 111, 131 Collagen, 6, 102, 111, 136, 137 Colloidal, 46, 111 Colon, 3, 78, 111, 125 Computational Biology, 75, 77, 111 Conduction, 31, 111, 131 Cones, 111, 141 Congenita, 19, 111, 139 Congestion, 104, 111 Conjugated, 51, 111 Conjunctiva, 111, 124, 145, 148 Connective Tissue, 6, 107, 108, 111, 118, 119, 126, 141, 146 Connective Tissue Cells, 111 Consciousness, 102, 111, 113, 138 Constipation, 84, 104, 111 Constriction, 111, 125 Consultation, 59, 111 Consumption, 53, 54, 111 Contraindications, ii, 6, 112 Contrast medium, 103, 112 Controlled clinical trial, 11, 112 Convulsion, 48, 112 Convulsive, 52, 53, 112, 116, 131 Coordination, 112, 129 Cornea, 104, 112 Coronary, 112, 128, 130 Coronary Thrombosis, 112, 128, 130 Cortex, 112, 137, 140 Cortical, 48, 112, 117, 142, 146 Corticosteroid, 112, 137 Cranial, 112, 118, 119, 120, 127, 135, 148 Craniocerebral Trauma, 105, 112, 120, 146 Creatine, 14, 16, 18, 19, 27, 112 Creatine Kinase, 16, 18, 112 Creatinine, 112, 113 Criterion, 44, 113 Crowns, 113, 114 Curare, 113, 129, 148 Curative, 113, 132, 147 Cyclic, 113, 120, 132, 138 D Dantrolene, 14, 23, 113 Decarboxylation, 113, 121 Decubitus, 6, 113 Decubitus Ulcer, 6, 113 Degenerative, 86, 113, 129, 133, 141 Delirium, 104, 113 Delusions, 113, 138

Dementia, 48, 50, 104, 113 Dendritic, 113, 127, 144 Density, 9, 107, 113, 133, 143 Dental Abutments, 114 Dentures, 4, 114 Depressive Disorder, 114, 126 Desensitization, 55, 114 Diagnostic procedure, 35, 64, 114 Dialyzer, 114, 120 Diarrhea, 97, 114, 118 Digestion, 106, 107, 114, 124, 126, 145 Digestive system, 33, 114 Direct, iii, 43, 67, 114, 121, 139, 140, 146 Distal, 9, 114, 115, 119, 135, 138 Diverticula, 3, 114 Diverticulitis, 4, 114 Diverticulum, 4, 114 Dominance, 114, 126 Dopamine, 104, 114, 132 Dorsal, 20, 114, 136, 144 Dosage Forms, 37, 114 Double-blind, 14, 115 Drive, ii, vi, 9, 25, 44, 115, 125 Drug Interactions, 68, 69, 115 Drug Tolerance, 115, 147 Duodenum, 106, 115, 116, 134, 145 Dwarfism, 15, 78, 115 Dyes, 44, 115 Dyskinesia, 48, 50, 104, 115 Dysphonia, 5, 39, 115 Dysplasia, 79, 115 Dystonia, 7, 39, 52, 104, 115 Dystrophy, 9, 78, 82, 85, 87, 115 E Edema, 6, 40, 41, 48, 115 Effector, 101, 115 Efferent, 115, 118, 129, 144 Efficacy, 9, 51, 115 Elastic, 5, 6, 115, 143 Elastin, 111, 115 Electrocoagulation, 111, 115 Electrode, 39, 40, 43, 115 Electrolyte, 29, 112, 113, 115, 137, 143 Electromyography, 5, 31, 61, 88, 98, 116 Electroshock, 116, 131 Embryo, 116, 123, 133 Emesis, 48, 116 Endocrine Glands, 116 Endocrine System, 53, 116 Endorphins, 116, 132 Endoscopic, 116, 129 Endothelium, 116, 132

154

Muscle Spasms

Endothelium-derived, 116, 132 End-stage renal, 110, 116, 136 Enkephalins, 116, 132 Environmental Exposure, 116, 133 Environmental Health, 74, 76, 116 Enzymatic, 102, 108, 116, 121, 141 Enzyme, 111, 115, 116, 120, 125, 127, 128, 138, 140, 150 Epidural, 6, 116, 144 Epinephrine, 101, 114, 116, 132 Erythrocytes, 103, 105, 107, 116 Esophageal, 4, 117 Esophageal Manometry, 4, 117 Esophageal Motility Disorders, 4, 117 Esophagitis, 4, 117 Esophagus, 4, 114, 117, 119, 126, 135, 140, 145 Esotropia, 117, 145 Essential Tremor, 78, 117 Ether, 44, 46, 117 Evacuation, 111, 117 Evoke, 117, 145 Excitability, 8, 117, 139 Excitation, 109, 113, 117, 132 Excitatory, 53, 105, 117, 120 Exocytosis, 39, 117 Exogenous, 106, 117 Exotropia, 117, 145 Extensor, 6, 117 Extracellular, 111, 117, 143 Extracellular Matrix, 111, 117 Extrapyramidal, 102, 104, 114, 117 Extremity, 98, 107, 118 Eye Injuries, 50, 118 F Facial, 9, 15, 40, 47, 52, 65, 118, 134, 143 Facial Expression, 118 Facial Nerve, 9, 118, 134 Facial Pain, 40, 47, 118 Family Planning, 75, 118 Fat, 104, 107, 108, 112, 113, 118, 126, 129, 141 Fatigue, 5, 29, 88, 98, 118, 120 Fatty acids, 118, 137 Feces, 111, 118, 145 Femur, 9, 118 Fibrosis, 79, 118, 141, 142 Flexion, 57, 118 Flexor, 117, 118, 146 Food Technology, 118, 128 Foodborne Illness, 86, 118 Foramen, 47, 109, 118, 135, 145

Forearm, 107, 118 Fundus, 118 Fungi, 103, 118, 128 G GABA, 53, 54, 105, 110, 119 Galanthamine, 37, 119 Gallbladder, 101, 114, 118, 119 Ganglia, 101, 105, 119, 131, 135, 144, 145 Gas, 119, 121, 132 Gastric, 114, 117, 119, 121 Gastroesophageal Reflux, 4, 119 Gastrointestinal, 42, 52, 107, 109, 116, 118, 119, 142, 143 Gastrointestinal tract, 109, 119, 142 Gene, 7, 79, 80, 106, 114, 119, 125, 133 Generator, 40, 119 Genetics, 57, 114, 119 Gestation, 119, 134 Giant Cells, 119, 141 Gland, 110, 112, 119, 126, 134, 138, 142, 145, 147 Glossopharyngeal Nerve, 118, 119 Glucocorticoid, 40, 41, 119, 137 Glucose, 78, 106, 120, 122, 124, 141 Glutamate, 48, 50, 51, 120, 128 Glutamic Acid, 51, 120, 132, 137 Glycine, 102, 120, 132 Glycoprotein, 119, 120 Gonadal, 120, 144 Governing Board, 120, 137 Gp120, 48, 120 Granulocytes, 105, 120, 150 Growth, 9, 78, 103, 115, 120, 127, 130, 131, 133, 136, 147, 148, 149 Guanylate Cyclase, 120, 132 H Haematemesis, 116, 120 Haemodialysis, 14, 120 Headache, 40, 47, 63, 87, 120, 122, 124 Headache Disorders, 120 Heart failure, 120, 137 Hemodialysis, 11, 13, 14, 16, 17, 18, 114, 120 Hemoglobin, 103, 117, 120, 121, 125, 126 Hemoglobinuria, 78, 121 Hemorrhage, 112, 115, 120, 121, 136, 145 Hemorrhoids, 87, 121 Hemostasis, 121, 142 Hepatic, 113, 121, 126 Hereditary, 121, 129, 131, 141 Heredity, 119, 121 Heterotropia, 121, 145

Index 155

Histamine, 54, 103, 104, 121 Histidine, 121 Homologous, 121, 146 Hormonal, 104, 112, 121 Hormone, 112, 115, 116, 121, 124, 137, 141, 147 Hydrogel, 38, 121 Hydrogen, 102, 105, 121, 129, 132, 135, 138 Hydrogenation, 106, 121 Hydrolysis, 106, 121, 125, 138 Hydrophilic, 121 Hydroxylysine, 111, 121 Hydroxyproline, 102, 111, 121 Hyperhidrosis, 12, 122 Hyperreflexia, 122, 146 Hypersensitivity, 54, 102, 114, 122, 141 Hypertension, 15, 120, 122, 137 Hyperthyroidism, 22, 122 Hypertrophy, 13, 122, 137 Hypnotic, 37, 122, 129 Hypoglycaemia, 50, 113, 122 Hypoglycemia, 48, 122 Hypoglycemic, 48, 122 Hypokinesia, 122, 134 Hypotension, 104, 122 Hypotensive, 4, 122 Hypothalamus, 105, 122 Hypothermia, 122 Hypothyroidism, 22, 122 Hypoxia, 48, 50, 113, 122, 146 Hypoxic, 48, 122, 144 I Ibuprofen, 38, 83, 122 Id, 26, 78, 82, 84, 85, 86, 87, 88, 89, 94, 96, 122 Idiopathic, 7, 9, 50, 123, 141 Immersion, 105, 123 Immune response, 54, 103, 105, 112, 123, 149 Immune system, 123, 126, 129, 150 Immunity, 46, 123 Immunodeficiency, 78, 123 Immunoglobulin, 12, 103, 123 Immunomodulator, 123, 126 Immunosuppressive, 119, 123 Immunotherapy, 114, 123 Immunotoxin, 26, 51, 123 Impairment, 104, 113, 115, 123, 128, 138 Impotence, 123, 144 In vitro, 48, 123 In vivo, 48, 123 Incision, 123, 124

Incompetence, 119, 123 Incontinence, 48, 50, 123, 130, 144 Indicative, 58, 123, 134, 149 Induction, 104, 116, 123 Infarction, 123 Infection, 6, 48, 108, 110, 113, 118, 123, 124, 126, 132, 134, 141, 145, 150 Influenza, 48, 124 Ingestion, 12, 124, 136 Inguinal, 122, 124 Inhalation, 101, 124, 128, 136 Innervation, 107, 118, 124 Inorganic, 124, 129 Inositol, 124, 128 Insulator, 124, 129 Insulin, 23, 124 Insulin-dependent diabetes mellitus, 124 Intermittent, 59, 124, 135 Intervertebral, 124, 142 Intervertebral Disk Displacement, 124, 142 Intestinal, 3, 108, 124, 127 Intestine, 107, 115, 121, 124, 125, 135 Intoxication, 113, 124, 150 Intracellular, 123, 124, 128, 132, 137, 138, 140 Intramuscular, 51, 124 Intramuscular injection, 51, 124 Intraocular, 118, 124 Intravenous, 9, 23, 124 Intrinsic, 17, 101, 124 Invasive, 40, 123, 124, 127 Involuntary, 4, 7, 8, 9, 42, 51, 52, 105, 110, 112, 117, 124, 130, 136, 140, 143 Ion Channels, 51, 124, 146 Ion Transport, 53, 125 Ions, 53, 105, 115, 121, 125, 128 Ipsilateral, 47, 125, 140 Ischemia, 41, 48, 104, 113, 125, 130 Isoenzyme, 112, 125 Isoleucine, 59, 125 Isopropyl, 46, 125 Isotonic, 43, 44, 125 J Joint, 6, 41, 59, 86, 104, 118, 125, 133, 145 K Kb, 74, 125 Kidney Disease, 33, 74, 79, 87, 125 Kinetic, 125 L Laceration, 125, 146 Lacrimal, 118, 125, 133

156

Muscle Spasms

Large Intestine, 114, 124, 125, 140 Laryngeal, 5, 39, 125 Larynx, 5, 125, 148 Laterality, 41, 126 Lens, 104, 111, 126 Lethargy, 122, 126 Leucine, 59, 126 Leukemia, 78, 126, 130 Library Services, 94, 126 Ligament, 126, 138, 145 Linkage, 7, 126 Lip, 126, 127 Lipid, 124, 126, 128, 129 Lithium, 45, 46, 104, 126 Lithium Chloride, 45, 126 Liver, 14, 16, 17, 20, 21, 42, 101, 104, 106, 110, 114, 118, 119, 121, 126, 140, 141 Liver Cirrhosis, 14, 16, 20, 21, 126 Localized, 39, 40, 41, 101, 122, 123, 126, 130, 136, 142, 144, 146, 148 Lower Esophageal Sphincter, 117, 119, 126 Lumbar, 50, 105, 108, 124, 126 Lymph, 105, 109, 110, 116, 126, 141 Lymph node, 105, 109, 126, 141 Lymphatic, 41, 116, 123, 126, 136, 144, 147 Lymphocyte, 103, 126, 127 Lymphoid, 103, 126, 127 Lymphoma, 78, 127 M Magnetic Resonance Imaging, 6, 127 Malabsorption, 78, 127 Malignancy, 6, 127 Malignant, 15, 78, 127, 130 Malingering, 6, 127 Malnutrition, 104, 127, 130 Mandible, 4, 47, 109, 127 Manic, 104, 106, 126, 127, 139 Manic-depressive psychosis, 127, 139 Manifest, 55, 127, 145 Maple Syrup Urine Disease, 59, 127 Masseter Muscle, 127, 148 Mastication, 127, 148 Maxillary, 40, 41, 47, 127 Maxillary Nerve, 47, 127 Mediator, 127, 142 MEDLINE, 75, 77, 79, 127 Meiosis, 127, 146 Melanocytes, 127, 128 Melanoma, 78, 128 Memantine, 48, 128 Membrane, 44, 53, 108, 111, 114, 117, 120, 124, 125, 128, 130, 133, 139, 141, 144

Membrane Potentials, 53, 128 Memory, 50, 113, 128 Meninges, 109, 112, 128 Meningitis, 128, 136 Menorrhagia, 88, 128 Mental, iv, 7, 33, 74, 76, 80, 109, 111, 113, 118, 122, 123, 128, 136, 138, 142 Mental Disorders, 33, 122, 128, 136, 138 Mesolimbic, 104, 128 Metabolic disorder, 59, 128 Metabolite, 106, 128, 137, 139 Metabotropic, 51, 128 Methylene Chloride, 46, 128 MI, 45, 51, 99, 128 Microbe, 128, 147 Microbiology, 104, 128 Microcirculation, 126, 128 Microwaves, 128, 139 Midazolam, 19, 128 Milliliter, 107, 129 Modification, 102, 129 Molecular, 8, 39, 75, 77, 106, 111, 129, 140, 148 Molecule, 103, 105, 106, 115, 116, 117, 120, 121, 129, 140 Morphine, 19, 129, 130, 133 Motility, 4, 129, 142 Motion Sickness, 129, 130 Motor nerve, 51, 129 Movement Disorders, 7, 12, 51, 82, 104, 129, 146 Mucins, 129, 141 Mucus, 44, 129 Multiple sclerosis, 23, 65, 129 Muscle Contraction, 7, 8, 47, 129, 131 Muscle Fibers, 129, 130 Muscle relaxant, 6, 37, 38, 52, 113, 129, 131 Muscle Relaxation, 39, 129, 130, 131 Muscle tension, 129 Muscular Atrophy, 78, 130 Muscular Dystrophies, 115, 130 Myalgia, 124, 130 Myelin, 129, 130, 142 Myelitis, 22, 130 Myelodysplasia, 9, 130 Myelogenous, 130 Myocardial infarction, 84, 112, 128, 130 Myocardium, 128, 130 Myosin, 129, 130 Myotonia, 19, 130, 139 Myotonic Dystrophy, 78, 130

Index 157

N Narcotic, 128, 129, 130 Nasal Mucosa, 124, 130 Nausea, 41, 103, 104, 114, 130 NCI, 1, 32, 73, 110, 130 Neck Pain, 6, 130 Need, 3, 6, 37, 40, 44, 49, 54, 57, 58, 61, 65, 90, 110, 130, 147 Neoplasia, 78, 130, 131 Neoplasm, 14, 130, 131, 144 Neoplastic, 118, 127, 131, 148 Nephropathy, 125, 131 Nerve Fibers, 107, 131, 144 Nervous System, 78, 101, 105, 108, 109, 127, 131, 132, 135, 145, 146 Neural, 9, 42, 101, 131 Neurodegenerative Diseases, 48, 105, 131 Neuroleptic, 102, 103, 131 Neurologic, 6, 31, 51, 131 Neuromuscular, 8, 16, 23, 39, 52, 82, 86, 101, 113, 131, 148 Neuromuscular Blockade, 52, 86, 131 Neuromuscular Blocking Agents, 39, 131 Neuromuscular Depolarizing Agents, 131 Neuromuscular Junction, 52, 101, 131 Neuromuscular Nondepolarizing Agents, 131 Neuronal, 48, 53, 131 Neurons, 117, 119, 129, 131, 132, 144, 145, 146 Neuropathy, 132, 135, 142 Neurosecretory Systems, 116, 132 Neurosis, 37, 132 Neurotoxin, 39, 51, 132 Neurotransmitter, 50, 101, 102, 107, 109, 114, 119, 120, 121, 125, 132, 146 Neutralization, 4, 132 Neutrons, 102, 132, 139 Niacin, 42, 132, 148 Nicotine, 48, 50, 132 Nitric Oxide, 21, 132 Norepinephrine, 101, 114, 132 Nuclei, 102, 127, 132, 138 Nucleus, 9, 105, 113, 124, 127, 132, 137, 138, 143, 146 O Ocular, 48, 52, 117, 132 Oculi, 106, 132 Ointments, 114, 133 Oncogene, 78, 133 Opacity, 113, 133 Opiate, 48, 50, 129, 133

Opium, 129, 133 Opsin, 133, 141 Orbicularis, 106, 133 Orbit, 133 Orbital, 47, 133 Orofacial, 118, 133 Orphenadrine, 11, 133 Orthostatic, 104, 133 Osmosis, 133 Osmotic, 38, 133 Ossification, 133 Osteoarthritis, 59, 133 Osteogenesis, 9, 133 Osteoporosis, 9, 133 P Palliative, 15, 87, 133, 147 Palpation, 41, 133 Palsy, 4, 9, 82, 133 Pancreas, 101, 114, 124, 134 Pancreatic, 78, 119, 134 Pancreatic cancer, 78, 134 Pancreatic Juice, 119, 134 Panic, 37, 134 Paralysis, 8, 39, 65, 113, 117, 134 Parasite, 134 Parasitic, 54, 134 Paresthesias, 6, 13, 134 Parkinsonism, 48, 50, 104, 133, 134 Parotid, 119, 134, 142 Paroxysmal, 7, 78, 120, 134 Patch, 43, 134 Pathologic, 15, 112, 122, 134 Pathologies, 36, 49, 134 Pathophysiology, 4, 5, 7, 20, 134 Patient Education, 83, 92, 94, 99, 134 Pelvic, 14, 134, 138 Pelvis, 101, 126, 134, 149 Penicillin, 134, 149 Peptide, 102, 134, 138, 147 Perforation, 104, 118, 134 Perfusion, 122, 134 Perinatal, 48, 134 Perineal, 122, 135 Periodontal disease, 11, 135 Peripheral Nervous System, 36, 49, 116, 131, 132, 133, 135 Peripheral Neuropathy, 13, 135 Peristalsis, 4, 135 Peritoneal, 59, 135 Peritoneal Cavity, 135 Peritoneal Dialysis, 59, 135 Peritoneum, 135

158

Muscle Spasms

PH, 15, 16, 20, 22, 107, 135 Pharmaceutical Solutions, 114, 135 Pharmacokinetic, 135 Pharmacologic, 36, 49, 103, 135, 148, 149 Pharynx, 119, 124, 135 Phosphorus, 108, 135 Photocoagulation, 111, 135 Photophobia, 41, 136 Physical Examination, 31, 136 Physical Therapy, 42, 49, 50, 136 Physiologic, 101, 122, 125, 136, 137, 140, 148 Pigments, 108, 136, 141 Piloerection, 122, 136 Pilot study, 41, 136 Pitch, 5, 136 Plants, 102, 120, 132, 136, 141, 148 Plasma, 21, 103, 108, 120, 121, 136, 140, 142 Plasma cells, 103, 136 Platelet Aggregation, 132, 136 Platelets, 132, 136 Plexus, 47, 107, 136 Pneumonia, 112, 136 Poisoning, 113, 118, 124, 130, 136 Polycystic, 79, 136 Polysaccharide, 103, 136 Posterior, 47, 102, 104, 105, 114, 119, 130, 133, 134, 136, 142 Postmenopausal, 133, 136 Postoperative, 85, 136 Post-traumatic, 40, 47, 120, 129, 137 Potassium, 27, 128, 137, 139 Potentiation, 109, 137 Practice Guidelines, 76, 83, 84, 86, 87, 137 Prazosin, 16, 137 Precursor, 103, 104, 114, 115, 116, 132, 137, 148, 149 Prednisolone, 17, 137 Presynaptic, 39, 132, 137, 146 Prevalence, 9, 21, 137 Prodrug, 37, 137 Progesterone, 137, 144 Progression, 103, 137 Progressive, 110, 113, 115, 120, 130, 131, 133, 137 Proline, 111, 121, 137 Prophase, 137, 146 Prophylaxis, 46, 48, 137 Prostaglandin, 41, 46, 137 Prostaglandins A, 46, 138 Prostaglandins D, 138

Prostate, 78, 138 Protease, 54, 102, 138 Protein S, 79, 106, 138 Proteins, 39, 102, 103, 108, 111, 113, 125, 129, 134, 136, 138, 140, 142 Proteolytic, 41, 102, 138 Protons, 102, 121, 138, 139 Proximal, 114, 137, 138 Psychic, 128, 132, 138, 142 Psychoactive, 138, 150 Psychosis, 37, 103, 138 Public Policy, 75, 139 Pulmonary, 106, 111, 139, 149 Pulmonary Artery, 106, 139, 149 Pulse, 5, 39, 40, 44, 139 Q Quinidine, 11, 110, 139 Quinine, 11, 14, 110, 139 Quinolinic, 48, 139 Quinolinic Acid, 48, 139 R Race, 38, 52, 139 Racemic, 38, 52, 139 Radiation, 47, 116, 139, 148, 150 Radiation therapy, 139, 148 Radio Waves, 31, 128, 139 Radiopharmaceutical, 119, 140 Randomized, 11, 115, 140 Reagent, 44, 140 Reality Testing, 138, 140 Receptor, 37, 48, 53, 54, 103, 109, 110, 114, 120, 128, 140, 142 Receptors, Serotonin, 140, 142 Rectum, 104, 107, 111, 114, 119, 123, 125, 138, 140 Recurrence, 106, 127, 140 Red Nucleus, 104, 140 Refer, 1, 116, 119, 131, 132, 138, 140, 148 Reflex, 85, 87, 140 Reflux, 4, 117, 119, 140 Refractory, 51, 115, 140 Regimen, 5, 115, 140 Regurgitation, 117, 119, 140 Relaxant, 140 Remission, 106, 127, 140 Renin, 11, 103, 140 Renin-Angiotensin System, 11, 140 Restoration, 113, 136, 140 Retina, 111, 126, 141 Retinal, 48, 141 Retinoblastoma, 78, 141 Retinol, 141

Index 159

Retinopathy, 48, 50, 136, 141 Rheumatism, 122, 141 Rheumatoid, 46, 141 Rheumatoid arthritis, 46, 141 Rhodopsin, 133, 141 Rigidity, 12, 22, 59, 134, 136, 141 Risk factor, 85, 141 Rod, 105, 141 S Saliva, 4, 141 Salivary, 114, 118, 134, 141 Salivary glands, 114, 118, 141 Saponins, 141, 144 Sarcoidosis, 17, 141 Schizoid, 142, 150 Schizophrenia, 37, 48, 50, 142, 150 Schizotypal Personality Disorder, 142, 150 Sciatica, 42, 58, 142 Scleroderma, 6, 142 Sclerosis, 36, 48, 78, 129, 142 Scoliosis, 9, 142 Screening, 31, 85, 110, 142 Secretion, 112, 115, 121, 122, 124, 129, 142 Sedative, 37, 54, 129, 142 Seizures, 53, 110, 113, 134, 142 Semen, 138, 142 Senile, 133, 142 Sensory loss, 130, 142, 144, 146 Serotonin, 54, 104, 132, 140, 142, 148 Serum, 16, 98, 113, 125, 142 Sex Determination, 79, 142 Shock, 23, 116, 143, 148 Side effect, 42, 54, 55, 67, 83, 101, 102, 104, 143, 147 Skeletal, 8, 11, 26, 36, 49, 53, 109, 112, 113, 115, 130, 131, 139, 143 Skeleton, 101, 118, 125, 137, 143 Skull, 41, 42, 112, 133, 143 Smooth muscle, 46, 54, 107, 111, 121, 129, 140, 143 Sodium, 23, 98, 128, 139, 143, 145 Solitary Nucleus, 105, 143 Solvent, 106, 128, 133, 135, 143 Soma, 143 Somatic, 7, 119, 127, 135, 143 Sound wave, 111, 143 Spasm, 8, 9, 10, 26, 39, 40, 41, 44, 45, 46, 47, 51, 52, 58, 63, 84, 85, 86, 87, 106, 112, 133, 143 Spasmodic, 5, 39, 65, 83, 107, 143, 148 Spasticity, 8, 12, 31, 36, 37, 48, 49, 105, 113, 143

Specialist, 89, 143 Species, 113, 116, 127, 134, 139, 143, 148, 149, 150 Specificity, 51, 101, 144 Spectrum, 128, 139, 144 Sphincter, 125, 144 Spike, 8, 144 Spina bifida, 9, 144 Spinal Cord Compression, 15, 144 Spinal Cord Vascular Diseases, 130, 144 Spinal Fractures, 144 Spinal Nerve Roots, 142, 144 Spinal Nerves, 135, 144 Spinous, 42, 144 Spleen, 126, 141, 144 Spondylitis, 57, 144 Sporadic, 131, 141, 144 Sterile, 43, 44, 144 Steroid, 40, 141, 144 Stimulant, 121, 145, 149 Stimulus, 31, 51, 115, 117, 124, 134, 140, 145, 147 Stomach, 4, 101, 114, 117, 118, 119, 121, 126, 130, 135, 140, 144, 145 Stool, 111, 123, 125, 145 Strabismus, 39, 145 Strained, 5, 145 Stress, 36, 42, 49, 98, 105, 116, 130, 141, 145 Stroke, 26, 31, 33, 48, 64, 65, 74, 145 Subacute, 123, 145 Subarachnoid, 22, 120, 136, 145 Subclinical, 123, 142, 145 Subcutaneous, 108, 115, 145 Support group, 59, 145 Supraorbital, 47, 145 Supraspinal, 105, 145 Sweat, 122, 145 Sympathetic Nervous System, 105, 145 Sympathomimetic, 17, 114, 116, 132, 145 Symphysis, 109, 138, 145 Symptomatic, 41, 47, 54, 146 Synapse, 101, 131, 137, 146, 148 Synapsis, 146 Synaptic, 8, 132, 146 Synaptic Transmission, 132, 146 Synovial, 46, 146 Systemic, 13, 41, 42, 57, 68, 107, 113, 116, 123, 137, 139, 141, 142, 146 T Tardive, 48, 104, 146 Taurine, 16, 21, 146 Telangiectasia, 79, 146

160

Muscle Spasms

Tendon, 143, 146 Tendonitis, 42, 146 Tetani, 146 Tetanic, 146 Tetanus, 14, 68, 146, 148 Thalamic, 104, 146 Thalamic Diseases, 104, 146 Therapeutics, 16, 51, 53, 69, 146 Thiamine, 59, 147 Thoracic, 50, 105, 107, 147, 150 Thorax, 101, 126, 147 Threshold, 117, 122, 147 Thrombosis, 138, 145, 147 Thymus, 126, 147 Thyroid, 86, 98, 122, 147 Thyroid Gland, 122, 147 Thyrotropin, 122, 147 Tin, 88, 135, 147 Tolerance, 44, 48, 110, 147 Tomography, 107, 147 Tone, 39, 59, 117, 143, 147 Tonic, 106, 110, 117, 147 Tonicity, 115, 125, 147 Tonus, 147 Topical, 40, 41, 61, 147 Toxic, iv, 40, 44, 105, 106, 110, 113, 116, 123, 132, 147, 148 Toxicity, 42, 48, 115, 147 Toxicokinetics, 147 Toxicology, 76, 148 Toxin, 5, 12, 13, 39, 51, 52, 64, 65, 83, 146, 147, 148 Trace element, 147, 148 Trachea, 107, 125, 135, 147, 148 Transcutaneous, 40, 148 Transfection, 106, 148 Translation, 102, 148 Transmitter, 101, 114, 124, 127, 132, 148 Transplantation, 14, 23, 110, 148 Trauma, 6, 9, 48, 84, 113, 117, 118, 148 Tremor, 7, 134, 148 Trigeminal, 9, 118, 127, 148 Trigger zone, 104, 148 Trismus, 19, 148 Tryptophan, 111, 139, 142, 148

Tuberous Sclerosis, 79, 148 Tubocurarine, 119, 148 U Ulcer, 6, 108, 113, 148, 149 Ulceration, 113, 148 Unconscious, 122, 148 Urethra, 138, 149 Urinary, 48, 50, 109, 123, 137, 149 Urinary Retention, 137, 149 Urine, 59, 97, 106, 112, 113, 121, 123, 127, 149 Uterus, 109, 118, 137, 149 V Vagina, 109, 149 Vaginal, 65, 149 Valine, 59, 149 Varicose, 20, 21, 149 Varicose vein, 20, 21, 149 Vascular, 21, 54, 116, 120, 123, 126, 128, 132, 144, 147, 149 Vasodilator, 107, 114, 121, 149 Vein, 124, 134, 149 Venous, 121, 138, 149 Ventricle, 122, 139, 149 Vertebrae, 41, 42, 50, 124, 144, 149 Vertebral, 106, 144, 149 Veterinary Medicine, 75, 149 Vinca Alkaloids, 149 Vincristine, 16, 149 Viral, 119, 124, 149 Virulence, 147, 149 Virus, 109, 119, 120, 149 Visceral, 105, 119, 135, 149 Visceral Afferents, 105, 119, 149 Vitro, 150 Vivo, 150 Volition, 124, 150 W White blood cell, 103, 105, 126, 129, 136, 150 Windpipe, 135, 147, 150 Withdrawal, 48, 53, 113, 150 X Xenograft, 103, 150 X-ray, 98, 104, 107, 112, 139, 150

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