Spinal Tap: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

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

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PINAL AP 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., 1960Spinal Tap: 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: 0-597-84633-2 1. Spinal Tap-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 spinal tap. 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 SPINAL TAP ............................................................................................... 3 Overview........................................................................................................................................ 3 Federally Funded Research on Spinal Tap ..................................................................................... 3 E-Journals: PubMed Central ......................................................................................................... 4 The National Library of Medicine: PubMed .................................................................................. 5 CHAPTER 2. PATENTS ON SPINAL TAP ........................................................................................... 21 Overview...................................................................................................................................... 21 Patents on Spinal Tap.................................................................................................................. 21 Patent Applications on Spinal Tap .............................................................................................. 24 Keeping Current .......................................................................................................................... 26 CHAPTER 3. PERIODICALS AND NEWS ON SPINAL TAP ................................................................. 27 Overview...................................................................................................................................... 27 News Services and Press Releases................................................................................................ 27 Academic Periodicals covering Spinal Tap .................................................................................. 28 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 33 Overview...................................................................................................................................... 33 NIH Guidelines............................................................................................................................ 33 NIH Databases............................................................................................................................. 35 Other Commercial Databases....................................................................................................... 37 APPENDIX B. PATIENT RESOURCES ................................................................................................. 39 Overview...................................................................................................................................... 39 Patient Guideline Sources............................................................................................................ 39 Finding Associations.................................................................................................................... 43 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 45 Overview...................................................................................................................................... 45 Preparation................................................................................................................................... 45 Finding a Local Medical Library.................................................................................................. 45 Medical Libraries in the U.S. and Canada ................................................................................... 45 ONLINE GLOSSARIES.................................................................................................................. 51 Online Dictionary Directories ..................................................................................................... 51 SPINAL TAP DICTIONARY ......................................................................................................... 53 INDEX ................................................................................................................................................ 77

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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 spinal tap 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 spinal tap, 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 spinal tap, 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 spinal tap. 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 spinal tap, 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 spinal tap. 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 SPINAL TAP Overview In this chapter, we will show you how to locate peer-reviewed references and studies on spinal tap.

Federally Funded Research on Spinal Tap The U.S. Government supports a variety of research studies relating to spinal tap. 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 spinal tap. 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 spinal tap. The following is typical of the type of information found when searching the CRISP database for spinal tap: •

Project Title: HIGH DOSE ACYCLOVIR VERSUS VIDARABINE IN NEONATAL HERPES SIMPLEX INFECTION Principal Investigator & Institution: Whitley, Richard J.; Professor of Pediatrics; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002

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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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Summary: We hypothesized that treatment with high dose acyclovir would decrease mortality and morbidity of CNS or disseminated neonatal herpes simplex virus infection both acutely and long-term. This trial is a randomized, double-blind controlled clinical trial utilizing high dose acyclovir Vs. standard vidarabine therapy. Patients will be treated in the GCRC for twenty-one consecutive days and then intermittently from day 28 through 6 months. Laboratory work including spinal tap for CSF fluid will be done on days 1 and 21. CT will be done on days 1 and 21 with other CTs as medically indicated. Follow-up out-patient visits will be at 1, 2, 3 and 4 years and will include neurological and developmental assessments. During the first phase of the study, 16 babies nation-wide were enrolled at a dosage of 45mg/kg/day. There was no evidence of toxicity at this doseage; thus, medication doseage was escalated to 60mg/kg/day. A total of 72 patients have been enrolled at the 60mg/kg/day dose at all centers. No new patients have been enrolled at UAB this year; 3 outptaient visits were recorded for follow-up. 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 “spinal tap” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for spinal tap in the PubMed Central database: •

Does bed rest after cervical or lumbar puncture prevent headache? A systematic review and meta-analysis. by Thoennissen J, Herkner H, Lang W, Domanovits H, Laggner AN, Mullner M.; 2001 Nov 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81623

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Prevention of headache after lumbar puncture: questionnaire survey of neurologists and neurosurgeons in United Kingdom:. by Serpell MG, Haldane GJ, Jamieson DR, Carson D.; 1998 Jun 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28569

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Randomised controlled trial of atraumatic versus standard needles for diagnostic lumbar puncture. by Thomas SR, Jamieson DR, Muir KW.; 2000 Oct 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27505

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The role of lumbar puncture in children with suspected central nervous system infection. by Kneen R, Solomon T, Appleton R.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=126268

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

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

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

A case of multiple sclerosis with cerebral venous thrombosis: the role of lumbar puncture and high-dose steroids. Author(s): Gunal DI, Afsar N, Tuncer N, Aktan S. Source: European Neurology. 2002; 47(1): 57-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11803195

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A procedure for direct lumbar puncture in rats. Author(s): De la Calle JL, Paino CL. Source: Brain Research Bulletin. 2002 November 30; 59(3): 245-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12431755

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A randomized trial of eutectic mixture of local anesthetics during lumbar puncture in newborns. Author(s): Kaur G, Gupta P, Kumar A. Source: Archives of Pediatrics & Adolescent Medicine. 2003 November; 157(11): 1065-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14609894

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Abducens palsy after lumbar puncture. Author(s): Niedermuller U, Trinka E, Bauer G. Source: Clinical Neurology and Neurosurgery. 2002 January; 104(1): 61-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11792480

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

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Absolute neutrophil count in aseptic and bacterial meningitis related to time of lumbar puncture. Author(s): Straussberg R, Harel L, Nussinovitch M, Amir J. Source: Pediatric Neurology. 2003 May; 28(5): 365-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12878298

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Acute hemorrhagic complication of diagnostic lumbar puncture. Author(s): Adler MD, Comi AE, Walker AR. Source: Pediatric Emergency Care. 2001 June; 17(3): 184-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11437143

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Acute neurologic deterioration following lumbar puncture in an epidural abscess occurring 14 months after epidural catheter placement. Author(s): Doonan J, Murphy P, Timothy J, Marks P. Source: Journal of Neurosurgical Anesthesiology. 2000 October; 12(4): 364-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11147386

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Anatomic evaluation of cisternal puncture. Author(s): Ward E, Orrison WW, Watridge CB. Source: Neurosurgery. 1989 September; 25(3): 412-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2771012

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Atraumatic lumbar puncture. Author(s): Wolpert SM. Source: Ajnr. American Journal of Neuroradiology. 2002 January; 23(1): 175-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11827894

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Calculating lumbar puncture depth in children. Author(s): Bilic E, Bilic E, Dadic M, Boban M. Source: Coll Antropol. 2003 December; 27(2): 623-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14746151

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Cerebral venous and sinus thrombosis with cerebrospinal fluid circulation block after the first methotrexate administration by lumbar puncture. Author(s): Bienfait HP, Gijtenbeek JM, van den Bent MJ, de Bruin HG, Voogt PJ, Pillay M. Source: Neuroradiology. 2002 November; 44(11): 929-32. Epub 2002 September 18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12428129

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Cerebrospinal fluid leakage after lumbar puncture in neonates: incidence and sonographic appearance. Author(s): Kiechl-Kohlendorfer U, Unsinn KM, Schlenck B, Trawoger R, Gassner I. Source: Ajr. American Journal of Roentgenology. 2003 July; 181(1): 231-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12818865

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Changing pattern of headache pointing to cerebral venous thrombosis after lumbar puncture and intravenous high-dose corticosteroids. Author(s): Aidi S, Chaunu MP, Biousse V, Bousser MG. Source: Headache. 1999 September; 39(8): 559-64. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11279971

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Cisternal puncture and cryptococcal meningitis. Author(s): Gonyea EF. Source: Archives of Neurology. 1973 March; 28(3): 200-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4119510

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Cisternal puncture complications. Treatment of coccidioidal meningitis with amphotericin B. Author(s): Keane JR. Source: Calif Med. 1973 September; 119(3): 10-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4741057

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Combined fourth and sixth cranial nerve palsy after lumbar puncture: a rare complication. A case report. Author(s): Follens I, Godts D, Evens PA, Tassignon MJ. Source: Bull Soc Belge Ophtalmol. 2001; (281): 29-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11702640

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Comparison of ventriculoperitoneal shunt tap and lumbar puncture in a child with meningitis. Author(s): Scribano PV, Pool S, Smally AJ. Source: Pediatric Emergency Care. 2002 August; 18(4): E1-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12187146

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Complication of spinal tap. Author(s): Trupp M. Source: Journal of Neurosurgery. 1982 August; 57(2): 297. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6283043

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Computed tomography of the head before a lumbar puncture in suspected meningitis -- is it helpful? Author(s): Steigbigel NH. Source: The New England Journal of Medicine. 2001 December 13; 345(24): 1768-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11742053

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Computed tomography of the head before lumbar puncture in adults with suspected meningitis. Author(s): Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Source: The New England Journal of Medicine. 2001 December 13; 345(24): 1727-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11742046

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Cortical venous thrombosis after lumbar puncture. Author(s): Mouraux A, Gille M, Dorban S, Peeters A. Source: Journal of Neurology. 2002 September; 249(9): 1313-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12242562

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Cranial CT before lumbar puncture in suspected meningitis. Author(s): Tattevin P, Bruneel F, Regnier B. Source: The New England Journal of Medicine. 2002 April 18; 346(16): 1248-51; Author Reply 1248-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11963945

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Cranial CT before lumbar puncture in suspected meningitis. Author(s): Segal S. Source: The New England Journal of Medicine. 2002 April 18; 346(16): 1248-51; Author Reply 1248-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11963944

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Cranial CT before lumbar puncture in suspected meningitis. Author(s): Tokuda Y, Nakazato N. Source: The New England Journal of Medicine. 2002 April 18; 346(16): 1248-51; Author Reply 1248-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11963943

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Cranial CT before lumbar puncture in suspected meningitis. Author(s): Bruzzi JF, Brennan DD. Source: The New England Journal of Medicine. 2002 April 18; 346(16): 1248-51; Author Reply 1248-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11963942

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Cranial CT before lumbar puncture in suspected meningitis. Author(s): Kastenbauer S, Winkler F, Pfister HW. Source: The New England Journal of Medicine. 2002 April 18; 346(16): 1248-51; Author Reply 1248-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11961158

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CSF collection time at lumbar puncture is influenced by plasma cholesterol and triglycerides. Author(s): Nordin C, Eklundh T, Eriksson M, Sjoberg S. Source: Neuropsychobiology. 2001 January; 43(1): 19-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11150894

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Delay of the diagnostic lumbar puncture and intrathecal chemotherapy in children with acute lymphoblastic leukemia who undergo routine corticosteroid testing: Tokyo Children's Cancer Study Group study L89-12. Author(s): Manabe A, Tsuchida M, Hanada R, Ikuta K, Toyoda Y, Okimoto Y, Ishimoto K, Okawa H, Ohara A, Kaneko T, Koike K, Sato T, Sugita K, Bessho F, Hoshi Y, Maeda M, Kinoshita A, Saito T, Tsunematsu Y, Nakazawa S. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2001 July 1; 19(13): 3182-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11432884

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Determination of leukocytosis in traumatic spinal tap specimens. Author(s): Mayefsky JH, Roghmann KJ. Source: The American Journal of Medicine. 1987 June; 82(6): 1175-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3605134

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Diagnostic and interventional ultrasonography in neonatal and infant lumbar puncture. Author(s): Coley BD, Shiels WE 2nd, Hogan MJ. Source: Pediatric Radiology. 2001 June; 31(6): 399-402. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11436885

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Diagnostic cerebrospinal fluid examination in children with acute lymphoblastic leukemia: significance of low leukocyte counts with blasts or traumatic lumbar puncture. Author(s): Burger B, Zimmermann M, Mann G, Kuhl J, Loning L, Riehm H, Reiter A, Schrappe M. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2003 January 15; 21(2): 184-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12525508

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Diagnostic investigations. Part 1. Lumbar puncture. Author(s): Blows W. Source: Nurs Times. 2002 September 3-9; 98(36): 25-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12244665

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Distinguishing traumatic lumbar puncture from true subarachnoid hemorrhage. Author(s): Shah KH, Edlow JA. Source: The Journal of Emergency Medicine. 2002 July; 23(1): 67-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12217474

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Does bed rest after cervical or lumbar puncture prevent headache? A systematic review and meta-analysis. Author(s): Thoennissen J, Herkner H, Lang W, Domanovits H, Laggner AN, Mullner M. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2001 November 13; 165(10): 1311-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11760976

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Does intrathecal mepivacaine cause post lumbar puncture headache? Author(s): Lee JS. Source: Anesthesia and Analgesia. 2003 September; 97(3): 926; Author Reply 926-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12933444

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End-of-treatment spinal tap in bacterial meningitis. Is it worthwhile? Author(s): Durack DT, Spanos A. Source: Jama : the Journal of the American Medical Association. 1982 July 2; 248(1): 75-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7087096

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Evidence-based emergency medicine. Feedback: computed tomography and lumbar puncture for the diagnosis of subarachnoid hemorrhage: the importance of accurate interpretation. Author(s): Schwartz DT. Source: Annals of Emergency Medicine. 2002 February; 39(2): 190-2; Author Reply 192-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11823775

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Evidence-based lumbar puncture: best practice to prevent headache. Author(s): Cooper N. Source: Hosp Med. 2002 October; 63(10): 598-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12422493

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Fatal lumbar puncture: fact versus fiction--an approach to a clinical dilemma. Author(s): Oliver WJ, Shope TC, Kuhns LR. Source: Pediatrics. 2003 September; 112(3 Pt 1): E174-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12949308

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Fine-needle, negative-pressure lumbar puncture: a safe technique for collecting CSF. Author(s): Linker G, Mirza N, Manetti G, Meyer M, Putnam KT, Sunderland T. Source: Neurology. 2002 December 24; 59(12): 2008-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12499507

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Fluoroscopy-guided lumbar puncture: decreased frequency of traumatic tap and implications for the assessment of CT-negative acute subarachnoid hemorrhage. Author(s): Eskey CJ, Ogilvy CS. Source: Ajnr. American Journal of Neuroradiology. 2001 March; 22(3): 571-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11237986

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Gadolinium enhancement of spinal subdural collection on magnetic resonance imaging after lumbar puncture. Author(s): Teksam M, Casey SO, McKinney A, Michel E, Truwit CL. Source: Neuroradiology. 2003 August; 45(8): 553-6. Epub 2003 July 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12879323

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Headache after diagnostic lumbar puncture. Authors should have used smaller gauge needles. Author(s): Turnbull D, McKevitt F. Source: Bmj (Clinical Research Ed.). 2001 April 21; 322(7292): 994. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11312245

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Headache after diagnostic lumbar puncture. Doctors given intrathecal methotrexate had headache when 20 gauge standard needle was used. Author(s): Baron S. Source: Bmj (Clinical Research Ed.). 2001 April 21; 322(7292): 994. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11312246

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Headache after diagnostic lumbar puncture. Smaller is better where needles are concerned. Author(s): Davies JR. Source: Bmj (Clinical Research Ed.). 2001 April 21; 322(7292): 993-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11312243

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Headache after diagnostic lumbar puncture. Using 20 gauge needle is blunderbuss technique. Author(s): Smeltzer JS. Source: Bmj (Clinical Research Ed.). 2001 April 21; 322(7292): 993; Author Reply 994. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11312241

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Herniated nerve root as a complication of spinal tap. Case report. Author(s): Siddiqi TS, Buchheit WA. Source: Journal of Neurosurgery. 1982 April; 56(4): 565-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6278106

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Hip flexion and lumbar puncture: a radiological study. Author(s): Fisher A, Lupu L, Gurevitz B, Brill S, Margolin E, Hertzanu Y. Source: Anaesthesia. 2001 March; 56(3): 262-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11251435

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Hip flexion for lumbar puncture--not easy in obstetric practice. Author(s): Plaat F, McCready-Hall L. Source: Anaesthesia. 2001 October; 56(10): 1023-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11576142

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How to do a cisternal puncture. Author(s): Kendall B. Source: Br J Hosp Med. 1980 December; 24(6): 571. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7272541

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How valuable is a lumbar puncture in the management of patients with suspected subarachnoid haemorrhage? Author(s): Beetham R, Fahie-Wilson M, Holbrook I, Thomas P, Milford Ward T, Watson I, Wenham P, White P. Source: Emergency Medicine (Fremantle, W.A.). 2002 June; 14(2): 195; Author Reply 196. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12147123

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How valuable is a lumbar puncture in the management of patients with suspected subarachnoid haemorrhage? Author(s): Foot C, Staib A. Source: Emergency Medicine (Fremantle, W.A.). 2001 September; 13(3): 326-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11554864

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Iatrogenic meningitis due to Streptococcus salivarius following a spinal tap. Author(s): Torres E, Alba D, Frank A, Diez-Tejedor E. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1993 September; 17(3): 525-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8218713

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Incidence of traumatic lumbar puncture. Author(s): Shah KH, Richard KM, Nicholas S, Edlow JA. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 2003 February; 10(2): 151-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12574013

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Intralesional cryosurgery using lumbar puncture and/or hypodermic needles for large, bulky, recalcitrant keloids. Author(s): Gupta S, Kumar B. Source: International Journal of Dermatology. 2001 May; 40(5): 349-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11555001

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Is a combination of Tc-SPECT or perfusion weighted magnetic resonance imaging with spinal tap test helpful in the diagnosis of normal pressure hydrocephalus? Author(s): Hertel F, Walter C, Schmitt M, Morsdorf M, Jammers W, Busch HP, Bettag M. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2003 April; 74(4): 479-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12640067

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Life-threatening intracranial hypotension after diagnostic lumbar puncture. Author(s): Francia A, Parisi P, Vitale AM, Esposito V. Source: Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2001 October; 22(5): 385-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11917976

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Looking at lumbar puncture in adults. Author(s): Tate J, Tasota FJ. Source: Nursing. 2000 November; 30(11): 91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11111668

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Lumbar puncture and the risk of herniation: when should we first perform CT? Author(s): van Crevel H, Hijdra A, de Gans J. Source: Journal of Neurology. 2002 February; 249(2): 129-37. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11985377

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Lumbar puncture associated with pneumocephalus: report of a case. Author(s): Kozikowski GP, Cohen SP. Source: Anesthesia and Analgesia. 2004 February; 98(2): 524-6, Table of Contents. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14742399

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Lumbar puncture following febrile convulsion. Author(s): Carroll W, Brookfield D. Source: Archives of Disease in Childhood. 2002 September; 87(3): 238-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12193441

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Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. Author(s): Kanegaye JT, Soliemanzadeh P, Bradley JS. Source: Pediatrics. 2001 November; 108(5): 1169-74. Erratum In: Pediatrics 2002 September; 110(3): 651. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11694698

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Lumbar puncture in pediatric oncology: conscious sedation vs. general anesthesia. Author(s): Ljungman G, Gordh T, Sorensen S, Kreuger A. Source: Medical and Pediatric Oncology. 2001 March; 36(3): 372-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11241439

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Lumbar puncture refusal in febrile convulsion. Author(s): Ling SG, Boey CC. Source: Singapore Med J. 2000 October; 41(10): 485-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11281439

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Lumbar puncture should not be performed in meningococcal disease. Author(s): Nadel S. Source: Archives of Disease in Childhood. 2001 April; 84(4): 375. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11280352

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Lumbar puncture. Author(s): Roos KL. Source: Seminars in Neurology. 2003 March; 23(1): 105-14. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12870112

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Microcatheterization of the cervical epidural space via lumbar puncture: technical note. Author(s): Amar AP, Wang MY, Larsen DW, Teitelbaum GP. Source: Neurosurgery. 2001 May; 48(5): 1183-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11334291

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One hundred years of lumbar puncture. Author(s): Cohn DF, Rabey MJ. Source: Korot. 1993-94; 10: 162-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11639669

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Optimal position for a spinal tap in preterm infants. Author(s): Gleason CA, Martin RJ, Anderson JV, Carlo WA, Sanniti KJ, Fanaroff AA. Source: Pediatrics. 1983 January; 71(1): 31-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6401357

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Paraplegia following cisternal puncture in thoracic osteochondroma. Author(s): Kumar S, Puri V, Gupta S, Malik R. Source: Indian Pediatrics. 1992 November; 29(11): 1421-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1294499

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Parenteral nutrition solution retrieved by lumbar puncture following left saphenous vein catheterization. Author(s): Clarke P, Wadhawan R, Smyth J, Emmerson AJ. Source: Journal of Paediatrics and Child Health. 2003 July; 39(5): 386-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12887673

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Parents' attitudes toward performance of lumbar puncture on their children. Author(s): Tan M, Tan H, Buyukavci M, Karakelleoglu C. Source: The Journal of Pediatrics. 2004 March; 144(3): 400-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15001957

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Perils and pitfalls of lumbar puncture in the emergency department. Author(s): Holdgate A, Cuthbert K. Source: Emergency Medicine (Fremantle, W.A.). 2001 September; 13(3): 351-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11554868

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Post lumbar puncture headache: is bed rest essential? Author(s): Vimala J, Peter JV, Jeyaseelan L, Prabhakar S, Cherian AM. Source: J Assoc Physicians India. 1998 November; 46(11): 930-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11229216

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Post lumbar puncture spinal subarachnoid hematoma causing paraplegia: a short report. Author(s): Pai SB, Krishna KN, Chandrashekar S. Source: Neurology India. 2002 September; 50(3): 367-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12391473

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Post-dural puncture headache and other complications after lumbar puncture. Author(s): Chordas C. Source: Journal of Pediatric Oncology Nursing : Official Journal of the Association of Pediatric Oncology Nurses. 2001 November-December; 18(6): 244-59. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11719905

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Pseudo-meningocele following apparently uncomplicated lumbar puncture--a common procedure with a rare complication. Author(s): Amsler P, Laing RJ, Marcus R, Booth S. Source: Journal of Pain and Symptom Management. 2002 October; 24(4): 363-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12505204

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Questioning the need for routine bone marrow aspiration and lumbar puncture in patients with retinoblastoma. Author(s): Azar D, Donaldson C, Dalla-Pozza L. Source: Clinical & Experimental Ophthalmology. 2003 February; 31(1): 57-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12580896

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Racial differences in rates of traumatic lumbar puncture. Author(s): Vachon GC. Source: Jama : the Journal of the American Medical Association. 2003 February 5; 289(5): 548; Author Reply 549. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12578478

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Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia. Author(s): Howard SC, Gajjar AJ, Cheng C, Kritchevsky SB, Somes GW, Harrison PL, Ribeiro RC, Rivera GK, Rubnitz JE, Sandlund JT, de Armendi AJ, Razzouk BI, Pui CH. Source: Jama : the Journal of the American Medical Association. 2002 October 23-30; 288(16): 2001-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12387652

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Safety of lumbar puncture for adults with acute leukemia and restrictive prophylactic platelet transfusion. Author(s): Vavricka SR, Walter RB, Irani S, Halter J, Schanz U. Source: Annals of Hematology. 2003 September; 82(9): 570-3. Epub 2003 August 02. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12904898

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Spinal anaesthesia for inguinal herniotomy in preterm infants sedated with nitrous oxide: a comparison of lumbar puncture in the lateral or sitting position. Author(s): Vila R, Lloret J, Munar F, Vinzo J. Source: Anaesthesia. 2002 December; 57(12): 1164-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12437706

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Spinal catheter insertion via seated lumbar puncture using a massage chair. Author(s): Williams MA. Source: Neurology. 2002 June 25; 58(12): 1859-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12084893

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Subdural hematoma following lumbar puncture. Author(s): Gaucher DJ Jr, Perez JA Jr. Source: Archives of Internal Medicine. 2002 September 9; 162(16): 1904-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12196091

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Syndrome of cerebrospinal fluid hypovolemia following lumbar puncture cerebrospinal fluid leak in a patient with idiopathic intracranial hypertension. Author(s): Koul R, Chacko A, Javed H, Jain R, Ganesh A, Srinivasan S. Source: Journal of Child Neurology. 2002 January; 17(1): 77-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11913582

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The first lumbar puncture. Author(s): Frederiks JA, Koehler PJ. Source: Journal of the History of the Neurosciences. 1997 August; 6(2): 147-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11619518

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The lumbar puncture for diagnosis of pediatric neurotransmitter diseases. Author(s): Hyland K. Source: Annals of Neurology. 2003; 54 Suppl 6: S13-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12891649

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The pathophysiology of lumbar puncture headache. Author(s): Levine DN, Rapalino O. Source: Journal of the Neurological Sciences. 2001 November 15; 192(1-2): 1-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11701146

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The role of lumbar puncture in children with suspected central nervous system infection. Author(s): Kneen R, Solomon T, Appleton R. Source: Bmc Pediatrics [electronic Resource]. 2002 September 2; 2(1): 8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12350236

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The role of lumbar puncture in suspected CNS infection--a disappearing skill? Author(s): Kneen R, Solomon T, Appleton R. Source: Archives of Disease in Childhood. 2002 September; 87(3): 181-3. Erratum In: Arch Dis Child 2002 December; 87(6): 563. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12193421

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The role of lumbar puncture in the management of elevated intracranial pressure in patients with AIDS-associated cryptococcal meningitis. Author(s): Antinori S, Ridolfo AL, Gianelli E, Piazza M, Gervasoni C, Monforte AA. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2000 November; 31(5): 1309-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11073737

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The spinal tap: a new look at an old test. Author(s): Marton KI, Gean AD. Source: Annals of Internal Medicine. 1986 June; 104(6): 840-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3518565

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Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Bed rest after lumbar puncture. Author(s): Teece S, Crawford I. Source: Emergency Medicine Journal : Emj. 2002 September; 19(5): 432-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12204997

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Traumatic lumbar puncture at diagnosis and outcome in childhood acute lymphoblastic leukemia. Author(s): Kebelmann-Betzing C, Seeger K, Wolf R, Henze G. Source: Blood. 2001 December 1; 98(12): 3496-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11732506

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Use of hypnosis in controlling lumbar puncture distress in an adult needle-phobic dementia patient. Author(s): Simon EP, Canonico MM. Source: Int J Clin Exp Hypn. 2001 January; 49(1): 56-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11190793

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Utility of the peripheral blood white blood cell count for identifying sick young infants who need lumbar puncture. Author(s): Bonsu BK, Harper MB. Source: Annals of Emergency Medicine. 2003 February; 41(2): 206-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12548270

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Value of lumbar puncture in the diagnosis of infantile epilepsy and folinic acidresponsive seizures. Author(s): Hyland K, Arnold LA. Source: Journal of Child Neurology. 2002 December; 17 Suppl 3: 3S48-55; Discussion 3S56. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12597055

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Vascular parkinsonism: clinical correlates predicting motor improvement after lumbar puncture. Author(s): Ondo WG, Chan LL, Levy JK. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 2002 January; 17(1): 91-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11835444

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When to do a lumbar puncture. Author(s): Riordan FA, Cant AJ. Source: Archives of Disease in Childhood. 2002 September; 87(3): 235-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12193440

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Which infants need lumbar puncture for suspected sepsis? Author(s): Wilhelm S, Kelsberg G, Safranek S. Source: The Journal of Family Practice. 2003 October; 52(10): 806-8; Discussion 808. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14529609

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CHAPTER 2. PATENTS ON SPINAL TAP 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.7 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 “spinal tap” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on spinal tap, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Spinal Tap By performing a patent search focusing on spinal tap, 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 7Adapted

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 spinal tap: •

Method for preventing loss of spinal fluid after spinal tap Inventor(s): Zukowski; Henry J. (72 N. Deeplands Rd., Grosse Pointe Shores, MI 48236) Assignee(s): None Reported Patent Number: 4,390,018 Date filed: May 17, 1982 Abstract: A method and apparatus for sealing a hole in the spinal canal of a patient made by a needle used to make a spinal tap. An elongated hemostatic thread is inserted into the lumen of the needle before the needle is removed from the patient after making a spinal tap and while the tip of the needle remains disposed in the hole in the spinal canal formed during penetration thereof by the needle. A wire inserted in the lumen of the needle is employed to advance the hemostatic member to the tip of the needle and to prevent withdrawal of the hemostatic member with the needle when the latter is subsequently withdrawn so that the hemostatic member will remain in situ in the hole as a plug to seal the same. Excerpt(s): This invention relates generally to a method of and apparatus for sealing a hole in the spinal canal of a patient made by a needle used to make a spinal tap. Insertion of a needle into the spinal canal through the midline of the back is an established medical procedure. The purpose of such a needle insertion is (1) to obtain a sample of spinal fluid for analysis, (2) to inject medications or contrast media as in x-ray examinations, or (3) to inject local anesthetic solutions for surgical anesthesia, pain control or diagnostic procedures. A complication of this procedure is the so-called post spinal tap headache. The purpose of this invention is the prevention of this complication. Web site: http://www.delphion.com/details?pn=US04390018__

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Patient positioning apparatus and method for spinal tap Inventor(s): Madden; Thomas C. (6195 Deerwood Dr., Greenwood, IN 46143) Assignee(s): None Reported Patent Number: 6,182,663 Date filed: April 26, 2000 Abstract: A footrest and an abdomen locator are supported on a post mounted on a base which rests on a floor. A patient is seated on the table of a medical cart, with feet on a footrest bar on a floor mounted positioning device. The cart table height is adjusted so that the patient's knees are higher than the pelvis, tipping the pelvis backward. A horizontally and vertically adjustable bar on the device is placed against the abdomen at about the height of the umbilicus, providing a stop about which the patient can curl the upper part of the body forward, reversing the normal lumbar curve, opening the space between vertebral bodies at the dorsal side, facilitating a spinal tap. Base support feet are provided for non-slip engagement with the floor during the procedure, and rollers are provided on the base and situated to facilitate tipping and rolling the base from one location to another after a procedure has been completed.

Patents 23

Excerpt(s): This invention relates generally patient support equipment for the healthcare field, and more particularly to a patient positioning apparatus and method for facilitating a spinal tap procedure. The difficult aspect of performing a spinal tap, is avoiding the spinous processes which protect the spinal canal. Various devices have been invented and patented in the past to facilitate the performance of a spinal tap. Examples of which I am aware are found in U.S. Pat. Nos. 5,357,982; 5,289,603; 4,732,145; 4,660,552; 4,444,381; 4,223,670; 3,984,093; and 3,829,079. Many of these devices are arranged to provide patient positioning and restraint features to facilitate a spinal tap or surgical procedure on a patient lying on his or her side, and appear to be better suited to pediatric patients than to adult patients. There is a need for apparatus facilitating the spinal tap procedure and wherein such apparatus is of simpler construction, easier for the physician to use, readily adaptable to positioning adult patients of various heights and builds, readily movable from place-to-place, and easy to store. The present invention addresses these needs. Web site: http://www.delphion.com/details?pn=US06182663__ •

Pediatric lumbar puncture immobilizer Inventor(s): Shaw; Fredrick C. (221 S. Main St., Yazoo City, MS 39194) Assignee(s): None Reported Patent Number: 5,357,982 Date filed: January 25, 1993 Abstract: A patient restraint, especially suited for pediatric patients, for securing and supporting the child during lumbar puncture procedures. A platform base supports the child on its side, acting as a lateral restraint. A padded mid-back support board, fixed to a bottom edge of the platform base, provides support for the lumbar region; an opening in the board provides access to the L4-L5 interspace region of the back. The child is clamped against this support board by a moveable padded abdominal stabilizer which is mounted on the platform base. A cervical support board is hinged to the mid-back support, and is fastened into an angled position to the mid-back support. A padded, triangular knee support is mounted to the base, at a position along a positioning groove which is inwardly angled from the bottom edge of the base, so that as the knee support moves inwardly, it moves upwardly. A child positioned against the mid-back support is secured by clamping the abdominal stabilizer against the child, holding its lower body and pelvis fixed against the mid-back support in proper position to expose the L4-L5 interspace. The spine is then tensioned by bending up the cervical stabilizer, flexing the upper back into the desired curved position, and also raising the knee stabilizer to bend and hold the legs in a bent position, thus approximating the desired fetal position. Excerpt(s): This patent relates to the field of medical apparatus for immobilizing patients, especially pediatric patients. A particular need exists for immobilizing a patient when performing a procedure which requires exact placement of an invasive probe or needle; this is particularly important when such placement includes the risk of serious injury or damage from an inadvertent motion of the patient. Notable among such procedures are spinal tap or lumbar puncture procedures, involving the insertion of a needle into the spinal canal through the spaces between lumbar vertebrae; any motion of the patient while the needle is inserted runs a serious risk of spinal damage. Since spinal taps are very uncomfortable, the risk of such motion is particularly severe in children. Several patient immobilizers have been developed for holding small children

24

Spinal Tap

in a proper position for a spinal tap. Such immobilizers usually involve strapping the child into a rigid position. Web site: http://www.delphion.com/details?pn=US05357982__ •

Restraint for use in performing a lumbar puncture Inventor(s): Cramer; Judith C. (R.R. #1, Yoder, IN 46798) Assignee(s): None Reported Patent Number: 4,223,670 Date filed: December 1, 1978 Abstract: A restraint for use in performing a Lumbar Puncture procedure on a pediatric patient, the restraint including a flexible panel having a plurality of portions, openings and straps for securing predetermined parts of a patient's body and securely holding same immobilized in a forwardly arched position with the subject's back fully exposed. Excerpt(s): The present invention relates to a restraining device for use in performing a spinal tap or lumbar puncture procedure and in particular to a garment-like restraint for engaging predetermined portions of a subject's body and securely immobilizing the subjects body in a forwardly arched position, the back of the subject being exposed. The lumbar puncture procedure, more commonly refered to as a "spinal tap" and in which a small sample of spinal fluid is taken from the patient is a valuable diagnostic test procedure. This procedure is, however, painful. Simultaneously, during the performance of this procedure it is essential that the patient remain quite still. This is to avoid injury to the patient by reason of a bent or broken needle caused in turn by movement of a patient during the procedure, and to obviate a traumatic tap and the drawing of a bloody test sample which can render the test of little or no value. Since a local anesthetic is rarely used, the difficulties in performing this procedure are further compounded when the procedure is performed on pediatric patients. It is therefore, necessary to have a nurse or other trained personnel present during the performance of the procedure to physically maintain the patient in a proper and essentially immobile position. Such a method is not entirely effective do to the quickness, strength, and unexpected movements of the pediatric patient. Correspondingly, use of trained personnel to physically restrain pediatric patients requires not only the presence of an additional person, it is also less than totally effective. Web site: http://www.delphion.com/details?pn=US04223670__

Patent Applications on Spinal Tap As of December 2000, U.S. patent applications are open to public viewing.8 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 spinal tap:

8

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

Patents 25

•

Spinal fluid collection system Inventor(s): Butler, Bradley S.; (Scottsdale, AZ), Egan, Michael; (Glendale, AZ) Correspondence: Stoneman Law Offices, Ltd; 3113 North 3rd Street; Phoenix; AZ; 85012; US Patent Application Number: 20020068882 Date filed: December 5, 2000 Abstract: A cerebrospinal fluid collection system and method for conveniently and safely holding in a test tube rack, during a spinal tap and collection procedure, sterile test tubes and spinal needles, needle sleeves and stylettes. A test tube rack has four holes for holding four sterile test tubes, two needle holes for holding a spinal needle, stylette or needle sleeve, and a handle for the physician to hold when moving the test tube rack during the CSF procedure. The handle can be held on the left side by a left hand, on the right side by a right hand, or in the front by either hand. The test tube rack also allows the physician to see when the appropriate amount of cerebrospinal fluid has been collected in each test tube, while such test tube is being held in the test tube rack. The test tube rack may be prepackaged with the other needed items in a sterile package. Excerpt(s): A spinal tap is a procedure which takes samples of a patient's cerebrospinal fluid (CSF). Spinal taps are performed when the physician suspects that the patient may have bleeding (such as subarachnoid hemorrhage) or an infection of the central nervous system (such as meningitis or encephalitis). These procedures are often performed in the emergency room but are also performed in a doctor's office or in a hospital setting. Usually, before beginning a spinal tap procedure, the physician, or another medical professional arranges the contents of a spinal tap "kit" on a tray, positioned next to where the physician will be sitting to perform the procedure. The "kit" usually consists of four sterile tubes, a spinal needle (with a stylette inserted through the spinal needle), along with items for sterilizing the patient's skin and draping the patient. Sometimes a test tube rack to hold the tubes is also positioned on the tray. Before the procedure, the physician or another medical professional removes all of these items from their sterile packaging, unscrews the caps from the tubes, and arranges everything on the tray for easy access during the procedure. Usually, the patient is asked to lie down in a curledup position, exposing the back. The physician then sterilizes the patient's back and numbs the skin around the insertion point. In other words, the physician or other medical professional does a "sterile prep and drape." The physician then inserts a spinal needle, with a stylette inside the spinal needle, between the patient's vertebrae (usually in the L3-4 or L4-5 interspace) and advances the needle until the needle has reached the fluid-filled area surrounding the patient's spine, the dural space. The stylette is used to prevent the tip of the spinal needle from becoming blocked by tissue as the needle is inserted through the patient's skin and other tissues. Once the needle is in place, the stylette is removed from the spinal needle and usually placed on the sterile tray. CSF flows through the needle and drips from the proximal end of the needle. The physician then takes four sterile tubes (three for pediatric patients) in turn from the tray and fills the tubes each with approximately 1 (or 1 cc) of CSF. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

26

Spinal Tap

Keeping Current In order to stay informed about patents and patent applications dealing with spinal tap, 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 “spinal tap” (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 spinal tap. You can also use this procedure to view pending patent applications concerning spinal tap. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

27

CHAPTER 3. PERIODICALS AND NEWS ON SPINAL TAP Overview In this chapter, we suggest a number of news sources and present various periodicals that cover spinal tap.

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

Spinal Tap for Lyme Disease Palsy Source: Reuters Health eLine Date: September 22, 1997

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Spinal Tap

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 “spinal tap” (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 “spinal tap” (or synonyms). If you know the name of a company that is relevant to spinal tap, 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 “spinal tap” (or synonyms).

Academic Periodicals covering Spinal Tap Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to spinal tap. In addition to

Periodicals and News 29

these sources, you can search for articles covering spinal tap 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.”

31

APPENDICES

33

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 Institute9: •

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/

9

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

34

Spinal Tap

•

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

Physician Resources 35

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 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:11 •

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

10

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). 11 See http://www.nlm.nih.gov/databases/databases.html.

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Spinal Tap

•

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 Gateway12 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.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “spinal tap” (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 3329 25 971 31 30 4386

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 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.16 Simply search by “spinal tap” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

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

13

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). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16

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.

Physician Resources 37

Coffee Break: Tutorials for Biologists17 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.18 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.19 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/.

17 Adapted 18

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. 19 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.

39

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 spinal tap 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 spinal tap. 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 spinal tap. 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 “spinal tap”:

40

Spinal Tap

Brain Cancer http://www.nlm.nih.gov/medlineplus/braincancer.html Diabetes http://www.nlm.nih.gov/medlineplus/diabetes.html Encephalitis http://www.nlm.nih.gov/medlineplus/encephalitis.html Guillain-Barre Syndrome http://www.nlm.nih.gov/medlineplus/guillainbarresyndrome.html Heart Diseases http://www.nlm.nih.gov/medlineplus/heartdiseases.html Hydrocephalus http://www.nlm.nih.gov/medlineplus/hydrocephalus.html Laboratory Tests http://www.nlm.nih.gov/medlineplus/laboratorytests.html Meningitis http://www.nlm.nih.gov/medlineplus/meningitis.html Pacemakers and Implantable Defibrillators http://www.nlm.nih.gov/medlineplus/pacemakersandimplantabledefibrillators.ht l Spinal Cord Diseases http://www.nlm.nih.gov/medlineplus/spinalcorddiseases.html Spinal Cord Injuries http://www.nlm.nih.gov/medlineplus/spinalcordinjuries.html Spinal Stenosis http://www.nlm.nih.gov/medlineplus/spinalstenosis.html Water Safety http://www.nlm.nih.gov/medlineplus/watersafetyrecreational.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on spinal tap. 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:

Patient Resources 41

•

Cryptococcal Infection Contact: National AIDS Treatment Information Project, Beth Israel Deaconess Medical Center, Beth Israel Hospital, 330 Brookline Ave Libby Bldg 317, Boston, MA, 02215, (617) 667-5520, http://www.natip.org. Summary: This fact sheet, for individuals with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), provides information about the cryptococcal infection or cryptococcosis. Cryptococcus, a fungus, probably enters the body when individuals breathe in air containing dust, particles of dried soil, or bird droppings. This infection often affects the meninges or the lining of the spinal cord, and may also cause pneumonia or widespread disease. The symptoms of cryptococcosis include fever, headache, stiff neck, nausea, vomiting, problems with vision, confused thinking, cough, shortness of breath, chest pain, and sores on the skin. Cryptococcosis is most often diagnosed using a spinal tap or blood work. This infection can be treated with fluconazole or amphotericin. Individuals with HIV can help to prevent cryptococcosis by taking fluconazole.

•

Evaluation of Dementia Source: Fairfax, VA: Alzheimer's Association, Northern Virginia Chapter. 4 p. Contact: Available from Alzheimer's Association, Northern Virginia Chapter. Yorktown 50 Building, Suite 401, 8316 Arlington Boulevard, Fairfax, VA 22031. (703) 207-7044 or (703) 207-7047 (FAX). PRICE: Free. Summary: This factsheet provides detailed information concerning medical evaluation of Alzheimer's disease and other dementias. Every evaluation should begin with the taking of a medical and psychiatric history, to include a neurological evaluation, a mental status exam, and assessments of medication and alcohol use. A complete blood count, urinalysis, syphilis test, and a battery of metabolic and electrolyte tests are also standard parts of the evaluation. Standard x-rays of the skull are usually not needed unless there is a possibility of fracture. A computerized tomographic (CT) scan or magnetic resonance image (MRI) are recommended if the blood tests do not reveal a definitive cause for the dementia. However, these scans cannot provide a definitive diagnosis of Alzheimer's disease. The only definitive test is a brain biopsy, a procedure which is rarely necessary. Other tests which may be useful for some patients include an electroencephalogram, spinal tap, and EKG.

•

Cryptococcal Meningitis Contact: University of New Mexico School of Medicine, New Mexico AIDS Education and Training Center, New Mexico AIDS InfoNet, PO Box 810, Arroyo Seco, NM, 87514, (505) 776-8032, http://www.aidsinfonet.org. Summary: This information sheet discusses cryptococcal meningitis, an opportunistic infection caused by a fungus often found in the soil. It enters the body when breathed in as dust and affects the lining of the spinal cord or brain, causing illness or death. The risk of cryptococcal infection increases when T-cell counts fall below 100. The information sheet explains the symptoms, diagnosis, treatment, and prevention of this disease. Cryptococcal meningitis is often diagnosed using lab tests that involve samples of spinal fluid, which are drawn through a spinal tap. Meningitis is treated using antifungal medications such as amphotericin B, fluconazole, and flucytosine used by themselves or in combinations. Repeat cases of meningitis may be reduced if individuals

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keep taking anti-fungal drugs. Taking fluconazole can help to reduce the likelihood of cryptococcal meningitis when CD4 cell counts are below 50. •

What Everyone Should Know About Lab Tests Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1998. 15 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. PRICE: $0.89 each for 1-99 copies; quantity discounts available. Order number: 38513C198. Summary: This Scriptographic booklet uses cartoon drawings and nontechnical language to describe the uses of laboratory tests, medical tests that analyze samples of a person's body fluids, tissues, or wastes. Designed for patients, the booklet first provides a general overview of laboratory tests and why it is important to understand the kinds of tests in use today. Laboratory tests are used to diagnose medical conditions, to screen for certain health problems, and to monitor treatment. The booklet then discusses blood tests (hematology), including red blood cell counts, white blood cell counts, the complete blood count (CDC), coagulation studies, blood chemistry tests, and serology tests (the study of antigen or antibody responses). For each test, the booklet explains what an abnormal result may indicate. The next section covers urine tests, which check for sugar levels, ketones, blood, bilirubin, proteins, drugs, hormones, and microorganisms. The booklet then briefly reviews other specimen and tissue tests, including biopsy, Pap test, throat culture, spinal tap, stool sample, sputum (spit) test, and gastric juice test. The final section explains some of the careful controls that laboratories employ in their testing methods, and why test results can sometimes take a long time to obtain. The booklet concludes by encouraging readers to understand the procedure that they are undergoing, to cooperate, and to follow any special instructions they may be given. A section of common questions and answers covers the types of laboratory personnel who may be involved, health concerns over blood tests, and why some tests may need to be repeated. The National Guideline Clearinghouse™

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

Assessment: prevention of post-lumbar puncture headaches. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Source: American Academy of Neurology - Medical Specialty Society; 2000 October; 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2815&nbr=2041&a mp;string=lumbar+AND+puncture 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

Patient Resources 43

located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

How a diagnosis of MS is made Summary: Current diagnosis of definite MS involves both clinical (history and neurological exam) and paraclinical (MRI, Spinal Tap, Evoked potentials) evidence. Source: Multiple Sclerosis Foundation, Inc. http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7797 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 spinal tap. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

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

•

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

•

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

•

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

•

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

•

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

•

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

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to spinal tap. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with spinal tap. 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 spinal tap. For more information, see the

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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 “spinal tap” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “spinal tap”. 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 “spinal tap” (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 “spinal tap” (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.20

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

20

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)21: •

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

•

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

•

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

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

•

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

•

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

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California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

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

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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/

•

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

21

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

Finding Medical Libraries 47

•

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

•

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

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

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

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

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

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

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

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

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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

•

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/

•

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

•

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

•

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

•

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

•

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

Finding Medical Libraries 49

•

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

•

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

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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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

51

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

•

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

•

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

•

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

53

SPINAL TAP 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] Abscess: A localized, circumscribed collection of pus. [NIH] Acute leukemia: A rapidly progressing cancer of the blood-forming tissue (bone marrow). [NIH]

Acute lymphoblastic leukemia: ALL. A quickly progressing disease in which too many immature white blood cells called lymphoblasts are found in the blood and bone marrow. Also called acute lymphocytic leukemia. [NIH] Acute lymphocytic leukemia: ALL. A quickly progressing disease in which too many immature white blood cells called lymphoblasts are found in the blood and bone marrow. Also called acute lymphoblastic leukemia. [NIH] Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Androgens: A class of sex hormones associated with the development and maintenance of

54

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the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] 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] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] 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] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aqueous: Having to do with water. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH] Aspiration: The act of inhaling. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements.

Dictionary 55

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] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [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] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [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] Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] 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] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blasts: Immature blood cells. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [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 heart chambers, it refers to the pressure in the systemic arteries, as measured, for example,

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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] 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 aspiration: The removal of a small sample of bone marrow (usually from the hip) through a needle for examination under a microscope. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [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] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [NIH] Brain Neoplasms: Neoplasms of the intracranial components of the central nervous system, including the cerebral hemispheres, basal ganglia, hypothalamus, thalamus, brain stem, and cerebellum. Brain neoplasms are subdivided into primary (originating from brain tissue) and secondary (i.e., metastatic) forms. Primary neoplasms are subdivided into benign and malignant forms. In general, brain tumors may also be classified by age of onset, histologic type, or presenting location in the brain. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] 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] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in

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obstructions. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Count: A count of the number of cells of a specific kind, usually measured per unit volume of sample. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, 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] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] 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] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [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] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves

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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] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Conscious Sedation: An alternative to general anesthesia in patients for whom general anesthesia is refused or considered inadvisable. It involves the administering of an antianxiety drug (minor tranquilizer) and an analgesic or local anesthetic. This renders the patient free of anxiety and pain while allowing the patient to remain in verbal contact with the physician or dentist. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] 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]

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Contrast Media: Substances used in radiography that allow visualization of certain tissues. [NIH]

Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Convulsion: A violent involuntary contraction or series of contractions of the voluntary muscles. [EU] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [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] 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] Cryosurgery: The use of freezing as a special surgical technique to destroy or excise tissue. [NIH]

Cryptococcosis: Infection with a fungus of the species Cryptococcus neoformans. [NIH] Cytosine: A pyrimidine base that is a fundamental unit of nucleic acids. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] 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] Diagnostic procedure: A method used to identify a disease. [NIH] Dilatation: The act of dilating. [NIH]

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Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] 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] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] 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] Duct: A tube through which body fluids pass. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Emergency Medicine: A branch of medicine concerned with an individual's resuscitation, transportation and care from the point of injury or beginning of illness through the hospital or other emergency treatment facility. [NIH] Emergency Treatment: First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured. [NIH] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalitis, Viral: Inflammation of brain parenchymal tissue as a result of viral infection. Encephalitis may occur as primary or secondary manifestation of Togaviridae infections; Herpesviridae infections; Adenoviridae infections; Flaviviridae infections; Bunyaviridae infections; Picornaviridae infections; Paramyxoviridae infections; Orthomyxoviridae infections; Retroviridae infections; and Arenaviridae infections. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [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]

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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] Epidural Space: Space between the dura mater and the walls of the vertebral canal. [NIH] Erythrocyte Indices: Quantification of size and cell hemoglobin content or concentration of the erythrocyte, usually derived from erythrocyte count, blood hemoglobin concentration, and hematocrit. Includes the mean cell volume (MCV), mean cell hemoglobin (MCH), and mean cell hemoglobin concentration (MCHC). Use also for cell diameter and thickness. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] 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] Febrile: Pertaining to or characterized by fever. [EU] 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] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [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] Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Flucytosine: A fluorinated cytosine analog that is used as an antifungal agent. [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 asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] 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]

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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]

Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] 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] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH]

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Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes virus: A member of the herpes family of viruses. [NIH] Herpes Zoster: Acute vesicular inflammation. [NIH] 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] Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. [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] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypodermic: Applied or administered beneath the skin. [EU] 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] Hypovolemia: An abnormally low volume of blood circulating through the body. It may result in hypovolemic shock. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] Incision: A cut made in the body during surgery. [NIH]

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Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infantile: Pertaining to an infant or to infancy. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Hemorrhages: Bleeding within the intracranial cavity, including hemorrhages in the brain and within the cranial epidural, subdural, and subarachnoid spaces. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intracranial Hypotension: A condition in which there is a diminution or loss of muscular tonicity, in consequence of which the muscles may be stretched beyond their normal limits. [NIH]

Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intrathecal: Describes the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. Drugs can be injected into the fluid or a sample of the fluid can be removed for testing. [NIH] Intrathecal chemotherapy: Anticancer drugs that are injected into the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. [NIH] Intravenous: IV. Into a vein. [NIH] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if

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obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] 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] 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] Laboratory Personnel: Those health care professionals, technicians, and assistants staffing a research or health care facility where specimens are grown, tested, or evaluated and the results of such measures are recorded. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocyte Count: A count of the number of white blood cells per unit volume in venous blood. A differential leukocyte count measures the relative numbers of the different types of white cells. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lipid: Fat. [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 scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a spinal tap. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

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] Lymphoblastic: One of the most aggressive types of non-Hodgkin lymphoma. [NIH]

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Lymphoblasts: Interferon produced predominantly by leucocyte cells. [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] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Mannans: Polysaccharides consisting of mannose units. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membranes: Thin layers of tissue which cover parts of the body, separate adjacent cavities, or connect adjacent structures. [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] Meningocele: A congenital or acquired protrusion of the meninges, unaccompanied by neural tissue, through a bony defect in the skull or vertebral column. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] 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] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH]

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Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [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] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasm: A new growth of benign or malignant tissue. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neutrophil: A type of white blood cell. [NIH] Nitrous Oxide: Nitrogen oxide (N2O). A colorless, odorless gas that is used as an anesthetic and analgesic. High concentrations cause a narcotic effect and may replace oxygen, causing death by asphyxia. It is also used as a food aerosol in the preparation of whipping cream. [NIH]

Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Oncology: The study of cancer. [NIH] Osteochondroma: A cartilage-capped benign tumor that often appears as a stalk on the

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surface of bone. It is probably a developmental malformation rather than a true neoplasm and is usually found in the metaphysis of the distal femur, proximal tibia, or proximal humerus. Osteochondroma is the most common of benign bone tumors. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Palsy: Disease of the peripheral nervous system occurring usually after many years of 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] Paraplegia: Severe or complete loss of motor function in the lower extremities and lower portions of the trunk. This condition is most often associated with spinal cord diseases, although brain diseases; peripheral nervous system diseases; neuromuscular diseases; and muscular diseases may also cause bilateral leg weakness. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] 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] 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]

Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] 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] Peripheral blood: Blood circulating throughout the body. [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 Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH]

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Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [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] Platelet Transfusion: The transfer of blood platelets from a donor to a recipient or reinfusion to the donor. [NIH] Pneumocephalus: Presence of air or gas within the intracranial cavity (e.g., epidural space, subdural space, intracerebral, etc.) which may result from traumatic injuries, fistulous tract formation, erosions of the skull from neoplasms or infection, neurosurgical procedures, and other conditions. [NIH] 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] 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] 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] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [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] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pseudotumor Cerebri: A condition marked by raised intracranial pressure and characterized clinically by headaches; nausea; papilledema, peripheral constriction of the visual fields, transient visual obscurations, and pulsatile tinnitus. Obesity is frequently associated with this condition, which primarily affects women between 20 and 44 years of age. Chronic papilledema may lead to optic nerve injury (optic nerve diseases) and visual loss (blindness). [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and

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treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [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] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] 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] 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] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans.

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In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [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] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [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] Sediment: A precipitate, especially one that is formed spontaneously. [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] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] 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

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brain. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] 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] 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 Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Spinal tap: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a lumbar puncture. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Spirochete: Lyme disease. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sputum: The material expelled from the respiratory passages by coughing or clearing the throat. [NIH] Stabilizer: A device for maintaining constant X-ray tube voltage or current. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Sterile: Unable to produce children. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [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] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [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]

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Subcutaneous: Beneath the skin. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Systemic: Affecting the entire body. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tonicity: The normal state of muscular tension. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] 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] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Umbilical Cord: The flexible structure, giving passage to the umbilical arteries and vein, which connects the embryo or fetus to the placenta. [NIH] Umbilicus: The pit in the center of the abdominal wall marking the point where the umbilical cord entered in the fetus. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH]

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

Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vaccinia: The cutaneous and occasional systemic reactions associated with vaccination using smallpox (variola) vaccine. [NIH] Vaccinia Virus: The type species of Orthopoxvirus, related to cowpox virus, but whose true origin is unknown. It has been used as a live vaccine against smallpox. It is also used as a vector for inserting foreign DNA into animals. Rabbitpox virus is a subspecies of vaccinia virus. [NIH] Varicella: Chicken pox. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricles: Fluid-filled cavities in the heart or brain. [NIH] Ventricular: Pertaining to a ventricle. [EU] 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] Vidarabine: A nucleoside antibiotic isolated from Streptomyces antibioticus. It has some antineoplastic properties and has broad spectrum activity against DNA viruses in cell cultures and significant antiviral activity against infections caused by a variety of viruses such as the herpes viruses, the vaccinia virus and varicella zoster virus. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH]

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Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zoster: A virus infection of the Gasserian ganglion and its nerve branches, characterized by discrete areas of vesiculation of the epithelium of the forehead, the nose, the eyelids, and the cornea together with subepithelial infiltration. [NIH]

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INDEX A Abdomen, 22, 53, 56, 62, 65, 68, 72, 73 Abdominal, 23, 53, 68, 73 Abscess, 6, 53 Acute leukemia, 16, 53 Acute lymphoblastic leukemia, 9, 16, 18, 53 Acute lymphocytic leukemia, 53 Acyclovir, 4, 53 Adrenal Cortex, 53, 59 Aerosol, 53, 67 Algorithms, 53, 55 Alimentary, 53, 64, 68 Alternative medicine, 28, 53 Amino Acids, 53, 68, 69 Anaesthesia, 12, 16, 53 Analgesic, 53, 58, 67 Analog, 53, 61 Androgens, 53, 59 Anesthesia, 10, 14, 22, 54, 58 Anesthetics, 5, 54 Antiallergic, 54, 59 Antibiotic, 14, 54, 72, 74 Antibodies, 54, 66 Antibody, 42, 54, 64, 71 Antifungal, 54, 61 Antigen, 42, 54, 64, 71 Anti-inflammatory, 54, 59, 62 Anti-Inflammatory Agents, 54, 59 Antimetabolite, 53, 54 Antineoplastic, 54, 59, 74 Antiviral, 53, 54, 74 Anxiety, 54, 58 Aqueous, 54, 55 Arteries, 54, 55, 56, 59, 66, 73 Aseptic, 6, 54 Asphyxia, 54, 67 Aspiration, 54 Ataxia, 54, 63 Autoimmune disease, 55, 67 B Bacteria, 54, 55, 61, 66, 71, 72, 74 Bacteriuria, 55, 74 Base, 22, 23, 55, 59, 65 Bed Rest, 4, 10, 15, 55 Benign, 55, 56, 62, 67 Benign tumor, 55, 67 Bilateral, 55, 68

Bile, 55, 61, 65 Bilirubin, 42, 55 Biopsy, 41, 42, 55 Biotechnology, 4, 5, 28, 35, 55 Bladder, 55, 61, 64, 67, 74 Blasts, 9, 55 Blood Cell Count, 42, 55, 62 Blood Platelets, 55, 69 Blood pressure, 55, 62, 63, 66 Blood vessel, 55, 56, 57, 62, 65, 68, 72, 73, 74 Body Fluids, 42, 56, 60 Bone Marrow, 16, 53, 56, 65 Bone marrow aspiration, 16, 56 Bone scan, 56, 70 Bowel, 56, 72 Bowel Movement, 56, 72 Brain Diseases, 56, 68 Brain Neoplasms, 56, 63 Branch, 49, 56, 60, 68, 72 C Candidiasis, 56, 61 Carbohydrate, 56, 59, 62, 69 Case report, 7, 12, 56, 58 Catheterization, 15, 56, 65 Cell, 41, 42, 55, 57, 61, 64, 67, 70, 74, 75 Cell Count, 41, 42, 57 Cellulose, 57, 61 Central Nervous System, 4, 17, 25, 56, 57, 61, 62, 63, 67 Central Nervous System Infections, 57, 62, 63 Cerebral, 5, 6, 7, 55, 56, 57, 63 Cerebral Infarction, 57, 63 Cerebrospinal, 6, 7, 9, 14, 17, 25, 57, 63, 65, 71, 72 Cerebrospinal fluid, 6, 7, 9, 14, 17, 25, 57, 63, 65, 71, 72 Cerebrum, 57 Cervical, 4, 10, 14, 23, 57 Cervix, 57, 61 Chemotherapy, 57 Chest Pain, 41, 57 Chin, 57, 66 Chlorophyll, 57, 61 Cholesterol, 9, 55, 57 Chronic, 57, 64, 69, 72 Circulatory system, 57, 64

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Clinical study, 58, 59 Clinical trial, 3, 4, 35, 58, 60, 70 Cloning, 55, 58 Coagulation, 42, 55, 58, 73 Computational Biology, 35, 58 Computed tomography, 8, 10, 58, 70 Computerized axial tomography, 58, 70 Computerized tomography, 58 Connective Tissue, 56, 58, 61, 62, 65 Conscious Sedation, 14, 58 Consciousness, 53, 58, 59, 70 Contraindications, ii, 58 Contrast Media, 22, 59 Controlled clinical trial, 4, 59 Convulsion, 14, 59 Coordination, 59, 67 Coronary, 59, 66 Coronary Thrombosis, 59, 66 Cortical, 8, 59, 71 Corticosteroid, 9, 59 Cranial, 7, 8, 9, 59, 62, 64, 68 Craniocerebral Trauma, 59, 62, 63 Cryosurgery, 13, 59 Cryptococcosis, 41, 59 Cytosine, 59, 61 D Databases, Bibliographic, 35, 59 Dementia, 18, 41, 59 Diagnostic procedure, 21, 22, 28, 59 Dilatation, 59, 69 Dilation, 60, 63 Direct, iii, 5, 60, 70 Distal, 60, 68, 69 Dorsal, 22, 60, 69 Dorsum, 60 Double-blind, 4, 60 Duct, 56, 60 Dura mater, 60, 61, 66, 68 E Edema, 60, 64 Electrocoagulation, 58, 60 Electrolyte, 41, 59, 60, 66 Electrons, 55, 60, 65, 70 Emergency Medicine, 10, 12, 13, 15, 18, 60 Emergency Treatment, 60 Encephalitis, 25, 40, 60 Encephalitis, Viral, 60 Endocrine Glands, 60 Environmental Health, 34, 36, 60 Epidural, 6, 14, 61, 64, 69 Epidural Space, 14, 61, 69 Erythrocyte Indices, 55, 61

Erythrocytes, 55, 56, 61 Extravasation, 61, 62 F Family Planning, 35, 61 Fat, 56, 59, 61, 62, 65, 67, 72 Febrile, 14, 61 Feces, 61, 72 Femur, 61, 68 Fetus, 61, 73, 74 Flexion, 12, 61 Fluconazole, 41, 61 Flucytosine, 41, 61 Fundus, 61 Fungi, 54, 61, 66, 74, 75 Fungus, 41, 56, 59, 61 G Gallbladder, 53, 61 Ganglia, 55, 56, 61, 63, 67, 68 Gas, 61, 63, 67, 69, 74 Gastric, 42, 61 Gene, 55, 62 Glucocorticoids, 53, 59, 62 Governing Board, 62, 69 Granulocytes, 62, 75 Groin, 62, 64 H Haematoma, 62 Haemorrhage, 12, 62 Headache, 4, 7, 10, 11, 12, 15, 16, 17, 22, 41, 62, 63 Headache Disorders, 62 Hematocrit, 55, 61, 62 Hematology, 16, 42, 62 Hematoma, 15, 17, 62 Heme, 55, 62 Hemoglobin, 55, 61, 62 Hemorrhage, 10, 11, 25, 59, 60, 62, 70 Hereditary, 63, 70 Herpes, 4, 53, 63, 74 Herpes virus, 63, 74 Herpes Zoster, 63 Hormonal, 59, 63 Hormone, 59, 63 Hormones, 42, 53, 59, 63 Hydrocephalus, 13, 40, 63, 64 Hydrogen, 55, 56, 63, 66 Hypertension, 63, 64 Hypodermic, 13, 63 Hypokinesia, 63, 68 Hypovolemia, 17, 63 I Id, 42, 43, 48, 50, 63

79

Idiopathic, 17, 63 Immune response, 54, 55, 59, 63, 75 Immune system, 63, 66, 67, 75 Immunodeficiency, 41, 63 In situ, 22, 63 In vitro, 63, 71 Incision, 63, 65 Incontinence, 63, 64 Infancy, 64 Infantile, 18, 64 Infarction, 57, 59, 64, 66 Infection, 4, 17, 25, 41, 54, 55, 56, 59, 60, 63, 64, 65, 66, 69, 72, 75 Inflammation, 54, 60, 63, 64, 66, 68, 69, 72 Inguinal, 16, 64 Insulator, 64, 67 Internal Medicine, 17, 18, 62, 64 Intestines, 53, 61, 64 Intoxication, 64, 75 Intracellular, 64 Intracranial Hemorrhages, 63, 64 Intracranial Hypertension, 17, 62, 63, 64 Intracranial Hypotension, 13, 64 Intracranial Pressure, 18, 64, 69 Intramuscular, 64, 68 Intrathecal, 9, 10, 11, 64 Intrathecal chemotherapy, 9, 64 Intravenous, 7, 64, 68 Intubation, 56, 64 Invasive, 23, 65, 66 Involuntary, 59, 65, 67 Ions, 55, 60, 63, 65 K Kb, 34, 65 L Laboratory Personnel, 42, 65 Lethargy, 63, 65 Leukemia, 65 Leukocyte Count, 9, 65 Leukocytes, 55, 56, 62, 65 Leukocytosis, 9, 65 Library Services, 48, 65 Lipid, 65, 67 Liver, 53, 55, 61, 62, 65, 70 Liver scan, 65, 70 Localized, 53, 62, 64, 65 Lumbar, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 22, 23, 24, 42, 65, 72 Lumbar puncture, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 23, 24, 42, 65, 72 Lumen, 22, 65 Lymph, 57, 58, 65

Lymph node, 57, 65 Lymphatic, 64, 65 Lymphoblastic, 65 Lymphoblasts, 53, 66 Lymphocyte, 54, 66 M Magnetic Resonance Imaging, 11, 13, 66, 70 Malformation, 66, 68 Mannans, 61, 66 MEDLINE, 35, 66 Membranes, 56, 60, 66 Memory, 59, 66 Meninges, 41, 57, 59, 60, 66, 72 Meningitis, 6, 7, 8, 9, 10, 13, 14, 18, 25, 40, 41, 61, 66 Meningocele, 16, 66 Mental, iv, 3, 34, 36, 41, 57, 59, 63, 66, 70, 71 Meta-Analysis, 4, 10, 66 MI, 22, 51, 66 Microbe, 66, 73 Mineralocorticoids, 53, 59, 66 Molecular, 35, 37, 55, 58, 66 Molecule, 54, 55, 66, 70 Monitor, 42, 66 Morphological, 61, 67 Morphology, 62, 67 Motion Sickness, 67 Multiple sclerosis, 5, 67 Muscular Diseases, 67, 68 Myelin, 67 Myocardium, 66, 67 N Narcotic, 67 Nausea, 41, 67, 69 Necrosis, 57, 64, 66, 67 Need, 16, 18, 19, 23, 42, 44, 67 Neonatal, 4, 9, 67 Neoplasm, 67, 68 Nerve, 7, 12, 54, 55, 57, 67, 68, 69, 70, 71, 75 Nervous System, 4, 25, 57, 67, 68 Neural, 66, 67 Neurologic, 6, 63, 67 Neuromuscular, 67, 68 Neutrophil, 6, 67 Nitrous Oxide, 16, 67 Nuclei, 60, 66, 67 O Oncology, 9, 14, 16, 67 Osteochondroma, 15, 67

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P Pachymeningitis, 66, 68 Palsy, 5, 7, 27, 68 Pancreas, 53, 68 Paraplegia, 15, 68 Parenteral, 14, 15, 68 Parkinsonism, 19, 68 Pathologic, 55, 56, 59, 68, 70, 72 Pathophysiology, 17, 68 Patient Education, 40, 46, 48, 51, 68 Pelvis, 22, 23, 53, 65, 68, 74 Peptide, 68, 69 Perfusion, 13, 68 Peripheral blood, 18, 68 Peripheral Nervous System, 68 Peripheral Nervous System Diseases, 68 Petechiae, 62, 68 Pharmacologic, 54, 68, 73 Photocoagulation, 58, 68 Physiology, 62, 69 Pigment, 55, 69 Pituitary Gland, 59, 69 Plasma, 9, 54, 62, 66, 69 Platelet Transfusion, 16, 69 Pneumocephalus, 14, 69 Pneumonia, 41, 58, 69 Poisoning, 64, 67, 69 Polysaccharide, 54, 57, 69 Posterior, 55, 60, 68, 69 Practice Guidelines, 36, 42, 69 Probe, 23, 69 Progressive, 59, 67, 69 Protein S, 55, 69 Proteins, 42, 53, 54, 66, 68, 69, 71, 73, 74 Proximal, 25, 60, 68, 69 Pseudotumor Cerebri, 64, 69 Psychiatric, 41, 69 Psychiatry, 13, 69 Psychic, 66, 70, 71 Public Policy, 35, 70 Publishing, 4, 70 Pulse, 66, 70 Purpura, 62, 70 R Radiation, 70, 71, 75 Radioactive, 56, 63, 65, 70, 71 Radiography, 59, 70 Radiological, 12, 70 Radiology, 9, 70 Randomized, 4, 5, 70 Receptor, 54, 70 Refer, 1, 61, 63, 70

Resorption, 63, 70 Respiration, 66, 70 Resuscitation, 60, 70 Retinoblastoma, 16, 70 Rigidity, 64, 68, 70 S Saphenous, 15, 70 Saphenous Vein, 15, 70 Scans, 41, 70 Schizoid, 71, 75 Schizophrenia, 71, 75 Schizotypal Personality Disorder, 71, 75 Sclerosis, 43, 67, 71 Screening, 58, 71, 74 Secretion, 59, 62, 66, 71 Sediment, 71, 74 Seizures, 18, 71 Sensibility, 53, 71 Sepsis, 19, 71 Septic, 54, 71 Serology, 42, 71 Serum, 66, 71 Shock, 63, 71 Shunt, 7, 71 Side effect, 71, 73 Skeleton, 61, 71 Skull, 41, 59, 64, 66, 69, 71 Soft tissue, 56, 71, 72 Specialist, 44, 60, 72 Species, 59, 72, 74 Spectrum, 72, 74 Spinal cord, 41, 57, 60, 61, 64, 66, 67, 68, 72 Spinal Cord Diseases, 40, 68, 72 Spinal tap, 4, 22, 23, 24, 25, 41, 42 Spinous, 23, 72 Spirochete, 72, 73 Sporadic, 70, 72 Sputum, 42, 72 Stabilizer, 23, 72 Staging, 70, 72 Sterile, 25, 54, 72 Steroids, 5, 59, 72 Stomach, 53, 61, 63, 64, 67, 72 Stool, 42, 64, 72 Stress, 67, 72 Subacute, 64, 72 Subarachnoid, 10, 11, 12, 15, 25, 62, 64, 72 Subclinical, 64, 71, 72 Subcutaneous, 60, 68, 73 Suppression, 59, 73 Syphilis, 41, 73 Systemic, 55, 56, 64, 73, 74

81

T Thoracic, 15, 73 Thorax, 53, 65, 73 Thrombosis, 6, 69, 73 Thrombus, 59, 64, 73, 74 Tissue, 25, 42, 53, 54, 55, 56, 58, 59, 60, 61, 62, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73 Tomography, 73 Tonicity, 64, 73 Toxic, iv, 73 Toxicity, 4, 73 Toxicology, 36, 73 Toxins, 54, 60, 64, 73 Transfection, 55, 73 Tremor, 68, 73 U Ultrasonography, 9, 73 Umbilical Cord, 73 Umbilicus, 22, 73 Unconscious, 54, 63, 73 Urethra, 74 Urinalysis, 41, 74 Urinary, 55, 63, 64, 74 Urine, 42, 55, 64, 74 Uterus, 57, 61, 74 V Vaccines, 74, 75 Vaccinia, 74

Vaccinia Virus, 74 Varicella, 74 Vascular, 19, 62, 64, 72, 73, 74 Vein, 64, 70, 73, 74 Venereal, 73, 74 Venous, 5, 6, 7, 8, 55, 57, 65, 69, 74 Venous blood, 55, 57, 65, 74 Venous Thrombosis, 5, 7, 8, 74 Ventricles, 57, 63, 74 Ventricular, 63, 74 Vertebrae, 23, 25, 72, 74 Vertebral, 22, 61, 66, 74 Veterinary Medicine, 35, 74 Vidarabine, 4, 74 Villi, 63, 74 Virulence, 73, 74 Virus, 4, 41, 57, 74, 75 W White blood cell, 18, 42, 53, 54, 65, 66, 67, 75 Withdrawal, 22, 75 X X-ray, 22, 41, 58, 70, 71, 72, 75 Y Yeasts, 61, 75 Z Zoster, 74, 75

82

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83

84

Spinal tap

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