The meaning of the symbols of dreams/ seen in a dream.

A condition of having lost the appetite for food... anorexia

Loss of hair-a malady in which the hair falls from one or more circumscribed round or oval areas, leaving the skin smooth and white.... alopecia

Lack of enough blood in the body causing paleness... anaemia

Abnormal accumulation of fluid in the peritoneal cavity... ascites

An agent that induces abortion... abortifacient

A type of disease or disorder having a sudden onset with severe symptoms, and generally a short or self-limited duration (such as a head cold or sprain). The opposite of CHRONIC.... acute

Failure of menstruation... amenorrhoea

A sudden loss of consciousness... apoplexy

Inflammation of a joint... arthritis

A localised collection of pus caused by suppuration in a tissue... abscess

The lack of free hydrochloric acid in the stomach; more broadly, inadequate or suppressed secretions. Without enough acid, proteins are not broken down, butterfats are not digested, Vitamin B12 may not be absorbed, and there is a long-term risk for the potential of food sensitivities to undigested foreign proteins.... achlorhydria

Specifically, the abnormal buildup of acids in the body, classically caused by diabetes or kidney disease. Broadly, the potential caused by increased protein intake or metabolism, coupled with inadequate intake (or loss) of alkali.... acidosis

The cause of a disease. The study of the causes of diseases. May be classified as follows: Genetic Congenital Infection Autoimmune Nutrition Toxic Environment Traumatic Neoplastic Metabolic Psychosomatic Degenerative Iatrogenic Idiopathic... aetiology

The presence of serum albumin and serum globulin in the urine... albuminuria

A term generally used to describe an adverse reaction by the body to any substance ingested by the affected individual. Strictly, allergy refers to any reactions incited by an abnormal immunological response to an ALLERGEN, and susceptibility has a strong genetic component. Most allergic disorders are linked to ATOPY, the predisposition to generate the allergic antibody immunoglobulin E (IgE) to common environmental agents (see ANTIBODIES; IMMUNOGLOBULINS). Because IgE is able to sensitise MAST CELLS (which play a part in in?ammatory and allergic reactions) anywhere in the body, atopic individuals often have disease in more than one organ. Since the allergic disorder HAY FEVER was ?rst described in 1819, allergy has moved from being a rare condition to one a?icting almost one in two people in the developed world, with substances such as grass and tree pollen, house-dust mite, bee and wasp venom, egg and milk proteins, peanuts, antibiotics, and other airborne environmental pollutants among the triggering factors. Increasing prevalence of allergic reactions has been noticeable during the past two decades, especially in young people with western lifestyles.

A severe or life-threatening reaction is often termed ANAPHYLAXIS. Many immune mechanisms also contribute to allergic disorders; however, adverse reactions to drugs, diagnostic materials and other substances often do not involve recognised immunological mechanisms and the term ‘hypersensitivity’ is preferable. (See also IMMUNITY.)

Adverse reactions may manifest themselves as URTICARIA, wheezing or di?culty in breathing owing to spasm of the BRONCHIOLES, swollen joints, nausea, vomiting and headaches. Severe allergic reactions may cause a person to go into SHOCK. Although symptoms of an allergic reaction can usually be controlled, treatment of the underlying conditon is more problematic: hence, the best current approach is for susceptible individuals to ?nd out what it is they are allergic to and avoid those agents. For some people, such as those sensitive to insect venom, IMMUNOTHERAPY or desensitisation is often e?ective. If avoidance measures are unsuccessful and desensitisation ine?ective, the in?ammatory reactions can be controlled with CORTICOSTEROIDS, while the troublesome symptoms can be treated with ANTIHISTAMINE DRUGS and SYMPATHOMIMETICS. All three types of drugs may be needed to treat severe allergic reactions.

One interesting hypothesis is that reduced exposure to infective agents, such as bacteria, in infancy may provoke the development of allergy in later life.

Predicted developments in tackling allergic disorders, according to Professor Stephen Holgate writing in the British Medical Journal (22 January 2000) include:

Identi?cation of the principal environmental factors underlying the increase in incidence, to enable preventive measures to be planned.

Safe and e?ective immunotherapy to prevent and reverse allergic disease.

Treatments that target the protein reactions activated by antigens.

Identi?cation of how IgE is produced in the body, and thus of possible ways to inhibit this process.

Identi?cation of genes affecting people’s susceptibility to allergic disease.... allergy

A system of medicine based on the theory that successful therapy depends on creating a condition antagonistic to, or incompatible with, the condition to be treated. Thus, drugs such as antibiotics are given to combat diseases caused by the organisms to which they are antagonistic.... allopathy

Protozoal disease caused by Entamoeba histolytica, which may present as an amoebic liver abscess, intestinal amoebiasis or disseminated amoebiasis.... amoebiasis

A zoonotic infection of humans contracted from sheep, cows and similar animals and their products. Caused by Bacillus anthracis, a spore-bearing Gram positive rod. Anthrax includes a cutaneous form (malignant pustule), a pneumonic form (Woolsorters’ disease) and intestinal anthrax. The form of the disease depends largely of the site of entry.... anthrax

Immunologic proteins, usually made from immunoglobulins, that are capable of binding to, and rendering inactive, foreign substances that have entered the skin envelope and have been deemed dangerous. They may be synthesized anew in the presence of a previously encountered substance (antigen); they may be present in small amounts at all times in the bloodstream; or they may be present in the tissues in a more primitive form designed to react to a broad spectrum of potential antigens. The latter may be responsible for some allergies.... antibody

An agent which neutralizes or opposes the action of a poison... antidote

A substance, usually a protein, that induces the formation of defending antibodies. Example: bacterial toxins, Juniper pollen (in allergies). Auto-immune disorders can occur when antibodies are formed against normal proteins created within the body.... antigen

A substance that prevents oxidation or slows a redox reaction. More generally, an agent that slows the formation of lipid peroxides and other free-radical oxygen forms, preventing the rancidity of oils or blocking damage from peroxides to the mitochondria of cells or cell membranes. (Examples : Vitamin E, Larrea (Chaparral), Gum Benzoin.)... antioxidant

A laxative or mild cathartic... aperient

Loss of voice, usually sudden. Commonly caused by emotional stress with no detectable physical abnormality in the LARYNX. Damage or disease of the larynx usually results in dysphonia (partial voice loss). Where no physical cause can be identi?ed, reassurance and, if the voice does not quickly return, PSYCHOTHERAPY are the treatment.... aphonia

The condition of blood vessels that have thickened, hardened, and lost their elasticity-”hardening of the arteries.” Aging and the formation of blood-derived fatty plaques within or directly beneath the inner lining of the arteries are the common causes. Many of the large arteries aid blood transport from the heart by their rebound elasticity, “kicking” it out; smaller ones have muscle coats that need to contract and relax in response to nerves. All this is compromised when there is arteriosclerosis.... arteriosclerosis

A traditional term meaning lack of strength.... asthenia

Causing soft tissues or drawing together... astringent

Absence of a palpable pulse, and thus of circula tion of blood around the body by the heart contraction. The cause may be asystole or ventricular fibrillation.... cardiac arrest

Abrasion means the rubbing-o? of the surface of the skin or of a mucous membrane due to some mechanical injury. Such injuries, though slight in themselves, are apt to allow the entrance of dirt-containing organisms, and so to lead to an ABSCESS or some more severe form of in?ammation.

Treatment The most e?ective form of treatment consists in the thorough and immediate cleansing of the wound with soap and water. An antiseptic such as 1 per cent cetrimide can then be applied, and a sterile dry dressing.... abrasion

An inflammatory disease occurring in or around the sebaceous glands... acne

A slow-growing, benign tumour in the auditory canal arising from the Schwann cells of the acoustic cranial nerve. The neuroma, which accounts for about 7 per cent of all tumours inside the CRANIUM, may cause facial numbness, hearing loss, unsteady balance, headache, and TINNITUS. It can usually be removed surgically, sometimes with microsurgical techniques that preserve the facial nerve.... acoustic neuroma

A condition, occurring especially in young women, in which there is persistent blueness of hands, feet, nose and ears as a result of slow circulation of blood through the small vessels of the skin.... acrocyanosis

A disorder caused by the increased secretion of growth hormone by an ADENOMA of the anterior PITUITARY GLAND. It results in excessive growth of both the skeletal and the soft tissues. If it occurs in adolescence before the bony epiphyses have fused, the result is gigantism; if it occurs in adult life the skeletal overgrowth is con?ned to the hands, feet, cranial sinuses and jaw. Most of the features are due to overgrowth of the cartilage of the nose and ear and of the soft tissues which increase the thickness of the skin and lips. Viscera such as the thyroid and liver are also affected. The overgrowth of the soft tissues is gradual.

The local effects of the tumour commonly cause headache and, less frequently, impairment of vision, particularly of the temporal ?eld of vision, as a result of pressure on the nerves to the eye. The tumour may damage the other pituitary cells giving rise to gonadal, thyroid or adrenocortical insu?ciency. The disease often becomes obvious in persons over about 45 years of age; they may also complain of excessive sweating, joint pains and lethargy. The diagnosis is con?rmed by measuring the level of growth hormone in the serum and by an X-ray of the skull which usually shows enlargement of the pituitary fossa.

Treatment The most e?ective treatment is surgically to remove the pituitary adenoma. This can usually be done through the nose and the sphenoid sinus, but large adenomas may need a full CRANIOTOMY. Surgery cures about 80 per cent of patients with a microadenoma and 40 per cent of those with a large lesion; the rate of recurrence is 5–10 per cent. For recurrences, or for patients un?t for surgery or who refuse it, a combination of irradiation and drugs may be helpful. Deep X-ray therapy to the pituitary fossa is less e?ective than surgery but may also be helpful, and recently more sophisticated X-ray techniques, such as gamma knife irradiation, have shown promise. Drugs – such as BROMOCRIPTINE, capergoline and quiangoline, which are dopamine agonists – lower growth-hormone levels in acromegaly and are particularly useful as an adjunct to radiotherapy. Drugs which inhibit growth-hormone release by competing for its receptors, octeotride and lanreotride, also have a place in treatment.

See www.niddk.nih.gov/health/endo/pubs/ acro/acro.htm

www.umm.edu/endocrin/acromegaly.htm... acromegaly

A chronic infectious condition caused by an anaerobic micro-organism, Actinomyces israelii, that often occurs as a COMMENSAL on the gums, teeth and tonsils. Commonest in adult men, the sites most affected are the jaw, lungs and intestine, though the disease can occur anywhere. Suppurating granulomatous tumours develop which discharge an oily, thick pus containing yellowish (‘sulphur’) granules. A slowly progressive condition, actinomycosis usually responds to antibiotic drugs but improvement may be slow and surgery is sometimes needed to drain infected sites. Early diagnosis is important. Treatment is with antibiotics such as penicillin and tetracyclines. The disease occurs in cattle, where it is known as woody tongue.... actinomycosis

A traditional Chinese method of healing by inserting thin needles into certain areas beneath the skin and rotating them. Its rationale is that disease is a manifestation of a disturbance of Yin and Yang energy in the body, and that acupuncture brings this energy back into balance by what is described as ‘the judicious stimulation or depression of the ?ow of energy in the various meridians’. What is still unclear to western doctors is why needling, which is the essence of acupuncture, should have the e?ect it is claimed to have. One theory is that the technique stimulates deep sensory nerves, promoting the production of pain-relieving ENDORPHINS. Of its e?cacy in skilled hands, however, there can be no question, and in China the technique is an alternative to anaesthesia for some operations. Acupuncture is increasingly used in the west, by medically quali?ed doctors as well as other practitioners of complementary medicine. As long as proper sterilisation procedures are followed, the treatment is safe: two recent and extensive UK studies detected no serious adverse effects.... acupuncture

An inflammation of one or several lymph nodes, or related lymphoid tissues.... adenitis

Malignant tumour of glandular epithelium.... adenocarcinoma

See NOSE, DISORDERS OF.... adenoids

Benign tumour of glandular epithelium.... adenoma

The abnormal union of two normally separate tissues. Adhesion may occur after in?ammation or surgery; the result is often a ?brous band between the adjacent tissues. Examples are adhesions between joint surfaces – which reduce mobility of a joint – or, after operation, between loops of intestine, where the ?brous band may cause obstruction. Movement of the heart may be restricted by adhesions between the organ and its membranous cover, the pericardial sac.... adhesion

Any substance given in concert with another to boost its activity. For instance, a CYTOTOXIC drug used to reinforce radiotherapy or surgery in the treatment of cancer is described as adjuvant therapy.

The term is also used to describe an ingredient added to a VACCINE to boost the immune system’s production of antibodies, thus enhancing the vaccine’s e?ectiveness in promoting immunity.... adjuvant

See PUBERTY.... adolescence

Also known as suprarenal glands, these are two small triangular ENDOCRINE GLANDS situated one upon the upper end of each kidney. (See diagram of ABDOMEN.)

Structure Each suprarenal gland has an enveloping layer of ?brous tissue. Within this, the gland shows two distinct parts: an outer, ?rm, deep-yellow cortical (see CORTEX) layer, and a central, soft, dark-brown medullary (see MEDULLA) portion. The cortical part consists of columns of cells running from the surface inwards, whilst in the medullary portion the cells are arranged irregularly and separated from one another by large capillary blood vessels.

Functions Removal of the suprarenal glands in animals is speedily followed by great muscular prostration and death within a few days. In human beings, disease of the suprarenal glands usually causes ADDISON’S DISEASE, in which the chief symptoms are increasing weakness and bronzing of the skin. The medulla of the glands produces a substance – ADRENALINE – the effects of which closely resemble those brought about by activity of the SYMPATHETIC NERVOUS SYSTEM: dilated pupils, hair standing on end, quickening and strengthening of the heartbeat, immobilisation of the gut, increased output of sugar from the liver into the bloodstream. Several hormones (called CORTICOSTEROIDS) are produced in the cortex of the gland and play a vital role in the metabolism of the body. Some (such as aldosterone) control the electrolyte balance of the body and help to maintain the blood pressure and blood volume. Others are concerned in carbohydrate metabolism, whilst others again are concerned with sex physiology. HYDROCORTISONE is the most important hormone of the adrenal cortex, controlling as it does the body’s use of carbohydrates, fats and proteins. It also helps to suppress in?ammatory reactions and has an in?uence on the immune system.... adrenal glands

See PLACENTA.... afterbirth

A sense of fear experienced in large open spaces and public places, agoraphobia is a symptom of psychological disorder (see MENTAL ILLNESS). There are said to be 300,000 sufferers in the United Kingdom. Those who suffer from what can be a most distressing condition can obtain help and advice from the National Phobics Society.... agoraphobia

Malaria... ague

See Acquired Immune Deficiency Syndrome.... aids

A colourless liquid, also called ethanol or ethyl-alcohol, produced by the fermentation of carbohydrates by yeast. Medically, alcohol is used as a solvent and an antiseptic; recreationally it is a widely used drug, taken in alcoholic drinks to give a pleasant taste as well as to relax, reduce inhibitions, and increase sociability. Taken to excess, alcohol causes much mental and physical harm – not just to the individual imbibing it, but often to their family, friends, community and work colleagues.

Alcohol depresses the central nervous system and disturbs both mental and physical functioning. Even small doses of alcohol will slow a person’s re?exes and concentration; potentially dangerous effects when, for example, driving or operating machinery. Drunkenness causes slurred speech, muddled thinking, amnesia (memory loss), drowsiness, erectile IMPOTENCE, poor coordination and dulled reactions – thereby making driving or operating machinery especially dangerous. Disinhibition may lead to extreme euphoria, irritability, misery or aggression, depending on the underlying mood at the start of drinking. Severe intoxication may lead to COMA and respiratory failure.

Persistent alcohol misuse leads to physical, mental, social and occupational problems, as well as to a risk of DEPENDENCE (see also ALCOHOL DEPENDENCE). Misuse may follow several patterns: regular but controlled heavy intake, ‘binge’ drinking, and dependence (alcoholism). The ?rst pattern usually leads to mainly physical problems such as gastritis, peptic ulcer, liver disease, heart disease and impotence. The second is most common among young men and usually leads to mainly social and occupational problems – getting into ?ghts, jeopardising personal relationships, overspending on alcohol at weekends, and missing days o? work because of hangovers. The third pattern – alcohol dependence – is the most serious, and can severely disrupt health and social stability.

Many researchers consider alcohol dependence to be an illness that runs in families, with a genetic component which is probably passed on as a vulnerable personality. But it is hard to disentangle genetic, environmental and social factors in such families. In the UK there are estimated to be around a million people suffering from alcohol dependence and a similar number who have di?culty controlling their consumption (together about 1:30 of the population).

Alcohol causes tolerance and both physical and psychological dependence (see DEPENDENCE for de?nitions). Dependent drinkers classically drink early in the morning to relieve overnight withdrawal symptoms. These symptoms include anxiety, restlessness, nausea and vomiting, and tremor. Sudden withdrawal from regular heavy drinking can lead to life-threatening delirium tremens (DTs), with severe tremor, hallucinations (often visual – seeing spiders and monsters, rather than the pink elephants of romantic myth), and CONVULSIONS. This must be treated urgently with sedative drugs, preferably by intravenous drip. Similar symptoms, plus severe INCOORDINATION and double-vision, can occur in WERNICKE’S ENCEPHALOPATHY, a serious neurological condition due to lack of the B vitamin thiamine (whose absorption from the stomach is markedly reduced by alcohol). If not treated urgently with injections of thiamine and other vitamins, this can lead to an irreversible form of brain damage called Korsako?’s psychosis, with severe amnesia. Finally, prolonged alcohol misuse can cause a form of dementia.

In addition to these severe neurological disorders, the wide range of life-threatening problems caused by heavy drinking includes HEPATITIS, liver CIRRHOSIS, pancreatitis (see PANCREAS, DISEASES OF), gastrointestinal haemorrhage, suicide and FETAL ALCOHOL SYNDROME; pregnant women should not drink alcohol as this syndrome may occur with more than a glass of wine or half-pint of beer a day. The social effects of alcohol misuse – such as marital breakdown, family violence and severe debt – can be equally devastating.

Treatment of alcohol-related problems is only moderately successful. First, many of the physical problems are treated in the short term by doctors who fail to spot, or never ask about, heavy drinking. Second, attempts at treating alcohol dependence by detoxi?cation or ‘drying out’ (substituting a tranquillising drug for alcohol and withdrawing it gradually over about a week) are not always followed-up by adequate support at home, so that drinking starts again. Home support by community alcohol teams comprising doctors, nurses, social workers and, when appropriate, probation o?cers is a recent development that may have better results. Many drinkers ?nd the voluntary organisation Alcoholics Anonymous (AA) and its related groups for relatives (Al-Anon) and teenagers (Alateen) helpful because total abstinence from alcohol is encouraged by intensive psychological and social support from fellow ex-drinkers.

Useful contacts are: Alcoholics Anonymous; Al-Anon Family Groups UK and Eire (including Alateen); Alcohol Concern; Alcohol Focus Scotland; and Alcohol and Substance Misuse.

1 standard drink =1 unit

=••• pint of beer

=1 measure of spirits

=1 glass of sherry or vermouth

=1 glass of wine

Limits within which alcohol is believed not to cause long-term health risks:... alcohol

See Sábila.... aloe

This condition, also known as mountain sickness, occurs in mountain climbers or hikers who have climbed too quickly to heights above 3,000 metres, thus failing to allow their bodies to acclimatise to altitude. The lower atmospheric pressure and shortage of oxygen result in hyperventilation – deep, quick breathing – and this reduces the amount of carbon dioxide in the blood. Nausea, anxiety and exhaustion are presenting symptoms, and seriously affected individuals may be acutely breathless because of pulmonary oedema (excess ?uid in the lungs). Gradual climbing over two or three days should prevent mountain sickness. In serious cases the individual must be brought down to hospital urgently. Most attacks, however, are mild.... altitude sickness

Amnesia means loss of memory.... amnesia

Severance of a limb, or part of a limb, from the rest of the body. The leg is the most common site of amputation. It is usually performed as a controlled operation and may be required for a variety of reasons. In the young, severe injury is the most common cause, when damage to the limb is so extensive as to make it non-viable or functionally useless. In the elderly, amputation is more often the result of vascular insu?ciency, resulting in gangrene or intractable pain.

Sarcoma (see CANCER) of bone, muscle or connective tissues in a limb is another reason for amputation.

The aim is to restore the patient to full mobility with a prosthetic (arti?cial) limb, which requires both a well-?tting PROSTHESIS and a well-healed surgical wound. If this is not possible, the aim is to leave the patient with a limb stump that is still useful for balancing, sitting and transferring. Common types of lower-limb amputation are shown in the illustration. The Symes amputation can be walked upon without requiring a prosthesis. The below-knee amputation preserves normal ?exion of the knee, and virtually normal walking can be achieved with a well-?tting arti?cial limb. Learning to walk is more di?cult following an above-knee amputation, but some highly motivated patients can manage well. After any amputation it is not unusual for the patient to experience the sensation that the limb is still present: this is called a ‘PHANTOM LIMB’ and the sensation may persist for a long time.... amputation

Pain reduction or relief.... analgesia

Relieving pain... analgesic

A localised swelling or dilatation of an artery (see ARTERIES) due to weakening of its wall. The most common sites are the AORTA, the arteries of the legs, the carotids and the subclavian arteries. The aorta is the largest artery in the body and an aneurysm may develop anywhere in it. A dissecting aneurysm usually occurs in the ?rst part of the aorta: it is the result of degeneration in the vessel’s muscular coat leading to a tear in the lining; blood then enters the wall and tracks along (dissects) the muscular coat. The aneurysm may rupture or compress the blood vessels originating from the aorta: the outcome is an INFARCTION in the organs supplied by the affected vessel(s). Aneurysms may also form in the arteries at the base of the brain, usually due to an inherited defect of the arterial wall.

Aneurysms generally arise in the elderly, with men affected more commonly than women. The most common cause is degenerative atheromatous disease, but other rarer causes include trauma, inherited conditions such as MARFAN’S SYNDROME, or acquired conditions such as SYPHILIS or POLYARTERITIS NODOSA. Once formed, the pressure of the circulating blood within the aneurysm causes it to increase in size. At ?rst, there may be no symptoms or signs, but as the aneurysm enlarges it becomes detectable as a swelling which pulsates with each heartbeat. It may also cause pain due to pressure on local nerves or bones. Rupture of the aneurysm may occur at any time, but is much more likely when the aneurysm is large. Rupture is usually a surgical emergency, because the bleeding is arterial and therefore considerable amounts of blood may be lost very rapidly, leading to collapse, shock and even death. Rupture of an aneurysm in the circle of Willis causes subarachnoid haemorrhage, a life-threatening event. Rupture of an aneurysm in the abdominal aorta is also life-threatening.

Treatment Treatment is usually surgical. Once an aneurysm has formed, the tendency is for it to enlarge progressively regardless of any medical therapy. The surgery is often demanding and is therefore usually undertaken only when the aneurysm is large and the risk of rupture is therefore increased. The patient’s general ?tness for surgery is also an important consideration. The surgery usually involves either bypassing or replacing the affected part of the artery using a conduit made either of vein or of a man-made ?bre which has been woven or knitted into a tube. Routine X-ray scanning of the abdominal aorta is a valuable preventive procedure, enabling ‘cold’ surgery to be performed on identi?ed aneurysms.... aneurysm

A feeling of constriction or su?ocation often accompanied by pain (see ANGINA PECTORIS).... angina

A painful chronic heart condition, characterized by an oppressive sensation, difficulty breathing, and pain in the chest or arms. Attacks are often triggered by exertion or a sudden adrenergic discharge, and the underlying cause is insufficient blood supply to the heart muscles... angina pectoris

Angelica archangelica. N.O. Umbelliferae.

Synonym: Garden Angelica.

Habitat: Marshes and watery places generally.

Features ? Stem up to five feet high ; erect, shiny, striated. Leaves lanceolate, serrate, terminal leaflet lobed. Umbels globular. Root fleshy, aromatic, much branched below.

Part used ? Root, herb, seed.

Action: Carminative, stimulant, expectorant, diaphoretic, diuretic.

Infusion of 1 ounce herb to 1 pint boiling water. Dose, a wineglassful frequently. Used in coughs, colds, urinary disorders. The sweetmeat known as candied angelica is made by preserving the dried leaf stalks with sugar.... angelica

A substance formed in tissues or blood vessels when there needs to be local or even massive vasoconstriction. The primary precursor is renin, made by the kidneys, and elevated when the blood seems dehydrated or low in volume; the next substance needed for this reaction is a liver protein, angiotensinogen; when both are present in the blood, local factors can then form this pressor substance. Excess production is often implicated in high blood pressure.... angiotensin

See SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.... ankylosing spondylitis

See under EATING DISORDERS.... anorexia nervosa

That state in which the body tissues have an inadequate supply of OXYGEN. This may be because the blood in the lungs does not receive enough oxygen, or because there is not enough blood to receive the oxygen, or because the blood stagnates in the body.... anoxia

Complete cessation of the secretion and excretion of urine... anuria

In nematodes, an opening of the alimentary system on the ventral side at the posterior end of the female nematodes.... anus

Narrowing of the AORTIC VALVE in the HEART which obstructs the ?ow of blood through it, with serious effects on the heart and the circulation. The muscle in the left ventricle works harder to compensate for the obstruction and thickens as a result. Stenosis is usually caused by the deposition of calcium on the valve and is commonly associated with ATHEROMA. Untreated, the condition leads to heart failure, but nowadays the stenosis can be treated surgically.... aortic stenosis

Inability to speak caused by disease in or injury to the cerebral cortex in the left half of the BRAIN (in a right-handed person), affecting the generation and content of speech as well as the understanding of language; often accompanied by problems with reading and writing (see DYSPHASIA). Comprehension and expression of language occur in two zones of the cerebral cortex (the outer layer of the main part of the brain). They are known as Wernicke’s area (comprehension) and Broca’s area (speech formulation).... aphasia

A drug which stimulates sexual desire... aphrodisiac

This is an in?ammatory condition of the APPENDIX, and is a common surgical emergency, affecting mainly adolescents and young adults. It is usually due to a combination of obstruction and infection of the appendix, and has a variable clinical course ranging from episodes of mild self-limiting abdominal pain to life-threatening illness. Abdominal pain beginning in the centre of the abdomen but which later shifts position to the right iliac fossa is the classic symptom. The patient usually has accompanying fever and sometimes nausea, vomiting, loss of appetite, diarrhoea, or even constipation. The precise symptoms vary with the exact location of the appendix within the abdomen. In some individuals the appendix may ‘grumble’ with repeated mild attacks which resolve spontaneously. In an acute attack, the in?ammatory process begins ?rst in the wall of the appendix but, if the disease progresses, the appendix can become secondarily infected and pus may form within it. The blood supply may become compromised and the wall become gangrenous. Eventually the appendix may rupture, giving rise to a localised abscess in the abdomen or, more rarely, free pus within the abdomen which causes generalised PERITONITIS. Rupture of the appendix is a serious complication and the patient may be severely unwell. Surgeons recognise that in order to make sure patients with appendicitis do not progress to peritonitis, a certain percentage of normal appendixes are removed when clinical signs are suspicious but not diagnostic of disease.

Treatment The best treatment is prompt surgical removal of the diseased appendix, usually with antibiotic cover. If performed early, before rupture occurs, APPENDICECTOMY is normally straightforward and recovery swift. If the appendix has already ruptured and there is abscess formation or free intra-abdominal pus, surgery is still the best treatment but postoperative complications are more likely, and full recovery may be slower.... appendicitis

Arteritis means in?ammation of an artery (see ARTERIES, DISEASES OF).... arteritis

Pain in joint... arthralgia

A form of PNEUMOCONIOSIS, in which widespread ?ne scarring occurs in the LUNGS, leading to severe breathing disability. The main hazard, however, is the risk of cancer (MESOTHELIOMA) of the lung or PLEURA, or sometimes of the ovary (see OVARIES). It is caused by the inhalation of mainly blue or brown asbestos dust, either during mining or quarrying, or in one of the many industries in which it is used – for example, as an insulating material, in the making of paper, cardboard and brake linings. A person suffering from asbestosis is entitled to compensation, as the disease is legally proscribed. About 900 people a year in the UK claim compensation, and 600 of these for mesothelioma; most patients with asbestosis now being diagnosed have it as a consequence of industrial practices used before 1970. The use of asbestos is now strictly controlled and, when blue asbestos is found in old buildings, skilled workmen are employed to dispose of it.... asbestosis

Asparagus officinalis

Description: The spring growth of this plant resembles a cluster of green fingers. The mature plant has fernlike, wispy foliage and red berries. Its flowers are small and greenish in color. Several species have sharp, thornlike structures.

Habitat and Distribution: Asparagus is found worldwide in temperate areas. Look for it in fields, old homesites, and fencerows.

Edible Parts: Eat the young stems before leaves form. Steam or boil them for 10 to 15 minutes before eating. Raw asparagus may cause nausea or diarrhea. The fleshy roots are a good source of starch.... asparagus

Infection caused by the opportunistic saprophytic fungus, Aspergillus. Can include the effects of aflatoxin which is formed by the fungi growing on mouldy foods such as peanuts and which can be associated with cancer of the liver.... aspergillosis

Inability to breath... asphyxia

Aspirin or acetylsalicylic acid is a white crystalline powder which is used like sodium salicylate as a remedy for reducing in?ammation and fever. Taken orally, it has some action in relieving pain and producing sleep and is therefore often used for headache and slighter degrees of insomnia (sleeplessness). Daily doses are now used in the prevention of coronary thrombosis (see HEART, DISEASES OF); the dose is 75–300 mg. Aspirin should be used with caution in people with DYSPEPSIA or PEPTIC ULCER. (See also ANALGESICS.)... aspirin

Absence of visible contraction of the heart, and consequent circulation of the blood, resulting rapidly in death. This may occur after envenomation.... asystole

Degenerative changes in the inner and middle coats of arteries. (See ARTERIES, DISEASES OF.)... atheroma

A form of arteriosclerosis, in which there is fatty degeneration of the middle coat of the arterial wall. (See ARTERIES, DISEASES OF.)... atherosclerosis

Absence of tone or vigour in muscles and other organs.... atony

Wasting of a tissue or organ... atrophy

An alkaloid derived from Belladonna (Atropa belladonna) and related plants that blocks some cholinergic or parasympathetic functions. It has been used to stop the cramps of diarrhea and is still found in some OTC cold remedies, since it dries up secretions. The main current medical use is in eye drops used to dilate the pupil.... atropine

The peculiar feeling which persons who are subject to epileptic seizures (see EPILEPSY) experience just before the onset of an attack. It may be a sensation of a cold breeze, a peculiar smell, a vision of some animal or person, or an unde?nable sense of disgust. An aura gives warning that a ?t is coming and may enable a place of safety or seclusion to be reached. It may also occur as a precursor to a MIGRAINE headache.... aura

A disorder, thought to be caused by a brain abnormality, that leads to a lifelong inability to relate in an ordinary way to people and situations. Autism is usually diagnosed before the age of three. It is rare, affecting around 20 people in every 10,000, and is three times more common in boys than in girls. The main features are a profound inability to form social relationships, delayed speech development, and a tendency to perform repeated compulsive actions or rituals. There is no cure at present, but behaviour therapy can help children to lead more normal lives.... autism

A colourless, pungent, fuming liquid. Secreted by the parietal cells in the lining of the stomach, it aids in the digestion of the food.... hydrochloric acid

Cessation of breathing, often caused by envenomation (or poisoning).... respiratory arrest

The final end product of certain native or dietary proteins, especially the nucleoproteins found in the nucleus of cells. Unlike the much smaller nitrogenous waste product urea, which is mostly recycled to form many amino acids, uric acid is an unrecyclable metabolite. It is a bent nail that won’t restraighten, and it must be excreted: nucleoprotein to purine to uric acid to the outside in the urine or the sweat. (See GOUT, PURINES.)... uric acid

The external use of essential oils from seeds, resins, herbs, barks and spices for relaxant purposes.

Plant essences give plants their scent and were known to the ancient civilisations of Egypt and Greece as the ‘vital force’ or spirit of the plant. They were used for inhalation, rubbing on the skin or as a healthful addition to baths and foot-baths. The art is complementary to phytotherapy, acupuncture and other systems of alternative medicine.

The aromatherapist uses oils individually or in blends of different oils. The natural concentrated oil is usually diluted by adding a vegetable oil before direct application to the skin. A massage oil usually comprises 6 drops essential oil to 10ml (2 teaspoons) carrier oil – Almond, Peanut or other vegetable oil.

The skin is known to be an integral part of the immune system. T-cells are scattered throughout, primarily in the epidermis or outer layer. It has been demonstrated that oils rubbed on the skin are readily absorbed and borne to distant organs in the body via the bloodstream to soothe, relax and heal. Some oils should not be used during pregnancy or lactation.

An oil may be used as a natural perfume. As a bath oil, 5-6 drops of a favourite oil may be added to bathwater. Oils freshen a room; stimulate or relax as desired when added to water on a warm radiator. Oils are never used on the skin undiluted.

The aromatherapist never uses essential oils internally. Other carrier oils may be used: Sesame seed, Sunflower seed, Apricot kernel and Wheatgerm. Usual methods of applying essential oils: massage, inhalation and baths. When adding oils to baths water should not be too hot which causes oils to evaporate.

Remedies absorbed into the body via the skin avoid metabolism by the liver as when taken by mouth.

When the therapy was used in a geriatric ward in Oxford drug expenditure on laxatives and night sedatives fell. It was reported to have given profoundly deaf patients, many of whom had multiple sensory deficits, tranquillity. The results of a randomised trial in patients on an intensive care unit showed significantly greater psychological improvement (as demonstrated with anxiety and mood rating scales) in those given aromatherapy (1 per cent Lavender and Grapeseed oil) over those massaged with Grapeseed oil only or those prescribed rest alone. (The Lancet 1990 336 (8723) 1120)

The governing body of the therapy in the UK is the Aromatherapy Organisations Council (AOC) which represents the majority of professional practitioners. Enquiries: AOC, 3 Latymer Close, Braybrooke, Market Harborough. Leicester LE16 8LN. Tel/Fax 01858 434242. ... aromatherapy

The lower part of the trunk. Above, and separated from it by the diaphragm, lies the thorax or chest, and below lies the PELVIS, generally described as a separate cavity though continuous with that of the abdomen. Behind are the SPINAL COLUMN and lower ribs, which come within a few inches of the iliac bones. At the sides the contained organs are protected by the iliac bones and down-sloping ribs, but in front the whole extent is protected only by soft tissues. The latter consist of the skin, a varying amount of fat, three layers of broad, ?at muscle, another layer of fat, and ?nally the smooth, thin PERITONEUM which lines the whole cavity. These soft tissues allow the necessary distension when food is taken into the STOMACH, and the various important movements of the organs associated with digestion. The shape of the abdomen varies; in children it may protrude considerably, though if this is too marked it may indicate disease. In healthy young adults it should be either slightly prominent or slightly indrawn, and should show the outline of the muscular layer, especially of the pair of muscles running vertically (recti), which are divided into four or ?ve sections by transverse lines. In older people fat is usually deposited on and inside the abdomen. In pregnancy the abdomen enlarges from the 12th week after conception as the FETUS in the UTERUS grows (see PREGNANCY AND LABOUR; ANTENATAL CARE).

Contents The principal contents of the abdominal cavity are the digestive organs, i.e. the stomach and INTESTINE, and the associated glands, the LIVER and PANCREAS. The position

of the stomach is above and to the left when the individual is lying down, but may be much lower when standing. The liver lies above and to the right, largely under cover of the ribs, and occupying the hollow of the diaphragm. The two KIDNEYS lie against the back wall on either side, protected by the last two ribs. From the kidneys run the URETERS, or urinary ducts, down along the back wall to the URINARY BLADDER in the pelvis. The pancreas lies across the spine between the kidneys, and on the upper end of each kidney is a suprarenal gland

(see ADRENAL GLANDS). The SPLEEN is positioned high up on the left and partly behind the stomach. The great blood vessels and nerves lie on the back wall, and the remainder of the space is taken up by the intestines or bowels (see INTESTINE). The large intestine lies in the ?anks on either side in front of the kidneys, crossing below the stomach from right to left, while the small intestine hangs from the back wall in coils which ?ll up the spaces between the other organs. Hanging down from the stomach in front of the bowels is the OMENTUM, or apron, containing much fat and helping to protect the bowels. In pregnancy the UTERUS, or womb, rises up from the pelvis into the abdomen as it increases in size, lifting the coils of the small intestine above it.

The PELVIS is the part of the abdomen within the bony pelvis (see BONE), and contains the rectum or end part of the intestine, the bladder, and in the male the PROSTATE GLAND; in the female the uterus, OVARIES, and FALLOPIAN TUBES.... abdomen

Ablation means the removal of any part of the body by a surgical operation.... ablation

An emotional release caused by the recall of past unpleasant experiences. This is normally the result of psychoanalytical treatment in which psychotherapy, certain drugs, or hypnosis (see HYPNOTISM) are used to e?ect the abreaction. The technique is used in the treatment of anxiety, hysteria, or other neurotic states.... abreaction

Uptake by the body tissues of ?uids or other substances. For example, food is absorbed from the digestive tract into the blood and lymph systems. Food is absorbed mainly in the small INTESTINE (jejunum and ileum), which is lined by multiple villi that increase its surface area. (See also DIGESTION; ASSIMILATION.)... absorption

Abortion is de?ned as the expulsion of a FETUS before it is normally viable, usually before 24 weeks of pregnancy. (There are exceptional cases nowadays in which fetuses as young as 22 weeks’ gestation have survived.) (See also PREGNANCY AND LABOUR.)

Spontaneous abortion Often called miscarriage, this may occur at any time before 28 weeks; 85 per cent occur in the ?rst 12 weeks of pregnancy. Of all diagnosed pregnancies, 25 per cent end in spontaneous abortion.

Spontaneous abortions occurring in early pregnancy are almost always associated with chromosomal abnormalities of the fetus. Other causes are uterine shape, maternal disorders such as DIABETES MELLITUS, diseases of the thyroid gland (see under ENDOCRINE GLANDS), and problems with the immune system (see IMMUNITY). Recurrent spontaneous abortion (that is, three or more) seems to be a particular problem in women who have an abnormal response of their immune system to pregnancy. Other factors include being older, having had a lot of babies previously, cigarette smoking and spontaneous (but not therapeutic) abortions in the past.

Early ULTRASOUND scans have altered the management of spontaneous abortions. These make it possible to distinguish between threatened abortion, where a woman has had some vaginal bleeding but the fetus is alive; inevitable abortion, where the neck of the uterus has started to open up; incomplete abortion, where part of the fetus or placenta is lost but some remains inside the uterus; and complete abortion. There is no evidence that bed rest is e?ective in stopping a threatened abortion becoming inevitable.

Inevitable or incomplete abortion will usually require a gynaecologist to empty (evacuate) the uterus. (Complete miscarriage requires no treatment.) Evacuation of the uterus is carried out using local or general anaesthetic, usually gentle dilatation of the neck of the uterus (cervix), and curetting-out the remaining products of the pregnancy.

A few late abortions are associated with the cervix opening too early, abnormal structural abnormalities of the uterus, and possibly infection in the mother.

Drugs are often used to suppress uterine contractions, but evidence-based studies show that these do not generally improve fetal salvage. In proven cases of cervical incompetence, the cervix can be closed with a suture which is removed at 37 weeks’ gestation. The evidence for the value of this procedure is uncertain.

Therapeutic abortion In the UK, before an abortion procedure is legally permitted, two doctors must agree and sign a form de?ned under the 1967 Abortion Act that the continuation of the pregnancy would involve risk – greater than if the pregnancy were terminated – of injury to the physical and/or mental health of the mother or any existing child(ren).

Legislation in 1990 modi?ed the Act, which had previously stated that, at the time of the abortion, the pregnancy should not have exceeded the 24th week. Now, an abortion may legally be performed if continuing the pregnancy would risk the woman’s life, or the mental health of the woman or her existing child(ren) is at risk, or if there is a substantial risk of serious handicap to the baby. In 95 per cent of therapeutic terminations in the UK the reason is ‘risk of injury to the physical or mental health of the woman’.

There is no time limit on therapeutic abortion where the termination is done to save the mother’s life, there is substantial risk of serious fetal handicap, or of grave permanent injury to the health of the mother.

About 190,000 terminations are carried out in the UK each year and only 1–1.5 per cent are over 20 weeks’ gestation, with the vast majority of these late abortions being for severe, late-diagnosed, fetal abnormality.

The maternal mortality from therapeutic abortion is less than 1 per 100,000 women and, provided that the procedure is performed skilfully by experienced doctors before 12 weeks of pregnancy, it is very safe. There is no evidence that therapeutic abortion is associated with any reduction in future fertility, increased rates of spontaneous abortion or preterm birth in subsequent pregnancies.

Methods of abortion All abortions must be carried out in premises licensed for doing so or in NHS hospitals. The method used is either surgical or medical, with the latter being used more and the former less as time goes on. Proper consent must be obtained, signed for and witnessed. Women under 16 years of age can consent to termination provided that the doctors obtaining the consent are sure she clearly understands the procedure and its implications. Parental consent in the under-16s is not legally required, but counselling doctors have a duty to record that they have advised young people to inform their parents. However, many youngsters do not do so. The woman’s partner has no legal say in the decision to terminate her pregnancy.

MEDICAL METHODS A combination of two drugs, mifepristone and a prostaglandin (or a prostaglandin-like drug, misoprostol – see PROSTAGLANDINS), may be used to terminate a pregnancy up to 63 days’ gestation. A similar regime can be used between nine and 12 weeks but at this gestation there is a 5 per cent risk of post-treatment HAEMORRHAGE.

An ultrasound scan is ?rst done to con?rm pregnancy and gestation. The sac containing the developing placenta and fetus must be in the uterus; the woman must be under 35 years of age if she is a moderate smoker, but can be over 35 if she is a non-smoker. Reasons for not using this method include women with diseases of the ADRENAL GLANDS, on long-term CORTICOSTEROIDS, and those who have a haemorrhagic disorder or who are on ANTICOAGULANTS. The drugs cannot be used in women with severe liver or kidney disease, and caution is required in those with CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), disease of the cardiovascular system, or prosthetic heart valves (see PROSTHESIS), as well as with those who have had a CAESAREAN SECTION or an ECTOPIC PREGNANCY in the past or who are being treated for HYPERTENSION.

Some clinics use this drug combination for pregnancies older than 12 weeks. In pregnancies approaching viability (20 weeks), pretreatment fetocide (killing of the fetus) with intrauterine drug therapy may be required.

SURGICAL METHODS Vacuum curettage is a method used up to 14–15 weeks. Some very experienced gynaecologists will perform abortions surgically by dilating the cervix and evacuating the uterine contents up to 22 weeks’ gestation. The greater the size of the pregnancy, the higher the risk of haemorrhage and perforation of the uterus. In the UK, illegal abortion is rare but in other countries this is not the case. Where illegal abortions are done, the risks of infection and perforation are high and death a de?nite risk. Legal abortions are generally safe. In the USA, partial-birth abortions are spoken of but, in fact, there is no such procedure recorded in the UK medical journals.... abortion

Acacia farnesiana

Description: Acacia is a spreading, usually short tree with spines and alternate compound leaves. Its individual leaflets are small. Its flowers are ball-shaped, bright yellow, and very fragrant. Its bark is a whitish-gray color. Its fruits are dark brown and podlike.

Habitat and Distribution: Acacia grows in open, sunny areas. It is found throughout all tropical regions.

Note: There are about 500 species of acacia. These plants are especially prevalent in Africa, southern Asia, and Australia, but many species are found in the warmer and drier parts of America.

Edible Parts: Its young leaves, flowers, and pods are edible raw or cooked.... acacia

The process by which the refractive power of the lens of the EYE is increased by constriction of the ciliary muscle, producing an increased thickness and curvature of the lens. Rays of light from an object further than 6 metres away are parallel on reaching the eye. These rays are brought to a focus on the retina, mainly by the cornea. If the eye is now directed at an object

closer than 6 metres away, the rays of light from this near object will be diverging by the time they reach the eye. In order to focus these diverging beams of light, the refracting power of the lens must increase. In other words the lens must accommodate.

The lens loses its elasticity with age, and thus becomes less spherical when tension in the zonule relaxes. This results in an increased longsightedness (presbyopia) requiring reading glasses for correction. (See AGEING.)... accommodation

Acetazolamide is a sulphonamide drug which acts by inhibiting the ENZYME, carbonic anhydrase. This enzyme is of great importance in the production of acid and alkaline secretions in the body. Acetazolamide is sometimes used as a second-line drug for partial seizures in EPILEPSY. It also has a diuretic action (see DIURETICS) and is used to treat GLAUCOMA. The drug has a range of side-effects. Related agents include dorzolamide and brinzolamide, used as eye-drops in patients resistant to beta blockers or who have contraindications to them.... acetazolamide

Acetylcysteine is a MUCOLYTIC drug that is used in the treatment of CYSTIC FIBROSIS and PARACETAMOL POISONING.... acetylcysteine

Achalasia is another term for SPASM, but indicates not so much an active spasm of muscle as a failure to relax.... achalasia

An acetic-acid ester of the organic base choline, acetylcholine is one of the substances which mediates the transmission of nerve impulses from one nerve to another, or from a nerve to the organ it acts on, such as muscles. It acts on both muscarinic receptors (blocked by ATROPINE and responsible for ganglionic and parasympathetic transmission and also for sympathetic innervation of sweat glands – see under AUTONOMIC NERVOUS SYSTEM) and nicotinic receptors (responsible for the transmission of nerve impulses to muscles and blocked by curare, thus causing paralysis). Acetylcholine is rapidly destroyed by cholinesterase, an ENZYME present in the blood. ANTICHOLINERGIC drugs such as PHYSOSTIGMINE prolong the action of acetylcholine.... acetylcholine

The commonest form of inherited retarded growth. It is a dominant hereditary disorder of endochondral ossi?cation, caused by mutations of ?broblast growth factor receptor 3 genes.The long bones of the arms and legs fail to grow properly, while the trunk and head develop normally. Achondroplasia affects both sexes and, while many infants are stillborn or die soon after birth, those who survive have normal intelligence, a normal expectation of life and good health.... achondroplasia

Aciclovir is an antiviral drug that inhibits DNA synthesis in cells infected by HERPES VIRUSES, although it does not eradicate them. It is only e?ective if started at the onset of infection; uses include the systemic treatment of herpes simplex infections of the skin and mucous membranes (including genital herpes), as well as of varicella-zoster (chickenpox) pneumonia and encephalitis. It is also used topically in the eye. It is especially valuable for the treatment of herpes infections in those with IMMUNODEFICIENCY and may be required for the prevention of recurrence and for prophylaxis – indeed, it may be life-saving. Similar medications include famciclovir and valaciclovir.... aciclovir

That part of the scapula, or shoulder blade, forming the tip of the shoulder and giving its squareness to the latter. It projects forwards from the scapula, and, with the CLAVICLE or collar-bone in front, forms a protective arch of bone over the shoulder-joint.... acromion

A disorder occurring predominantly in middle-aged women in which there is numbness and tingling of the ?ngers.... acroparaesthesia

See DEPENDENCE.... addiction

See ATTENTION DEFICIT DISORDER (HYPERACTIVITY SYNDROME).... adhd

Adipose tissue, or fat, is a loose variety of ?brous tissue in the meshes of which lie cells, each of which is distended by several small drops, or one large drop, of fat. This tissue replaces ?brous tissue when the amount of food taken is in excess of the bodily requirements. Adipose tissue occurs as a layer beneath the skin and also around several internal organs. (See DIET; FAT; OBESITY.)... adipose tissue

Adrenaline is the secretion of the adrenal medulla (see ADRENAL GLANDS). Its e?ect is similar to stimulation of the SYMPATHETIC NERVOUS SYSTEM as occurs when a person is excited, shocked or frightened. In the United States Pharmacopoeia it is known as epinephrine. It is also prepared synthetically. Among its important effects are raising of the blood pressure, increasing the amount of glucose in the blood, and constricting the smaller blood vessels.

Adrenaline has an important use when injected intramuscularly or intravenously in the treatment of ANAPHYLAXIS. Many patients prone to this condition are prescribed a pre-assembled adrenaline-containing syringe and needle (Min-i-Jet, Epipen) and are taught how to self-administer in an emergency. Adrenaline may be applied directly to wounds, on gauze or lint, to check haemorrhage; injected along with some local anaesthetic it permits painless, bloodless operations to be performed on the eye, nose, etc. Nowadays it is rarely, if ever, used hypodermically and is no longer given to treat ASTHMA. In severe cardiac arrest, adrenaline (1 in 10,000) by central intravenous injection is recommended. It can be given through an endotracheal tube as part of neonatal resuscitation.... adrenaline

An inherited condition, the adrenogenital syndrome – also known as congenital adrenal hyperplasia – is an uncommon disorder affecting about 1 baby in 7,500. The condition is present from birth and causes various ENZYME defects as well as blocking the production of HYDROCORTISONE and ALDOSTERONE by the ADRENAL GLANDS. In girls the syndrome often produces VIRILISATION of the genital tract, often with gross enlargement of the clitoris and fusion of the labia so that the genitalia may be mistaken for a malformed penis. The metabolism of salt and water may be disturbed, causing dehydration, low blood pressure and weight loss; this can produce collapse at a few days or weeks of age. Enlargement of the adrenal glands occurs and the affected individual may also develop excessive pigmentation in the skin.

When virilisation is noted at birth, great care must be taken to determine genetic sex by karyotyping: parents should be reassured as to the baby’s sex (never ‘in between’). Blood levels of adrenal hormones are measured to obtain a precise diagnosis. Traditionally, doctors have advised parents to ‘choose’ their child’s gender on the basis of discussing the likely condition of the genitalia after puberty. Thus, where the phallus is likely to be inadequate as a male organ, it may be preferred to rear the child as female. Surgery is usually advised in the ?rst two years to deal with clitoromegaly but parent/ patient pressure groups, especially in the US, have declared it wrong to consider surgery until the children are competent to make their own decision.

Other treatment requires replacement of the missing hormones which, if started early, may lead to normal sexual development. There is still controversy surrounding the ethics of gender reassignment.

See www.baps.org.uk... adrenogenital syndrome

Pains similar to but feebler than those of labour, occurring in the two or three days following childbirth. (See PREGNANCY AND LABOUR.)

Causes are generally the presence of a blood clot or retained piece of PLACENTA which the womb (see UTERUS) is attempting to expel.... afterpains

An inherited condition found in male infants, in which there is no GAMMA-GLOBULIN in the blood. These children are particularly susceptible to infections, as they are unable to form ANTIBODIES to any infecting micro-organism. Acquired agammaglobulinaemia is a rare disorder occurring in both sexes in their 20s and 40s, characterised by recurrent bacterial infections. The cause is a disturbance in the working of the immune system. (See IMMUNITY.)... agammaglobulinaemia

Also known as agar-agar. A gelatinous substance made from seaweed, agar is used in preparing culture-media for use in bacteriological laboratories; it is also sometimes used to treat constipation.... agar

Agave species

Description: These plants have large clusters of thick, fleshy leaves borne close to the ground and surrounding a central stalk. The plants flower only once, then die. They produce a massive flower stalk.

Habitat and Distribution: Agaves prefer dry, open areas. They are found throughout Central America, the Caribbean, and parts of the western deserts of the United States and Mexico.

Edible Parts: Its flowers and flower buds are edible. Boil them before eating.

CAUTION

The juice of some species causes dermatitis in some individuals.

Other Uses: Cut the huge flower stalk and collect the juice for drinking. Some species have very fibrous leaves. Pound the leaves and remove the fibers for weaving and making ropes. Most species have thick, sharp needles at the tips of the leaves. Use them for sewing or making hacks. The sap of some species contains a chemical that makes the sap suitable for use as a soap.... agave

Agenesis means incomplete development, or the failure of any part or organ of the body to develop normally.... agenesis

The condition in which, in certain diseases of the brain, the patient loses the ability to recognise the character of objects through the senses

– touch, taste, sight, hearing.... agnosia

(1) A muscle which contracts and causes a movement. Contraction of an agonist is complemented by relaxation of its antagonist (see below).

(2) A drug that acts through receptors on the surface of the cell or within the cell and provokes a biological response. As the body contains natural agonists that combine with cell receptors, any ‘occupation’ of these cell receptors by drug molecules will have a pharmacological e?ect on the individual. The intensity of that pharmacological e?ect is believed to be directly proportional to the number of receptors on the cell that combine with the drug molecule. For example, the natural agonist noradrenaline contracts the smooth muscle of blood vessels; the drug agonist phenylnephrine has a similar e?ect.

Antagonists are drugs which will combine with the receptor site to prevent another agent from producing its greatest e?ect. If the drug has no e?cacy of its own, but simply prevents the agonist from acting at the receptor site, it is called a full antagonist. A partial antagonist is a drug that provokes some activity at the receptor site. An example of an antagonist is prazosin, which acts against the natural agonist noradrenaline at the receptor site of the cells of blood-vessel muscle and prevents the vascular muscle from contracting.... agonist

A condition in which the white cells or LEUCOCYTES in the blood of the polynuclear or granular variety become greatly lessened in numbers or disappear altogether. It is usually caused by taking such drugs as amidopyrine, thiourea, sulphonamides, chloramphenicol and the immunosuppressant drugs.... agranulocytosis

Loss of power to express ideas by writing. (See APHASIA.)... agraphia

Agrimonia eupatoria. N.O. Rosaceae.

Synonym: Stickwort.

Habitat: Hedgerows, field borders and dry waste places.

Features ? One of our prettiest wild plants, the erect, round, hairy stem reaching a height of two feet. The numerous pinnate leaves, hairy on both sides, and 5-6 inches long, grow alternately, having 3-5 pairs of lanceolate, toothed leaflets, with intermediate smaller ones, and still smaller ones between these. The many small, star-like, bright yellow flowers are arranged in long, tapering spikes. The root is woody, and the seeds form little burs, the taste being astringent and slightly bitter.

Part used ? The whole herb.

Action: Acts as a mild astringent, tonic and diuretic, these qualities being useful in loose coughs and relaxed bowels.

Agrimony is an old remedy for debility, as it gives tone to the whole

system. It is administered as a decoction of one ounce to 1 1/2 pints water, simmered down to 1 pint, in half teacupful or larger doses, and may be sweetened with honey or black treacle if desired. The herb has been recommended for dyspepsia, but is probably only useful in this disorder when carefully combined with other more directly operating agents.... agrimony

Loss or impairment of voluntary movement, or immobility. It is characteristically seen in PARKINSONISM.... akinesia

A group of inherited disorders characterised by absence of or decrease in MELANIN in the skin, hair and eyes. The skin is pink, the hair white or pale yellow, and the iris of the eye translucent. Nystagmus (see under EYE, DISORDERS OF), PHOTOPHOBIA, SQUINT and poor eyesight are common. Photoprotection of both skin and eyes is essential. In the tropics, light-induced skin cancer may develop early.... albinism

Aldosterone is a hormone secreted by the adrenal cortex (see ADRENAL GLANDS). It plays an important part in maintaining the electrolyte balance of the body by promoting the reabsorption of sodium and the secretion of potassium by the renal tubules. It is thus of primary importance in controlling the volume of the body ?uids.... aldosterone

Alexia is another name for WORD BLINDNESS. (See also APHASIA; DYSLEXIA.)... alexia

Alkalosis means an increase in the alkalinity (see ALKALI) of the blood, or, more accurately, a decrease in the concentration of hydrogen ions in the blood. It occurs, for example, in patients who have had large doses of alkalis for the treatment of gastric ulcer. (See ACID BASE BALANCE; ACIDOSIS.)... alkalosis

Substances found commonly in various plants. They are natural nitrogenous organic bases and combine with acids to form crystalline salts. Among alkaloids, morphine was discovered in 1805, strychnine in 1818, quinine and ca?eine in 1820, nicotine in 1829, and atropine in 1833. Only a few alkaloids occur in the animal kingdom, the outstanding example being ADRENALINE, which is formed in the medulla of the suprarenal, or adrenal, gland. Alkaloids are often used for medicinal purposes. The name of an alkaloid ends in ‘ine’ (in Latin, ‘ina’).

Neutral principals are crystalline substances with actions similar to those of alkaloids but having a neutral reaction. The name of a neutral principal ends in ‘in’, e.g. digitalin, aloin.

The following are the more important alkaloids, with their source plants:

Aconite, from Monkshood.

Atropine, from Belladonna (juice of Deadly

Nightshade).

Cocaine, from Coca leaves.

Hyoscine, from Henbane.

Morphine, Codeine, from Opium (juice of

Poppy). Thebaine, Nicotine, from Tobacco. Physostigmine, from Calabar beans. Pilocarpine, from Jaborandi leaves. Quinidine, from Cinchona or Peruvian bark. Strychnine, from Nux Vomica seeds.... alkaloids

Alkylating agents are so named because they alkylate or chemically react with certain biochemical entities, particularly those concerned with the synthesis of NUCLEIC ACID. Alkylation is the substitution of an organic grouping in place of another grouping in a molecule.

Alkylating agents are important because they interfere with the growth and reproduction of cells, disrupting their replication. This CYTOTOXIC property is used to retard the division and growth of cancer cells, and alkylating drugs are widely used in the chemotherapy of malignant tumours – often in conjunction with surgery and sometimes with radiotherapy. Unfortunately, troublesome side-effects occur, such as: damage to veins when the drug is given intravenously, with resultant leakage into adjacent tissues; impaired kidney function due to the formation of URIC ACID crystals; nausea and vomiting; ALOPECIA (hair loss); suppression of BONE MARROW activity (production of blood cells); and adverse effects on reproductive function, including TERATOGENESIS. Indeed, cytotoxic drugs must not be given in pregnancy, especially during the ?rst three months. Prolonged use of alkylating drugs, especially when accompanying radiotherapy, is also associated with a sign?cant rise in the incidence of acute non-lymphocytic LEUKAEMIA. Among the dozen or so alkylating drugs in use are CYCLOPHOSPHAMIDE, CHLORAMBUCIL, MELPHALAN, BUSULFAN and THIOTEPA. (See also CHEMOTHERAPY.)... alkylating agents

An allele, or allelomorph, is a gene (see GENES) which may exist in one or more forms, only one of which can occur in a given chromosome (see CHROMOSOMES). Two alleles of a given gene are at the same relative positions on a pair of homologous (similarly structured) chromosomes. If the two alleles are identical, the subject is homozygous for the gene – namely, the genes will exert a unanimous in?uence on a particular characteristic. If the alleles are di?erent, with one having a dominant and the other a recessive in?uence, the subject is heterozygous.... allele

Any substance – usually a protein – which, taken into the body, makes the body hypersensitive or ‘allergic’ to it. Thus, in hay fever, the allergen is pollen. (See ALLERGY.)... allergen

A drug used to treat GOUT. It acts by suppressing the formation of uric acid. It is also being used in treatment of uric acid stone in the kidney.... allopurinol

Money, Luck, Healing ... allspice

Prunus amygdalus

Description: The almond tree, which sometimes grows to 12.2 meters, looks like a peach tree. The fresh almond fruit resembles a gnarled, unripe peach and grows in clusters. The stone (the almond itself) is covered with a thick, dry, woolly skin.

Habitat and Distribution: Almonds are found in the scrub and thorn forests of the tropics, the evergreen scrub forests of temperate areas, and in desert scrub and waste in all climatic zones. The almond tree is also found in the semidesert areas of the Old World in southern Europe, the eastern Mediterranean, Iran, the Middle East, China, Madeira, the Azores, and the Canary Islands.

Edible Parts: The mature almond fruit splits open lengthwise down the side, exposing the ripe almond nut. You can easily get the dry kernel by simply cracking open the stone. Almond meats are rich in food value, like all nuts. Gather them in large quantities and shell them for further use as survival food. You could live solely on almonds for rather long periods. When you boil them, the kernel’s outer covering comes off and only the white meat remains.... almond

Causing a favorable change in the disordered functions of the body or metabolism... alterative

See COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM).... alternative medicine

A light metallic element. It occurs in bauxite and other minerals and its compounds are found in low concentration in the body. Their function, if any, is unknown but they are believed to be harmful. Aluminium hydroxide is, however, a safe, slow-acting substance that is widely used in the treatment of indigestion, gastric ulcers (see STOMACH, DISEASES OF) and oesophagitis (see OESOPHAGUS, DISEASES OF), acting as an antacid (see ANTACIDS). Other ingested sources of aluminium include cooking utensils, kitchen foil and some cooking and food additives. Most aluminium is excreted; the rest is deposited in the brain, liver, lungs and thyroid gland. Prolonged use of aluminium-based antacids can cause loss of appetite, tiredness and weakness. It has been suggested that ALZHEIMER’S DISEASE is more common in areas with water which contains a high concentration of the element, but this issue is controversial.... aluminium

In?ammation of the alveoli (see ALVEOLUS) of the lungs caused by an allergic reaction. When the in?ammation is caused by infection it is called PNEUMONIA, and when by a chemical or physical agent it is called pneumonitis. It may be associated with systemic sclerosis or RHEUMATOID ARTHRITIS.

Extrinsic allergic alveolitis is the condition induced by the lungs becoming allergic (see ALLERGY) to various factors or substances. It includes BAGASSOSIS, FARMER’S LUNG and BUDGERIGAR-FANCIER’S LUNG, and is characterised by the onset of shortness of breath, tightness of the chest, cough and fever. The onset may be sudden or gradual. Treatment consists of removal of the affected individual from the o?ending material to which he or she has become allergic. CORTICOSTEROIDS give temporary relief.

Fibrosing alveolitis In this disease there is di?use FIBROSIS of the walls of the alveoli of the lungs. This causes loss of lung volume with both forced expiratory volume and vital capacity affected, but the ratio between them remaining normal. The patient complains of cough and progressive DYSPNOEA. Typically the patient will be cyanosed (blue – see CYANOSIS), clubbed (see CLUBBING), and have crackles in the mid- and lower-lung ?elds. Blood gases will reveal HYPOXIA and, in early disease, hypocapnia (de?ciency of carbon dioxide in the blood due to hyperventilation). There is an association with RHEUMATOID ARTHRITIS (about one-eighth of cases), systemic lupus erythematosus (see under LUPUS), and systemic SCLEROSIS. Certain drugs – for example, bleomycin, busulphan and hexamethonium – may also cause this condition, as may high concentrations of oxygen, and inhalation of CADMIUM fumes.... alveolitis

A drug used to treat certain virus infections which is also of value in the prevention of some forms of in?uenza. It is also used to treat PARKINSONISM.... amantadine

Amaranthus species

Description: These plants, which grow 90 centimeters to 150 centimeters tall, are abundant weeds in many parts of the world. All amaranth have alternate simple leaves. They may have some red color present on the stems. They bear minute, greenish flowers in dense clusters at the top of the plants. Their seeds may be brown or black in weedy species and light-colored in domestic species.

Habitat and Distribution: Look for amaranth along roadsides, in disturbed waste areas, or as weeds in crops throughout the world. Some amaranth species have been grown as a grain crop and a garden vegetable in various parts of the world, especially in South America.

Edible Parts: All parts are edible, but some may have sharp spines you should remove before eating. The young plants or the growing tips of alder plants are an excellent vegetable. Simply boil the young plants or eat them raw. Their seeds are very nutritious. Shake the tops of alder plants to get the seeds. Eat the seeds raw, boiled, ground into flour, or popped like popcorn.... amaranth

Defective vision for which no recognisable cause exists in any part of the eye. It may be due to such causes as defective development or excessive use of tobacco or alcohol. The most important form is that associated with SQUINT, or gross di?erence in refraction between the two eyes. It has been estimated that in Britain around 5 per cent of young adults have amblyopia due to this cause.... amblyopia

This is absence of the limbs, usually a congenital defect.... amelia

A diuretic that acts without causing excessive loss of potassium (see DIURETICS).... amiloride

Chemical compounds that are the basic building-blocks of all proteins. Each molecule consists of nitrogenous amino and acidic carboxyl groups of atoms joined to a group of carbon atoms. Polypeptides are formed by amino-acid molecules linking via peptide bonds. Many polypeptides link up in various con?gurations to form protein molecules. In humans, proteins are made up from 20 di?erent amino acids: nine of these are labelled ‘essential’ (or, as is now preferred, ‘indispensable’) amino acids because the body cannot manufacture them and is dependent on the diet for their provision. (See also INDISPENSABLE AMINO ACIDS.)... amino acids

A combination of theophylline and ethylenediamine. It is used intravenously in the treatment of acute severe ASTHMA, or as an oral preparation in the treatment of chronic asthma.... aminophylline

(in the form of amiodarone hydrochloride) is a drug used to treat ARRHYTHMIA of the HEART and initiated only under supervision in hospital or by an appropriate specialist. Given by mouth or intravenous infusion, amiodarone can help to control paroxysmal supraventricular, nodal and ventricular TACHYCARDIA as well as FIBRILLATION of the auricles and ventricles of the heart. It may take some time to achieve control, and several weeks to be eliminated from the body when treatment is stopped. The drug has a range of potentially serious side-effects.... amiodarone

See ANTIDEPRESSANT DRUGS.... amitriptyline

A diagnostic procedure for detecting abnormalities of the FETUS. Usually carried out between the 16th and 18th week of pregnancy, amniocentesis is performed by piercing the amniotic sac in the pregnant UTERUS with a hollow needle and withdrawing a sample of AMNIOTIC FLUID for laboratory analysis. As well as checking for the presence of abnormal fetal cells, the procedure can show the sex of the fetus. The risk of early rupture of the fetal membranes or of miscarriage is low (around 0.5 per cent).... amniocentesis

Amnion is the tough ?brous membrane which lines the cavity of the womb (UTERUS) during pregnancy, and contains between 0·5 and 1 litre (1–2 pints) of ?uid in which the EMBRYO ?oats. It is formed from the ovum (egg) along with the embryo, and in labour the part of it at the mouth of the womb forms the ‘bag of waters’. (See PREGNANCY AND LABOUR.) When a child is ‘born with a CAUL’, the caul is a piece of amnion.... amnion

The clear ?uid contained within the AMNION that surrounds the FETUS in the womb and protects it from external pressure. The ?uid, comprising mainly water, is produced by the amnion and is regularly circulated, being swallowed by the fetus and excreted through the kidneys back into the amniotic sac. By the 35th week of pregnancy there is about 1 litre of ?uid, but this falls to 0.5 litres at term. The amniotic sac normally ruptures in early labour, releasing the ?uid or ‘waters’.... amniotic fluid

A minute protozoan organism consisting of a single cell, in which a nucleus is surrounded by protoplasm that changes its shape as the protozoon progresses or absorbs nourishment. Several varieties are found under di?erent conditions within the human body. One variety, Entamoeba coli, is found in the large intestine of humans without any associated disease; another, Entamoeba gingivalis, is found in the sockets of the teeth and associated with PYORRHOEA. Entamoeba histolytica is the causative organism of amoebic dysentery (see DYSENTERY); Acanthamoeba and Naegleria fowleri cause the infection of the brain known as MENINGOENCEPHALITIS. Entamoeba histolytica may also cause meningoencephalitis. Other forms are found in the genital organs.... amoeba

See PENICILLIN; ANTIBIOTICS.... amoxicillin

See PENICILLIN; ANTIBIOTICS.... ampicillin

An ENZYME in pancreatic juice which facilitates the conversion of starch to maltose. (See PANCREAS.)... amylase

A rare condition in which deposits of complex protein, known as amyloid, are found in various parts of the body. It is a degenerative condition resulting from various causes such as chronic infection, including tuberculosis and rheumatoid arthritis.... amyloidosis

Loss of muscle bulk and strength caused by a disorder of the nerve that supplies the muscle. The loss is progressive and characterises chronic NEUROPATHY. Patients with DIABETES MELLITUS and MOTOR NEURONE DISEASE (MND) often suffer from amyotrophy as well as spasticity (see SPASTIC) of muscles.... amyotrophy

Production by the body of complex molecules like fat and proteins from simpler substances taken in the diet.... anabolism

A process where oxygen is not used.... anaerobic

Inducing loss of feeling or consciousness... anaesthetic

Having a restorative or stimulating effect, as on the central nervous system... analeptic

The loss or absence of sensation or feeling. Commonly used to describe a reversible process which allows operations and painful or unpleasant procedures to be performed without distress to the patient.

The speciality of anaesthesia broadly covers its provision for SURGERY, intensive therapy (intensive care), chronic pain management, acute pain management and obstetric analgesia. Anaesthetists in Britain are trained specialists with a medical degree, but in many countries some anaesthetists may be nurse practitioners working under the supervision of a medical anaesthetist.

The anaesthetist will assess the patient’s ?tness for anaesthesia, choose and perform the appropriate type of anaesthetic while monitoring and caring for the patient’s well-being, and, after the anaesthetic, supervise recovery and the provision of post-operative pain relief.

Anaesthesia may be broadly divided into general and local anaesthesia. Quite commonly the two are combined to allow continued relief of pain at the operation site after the patient awakens.

General anaesthesia is most often produced by using a combination of drugs to induce a state of reversible UNCONSCIOUSNESS. ‘Balanced’ anaesthesia uses a combination of drugs to provide unconsciousness, analgesia, and a greater or lesser degree of muscle relaxation.

A general anaesthetic comprises induction, maintenance and recovery. Historically, anaesthesia has been divided into four stages (see below), but these are only clearly seen during induction and maintenance of anaesthesia using inhalational agents alone.

(1) Onset of induction to unconsciousness

(2) Stage of excitement

(3) Surgical anaesthesia

(4) Overdosage

Induction involves the initial production of unconsciousness. Most often this is by INTRAVENOUS injection of a short-acting anaesthetic agent such as PROPOFOL, THIOPENTONE or ETOMIDATE, often accompanied by additional drugs such as ANALGESICS to smooth the process. Alternatively an inhalational technique may be used.

Maintenance of anaesthesia may be provided by continuous or intermittent use of intravenous drugs, but is commonly provided by administration of OXYGEN and NITROUS OXIDE or air containing a volatile anaesthetic agent. Anaesthetic machines are capable of providing a constant concentration of these, and have fail-safe mechanisms and monitors which guard against the patient’s receiving a gas mixture with inadequate oxygen (see HYPOXIC). The gases are adminstered to the patient via a breathing circuit either through a mask, a laryngeal mask or via ENDOTRACHEAL INTUBATION. In recent years, concerns about side-effects and pollution caused by volatile agents have led to increased popularity of total intravenous anaesthesia (TIVA).

For some types of surgery the patient is paralysed using muscle relaxants and then arti?cially ventilated by machine (see VENTILATOR). Patients are closely monitored during anaesthesia by the anaesthetist using a variety of devices. Minimal monitoring includes ELECTROCARDIOGRAM (ECG), blood pressure, PULSE OXIMETRY, inspired oxygen and end-tidal carbon-dioxide concentration – the amount of carbon dioxide breathed out when the lungs are at the ‘empty’ stage of the breathing cycle. Analgesic drugs (pain relievers) and local or regional anaesthetic blocks are often given to supplement general anaesthesia.

Volatile anaesthetics are either halogenated hydrocarbons (see HALOTHANE) or halogenated ethers (iso?urane, en?urane, des?urane and sevo?urane). The latter two are the most recently introduced agents, and produce the most rapid induction and recovery – though on a worldwide basis halothane, ether and chloroform are still widely used.

Despite several theories, the mode of action of these agents is not fully understood. Their e?cacy is related to how well they dissolve into the LIPID substances in nerve cells, and it is thought that they act at more than one site within brain cells – probably at the cell membrane. By whatever method, they reversibly depress the conduction of impulses within the CENTRAL NERVOUS SYSTEM and thereby produce unconsciousness.

At the end of surgery any muscle relaxant still in the patient’s body is reversed, the volatile agent is turned o? and the patient breathes oxygen or oxygen-enriched air. This is the reversal or recovery phase of anaesthesia. Once the anaesthetist is satis?ed with the degree of recovery, patients are transferred to a recovery area within the operating-theatre complex where they are cared for by specialist sta?, under the supervision of an anaesthetist, until they are ready to return to the ward. (See also ARTIFICIAL VENTILATION OF THE LUNGS.) Local anaesthetics are drugs which reversibly block the conduction of impulses in nerves. They therefore produce anaesthesia (and muscle relaxation) only in those areas of the body served by the nerve(s) affected by these drugs. Many drugs have some local anaesthetic action but the drugs used speci?cally for this purpose are all amide or ester derivatives of aromatic acids. Variations in the basic structure produce drugs with di?erent speeds of onset, duration of action and preferential SENSORY rather than MOTOR blockade (stopping the activity in the sensory or motor nerves respectively).

The use of local rather than general anaesthesia will depend on the type of surgery and in some cases the unsuitability of the patient for general anaesthesia. It is also used to supplement general anaesthesia, relieve pain in labour (see under PREGNANCY AND LABOUR) and in the treatment of pain in persons not undergoing surgery. Several commonly used techniques are listed below:

LOCAL INFILTRATION An area of anaesthetised skin or tissue is produced by injecting local anaesthetic around it. This technique is used for removing small super?cial lesions or anaesthetising surgical incisions.

NERVE BLOCKS Local anaesthetic is injected close to a nerve or nerve plexus, often using a peripheral nerve stimulator to identify the correct point. The anaesthetic di?uses into the nerve, blocking it and producing anaesthesia in the area supplied by it.

SPINAL ANAESTHESIA Small volumes of local anaesthetic are injected into the cerebrospinal ?uid through a small-bore needle which has been inserted through the tissues of the back and the dura mater (the outer membrane surrounding the spinal cord). A dense motor and sensory blockade is produced in the lower half of the body. How high up in the body it reaches is dependent on the volume and dose of anaesthetic, the patient’s position and individual variation. If the block is too high, then respiratory-muscle paralysis and therefore respiratory arrest may occur. HYPOTENSION (low blood pressure) may occur because of peripheral vasodilation caused by sympathetic-nerve blockade. Occasionally spinal anaesthesia is complicated by a headache, perhaps caused by continuing leakage of cerebrospinal ?uid from the dural puncture point.

EPIDURAL ANAESTHESIA Spinal nerves are blocked in the epidural space with local anaesthetic injected through a ?ne plastic tube (catheter) which is introduced into the space using a special needle (Tuohy needle). It can be used as a continuous technique either by intermittent injections, an infusion or by patient-controlled pump. This makes it ideal for surgery in the lower part of the body, the relief of pain in labour and for post-operative analgesia. Complications include hypotension, spinal headache (less than 1:100), poor e?cacy, nerve damage (1:12,000) and spinal-cord compression from CLOT or ABSCESS (extremely rare).... anaesthesia

Increasing sensitivity of the body to a protein after an initial reaction which may have been mild. The second or third exposure to this protein may cause severe respiratory or circulatory embarrassment, leading to death.... anaphylaxis

Type of cancerous change in which the cancer cells involved do not resemble the cells from which theyarose. Undifferentiated.... anaplasia

Diffused dropsy in the skin and subcutaneous tissue... anasarca

Direct intercommunication of the branches of two or more veins or arteries without any intervening network of capillary vessels. The term also describes the surgical joining of two hollow blood vessels, nerves or organs such as intestines to form an intercommunication.... anastomosis

The science which deals with the structure of the bodies of men and animals. Brief descriptions of the anatomy of each important organ are given under the headings of the various organs. It is studied by dissection of bodies bequeathed for the purpose, or of the bodies of those who die in hospitals and similar institutions, unclaimed by relatives.... anatomy

A parasitic infection caused by the nematodes Ancylostoma duodenale and Necator americanus, resulting in hookworm disease. These infections are exceedingly common in tropical and developing countries, millions of people being affected. Classically, A. duodenale occurred in the Far East, Mediterranean littoral, and Middle East, and N. americanus in tropical Africa, Central and South America, and the Far East; however, in recent years, geographical separation of the two human species is less distinct. In areas where standards of hygiene and sanitation are unsatisfactory, larvae (embryos) enter via intact skin, usually the feet. ‘Ground itch’ occasionally occurs as larvae enter the body. They then undergo a complex life-cycle, migrating through the lungs, trachea, and pharynx. Adult worms are 5–13 (mean 12) mm in length; their normal habitat is the small INTESTINE – especially the jejunum – where they adhere to the mucosa by hooks, thus causing seepage of blood into the lumen. A worm-pair produces large numbers of eggs, which are excreted in faeces; when deposited on moist soil they remain viable for many weeks or months. Clinical manifestations include microcytic hypochromic ANAEMIA, hypoalbuminaemia (low serum protein) and, in a severe case, OEDEMA. A chronic infection in childhood can give rise to physical, mental and sexual retardation. Treatment is with one of the benzimidazole compounds, usually mebendazole or albendazole; however, in developing countries, cheaper preparations are used, including tetrachloroethylene, bephenium hydroxynaphthoate, and pyrantel embonate. Anaemia usually responds to iron supplements; blood transfusion is rarely indicated.

Ancylostoma braziliensis A nematode infection of dogs, which in humans causes local disease (larva migrans) only, generally on the soles of the feet. It is usually acquired by walking on beaches contaminated with dog faeces in places such as the Caribbean.... ancylostomiasis

A usually colourful group of Anthozoans common on reefs. Contact with human skin of divers or snorkellers may cause severe, localised skin reactions, and systemic symptoms including severe tiredness. Research is current in this area.... anemone

The term given to the condition in which a child is born with a defect of the skull and absence of the brain. Anencephaly is the most common major malformation of the central nervous system. It has an incidence of 0·65 per 1,000 live births. There is complete absence of the cerebral hemispheres and overlying skull, and the brain stem and cerebellum are atrophic. If the pregnancy goes to term the infants rapidly die, but in 50 per cent of pregnancies associated with anencephaly, spontaneous abortion occurs. It is possible to detect the presence of anencephaly in the fetus by measuring the level of ALPHA-FETO PROTEIN in the mother’s serum or in the amniotic ?uid. (See also SPINA BIFIDA.)... anencephaly

Also called angioneurotic oedema; see under URTICARIA.... angio-oedema

Radiography of blood vessels made visible by injecting into them a radio-opaque substance. In the case of arteries this is known as arteriography; the corresponding term for veins being venography or phlebography. This procedure demonstrates whether there is any narrowing or ballooning of the lumen of the vessel, changes usually caused by disease or injury.... angiography

A TUMOUR composed of blood vessels. (See NAEVUS.)... angioma

See Anís.... anise

The condition of a joint in which the movements are restricted by ?brous bands, or by malformation, or by actual union of the bones. (See JOINTS, DISEASES OF.)... ankylosis

A medicine that allays pain... anodyne

A mosquito genus in the subfamily Anophelinae. Only certain species transmit human malaria and filariasis.... anopheles

Loss of sense of smell. (See NOSE, DISORDERS OF.)... anosmia

(1) A muscle the contraction of which opposes that of another muscle called the AGONIST. When the agonist contracts, the antagonist relaxes.

(2) The action of one drug in opposing the action of another.... antagonist

An adjective that describes or relates to the front part of the body, limbs, or organs.... anterior

The change which takes place in the lungs and bronchial glands of coal-miners, and others, who inhale coal-dust constantly. The lungs are amazingly e?cient in coping with this problem; during a working lifetime a coal-miner may inhale around 5,000 grams of dust, but at POST-MORTEM EXAMINATION it is rare to ?nd more than about 40 grams in the lungs. The affected tissues change in colour from greyish pink to jet black, owing to loading with minute carbon particles. (See PNEUMOCONIOSIS.)... anthracosis

Killing disease causing microorganisms ... antibiotic

Antibiotic is the term used to describe any antibacterial agent derived from micro-organisms, although most of them are now prepared synthetically. Such agents destroy or inhibit the growth of other micro-organisms: examples are penicillin, cephalosporin, amino-glycosides, streptomycin, and tetracycline.

Penicillin was the ?rst antibiotic to be discovered and used in the 1940s. The discovery and isolation in 1958 of the penicillin nucleus, 6-amino penicillanic acid (6-PNA), allowed many new penicillins to be synthesised. These are now the largest single group of antibiotics used in clinical medicine. Most staphylococci (see STAPHYLOCOCCUS) have now developed resistance to benzylpenicillin, the early form of the drug, because they produce penicillinases – enzymes which break down the drug. Other types of penicillin such as cloxacillin and ?ucoxacillin are not affected and are used against penicillin-resistant staphylococci.

The cephalosporins are derived from the compound cephalosporin C, which is obtained by fermentation of the mould cephalosporium.

The cephalosporin nucleus 7 amino cephalosporanic (7-ICA) acid has been the basis for the production of the semi-synthetic compounds of the cephalosporin nucleus. The ?rst semi-synthetic cephalosporin, cephalothin, appeared in 1962; it was followed by cephaloridine in 1964. The original cephalosporins had to be given by injection, but more recent preparations can be given by mouth. The newer preparations are less readily destroyed by betalactamases and so they have a much broader spectrum of antibacterial activity. The newer cephalosporins include cephalexin, cefazolin, cephacetrile, cephapirin, cefamandole, cefuroxine, cephrodine, cefodroxil and cefotaxine. Inactivation of beta-lactamase is the basis of bacterial resistance both to the penicillins and to the cephalosporins, so that attempts to prepare these antibiotics with resistance to betalactamase is of great importance. A synthetic inhibitor of beta-lactamase called clavulanic acid has been synthesised; this is used in combination with the penicillins and cephalosporins to prevent resistance. The cephamycins are a new addition to the beta-lactam antibiotics. They are similar in structure to the cephalosporins but are produced, not by fungi, but by actinomycetes.

Overuse and misuse of antibiotics have resulted in many bacteria becoming resistant to them. Hospitals, in particular, have problems with METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA). Combinations of antibiotics are needed to combat resistant strains of bacteria, another example being Mycobacterium tuberculosis.... antibiotics

An agent that impedes the impulses or actions of the nerves or fibers of the parasympathetic ganglia, competing with, and blocking the release of acetycholine at what are called the muscarinic sites. Cholinergic functions affected are those that induce spasms and cramps of the intestinal tracts and allied ducts. Examples: Atropine, Datura, Garrya.... anticholinergic

Inhibiting the clotting of blood ... anticoagulant

Literally, substances meant to oppose depressions or sadness, and generally heterocyclic types such as Elavil, MAO inhibitors like phenelzine, or lithium carbonate. This category of substances formerly included stuff like amphetamines and other stimulants. Our only plants that could fit the current definition would be Hypericum, Peganum and perhaps Oplopanax.... antidepressant

Stopping emesis or vomiting ... antiemetic

An exogenous agent that inhibits the release of histamine, the amino acid derivative that stimulates vasodilation and permeability under many circumstances, particularly tissue irritation. The most common type of antihistamine, the H1 receptor antagonist, produces many moderate side effects, and the H2 receptor antagonist cimetidine is even more problematic. That they are so commonly used can lull both physician and patient into trivializing their iatrogenic potential. Histamines, which are most abundant in the skin, respiratory, and GI tract mucus membranes, help heal; using antihistamines to inhibit the healing response for the whole body simply in order to lessen the acute but physiologically superficial symptoms of something like hay fever is to risk many subtle side effects.... antihistamine

A group of drugs used to treat high blood pressure (HYPERTENSION). Untreated hypertension leads to STROKE, heart attacks and heart failure. The high incidence of hypertension in western countries has led to intensive research to discover antihypertensive drugs, and many have been marketed. The drugs may work by reducing the power of the heartbeat, by dilating the blood vessels or by increasing the excretion of salts and water in the urine (diuresis). Antihypertensive treatment has greatly improved the prognosis of patients with high blood pressure by cutting the frequency of heart and renal failure (see KIDNEYS, DISEASES OF), stroke, and coronary thrombosis (see HEART, DISEASES OF). Drugs used for treatment can be classi?ed as follows: diuretics; vasodilator antihypertensives; centrally acting antihypertensives; adrenergic neurone-blocking drugs; alpha-adrenoreceptorblocking drugs; drugs affecting the renin-angiotensin system; ganglion-blocking drugs; and tyrosine hydroxylase inhibitors. The drugs prescribed depend on many factors, including the type of hypertension being treated. Treatment can be di?cult because of the need to balance the e?ectiveness of a drug in reducing blood pressure against its side-effects.... antihypertensive drugs

Preventing or relieving itching... antipruritic

Counteracting fever... antipyretic

A chemical sterilising substance to kill or control pathogenic microbes... antiseptic

Antiseptics prevent the growth of disease-causing micro-organisms without damaging living tissues. Among chemicals used are boric acid, carbolic acid, hydrogen peroxide and products based on coal tar, such as cresol. Chlorhexidines, iodine, formaldehyde, ?avines, alcohol and hexachlorophane are also used. Antiseptics are applied to prevent infection – for example, in preparing the skin before operation. They are also used externally to treat infected wounds.... antiseptics

A substance used to relieve or prevent spasms of the smooth muscles of the intestinal tract, bronchi, or uterus.(Examples: barbiturates, Garrya.)... antispasmodic

Any one of various preparations that contain ANTIBODIES which combine and neutralise the effects of a particular toxin (see TOXINS) released into the bloodstream by BACTERIA. Examples are the toxins produced by DIPHTHERIA and TETANUS. Antitoxins are produced from the blood of humans or animals that have been exposed to a particular toxin – whether by INFECTION or by INOCULATION – and thus have produced antibodies against it. They are usually given by intramuscular injection.... antitoxin

Controlling or preventing cough... antitussive

Antibody mixtures produced by an animal after exposure to small doses of an injected venom that may be harmful to man. As the doses are small, the injection is not lethal and antibodies are formed. This resultant antibodymixture is then collected from the animal’s blood, purified, concentrated, and thus becomes an antivenom. It can then be injected into humans to counteract symptoms (or death) produced by the venom of the animal potentially lethal to humans. An antivenom is specific for the venom against which it is prepared, and does not neutralise other antivenoms. A rare exception to this is Tiger snake (Notechis scutatus) antivenom which can be used to effectivelycounteract the venom of the sea snakes if specific sea snake antivenom is not available.... antivenom

The large vessel which opens out of the left ventricle of the HEART and carries blood to all of the body. It is about 45 cm (1••• feet) long and 2·5 cm (1 inch) wide. Like other arteries it possesses three coats, of which the middle one is much the thickest. This consists partly of muscle ?bre, but is mainly composed of an elastic substance called elastin. The aorta passes ?rst to the right, and lies nearest the surface behind the end of the second right rib-cartilage; then it curves backwards and to the left, passes down behind the left lung close to the backbone, and through an opening in the diaphragm into the abdomen. There it divides, at the level of the navel, into the two common iliac arteries, which carry blood to the lower limbs.

Its branches, in order, are: two coronary arteries to the heart wall; the brachiocephalic, left common carotid, and left subclavian arteries to the head, neck and upper limbs; several small branches to the oesophagus, bronchi, and other organs of the chest; nine pairs of intercostal arteries which run around the body between the ribs; one pair of subcostal arteries which is in series with the intercostal arteries; four (or ?ve) lumbar arteries to the muscles of the loins; coeliac trunk to the stomach, liver and pancreas; two mesenteric arteries to the bowels; and suprarenal, renal and testicular arteries to the suprarenal body, kidney, and testicle on each side. From the termination of the aorta rises a small branch, the median sacral artery, which runs down into the pelvis. In the female the ovarian arteries replace the testicular.

The chief diseases of the aorta are ATHEROMA

and ANEURYSM. (See ARTERIES, DISEASES OF; COARCTATION OF THE AORTA.)... aorta

A rare degenerative condition of the lining of the AORTA. It may be the result of arteritis (in?ammation of the arteries) or a consequence of untreated SYPHILIS. Aortitis may lead to thinning of the aorta’s wall and development of an ANEURYSM.... aortitis

Aortography is the technique of rendering the AORTA visible in an X-ray ?lm by injecting a radio-opaque substance into it. The procedure is used to detect the presence of an ANEURYSM. (See also ANGIOGRAPHY.)... aortography

The pointed portion of any organ which has a conical shape. The apex of each lung reaches about 3·5–5 cm (1••• or 2 inches) above the collar-bone into the neck. In health, the apex of the heart can be felt below the ?fth rib immediately inside the nipple.... apex

This is the beat of the APEX of the HEART, which can be felt through the skin to the left of the breastbone between the ?fth and sixth ribs.... apex beat

A method of assessing at birth whether or not a baby requires resuscitation. The newborn is routinely assessed at 1 minute of age and again at 5 minutes, and a value of 0, 1 or 2 given to each of ?ve signs: colour, heart rate, muscle tone, respiratory (or breathing) e?ort, and the response to stimulation. A total score of 7 or more indicates that the newborn child is in excellent condition. An Apgar score of 5 or less at 15 or 20 minutes predicates an increased risk of subsequent CEREBRAL PALSY.... apgar score

Absence of the lens of the EYE.... aphakia

Single or multiple (and often recurrent) transiently painful ulcers in the oral mucous membrane that are usually self-limiting. The cause is unknown and treatment is symptomatic.... aphthous ulcer

Apicectomy is the minor operation carried out to try to save a tooth which has an ABSCESS on it or which does not respond to root treatment. In this, the abscess and the APEX of the tooth are removed.... apicectomy

The complete or partial failure of tissue or an organ to develop.... aplasia

A general term meaning the cessation of breathing. Apnoea is a medical emergency: death soon follows if breathing is not quickly restored (see APPENDIX 1: BASIC FIRST AID). Apnoea may be caused by an obstruction to the airway, for example by the tongue during general ANAESTHESIA, or by a disturbance of the mechanisms that control breathing. Rapid heavy breathing reduces the blood levels of carbon dioxide and can lead to a brief period of apnoea.

Neonatal apnoeic attacks may represent a serious emergency, being caused by prematurity, milk aspiration, heart failure, infection, HYPOXIA, HYPOGLYCAEMIA or HYPOCALCAEMIA. If stimulation of the baby does not immediately restore breathing, then bag-and-mask ventilation should be used.... apnoea

Aponeurosis is the term applied to the white ?brous membrane which serves as an investment for the muscles and which covers the skull beneath the scalp.... aponeurosis

Appendicectomy, or appendectomy, is the operation for the removal of the vermiform appendix in the ABDOMEN (see APPENDICITIS).... appendicectomy

A term applied to the appendages of several hollow organs: for example, the larynx has two pouches called appendices, and the epiploic appendices are the tags of fat that hang from the exterior part of the large intestine. The commonest application, however, is to the vermiform appendix of the large intestine. This is a short, slim, blind-ended tube up to 10 cm long attached to the caecum (a pouch at the start of the large intestine). Its function is unknown, though it may once have had one in ancestral humans. It is, however, prone to in?ammation and infection (see APPENDICITIS).... appendix

This is a genetically controlled type of cell death. There is an orchestrated collapse of a cell (see CELLS), typi?ed by destruction of the cell’s membrane; shrinkage of the cell with condensation of CHROMATIN; and fragmentation of DNA. The dead cell is then engulfed by adjacent cells. This process occurs without evidence of the in?ammation normally associated with a cell’s destruction by infection or disease.

Apoptosis, ?rst identi?ed in 1972, is involved in biological activities including embryonic development, ageing and many diseases. Its importance to the body’s many physiological and pathological processes has only fairly recently been understood, and research into apoptosis is proceeding apace.

In adults, around 10 billion cells die each day

– a ?gure which balances the number of cells arising from the body’s stem-cell populations (see STEM CELL). Thus, the body’s normal HOMEOSTASIS is regulated by apoptosis. As a person ages, apoptopic responses to cell DNA damage may be less e?ectively controlled and so result in more widespread cell destruction, which could be a factor in the onset of degenerative diseases. If, however, apoptopic responses become less sensitive, this might contribute to the uncontrolled multiplication of cells that is typical of cancers. Many diseases are now associated with changed cell survival: AIDS (see AIDS/HIV); ALZHEIMER’S DISEASE and PARKINSONISM; ischaemic damage after coronary thrombosis (see HEART, DISEASES OF) and STROKE; thyroid diseases (see THYROID GLAND, DISEASES OF); and AUTOIMMUNE DISORDERS. Some cancers, autoimmune disorders and viral infections are associated with reduced or inhibited apoptosis. Anticancer drugs, GAMMA RAYS and ULTRAVIOLET RAYS (UVR) initiate apoptosis. Other drugs – for example, NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) – alter the process of apoptosis. Research is in train to harness new knowledge about apoptosis for the development of new treatments and modi?cations of existing ones for serious disorders such as cancer and degenerative nervous diseases.... apoptosis

Appetite is the craving for the food necessary to maintain the body and to supply it with suf?cient energy to carry on its functions. The ultimate cause of appetite is a question of supply and demand in the muscles and various organs, but the proximate cause is doubtful. Unlike hunger, it is probably an acquired, rather than an inborn, sensation. Whatever other factors may be concerned, the tone of the STOMACH is of importance. Signi?cant factors in stimulating appetite are anticipation and the sight and smell of well-cooked food. Individuals who eat unsuitable substances such as faeces are described as suffering from pica, which occurs sometimes during pregnancy, in children, and often in mental disorders. The two chief disorders, however, are excessive increase of appetite, and diminution or loss of appetite (see also EATING DISORDERS).

Excessive appetite may simply be a bad habit, due to habitual over-indulgence in good food and resulting in GOUT, OBESITY, etc. – according to the other habits and constitution of the person. It may also be a sign of DIABETES MELLITUS or thyrotoxicosis (see under THYROID GLAND, DISEASES OF).

Diminished appetite is a sign common to almost all diseases causing general weakness, because the activity of the stomach and the secretion of gastric juice fail early when vital power is low. It is the most common sign of DYSPEPSIA due to gastritis, and of cancer of the stomach. In some cases it is a manifestation of stress or strain such as domestic worry or dif?culties at work. Indeed, appetite seems to be particularly susceptible to emotional disturbances, as is evidenced by the linked conditions of BULIMIA (pathological overeating) and anorexia nervosa (pathological dieting) – see also EATING DISORDERS.... appetite

See Manzana.... apple

See “geriatric assessment”.... appraisal

Apraxia, or dyspraxia, is the loss of ability to make accurate skilled movements. The cause is a disorder of the cerebral cortex of the BRAIN: the patient is unable to coordinate his or her movements. Apraxia di?ers from clumsiness resulting from muscular weakness, loss of sensation or disease in the cerebellum (see BRAIN).

The condition is usually a consequence of disease in the brain’s parietal lobes, though frontal-lobe disease may cause it. A person with gait apraxia has normal power in the legs and no abnormal signs suggesting cerebellar disease, but cannot perform the normal act of walking because of malfunction in the cerebrum.... apraxia

Arachnodactyly, or MARFAN’S SYNDROME, is a congenital condition characterised by extreme length and slenderness of the ?ngers and toes – and, to a lesser extent, of the limbs and trunk; laxity of the ligaments; and dislocation of the lens of the eye. The antero-posterior diameter of the skull is abnormally long, and the jaw is prominent. There may also be abnormalities of the heart.... arachnodactyly

A class of viruses transmitted by arthropods. Name contracted from “arthropod-borne viruses”.... arbovirus

Areola literally means a small space, and is the term applied to the red or dusky ring around the nipple, or around an in?amed part. Increase in the duskiness of the areola on the breast is an important early sign of pregnancy.... areola

Arrhythmia means any variation from the normal regular rhythm of the heartbeat. The condition is produced by some affection interfering with the mechanism which controls the beating of the heart, and includes the following disorders: sinus arrhythmia, atrial ?brillation, atrial ?utter, heart block, extrasystoles, pulsus alternans, and paroxysmal atrial tachycardia, ventricular tachycardia and ventricular ?brillation. (See HEART, DISEASES OF; ELECTROCARDIOGRAM (ECG).)... arrhythmia

A metalloid with industrial use in glass, wood preservative, herbicide, semiconductor manufacture, and as an alloy additive. It may be a component in alternative or traditional remedies both intentionally and as a contaminant. Common in the environment and in food, especially seafood, arsenic is odourless and tasteless and highly toxic by ingestion, inhalation and skin contact. It binds to sulphydryl groups inhibiting the action of many enzymes (see ENZYME) and also disrupts oxidative phosphorylation by substituting for PHOSPHORUS. Clinical effects of acute poisoning range from severe gastrointestinal effects to renal impairment or failure characterised by OLIGURIA, HAEMATURIA, PROTEINURIA and renal tubular necrosis. SHOCK, COMA and CONVULSIONS are reported, as are JAUNDICE and peripheral NEUROPATHY. Chronic exposures are harder to diagnose as effects are non-speci?c: they include gastrointestinal disturbances, hyperpigmentation and HYPERKERATOSIS of skin, localised OEDEMA, ALOPECIA, neuropathy, PARAESTHESIA, HEPATOMEGALY and jaundice. Management is largely supportive, particularly ensuring adequate renal function. Concentrations of arsenic in urine and blood can be measured and therapy instituted if needed. Several CHELATING AGENTS are e?ective: these include DMPS (2, 3-dimercapto-1-propanesulphonate), penicillamine and dimercaprol; DMPS is now agent of choice.... arsenic

See ANGIOGRAPHY.... arteriography

A small artery (see ARTERIES).... arteriole

An operation for ?xating the bones in a diseased joint in a given position so that the joint cannot be moved. It is usually done if pain and deformity in a diseased joint – caused, for instance, by RHEUMATOID ARTHRITIS – are so bad that they cannot be relieved by drugs, PHYSIOTHERAPY, splinting or ARTHROPLASTY.... arthrodesis

A term applied to any form of joint disease.... arthropathy

The use of metal or plastic components to replace a joint or part of a joint. Arthroplasty was ?rst used in the 1930s to replace diseased hip-joints and has been routinely used since the 1960s, enabling thousands of people, especially the older generation, to resume normal life free from pain and disability. Replacement of other joints – for instance, knees, ?ngers, shoulders and elbows – has now become routine. (See JOINTS, DISEASES OF and diagram.)... arthroplasty

Inspection of the interior of a joint (usually the knee) to diagnose any disorder there. The instrument used is a type of ENDOSCOPE called an ARTHROSCOPE. The knee is often affected by conditions that are not easy to diagnose and are not revealed by X-ray examination. Surgery can be performed using arthroscopy and this reduces the time a patient has to be in hospital.... arthroscopy

A genus of nematodes which includes the intestinal roundworm of humans, Ascaris lumbricoides).... ascaris

Absence of septic matter, or freedom from infection. The prevention of the access of microorganisms.... asepsis

Ascariasis is the disease produced by infestation with the roundworm Ascaris lumbricoides, also known as the maw-worm. Super?cially it resembles a large earthworm: the male measures about 17 cm (7 inches) and the female 23 cm (9 inches) in length. Ascariasis is a dirt disease, most prevalent where sanitation and cleanliness are lacking, particularly in the tropics and subtropics. Consumption of food contaminated by the ova (eggs), especially salad vegetables, is the commonest cause of infection. In children, infection is commonly acquired by crawling or playing on contaminated earth, and then sucking their ?ngers. After a complicated life-cycle in the body the adult worms end up in the intestines, whence they may be passed in the stools. A light infection may cause no symptoms. A heavy infection may lead to colic, or even obstruction of the gut. Occasionally a worm may wander into the stomach and be vomited up.

Treatment Mebendazole is the drug of choice in the UK, being given as a single dose. It should be combined with hygienic measures to break the cycle of autoinfection. All members of the family require treatment. Other ANTHELMINTICS include piperazine and pyrantel.... ascariasis

Ascorbic acid, or vitamin C (see APPENDIX 5: VITAMINS), is a simple sugar found in living tissues – its highest concentrations being in the adrenal cortex (see ADRENAL GLANDS) and the eye. Stress and CORTICOTROPIN lead to a loss of ascorbic acid from the adrenal cortex. Fresh fruit and vegetables, particularly blackcurrants, citrus fruits, berries and green vegetables, are the richest dietary sources; it may also be synthetically prepared. Ascorbic acid is easily eliminated from the diet by traditional methods of cooking, being very soluble in water and easily destroyed by heat, alkalis, traces of copper or by an oxidase released by damage to plant tissues. De?ciency may lead to SCURVY, traditionally associated with sailors, among elderly people living alone or in poor communities living at subsistence level. It has been claimed that large doses (1–2 g daily) will prevent the common cold, but few large controlled trials have been carried out and it is inadvisable for people to dose themselves with large quantities of ascorbic acid, which may result in the formation of oxalate stones in the urinary tract. (See also VITAMIN.)... ascorbic acid

Aspartame is an arti?cial sweetener, 200 times as sweet as sugar but without the bitter aftertaste of saccharine.... aspartame

Aspiration means the withdrawal of ?uid or gases from the natural cavities of the body or from cavities produced by disease. It may be performed for curative purposes; alternatively, a small amount of ?uid may be drawn o? for diagnosis of its nature or origin. An instrument called an aspirator is used to remove blood and ?uid from a surgical-operation site – for example, the abdomen or the mouth (in dentistry).

PLEURISY with e?usion is a condition requiring aspiration, and a litre or more of ?uid may be drawn o? by an aspirator or a large syringe and needle. Chronic abscesses and tuberculous joints may call for its use, the operation being done with a small syringe and hollow needle. PERICARDITIS with e?usion is another condition in which aspiration is sometimes performed. The spinal canal is aspirated by the operation of LUMBAR PUNCTURE. In children the ventricles of the brain are sometimes similarly relieved from excess of ?uid by piercing the fontanelle (soft spot) on the infant’s head. (See HYDROCEPHALUS.)... aspiration

Astereognosis means the loss of the capacity to recognise the nature of an object by feeling it, and indicates a lesion (e.g. tumour) of the brain.... astereognosis

Asthma is a common disorder of breathing characterised by widespread narrowing of smaller airways within the lung. In the UK the prevalence among children in the 5–12 age group is around 10 per cent, with up to twice the number of boys affected as girls. Among adults, however, the sex incidence becomes about equal. The main symptom is shortness of breath. A major feature of asthma is the reversibility of the airway-narrowing and, consequently, of the breathlessness. This variability in the obstruction may occur spontaneously or in response to treatment.

Cause Asthma runs in families, so that parents with asthma have a strong risk of having children with asthma, or with other atopic (see ATOPY) illnesses such as HAY FEVER or eczema (see DERMATITIS). There is therefore a great deal of interest in the genetic basis of the condition. Several GENES seem to be associated with the condition of atopy, in which subjects have a predisposition to form ANTIBODIES of the IgE class against allergens (see ALLERGEN) they encounter – especially inhaled allergens.

The allergic response in the lining of the airway leads to an in?ammatory reaction. Many cells are involved in this in?ammatory process, including lymphocytes, eosinophils, neutrophils and mast cells. The cells are attracted and controlled by a complex system of in?ammatory mediators. The in?amed airway-wall produced in this process is then sensitive to further allergic stimuli or to non-speci?c challenges such as dust, smoke or drying from the increased respiration during exercise. Recognition of this in?ammation has concentrated attention on anti-in?ammatory aspects of treatment.

Continued in?ammation with poor control of asthma can result in permanent damage to the airway-wall such that reversibility is reduced and airway-narrowing becomes permanent. Appropriate anti-in?ammatory therapy may help to prevent this damage.

Many allergens can be important triggers of asthma. House-dust mite, grass pollen and animal dander are the commonest problems. Occupational factors such as grain dusts, hard-metals fumes and chemicals in the plastic and paint industry are important in some adults. Viral infections are another common trigger, especially in young children.

The prevalence of asthma appears to be on the increase in most countries. Several factors have been linked to this increase; most important may be the vulnerability of the immature immune system (see IMMUNITY) in infants. High exposure to allergens such as house-dust mite early in life may prime the immune system, while reduced exposure to common viral infections may delay the maturation of the immune system. In addition, maternal smoking in pregnancy and infancy increases the risk.

Clinical course The major symptoms of asthma are breathlessness and cough. Occasionally cough may be the only symptom, especially in children, where night-time cough may be mistaken for recurrent infection and treated inappropriately with antibiotics.

The onset of asthma is usually in childhood, but it may begin at any age. In childhood, boys are affected more often than girls but by adulthood the sex incidence is equal. Children who have mild asthma are more likely to grow out of the condition as they go through their teenaged years, although symptoms may recur later.

The degree of airway-narrowing, and its change with time and treatment, can be monitored by measuring the peak expiratory ?ow with a simple monitor at home – a peak-?ow meter. The typical pattern shows the peak ?ow to be lowest in the early morning and this ‘morning dipping’ is often associated with disturbance of sleep.

Acute exacerbations of asthma may be provoked by infections or allergic stimuli. If they do not respond quickly and fully to medication, expert help should be sought urgently since oxygen and higher doses of drugs will be necessary to control the attack. In a severe attack the breathing rate and the pulse rate rise and the chest sounds wheezy. The peak-?ow rate of air into the lungs falls. Patients may be unable to talk in full sentences without catching their breath, and the reduced oxygen in the blood in very severe attacks may produce the blue colour of CYANOSIS in the lips and tongue. Such acute attacks can be very frightening for the patient and family.

Some cases of chronic asthma are included in the internationally agreed description CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) – a chronic, slowly progressive disorder characterised by obstruction of the air?ow persisting over several months.

Treatment The ?rst important consideration in the treatment of asthma is avoidance of precipitating factors. When this is a speci?c animal or occupational exposure, this may be possible; it is however more di?cult for house-dust mite or pollens. Exercise-induced asthma should be treated adequately rather than avoiding exercise.

Desensitisation injections using small quantities of speci?c allergens are used widely in some countries, but rarely in the UK as they are considered to have limited value since most asthma is precipitated by many stimuli and controlled adequately with simple treatment.

There are two groups of main drugs for the treatment of asthma. The ?rst are the bronchodilators which relax the smooth muscle in the wall of the airways, increase their diameter and relieve breathlessness. The most useful agents are the beta adrenergic agonists (see ADRENERGIC RECEPTORS) such as salbutamol and terbutaline. They are best given by inhalation into the airways since this reduces the general side-effects from oral use. These drugs are usually given to reverse airway-narrowing or to prevent its onset on exercise. However, longer-acting inhaled beta agonists such as salmeterol and formoterol or the theophyllines given in tablet form can be used regularly as prevention. The beta agonists can cause TREMOR and PALPITATION in some patients.

The second group of drugs are the antiin?ammatory agents that act to reduce in?ammation of the airway. The main agents in this group are the CORTICOSTEROIDS. They must be taken regularly, even when symptoms are absent. Given by inhalation they have few side-effects. In acute attacks, short courses of oral steroids are used; in very severe disease regular oral steroids may be needed. Other drugs have a role in suppressing in?ammation: sodium cromoglycate has been available for some years and is generally less e?ective than inhaled steroids. Newer agents directed at speci?c steps in the in?ammatory pathway, such as leukotriene receptor-antagonists, are alternative agents.

Treatment guidelines have been produced by various national and international bodies, such as the British Thoracic Society. Most have set out treatment in steps according to severity, with objectives for asthma control based on symptoms and peak ?ow. Patients should have a management plan that sets out their regular treatment and their appropriate response to changes in their condition.

Advice and support for research into asthma is provided by the National Asthma Campaign.

See www.brit-thoracic.org.uk

Prognosis Asthma is diagnosed in 15–20 per cent of all pre-school children in the developed world. Yet by the age of 15 it is estimated that fewer than 5 per cent still have symptoms. A study in 2003 reported on a follow-up of persons born in 1972–3 who developed asthma and still had problems at the age of nine. By the time these persons were aged 26, 27 per cent were still having problems; around half of that number had never been free from the illness and the other half had apparently lost it for a few years but it had returned.... asthma

An error of refraction in the EYE due to the cornea (the clear membrane in front of the eye) being unequally curved in di?erent directions, so that rays of light in di?erent meridians cannot be brought to a focus together on the retina. The curvature, instead of being globular, is egg-shaped, longer in one axis than the other. The condition causes objects to seem distorted and out of place, a ball for instance looking like an egg, a circle like an ellipse. The condition is remedied by suitable spectacles of which one surface forms part of a cylinder. A hard contact lens may be ?tted to achieve an evenly curved surface. Astigmatism may be caused by any disease that affects the shape of the cornea – for example, a meibomian cyst (a swollen sebaceous gland in the eyelid) may press on the cornea and distort it.... astigmatism

The lack of any symptoms of disease, whether or not a disease is present.... asymptomatic

Loss of coordination, though the power necessary to make the movements is still present. Thus an ataxic person may have a good grip in each hand but be unable to do any ?ne movements with the ?ngers; or, if the ataxia be in the legs, the person throws these about a great deal in walking while still being able to lift the legs and take steps quite well. This is due to a sensory defect or to disease of the cerebellum. (See FRIEDREICH’S ATAXIA; LOCOMOTOR ATAXIA.)... ataxia

Collapse of a part of the lung, or failure of the lung to expand at birth.... atelectasis

One of several BETA-ADRENOCEPTORBLOCKING DRUGS used in the treatment of high blood pressure, ANGINA and ARRHYTHMIA. One of its practical advantages is that only one dose a day need be taken. Atenolol, being a beta-blocking drug, may precipitate ASTHMA – an e?ect that may be dangerous. Among the side-effects are fatigue and disturbed sleep.... atenolol

Athetosis is the name for slow, involuntary writhing and repeated movements of the face, tongue, hands and feet, caused by disease of the brain. It is usually a manifestation of CEREBRAL PALSY. Drugs used to treat PARKINSONISM can also cause athetosis.... athetosis

The ?rst cervical vertebra. (See SPINAL COLUMN.)... atlas

Atopy, meaning out of place, is a form of hypersensitivity characterised – amongst other features – by a familial tendency. It is due to the propensity of the affected individual to produce large amounts of reagin ANTIBODIES which stick to MAST CELLS in the mucosa, so that when the ANTIGEN is inhaled, HISTAMINE is released from the mast cell. Atopy is the condition responsible for ASTHMA and HAY FEVER (see also ALLERGY). It is estimated that 10 per cent of the human race is subject to atopy. (See also DERMATITIS.)... atopy

The absence of a natural opening, or closure of it by a membrane. Thus atresia may be found in newborn infants, preventing the bowels from moving. In young girls after puberty, absence of the menstrual ?ow may be due to such a malformation at the entrance to the VAGINA.... atresia

The atria (see ATRIUM) of the heart contain peptides with potent diuretic and vasodilating properties. It has been known since 1980 that extracts of human atria have potent diuretic and natriuretic effects in animals (see DIURETICS). In 1984 three polypeptide species were isolated from human atria and were called alpha, beta and gamma human atrial natriuretic peptides. Plasma concentration of immunoreactive atrial natriuretic peptide can now be measured: the levels are low in healthy subjects and are increased in patients with congestive heart failure. Infusion of the peptides reduces blood pressure and causes a natriuresis and diuresis.... atrial natriuretic peptide

See HEART, DISEASES OF – Congenital heart disease.... atrial septal defect

(Plural: atria.) Atrium is the name now given to the two upper cavities of the HEART. These used to be known as the auricles of the heart. The term is also applied to the part of the ear immediately internal to the drum of the ear.... atrium

A graph produced during hearing tests (with an audiometer) that shows the hearing threshold – the minimal audible loudness level – for a range of sound frequencies.... audiogram

See VESTIBULOCOCHLEAR NERVE.... auditory nerve

A term applied both to the pinna or ?ap of the ear, and also to the ear-shaped tip of the atrium of the heart.... auricle

An instrument for examining the ear. The source of illumination may be incorporated into the instrument, as in the electric auriscope, or it may be an independent light which is re?ected into the ear by means of a forehead mirror. (See EAR, DISEASES OF.)... auriscope

An antibody (see ANTIBODIES) produced by a person’s immune system (see IMMUNITY) that acts against the body’s own tissues, resulting in AUTOIMMUNITY.... autoantibody

The method used by physicians to determine, by listening, the condition of certain internal organs. The ancient physicians appear to have practised a kind of auscultation, by which they were able to detect the presence of air or ?uids in the cavities of the chest and abdomen.

In 1819 the French physician, Laennec, introduced the method of auscultation by means of the STETHOSCOPE. Initially a wooden cylinder, the stethoscope has evolved into a binaural instrument consisting of a small expanded chest-piece and two ?exible tubes, the ends of which ?t into the ears of the observer. Various modi?cations of the binaural stethoscope have been introduced.

Conditions affecting the lungs can often be recognised by means of auscultation and the stethoscope. The same is true for the heart, in which disease can, by auscultation, often be identi?ed with striking accuracy. But auscultation is also helpful in the investigation of aneurysms (see ANEURYSM) and certain diseases of the OESOPHAGUS and STOMACH. The stethoscope is also a valuable aid in the detection of some forms of uterine tumours, especially in the diagnosis of pregnancy.... auscultation

This is a very e?ective way of ensuring that material (e.g. surgical dressings) is completely sterilised, and that even the most resistant bacteria with which it may be contaminated are destroyed. Its use is based upon the fact that water boils when its vapour pressure is equal to the pressure of the surrounding atmosphere. This means that if the pressure inside a closed vessel is increased, the temperature at which water inside the vessel boils will rise above 100 degrees centigrade. By adjusting the pressure, almost any temperature for the boiling of the water will be obtained.... autoclave

The state of having acquired an immunologic memory that says a normal cell membrane is “other”, and having forming antibody responses against it. A viral infection or organic chemical (hapten) may have started the response, but surviving healthy cells may have so close a charge pattern (epitope) that acquired immunity keeps on as if the cell was still “other”. Any physical stress that causes the target tissue to become inflamed or replicate rapidly to heal can restimulate the auto-immune response.... autoimmunity

Part of the nervous system which regulates the bodily functions that are not under conscious control: these include the heartbeat, intestinal movements, salivation, sweating, etc. The autonomic nervous system consists of two main divisions – the SYMPATHETIC NERVOUS SYSTEM and the PARASYMPATHETIC NERVOUS SYSTEM. The smooth muscles, heart and most glands are connected to nerve ?bres from both systems and their proper functioning depends on the balance between these two. (See also NERVES; NERVOUS SYSTEM.)... autonomic nervous system

A POST-MORTEM EXAMINATION, or the examin ation of the internal organs of a dead body. (See NECROPSY.)... autopsy

The performance of acts without conscious will, as, for example, after an attack of epilepsy or concussion of the brain. In such conditions the person may perform acts of which he or she is neither conscious at the time nor has any memory afterwards. It is especially liable to occur when persons suffering from epilepsy, mental subnormality, or concussion consume alcoholic liquors. It may also occur following the taking of barbiturates or PSYCHEDELIC DRUGS. There are, however, other cases in which there are no such precipitatory factors. Thus it may occur following hypnosis, mental stress or strain, or conditions such as FUGUE or somnambulism (see SLEEP). The condition is of considerable importance from a legal point of view, because acts done in this state, and for which the person committing them is not responsible, may be of a criminal nature. According to English law, however, it entails complete loss of consciousness, and only then is it a defence to an action for negligence. A lesser impairment of consciousness is no defence.... automatism

Geum urbanum. N.O. Rosaceae.

Synonym: Colewort, Herb Bennet.

Habitat: Hedges, woods and shady banks,

Features ? This slender, sparsely branched plant reaches a height of one to two feet. The stem leaves have two leaflets, with one margin-toothed terminal lobe. The root leaves are on long stalks with two small leaflets at the base. The yellow, erect flowers, with naked styles, appear between May and September. The root is short, hard and rough, with light brown rootlets.

Part used ? Herb and root.

Action: Astringent, tonic, antiseptic and stomachic.

The properties of Avens make for success in the treatment of diarrhoea and dysentery. The tonic effect upon the glands of the stomach and alimentary tract point to its helpfulness in dyspepsia. In general debility continued use has had good results. The astringent qualities may also be utilized in cases of relaxed throat Although wineglass-ful doses three or four times daily of the 1 ounce to 1 pint infusion are usually prescribed, Avens may be taken freely, and is, indeed, used by country people in certain districts as a beverage in place of tea or coffee.... avens

See Aguacate.... avocado

Forcible tearing away of one tissue from another. For example, a tendon may be avulsed from the bone to which it is attached, or a nerve may be injured and torn away – avulsed – from the tissue in which it runs.... avulsion

Anatomical name for the armpit.... axilla

The name applied to the second cervical vertebra. (See SPINAL COLUMN.)... axis

Nerve ?bre: an elongated projection of a nerve cell or NEURON(E) that carries an electrical impulse to the tissue at the end of the axon.

Large axons are covered by a sheath of insulating myelin which is interrupted at intervals by nodes of Lanvier, where other axons branch out. An axon may be more than a metre long. It ends by branching into several ?laments called telodendria, and these are in contact with muscle or gland membranes and other nerves (see NERVE).... axon

A CYTOTOXIC and an immunosuppressive drug (see IMMUNOSUPPRESSION). In the ?rst of these capacities it is proving to be of value in the treatment of acute leukaemia. As an immunosuppressive agent it reduces the antibody response of the body (see ANTIBODIES), and is thereby helping to facilitate the success of transplant operations (see TRANSPLANTATION) by reducing the chances of the transplanted organ (e.g. the kidney) being rejected by the body. Azathioprine is also proving to be of value in the treatment of AUTOIMMUNE DISORDERS.... azathioprine

The condition characterised by lack of spermatozoa (see SPERMATOZOON) in the SEMEN.... azoospermia

Uncoordinated movements, including an unsteady gait, caused by damage to or disease of the cerebellum (see BRAIN). Brain tumours, MULTIPLE SCLEROSIS (MS) and stroke can result in ataxia – as can excessive consumption of alcohol, and degeneration of the cerebellum as a result of an inherited disease. A?ected victims may have slurred speech, hand tremors and nystagmus (see under EYE, DISORDERS OF).... cerebellar ataxia

See ADRENOGENITAL SYNDROME and GENETIC DISORDERS.... congenital adrenal hyperplasia

See DNA.... deoxyribonucleic acid

This traditional term covers the neglect, physical injury, emotional trauma and sexual abuse of a child. Professional sta? responsible for the care and well-being of children now refer to physical injury as ‘non-accidental injury’. Child abuse may be caused by parents, relatives or carers. In England around 35,000 children are on local-authority social-service department child-protection registers – that is, are regarded as having been abused or at risk of abuse. Physical abuse or non-accidental injury is the most easily recognised form; victims of sexual abuse may not reveal their experiences until adulthood, and often not at all. Where child abuse is suspected, health, social-care and educational professionals have a duty to report the case to the local authority under the terms of the Children Act. The authority has a duty to investigate and this may mean admitting a child to hospital or to local-authority care. Abuse may be the result of impulsive action by adults or it may be premeditated: for example, the continued sexual exploitation of a child over several years. Premeditated physical assault is rare but is liable to cause serious injury to a child and requires urgent action when identi?ed. Adults will go to some lengths to cover up persistent abuse. The child’s interests are paramount but the parents may well be under severe stress and also require sympathetic handling.

In recent years persistent child abuse in some children’s homes has come to light, with widespread publicity following o?enders’ appearances in court. Local communities have also protested about convicted paedophiles, released from prison, coming to live in their communities.

In England and Wales, local-government social-services departments are central in the prevention, investigation and management of cases of child abuse. They have four important protection duties laid down in the Children Act 1989. They are charged (1) to prevent children from suffering ill treatment and neglect; (2) to safeguard and promote the welfare of children in need; (3) when requested by a court, to investigate a child’s circumstances; (4) to investigate information – in concert with the NSPCC (National Society for the Prevention of Cruelty to Children) – that a child is suffering or is likely to suffer signi?cant harm, and to decide whether action is necessary to safeguard and promote the child’s welfare. Similar provisions exist in the other parts of the United Kingdom.

When anyone suspects that child abuse is occurring, contact should be made with the relevant social-services department or, in Scotland, with the children’s reporter. (See NONACCIDENTAL INJURY (NAI); PAEDOPHILIA.)... child abuse

See ANAESTHESIA.... epidural anaesthesia

A valuable antistaphylococcal antibiotic used both orally and topically. It is particularly useful in osteomyelitis (see BONE, DISORDERS OF).... fusidic acid

One of the constituents of the vitamin B complex, folic acid derives its name from the fact that it is found in many green leaves, including spinach and grass. It has also been obtained from liver, kidney and yeasts. It has proved to be of value in the treatment of macrocytic anaemias (see ANAEMIA), particularly those associated with SPRUE and nutritional de?ciencies.

In order to prevent NEURAL TUBE defects and cleft lip or palate (see CLEFT PALATE), all women planning to become pregnant should be advised to have a diet rich in folic acid in the months before conception until 13 weeks’ gestation, or to take folic acid tablets.

Recent research has suggested that adequate levels of folic acid can prevent the build-up of homocysteine, a compound in the blood closely associated with heart attacks and strokes. It has been suggested that the o?cial recommendation of 200 micrograms a day in the diet should be doubled. (See APPENDIX 5: VITAMINS.)... folic acid

See visceral leishmaniasis.... kala azar

A colourless, syrupy, sour liquid, which is produced by the action of a bacterium upon lactose, the sugar found in milk. The growth of this organism and consequent formation of lactic acid cause the souring of milk, and the same change takes place to a limited extent when food is long retained in the stomach.

Lactic acid (CH3.CHOH.COOH) is produced in the body during muscular activity, the lactic acid being derived from the breakdown of GLYCOGEN. Muscle fatigue is associated with an accumulation of lactic acid in the muscle. Recovery follows when enough oxygen gets to the muscle, part of the lactic acid being oxidised and most of it then being built up once more into glycogen.... lactic acid

See RADIOTHERAPY.... linear accelerator

A detailed review and evaluation of selected clinical records by qualified professional personnel for the purpose of evaluating the quality of medical care.... medical audit

One of the NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) that is an analgesic (see ANALGESICS) for mild to moderate pain in RHEUMATOID ARTHRITIS, OSTEOARTHRITIS and other musculoskeletal disorders. Also used for DYSMENNORRHOEA and MENORRHAGIA. It must be used with care as it has several side-effects, in particular diarrhoea and occasional haemolytic ANAEMIA. It must not be used in patients with INFLAMMATORY BOWEL DISEASE (IBD).... mefenamic acid

A statistical procedure to combine results from different studies on a similar topic. The combination of results from multiple studies may produce a stronger conclusion than can be provided by any singular study. Meta-analysis is generally most appropriate when there are no definitive studies on a topic and non-definitive studies are in some disagreement.... meta-analysis

An antibiotic drug, active against gram-negative (see GRAM’S STAIN) micro-organisms, used to treat and prevent infections of the URINARY TRACT.... nalidixic acid

Nicotinic acid is a member of the vitamin B complex. It is essential for human nutrition, the normal daily requirement for an adult being about 15–20 mg. A de?ciency of nicotinic acid is one of the factors in the etiology of PELLAGRA, and either nicotine acid or NICOTINAMIDE is used in the treatment of this condition. Nicotinic acid also reduces the concentration of blood lipids (see HYPERLIPIDAEMIA).... nicotinic acid

Group of chemicals found in cells and which carry biochemical codes for heredity and day-to-dayfunctioning of cells.... nucleic acid

A deterioration in the ?bres of the optic nerve (see EYE) resulting in partial or complete loss of vision. It may be caused by damage to the nerve from in?ammation or injury, or the atrophy may be secondary to disease in the eye.... optic atrophy

This is an irritant poison that is used domestically for cleaning purposes. It is also found in many plants including rhubarb and sorrel. Oxalic acid, when swallowed, produces burning of the mouth and throat, vomiting of blood, breathlessness and circulatory collapse. Calcium salts, lime water or milk should be given by mouth. An injection of calcium gluconate is an antidote.... oxalic acid

This plays an important part in the transfer of acetyl groups in the body’s METABOLISM and is one of the essential constituents of the diet. The daily requirement is probably around 10 milligrams. It is widely distributed in food stu?s, both animal and vegetable; yeast, liver and egg-yolk are particularly rich sources. (See APPENDIX

5: VITAMINS.)... pantothenic acid

See DUCTUS ARTERIOSUS.... patent ductus arteriosus

The term applied to a collection of pus or an ABSCESS which occurs complicating an attack of TONSILLITIS. The collection of pus forms between the tonsil and the superior constrictor muscle of the pharynx. This condition is also known as quinsy; treatment drainage of the abscess and the administration of appropriate antibiotics.... peritonsillar abscess

An autoimmune disease in which sensitised lymphocytes (see LYMPHOCYTE) destroy the parietal cells of the STOMACH. These cells normally produce intrinsic factor, which is the carrier protein for vitamin B12 that permits its absorption in the terminal ileum. Without intrinsic factor, vitamin B12 cannot be absorbed and this gives rise to a macrocytic ANAEMIA. The skin and mucosa become pale and the tongue smooth and atrophic. A peripheral NEUROPATHY is often present, causing paraesthesiae (see under TOUCH), numbness and even ATAXIA. The more severe neurological complication of sub-acute combined degeneration of the cord is fortunately more rare. The anaemia gets its name from the fact that before the discovery of vitamin B12 it was uniformly fatal. Now a monthly injection of vitamin B12 is all that is required to keep the patient healthy.... pernicious anaemia

An aseptic (that is, not involving infection) ARTHRITIS secondary to an episode of infection elsewhere in the body. It often occurs in association with ENTERITIS caused by salmonella (see FOOD POISONING) and certain SHIGELLA strains, and in both YERSINEA and CAMPYLOBACTER enteritis. Non-gonococcal urethritis, usually due to CHLAMYDIA, is another cause of reactive arthritis; Reiter’s syndrome is a particularly ?orid form, characterised by mucocutaneous and ocular lesions.

The SYNOVITIS usually starts acutely and is frequently asymmetrical, with the knees and ankles most commonly affected. Often there are in?ammatory lesions of tendon sheaths and entheses (bone and muscle functions) such as plantar fasciitis (see FASCIITIS). The severity and duration of the acute episode are extremely variable. Individuals with the histocompatibility antigen HLA B27 are particularly prone to severe attacks.... reactive arthritis

A chronic in?ammation of the synovial lining (see SYNOVIAL MEMBRANE) of several joints, tendon sheaths or bursae which is not due to SEPSIS or a reaction to URIC ACID crystals. It is distinguished from other patterns of in?ammatory arthritis by the symmetrical involvement of a large number of peripheral joints; by the common blood-?nding of rheumatoid factor antibody; by the presence of bony erosions around joints; and, in a few, by the presence of subcutaneous nodules with necrobiotic (decaying) centres.

Causes There is a major immunogenetic predisposition to rheumatoid arthritis in people carrying the HLA-DR4 antigen (see HLA SYSTEM). Other minor immunogenetic factors have also been implicated. In addition, there is a degree of familial clustering which suggests other unidenti?ed genetic factors. Genetic factors cannot alone explain aetiology, and environmental and chance factors must be important, but these have yet to be identi?ed.

Epidemiology Rheumatoid arthritis more commonly occurs in women from the age of 30 onwards, the sex ratio being approximately 4:1. Typical rheumatoid arthritis may occur in adolescence, but in childhood chronic SYNOVITIS usually takes one of a number of di?erent patterns, classi?ed under juvenile chronic arthritis.

Pathology The primary lesion is an in?ammation of the synovial membrane of joints. The synovial ?uid becomes diluted with in?ammatory exudate: if this persists for months it leads to progressive destruction of articular CARTILAGE and BONE. Cartilage is replaced by in?ammatory tissue known as pannus; a similar tissue invades bone to form erosions. Synovitis also affects tendon sheaths, and may lead to adhesion ?brosis or attrition and rupture of tendons. Subcutaneous and other bursae may be involved. Necrobiotic nodules also occur at sites outside synovium, including the subcutaneous tissues, the lungs, the pericardium and the pleura.

Clinical features Rheumatoid arthritis varies from the very mild to the severely disabling. Many mild cases probably go undiagnosed. At least 50 per cent of patients continue to lead a reasonably normal life; around 25 per cent are signi?cantly disabled in terms of work and leisure activities; and a minority become markedly disabled and are limited in their independence. There is often an early acute phase, followed by substantial remission, but in other patients gradual step-wise deterioration may occur, with progressive involvement of an increasing number of joints.

The diagnosis of rheumatoid arthritis is largely based on clinical symptoms and signs. Approximately 70 per cent of patients have rheumatoid factor ANTIBODIES in the SERUM but, because of the large number of false positives and false negatives, this test has very little value in clinical practice. It may be a useful pointer to a worse prognosis in early cases if the level is high. X-RAYS may help in diagnosing early cases and are particularly helpful when considering surgery or possible complications such as pathological fracture. Patients commonly develop ANAEMIA, which may be partly due to gastrointestinal blood loss from antiin?ammatory drug treatment (see below).

Treatment involves physical, pharmacological, and surgical measures, together with psychological and social support tailored to the individual patient’s needs. Regular activity should be maintained. Resting of certain joints such as the wrist with splints may be helpful at night or to assist prolonged manual activities. Sound footwear is important. Early use of antirheumatic drugs reduces long-term disability. Drug treatment includes simple ANALGESICS, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), and slow-acting drugs including GOLD SALTS (in the form of SODIUM AUROTHIOMALATE), PENICILLAMINE, SULFASALAZINE, METHOTREXATE and AZATHIOPRINE.

The non-steroidal agents are largely e?ective in reducing pain and early-morning sti?ness, and have no e?ect on the chronic in?ammatory process. It is important, especially in the elderly, to explain to patients the adverse effects of NSAIDs, the dosage of which can be cut by prescribing paracetamol at the same time. Combinations of anti-rheumatic drugs seem better than single agents. The slow-acting drugs take approximately three months to act but have a more global e?ect on chronic in?ammation, with a greater reduction in swelling and an associated fall in erythrocyte sedimentation rate (ESR) and rise in the level of HAEMOGLOBIN. Local CORTICOSTEROIDS are useful, given into individual joints. Systemic corticosteroids carry serious problems if continued long term, but may be useful under special circumstances. Much research is currently going on into the use of tumour necrosis factor antagonists such as INFLIXIMAB and etanercept, but their precise role remains uncertain.... rheumatoid arthritis

A crystalline substance sparingly soluble in water that is used externally in ointments and pastes. It has antifungal properties and helps to loosen and remove scales. In high concentrations it is useful in treatment of verrucae (WARTS) and corns (see CORNS AND BUNIONS).... salicylic acid

Infection in a joint which becomes warm, swollen and sore, with restricted movement. The infectious agent may enter the joint as a result of a penetrating wound or via the bloodstream. The condition is treated by ARTHROTOMY or ARTHROSCOPY, joint irrigation and ANTIBIOTICS. Unless treated, the articular CARTILAGE of the joint is destroyed, resulting in a painful, deformed and sometimes immobile joint. (See ARTHRITIS.)... septic arthritis

See CHILD ABUSE.... sexual abuse

Repeated attacks of ASTHMA, with no respite between the spasms, usually lasting for more than 24 hours. The patient is seriously distressed and, untreated, the condition may lead to death from respiratory failure and exhaustion. Continuous or very frequent use of nebulised bronchodilators, intravenous corticosteroid treatment, and other skilled medical care are urgently required.... status asthmaticus

An ABSCESS that develops under the DIAPHRAGM, usually on the right side of the abdomen between the liver and the diaphragm. The cause may be an organ that has perforated – for instance, a peptic ulcer in the stomach or intestine. An abscess may also occur after an abdominal operation, usually when the bowel or stomach has been operated on. Antibiotics and sometimes surgery are the method of treatment.... subphrenic abscess

In?ammation of the TEMPORAL ARTERY. Also known as giant cell arteritis, it often affects other arteries too, mainly in the head. It predominantly affects the elderly. The artery becomes tender with reddening of the overlying skin; headache and blindness may also occur. The diagnosis is con?rmed by temporal artery BIOPSY, and treatment is with steroids (see STEROID).... temporal arteritis

A drug used in the control of bleeding. It inhibits the activation of PLASMINOGEN and FIBRINOLYSIS, and may be useful when bleeding cannot be stopped – for instance, dental extraction in HAEMOPHILIA. The drug is also useful in MENORRHAGIA.... tranexamic acid

A preparation used in the treatment of cholesterol gall-stones when laparoscopic CHOLECYSTECTOMY and endoscopic biliary procedures cannot be used (see GALL-BLADDER, DISEASES OF).... ursodeoxycholic acid

The temporary loss of consciousness caused by an abrupt slowing of the heartbeat. This may happen following SHOCK, acute pain, fear, or stress. A common cause of fainting in normal people, a vasovagal attack may be a consequence of overstimulation of the VAGUS nerve which is involved in the control of breathing and the circulation.... vasovagal attack

See VISION.... visual acuity

See: FISSURE, ANAL. ... anal fissure

A disease causing failure of adrenal gland function, in particular deficiency of adrenal cortical hormones, mainly cortisol and aldosterone. Commonest causes are tuberculosis and auto- immune disease.

Symptoms: (acute) abdominal pain, muscle weakness, vomiting, low blood pressure due to dehydration, tiredness, mental confusion, loss of weight and appetite. Vomiting, dizzy spells. Increased dark pigmentation around genitals, nipples, palms and inside mouth. Persistent low blood pressure with occasional low blood sugar. Crisis is treated by increased salt intake. Research project revealed a craving for liquorice sweets in twenty five per cent of patients.

Herbs with an affinity for the adrenal glands: Parsley, Sarsaparilla, Wild Yam, Borage, Liquorice, Ginseng, Chaparral. Where steroid therapy is unavoidable, supplementation with Liquorice and Ginseng is believed to sustain function of the glands. Ginseng is supportive when glands are exhausted by prolonged stress. BHP (1983) recommends: Liquorice, Dandelion leaf.

Alternatives. Teas. Gotu Kola, Parsley, Liquorice root, Borage, Ginseng, Balm.

Tea formula. Combine equal parts: Balm and Gotu Kola. Preparation of teas and tea mixture: 1 heaped teaspoon to each cup boiling water: infuse 5-10 minutes; 1 cup 2 to 3 times daily.

Tablets/capsules. Ginseng, Seaweed and Sarsaparilla, Wild Yam, Liquorice. Dosage as on bottle. Formula. Combine: Gotu Kola 3; Sarsaparilla 2; Ginseng 1; Liquorice quarter. Doses. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 30-60 drops. Tinctures: 1-2 teaspoons 2 to 3 times daily.

Formula. Alternative. Tinctures 1:5. Echinacea 20ml; Yellow Dock 10ml; Barberry 10ml; Sarsaparilla 10ml; Liquorice (liquid extract) 5ml. Dose: 1-2 teaspoons thrice daily.

Supplementation. Cod liver oil. Extra salt. B-Vitamins. Folic acid. ... addison’s disease

A progressive brain deterioration first described by the German Neurologist, Alois Alzheimer in 1906. Dementia. Not an inevitable consequence of ageing. A disease in which cells of the brain undergo change, the outer layer (cerebral cortex) leading to tangles of nerve fibres due to reduced oxygen and blood supply to the brain.

The patient lives in an unreal world in which relatives have no sense of belonging. A loving gentle wife they once knew is no longer aware of their presence. Simple tasks, such as switching on an electrical appliance are fudged. There is distressing memory loss, inability to think and learn, speech disturbance – death of the mind. Damage by free radicals implicated.

Symptoms: Confusion, restlessness, tremor. Finally: loss of control of body functions and bone loss.

A striking similarity exists between the disease and aluminium toxicity. Aluminium causes the brain to become more permeable to that metal and other nerve-toxins. (Tulane University School of Medicine, New Orleans). High levels of aluminium are found concentrated in the neurofibrillary tangles of the brain in Alzheimer’s disease. Entry into the body is by processed foods, cookware, (pots and pans) and drugs (antacids).

“Reduction of aluminium levels from dietary and medicinal sources has led to a decline in the incidence of dementia.” (The Lancet, Nov 26, 1983).

“Those who smoke more than one packet of cigarettes a day are 4.5 times more likely to develop Alzheimer’s disease than non-smokers.” (Stuart Shalat, epidemiologist, Harvard University).

Researchers from the University of Washington, Seattle, USA, claim to have found a link between the disease and head injuries with damage to the blood/brain barrier.

Also said to be associated with Down’s syndrome, thyroid disease and immune dysfunction. Other contributory factors are believed to be exposure to mercury from dental amalgam fillings. Animal studies show Ginkgo to increase local blood flow of the brain and to improve peripheral circulation. Alternatives. Teas: Alfalfa, Agrimony, Lemon Balm, Basil, Chaparral, Ginkgo, Chamomile, Coriander (crushed seeds), Ginseng, Holy Thistle, Gotu Kola, Horsetail, Rosemary, Liquorice root (shredded), Red Clover flowers, Skullcap, Ladies Slipper.

Tea. Formula. Combine, equal parts: German Chamomile, Ginkgo, Lemon Balm. 1 heaped teaspoon to cup boiling water; infuse 5-15 minutes. 1 cup freely.

Decoction. Equal parts: Black Cohosh, Blue Flag root, Hawthorn berries. 1 teaspoon in each cupful water; bring to boil and simmer 20 minutes. Dose: half-1 cup thrice daily.

Powders. Formula. Hawthorn 1; Ginkgo 1; Ginger half; Fringe Tree half. Add pinch Cayenne pepper. 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Liquid extracts. Formula. Hawthorn 1; Ephedra half; Ginkgo 1. Dose: 30-60 drops, thrice daily, before meals.

Topical. Paint forehead and nape of neck with Tincture Arnica.

Diet: 2 day fluid-only fast once monthly for 6 months. Low fat, high fibre, lecithin. Lacto-vegetarian. Low salt.

Supplements. Vitamin B-complex, B6, B12, Folic acid, A, C, E, Zinc. Research has shown that elderly patients at high risk of developing dementia have lower levels of Vitamins A, E and the carotenes. Zinc and Vitamin B12 are both vital cofactors for brain enzymes.

Alzheimer’s Disease linked with zinc. Zinc is believed to halt cerebral damage. Senile plaques in the brain produce amyloid, damaging the blood-brain barrier. Toxic metals then cross into the brain, displacing zinc. This then produces abnormal tissue. (Alzheimer Disease and Associated Disorders, researchers, University of Geneva).

Japanese study. Combination of coenzyme Q10, Vitamin B6 and iron. Showed improved mental function. Abram Hoffer MD, PhD. Niacin 500mg tid, Vitamin C 500mg tid, Folic acid 5mg daily, Aspirin 300mg daily, Ginkgo herb 40mg daily. (International Journal of Alternative and Complementary Medicine, Feb 1994 p11)

Alzheimer’s Disease Society. 2nd Floor, Gordon House, 10 Greencoat Place, London SW1P 1PH, UK. Offers support to families and carers through membership. Practical help and information. Send SAE. ... alzheimer’s disease

Superficial infection of the skin of the feet by a fungus. Ringworm of the feet. Scaly lesions, sometimes with blisters. May be secondary infection from lymphadenitis or cellulitis – in which cases internal treatment would be indicated. Begins between the toes before spreading to plantar surface. Differential diagnosis. Eczema, psoriasis or dermatitis from shoes.

Symptoms. Itchy redness and peeling. Sore raw areas left after removal of patches of skin. Possible invasion of other parts of the body: fingers, palms. The fungus can be picked up walking bare-feet in sport’s clubs, schools or swimming baths. Worse in warm weather. Resistant to cleansing.

Treatment. Tablets/capsules. Echinacea, Thuja, Poke root.

Formula. Echinacea 2; Goldenseal 1; Poke root half. Mix. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Thrice daily before meals.

Topical. Alternatives:– Thuja lotion applied on lint or suitable material (1 teaspoon Liquid extract Thuja in 1oz (30ml) distilled extract of Witch Hazel. Wild Indigo salve (1 teaspoon Wild Indigo powder in 1oz (30ml) honey – store in screw-top jar.

Aloe Vera, fresh juice or gel.

Tea Tree oil: if too strong may be diluted many times.

Comfrey cream. Castor oil. Mullein oil. Houseleek.

Black Walnut: tincture or Liquid extract. Cider vinegar. Bran bath.

Night foot-wash. With water to which has been added a few drops of tincture Thuja, Myrrh, or Tea

Tree oil.

Light sprinkle of powdered Myrrh or Goldenseal in sock or shoe. ... athlete’s foot

Arrhythmia. Heart flutter. Disorderly uncoordinated contraction of atrial muscle wall, the ventricles responding irregularly.

Causes: thyrotoxicosis, valvular or coronary disease. Present in mitral stenosis and myocarditis. Precursor of heart failure. Carrying a bucket of coal upstairs may be sufficient to precipitate an attack. Symptoms. Pulse irregular in time and force, breathlessness, visible pulse in neck, excessive heart beats of sudden onset or permanent, with breathlessness often from emotional excitement.

Treatment. Patient should avoid excessive physical exercise or give way to anxiety and depression. Alternatives:– Tea. Equal parts: Hawthorn (berries or blossoms), Broom, Valerian. 1-2 teaspoons in each cup boiling water; infuse 5-15 minutes; dose – half-1 cup thrice daily.

Tablets/capsules. Hawthorn, Valerian, Motherwort.

Formula. Hawthorn 2; Passion flower 2; Broom 3. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or honey thrice daily. Practitioner. Tincture Gelsemium (BPC 1973): 2-5 drops. Tincture Lily of the Valley: 0.5-1ml.

Undue violence. Tincture Gelsemium 1; Tincture Cactus 2. Mix. Dose: 5-10 drops. Where heart muscle is damaged, add 1 part Liquid Extract Black Cohosh.

Broom. Spartiol Drops, 20 drops thrice daily. (Klein)

Diet. See: DIET – HEART AND CIRCULATION. ... atrial fibrillation

See: ARTERITIS. ... giant cell arteritis

See ABDOMEN, DISEASES OF.... abdomen, acute

This is the sixth nerve rising from the brain and controls the external rectus muscle of the EYE, which turns the eye outwards. It is particularly liable to be paralysed in diseases of the nervous system, thus leading to an inward squint.... abducent nerve

To abduct means to move a part of the body – for example, a limb – away from the mid line. (Opposite: ADDUCT.)... abduct

A brief summary or digest of a study and its results. It should include the problem investigated, the subjects and instruments involved, the design and procedures and the major conclusions.... abstract

(Greek) Thorny; in mythology, a nymph who was loved by Apollo Akantha, Ackantha, Acanthah, Akanthah, Ackanthah... acantha

Acanthosis nigricans is a darkly pigmented verrucous skin change, usually occurring around the neck and axilla. It may be inherited but is most commonly acquired, and is associated with adenocarcinoma – usually of the stomach (see CANCER) – and certain hormonal disorders

The group of arthropod insects that include the parasitic MITES and TICKS.... acanthosis nigricans

The group of animal parasites which includes Sarcoptes scabiei, the cause of the skin disease known as itch, or SCABIES. This parasite used to be known as Acarus scabiei.... acarus

Archaic term for delivery of a baby (see PREGNANCY AND LABOUR).... accouchement

One of the BETA-ADRENOCEPTOR-BLOCKING DRUGS (beta blockers) used to treat HYPERTENSION and ANGINA. Like other beta blockers, it slows the heart rate and may precipitate heart failure, so should not be given to patients with incipient heart failure. Acebutolol can be used with caution in patients whose heart failure is satisfactorily controlled.... acebutolol

In 2000, more than 12,000 people died in or as a result of accidents in the UK, nearly half occurring at home and around a third in motor vehicle incidents. Many of these deaths would have been preventable, had appropriate safety measures been taken. A high proportion of deaths from accidents occur in males between ?ve and 34 years of age; alcohol is a signi?cant factor. Since the introduction of compulsory use of car seatbelts in the UK in the 1980s, the incidence of deaths from driving has fallen. With employers more aware of the risks of injury and death in the work place – with legislation reinforcing education – the number of such incidents has fallen over the past 50 years or more: this group now accounts for less than 2 per cent of all accidental deaths. Accidental deaths in the elderly are mainly caused by falls, mostly at home. In infants, choking is a signi?cant cause of accidental death, with food and small objects presenting the main hazards. Poisoning (often from drug overdose) and drowning are notable causes between the mid-20s and mid-40s.

See www.rospa.com... accidental death

The cup-shaped socket on the pelvis in which rests the head of the femur or thigh-bone, the two forming the HIP-JOINT.... acetabulum

An organic acid produced by the LIVER when it is rapidly oxidising fatty acids – a metabolic process which occurs, for example, during starvation. The acid produced is then converted to ACETONE, which is excreted.... acetoacetic acid

Acetone is a volatile, colourless organic compound of the KETONE group produced by the partial oxidation of fatty acids. In some abnormal conditions, such as starvation, uncontrolled diabetes (see DIABETES MELLITUS) or prolonged vomiting, acetone and other ketones can accumulate in the blood. Acetone may then appear in the urine, along with beta-hydroxybutyric and aceotacic acids, presaging developing COMA.... acetone

A thick tendon that joins the calf muscles to the heel bone (calcaneus) and pulls up that bone. The tendon is prone to rupture in middle-aged people playing vigorous sports such as squash or tennis. Named after the classical Greek hero Achilles, who was reputedly vulnerable to his enemies only in his heel.... achilles tendon

In our context, a substance having a pH below that of neutral water (7.0) when in solution. Most metabolic waste products are acidic. Sour. See pH... acid

The balance between the acid and alkaline elements present in the blood and body ?uids.

The normal hydrogen ion concentration of the PLASMA is a constant pH 7·4, and the lungs and kidneys have a crucial function in maintaining this ?gure. Changes in pH value will cause ACIDOSIS or ALKALOSIS.... acid base balance

Acinus is the name applied to each of the minute sacs of which secreting glands are composed, and which usually cluster around the branches of the gland-duct like grapes on their stem. (See GLAND.)... acinus

See ROSACEA.... acne rosacea

Linn.

Habitat: The alpine zone of the Himalayas from Gilgit to Kumaon.

Ayurvedic: Vatsanaabha (related sp.).

Folk: Tilia Kachnaag, Dudhia.

Action: Nervine tonic.

Air-dried roots of the plant are reported to contain 1% indaconitine.... acorus calamus

Relating to hearing and the response to sound. For acoustic nerve, see VESTIBULOCOCHLEAR NERVE.... acoustic

Jacq. ex Stapf. 15

Family: Ranunculaceae. ^A

Habitat: The alpine Himalayas of Sikkim, Nepal, the adjoining parts of southern Tibet, between altitudes of 3,000 m and 4,800 m. Ayurvedic: Prativishaa, Shyaamkan- daa, Patis. Folk: Bikhamaa.

Action: Root—antiemetic, antidiar- rhoeal, antirheumatic, antiperiodic.

The root contains diterpenoid alkaloids and a nitrogenous non-alkaloid compound, benzamide. Alkaloids include vakognavine, palmatisine, vaka- tisine, vakatisinine and vakatidine.

The root is intensely bitter, like quinine, is used with Piper longum for diarrhoea and vomiting; used externally as an application for rheumatism.... aconitum violaceum

Biting, pungent... acrid

Pre?x meaning extremity or tip.... acro

See DACTINOMYCIN.... actinomycin d

See ACICLOVIR.... acyclovir

A slowly diminishing reaction of a sense organ to persistent or repetitive stimulation. For example, a persistent smell may after a while result in the nose failing to signal its presence; the pressure-sensitive nerve endings in the skin may become accustomed to the presence of clothes on the body; regular background noise may be screened out by the cochlear nerve that links ear and brain.... adaptation

A recent (and to me, slightly flaky) term used to describe agents, often botanical, that stimulate non-specific resistance, and that seem to decrease hypothalamus and pituitary over-reactions to perceived...not real...stress.... adaptogen

To move a limb or any other part towards the midline of the body. (Opposite: ABDUCT.)... adduct

A condition in which multiple glandular over-growths occur.... adenomatosis

Adonis vernalis. N.O. Ranunculaceae.

Synonym: False Hellebore, Pheasant's Eye.

Habitat: Cornfields and meadows.

Features ? Stem up to one foot high. Leaves alternate, divided pinnately into linear segments. Flowers large, yellow, solitary at termination of stem. Oval head of achenes succeeds flower.

Part used ? Herb.

Action: Cardiac, tonic, diuretic.

Highly esteemed in cases where stimulation of heart's action is necessary, heart strain and cardiac dropsy. Diuretic qualities of value in kidney affections. Dose, 1-2 drops of the fluid extract.... adonis

Called epinephrine in the U.S., this is a substance secreted into the bloodstream and reacted to by specialized receptors throughout the body, initiating a “code blue” or flight-or-fight response. Many receptors are a regular part of sympathetic function, and respond to their own local relative, norepinephrine or noradrenalin, in the course of normal autonomic nervous system interplay. See: SYMPATHETIC, PARASYMPATHETIC, LIMBIC... adrenalin

Functions that are dominated by epinephrine (the blood hormone) or norepinephrine (local sympathetic adrenergic nerve stimulus)... adrenergic

A mosquito genus in the sub-family Culicine. Various species may transmit arboviral and filarial infections.... aedes

The bleating or punchinello tone given to the voice as heard by AUSCULTATION with a stethoscope, when there is a small amount of ?uid in the pleural cavity in the chest.... aegophony

Swallowing abnormal quantities of air which can occur during rapid eating or drinking. Indigestion-sufferers sometimes do this to relieve their symptoms, and it is a common sign of anxiety.... aerophagy

See INHALANTS.... aerosol

An adjective to describe nerves, blood vessels or lymphatic vessels that conduct their electrical charge or contents inwards to the brain, spinal cord or relevant organ. (Opposite: EFFERENT.)... afferent

A substance, living or inanimate, or a force, sometimes rather intangible, the excessive presence or relative lack of which is the immediate or proximal cause of a particular disease.... agent

An ANTIGEN that stimulates production of an agglutinin – an antibody that causes AGGLUTINATION or clumping of bacteria, blood cells or other antigenic particles. In the case of blood cells, this should not be confused with the clumping that happens in blood COAGULATION, which is a di?erent process.... agglutinogen

The result of a combination of natural, largely genetically programmed changes occurring in all body systems. Diseases or injuries may in?uence these changes, which impair the body’s homeostatic mechanisms; environment and lifestyle also affect the ageing process.

The effects of ageing include: cessation of MENSTRUATION in females; wrinkling of the skin due to a loss of elastic tissue; failing memory (especially short term) and a reduced ability to learn new skills, along with slowed responses

– changes caused by the loss of or less e?cient working of nerve cells; the senses become less acute; the lungs become less e?cient, as does heart muscle, both causing a fall in exercise tolerance; arteries harden, resulting in a rise in blood pressure and poor blood circulation; joints are less mobile, bones beome more brittle (OSTEOPOROSIS) and muscle bulk and strength are reduced; the lens of the EYE becomes less elastic, resulting in poorer sight, and it may also become opaque (CATARACT).

In developed countries people are living longer, in part because infant and child mortality rates have dropped dramatically over the past 100 years or so. Improved standards of living and more e?ective health care have also contributed to greater longevity: the proportion of people over 65 years of age has greatly increased, and that of the over-75s is still rising. The 2001 census found 336,000 people in the UK aged over 90 and there are 36,000 centenarians in the US. This extreme longevity is attributed to a particular gene (see GENES) slowing the ageing process. Interestingly, those living to 100 often retain the mental faculties of people in their 60s, and examination of centenarians’ brains show that these are similar to those of 60-year-olds. (See MEDICINE OF AGEING; CLIMACTERIC.)

Help and advice can be obtained from Age

Concern and Help the Aged. See www.helpthaged.org.uk www.ageconcern.org.uk... ageing

The adherence together of small bodies in a ?uid. Thus, blood corpuscles agglutinate into heaps (rouleaux) when added to the serum of a person belonging to an incompatible blood group. Bacteria agglutinate into clumps and die when exposed to the presence of antibodies in the blood. This is important in regard to diagnosis of certain diseases due to bacteria. In typhoid fever (see ENTERIC FEVER), for example, the blood of an animal is immunised against typhoid bacilli by repeated injections of these.

The blood serum of the animal, known now as anti-typhoid serum, is issued to laboratories for use when bacilli are found in the excretions of a patient who is possibly suffering from typhoid fever. The bacilli are exposed to the action of a drop of the serum; if the serum shows the power of agglutinating these bacteria, this forms evidence that the bacteria in question are typhoid bacilli. The reaction may also be carried out in the contrary manner: that is to say, the serum from the blood of a patient who may be suffering from typhoid fever, but in whom the diagnosis is still doubtful, is added to a drop of ?uid containing typhoid bacilli; if these are agglutinated into clumps by the patient’s serum, the patient is then known to be suffering from typhoid fever. If they do not agglutinate, the symptoms are due to some other condition. This reaction for typhoid fever is known as the Widal reaction. Comparable agglutination reactions, using an appropriate serum, are used in the diagnosis of a number of diseases, including glandular fever (when it is known as the Paul-Bunnell reaction), typhus fever (when it is known as the Weil-Felix reaction), undulant fever, and Weil’s disease. (For more information about these diseases, see under separate entries.)... agglutination

A general term that covers a range of hostile behaviour, some of which may extend beyond normal social behaviour. Some physical diseases cause aggressive outbursts: temporal lobe EPILEPSY and hypoglycaemia (see DIABETES MELLITUS) are examples. Certain mental disorders – such as antisocial personality disorders, alcohol or drug abuse, and SCHIZOPHRENIA – may be associated with aggression.

Male sex hormones (see under ANDROGEN) appear to be linked to aggressive behaviour, and aggression is more common among adolescents and young adults than other sections of the population.... aggression

A variety of chronic symptoms and physical findings that occur in some persons who are infected with HIV, but do not meet the Centres for Disease Control’s definition of AIDS. Symptoms may include chronic swollen glands, recurrent fevers, unintentional weight loss, chronic diarrhoea, lethargy, minor alterations of the immune system (less severe than those that occur in AIDS), and oral thrush. ARC may or may not develop into AIDS.... aids-related complex

Alastrim, or variola minor, is a form of SMALLPOX which di?ers from ordinary smallpox in being milder and having a low mortality.... alastrim

A drug adjunct to surgery in the treatment of hydatid cysts (see under CYSTS) caused by Taenia echinococcus, a small tapeworm (see TAENIASIS). If surgery is not possible, albendazole can be used on its own. The drug is also used to treat STRONGYLOIDIASIS.... albendazole

Alcohol dependence, or alcoholism, is described under ALCOHOL but a summary of the symptoms may be helpful in spotting the disorder. Behavioural symptoms vary but include furtiveness; aggression; inappropriately generous gestures; personality changes (sel?shness, jealousy, irritability and outbursts of anger); empty promises to stop drinking; poor appetite; scru?y appearance; and long periods of drunkenness.... alcohol dependence

Alfacalcidol is a synthetic form (or analogue) of vitamin D. (See APPENDIX 5: VITAMINS.)... alfacalcidol

Prosperity, Anti-Hunger, Money ... alfalfa

A fever in which the patient suffers from peripheral vascular collapse. Also known as a “cold” fever as their skin feels cold and clammy.... algid

A set of instructions performed in a logical sequence to solve a problem. Algorithms are used increasingly in emergency situations, for example by ambulance controllers or by organisations such as NHS Direct. Each answer to a question leads on down a decision tree to the next question, eventually resulting in a recommended action or response.... algorithm

See GASTROINTESTINAL TRACT.... alimentary canal

A substance which neutralises an acid to form a salt, and turns litmus and other vegetable dyes blue. Alkalis are generally oxides or carbonates of metals.... alkali

One of a varied family of alkaline, nitrogen-containing substances, usually plant-derived, reacting with acids to form salts. Normally intensely bitter, alkaloids form a body of substances widely used in drug and herbal therapy. They are usually biologically active and have a toxic potential. The term is more pharmaceutical and medical than chemical since alkaloids come from a variety of otherwise unrelated organic compounds. (Examples: caffeine, morphine, berberine).... alkaloid

Purification, Prosperity ... alkanet

See OCHRONOSIS.... alkaptonuria

Prepared synthetically, this powder, which occurs naturally in comfrey root, has been used as an ADJUVANT in the treatment of skin ulcers. It has been thought to stimulate the formation of the surface epithelial layer of skin, but its therapeutic value is now more dubious.... allantoin

A vascular structure which, very early in the life of an EMBRYO, grows out from its hind-gut. The end becomes attached to the wall of the womb (see UTERUS); it spreads out, becomes stalked, and later develops into the PLACENTA and umbilical cord, which forms the only connection between mother and embryo.... allantois

See HAY FEVER.... allergic rhinitis

A piece of tissue or an organ, such as the kidney, transplanted from one to another of the same species – from person to person, for example. Also known as a homograft.... allograft

See Sábila.... aloe vera

(Greek) Possessing the power to heal; wholesome

Althia, Althaea, Altha, Altheda, Althya... althea

Alstonia venenata

Apocynaceae

San: Visaghni, Anadana;

Mal: Analivegam;

Tam: Sinnappalai;

Kan: Addasarpa

Importance: Alstonia is a large shrub with straight bole and growing upto about 6m height. The roots are useful in skin diseases, erysipelas, leprosy, cobra bite and other venomous bites, epilepsy, fatigue, fever and otalgia. The fruits are useful in syphilis, insanity and epilepsy. The plant is believed to repel snakes.

Distribution: The plant is distributed throughout India in deciduous forests in areas up to 1800m elevation.

Botany: Alstonia venenata R.Br., belonging to the family Apocynaceae, is a large shrub to small tree up to 6m in height with greyish brown bark and bright yellow hard and woody root. Leaves are simple, arranged in whorls of 3-6, membranous, lanceolate, margins wavy, finely acuminate, main nerves numerous, close, parallel and united by inter marginal nerve. Flowers are white, arranged in terminal sub umbellate cymes or in racemes. Fruits are fusiform with stalked and beaked follicles, tapering at both ends. Seeds are many flattened with a tuft of hair at each end (Warrier et al, 1993). Other important species belonging to the genus Alstonia are the following.

1. A. scholaris R. Br.

This tree is common throughout India. The bark is valuable in debility and after effects of fever, chronic diarrhoea, dysentery and catarrhal fever. The milky juice is applied to ulcers and rheumatic pains, mixed with oil and dropped into ear to relieve earache. Ditanin is the active principle of the bark, possessing powerful febrifuge properties. The bark is astringent, tonic and febrifuge (Nadkarni, 1998).

2. A. spectabilis R. Br.

It is a large evergreen tree seen in tropical forests of Andamans. The bark contains alkaloids such as alstonamine, ditamine, echitamine and echitenine (Chopra et al,1980)

Agrotechnology: The plant is propagated mainly by seeds. Seeds are to be sown on seedbeds and germinated ones are to be transferred to polybags. About three months old seedlings are used for transplanting. If seeds are not available, thin stem cuttings can be planted in polybags and rooted cuttings used. Pits of size 60cm cube are to be taken at 3m spacing, filled with dried cowdung, sand and topsoil and made into a mound. To this mounds seedlings from polybags are to be transplanted. Irrigation is essential during early stages of growth. Application of organic manure every year is beneficial. Regular weeding is to be done. The plant is not attacked by any serious pests or diseases. Flowers are formed in the first year itself. It can be used for medicinal purposes after seven years of growth. Fruits and roots are the economical parts (Prasad et al,1997).

Properties and activity: The plant is a rich source of indole alkaloids. Alkaloids are present in various parts. Stem bark and root contain venenatine, alstovenine, 3-dehydroalstovenine and reserpine. Stem bark contains venoxidine (venenatine Nb -oxide), anhydroalstonatine, kopsinine, venalstonine, venalstonidine(venalstonine-6,7-epoxide), echitovenine and veneserpine. Fruits contain echitovenidine, (+)minovincinine, echitoserpidine, echitoserpine, echitoveniline, 11-methoxy echitovonidine, 11-methoxy (-) minovinicinine, echitoserpiline, (-)vincadifformine, 11-methoxy(-)vincadifformine and venoterpine. Leaves contain echitovenaldine, echitoveniline, alstolenine, deacetylakuammiline, polynuridine, dihydropolynuridine and raucaffrininoline. The yellow tint in bark is because of the presence of 3-alstovenine. A number of indole alkaloids have been further isolated from the plant. In addition to alkaloids fruits contain -amyrin acetate and lupeol ester of -hydroxy acid (Husain et al,1992).

The root is bitter, astringent, thermogenic, depurative, antitoxic, febrifuge and anodyne. The alkaloid alstovenine in lower doses exhibited monoamine oxidase inhibitor activity, while in higher doses it showed marked central stimulant effect. Veninatine exhibited reserpine like activity. Alcoholic extract of the fruits showed initial activation effect on acetylcholine esterase, followed alternately by inhibition and activation of the enzyme.... alstonia

(1) The minute divisions of glands and the air sacs of the lungs.

(2) The sockets of the teeth in the jawbone.... alveolus

The psychological state in which a person concurrently hates and loves the same object or person.... ambivalence

Sudden transitory impairment, or loss, of vision. It usually affects only one eye, and is commonly due to circulatory failure. In its simplest form it occurs in normal people on rising suddenly from the sitting or recumbent position, when it is due to the effects of gravity. It also occurs in migraine. A not uncommon cause, particularly in elderly people, is transient ocular ISCHAEMIA, resulting from blockage of the circulation to the retina (see EYE) by emboli (see EMBOLISM) from the common carotid artery or the heart. Treatment in this last group of cases consists of control of the blood pressure if this is raised, as it often is in such cases; and the administration of drugs that reduce the stickiness of blood platelets, such as aspirin. In some instances, removal of the part of the carotid artery from which the emboli are coming may be indicated.... amaurosis fugax

Agressive benign tumour of jaw, usually the lower jaw. It is more common in Asian and African people. It results from a proliferation of ameloblast cells, which is the cell that forms enamel.... ameloblastoma

An e?ective local anaesthetic for topical application. Rapidly absorbed from mucous membranes, it should never be applied to in?amed, traumatised or highly vascular surfaces – nor used when providing anaesthesia for bronchoscopy or cystoscopy. Amethocaine is used in ophthalmology and in skin preparations. It may sensitise the skin. (See ANAESTHESIA.)... amethocaine

See REFRACTION.... ametropia

A drug that inhibits the synthesis of adrenal CORTICOSTEROIDS. It is proving to be of value in the treatment of cancer of the breast in post-menopausal women.... aminoglutethimide

A group of antibiotics usually reserved for use in patients with severe infections. They are e?ective against a wide range of BACTERIA including some gram-positive and many gram-negative organisms (see GRAM’S STAIN). Aminoglycosides must be used cautiously because they can damage the inner ear – thus affecting hearing – and the kidneys. Examples of this group are AMIKACIN and GENTAMICIN (e?ective against Pseudomonas aeuriginosa), NEOMYCIN (used only for topical administration for skin infections), and STREPTOMYCIN (e?ective in combination with other drugs against Mycobacterium tuberculosis).... aminoglycosides

An arrest of the development of the mind from birth to early age.... amentia

A compound of hydrogen and nitrogen that occurs naturally. The solution is colourless with a pungent smell; it is used in urine testing. In humans, certain inherited defects in the metabolism of ammonia can cause neurological symptoms including mental retardation. In vapour form it is a noxious gas.... ammonia

See AMNION.... amniotic sac

A group of drugs closely related to ADRENALINE which act by stimulating the SYMPATHETIC NERVOUS SYSTEM. When taken by mouth they have a profound stimulating e?ect on the brain, producing a sense of well-being and con?dence and seemingly increasing the capacity for mental work. They are, however, drugs of DEPENDENCE and their medical use is now strictly limited – for example, to the treatment of NARCOLEPSY.

Because amphetamines inhibit appetite, they rapidly achieved a reputation for slimming purposes. However, they should not be used for this purpose; their dangers far outweigh their advantages.... amphetamines

A highly toxic, polygenic antifungal drug that must be given only under close medical supervision and for severe systemic fungal infections (see FUNGAL AND YEAST INFECTIONS). It is not absorbed from the gut so is normally given parenterally (see PARENTERAL). Oral and intestinal candidiasis (see CANDIDA) can, however, be treated with amphotericin tablets.... amphotericin

A small glass container having one end drawn out into a point capable of being sealed so as to preserve its contents sterile. It is used for containing solutions for hypodermic injection.... ampoule

A volatile, oily liquid prepared by the action of nitric and nitrous acids on amyl alcohol. It was used for many years to treat angina but has been superseded by other nitrate drugs such as glyceril trinitrate. The substance is misused by drug abusers to produce a ‘high’ and is referred to as ‘poppers’.... amyl nitrite

The name applied to any carbohydrate of the starch group.... amylose

Promoting anabolism. Specifically, an agent or function that stimulates the organization of smaller substances into larger ones. Examples: making a starch out of sugars, a protein out of amino acids, or making triglycerides out of fatty acids are anabolic functions. Anabolic steroids are internal or external substances that will induce increased body size or mass. The opposite of CATABOLIC.... anabolic

The nitrogen-retaining e?ect of ANDROGEN, a steroid hormone, is responsible for the larger muscle mass of the male. This is called an anabolic e?ect. Attempts have been made to separate the anabolic effects of hormones from their virilising effects (see VIRILISATION), but these have been only partially successful. Thus, anabolic steroids have the property of protein-building so that when taken, they lead to an increase in muscle bulk and strength. All the anabolic steroids have some androgenic activity but they cause less virilisation than androgens in women. Androgenic side-effects may result from any of these anabolic compounds, especially if they are given for prolonged periods: for this reason they should all be used with caution in women, and are contraindicated in men with prostatic carcinoma. Jaundice due to stasis of bile in the intrahepatic canaliculi is a hazard, and the depression of pituitary gonadotrophin production is a possible complication.

Anabolic steroids have been used to stimulate protein anabolism in debilitating illness, and to promote growth in children with pituitary dwar?sm and other disorders associated with interference of growth. Stimulation of protein anabolism may also be of value in acute renal failure, and the retention of nitrogen and calcium is of probable bene?t to patients with OSTEOPOROSIS and to patients receiving corticosteroid therapy. Anabolic steroids may stimulate bone-marrow function in hypoplastic ANAEMIA.

They have been widely abused by athletes and body-builders aiming to improve their strength, stamina, speed or body size. However, there are considerable doubts over their e?cacy, with little experimental evidence that they work. Dangerous adverse effects include precocious myocardial infarction (see HEART, DISEASES OF – Coronary thrombosis), DIABETES MELLITUS, liver disease, precocious carcinoma of the prostate, acne, and severe psychiatric disorders. Anabolic steroids should not be used by athletes, who face bans from o?cial competitions if they take them.

The anabolic steroids in therapeutic use include nandrolone and stanozolol.... anabolic steroids

The term applied to bacteria having the power to live without air. Such organisms are found growing freely, deep in the soil – as, for example, the tetanus bacillus.... anaerobe

Analysis means a separation into component parts by determination of the chemical constituents of a substance. The process of analysis is carried out by various means, for example: chromatographic analysis by means of the adsorption column; colorimetric analysis by means of various colour tests; densimetric analysis by estimation of the speci?c gravity; gasometric analysis by estimation of the di?erent gases given o? in some process; polariscope analysis by means of the polariscope; and volumetric analysis by measuring volumes of liquids. Analysis is also sometimes used as an abbreviation for PSYCHOANALYSIS.... analysis

Having the power to lessen or inhibit sexual feeling... anaphrodisiac

The general term for any one of a group of HORMONES which govern the development of the sexual organs and the secondary sexual characteristics of the male. TESTOSTERONE, the androgenic hormone formed in the interstitial cells of the testis (see TESTICLE), controls the development and maintenance of the male sex organs and secondary sex characteristics. In small doses it increases the number of spermatozoa (see SPERMATOZOON) produced, but in large doses it inhibits the gonadotrophic activity of the anterior PITUITARY GLAND and suppresses the formation of the spermatozoa. It is both androgenic and anabolic in action. The anabolic e?ect includes the ability to stimulate protein synthesis and to diminish the catabolism of amino acids, and this is associated with retention of nitrogen, potassium, phosphorus and calcium. Doses in excess of 10 mg daily to the female may produce VIRILISM.

Unconjugated testosterone is rarely used clinically because its derivatives have a more powerful and prolonged e?ect, and because testosterone itself requires implantation into the subcutaneous fat using a trocar and cannula for maximum therapeutic bene?t. Testosterone propionate is prepared in an oily solution, as it is insoluble in water; it is e?ective for three days and is therefore administered intramuscularly twice weekly. Testosterone phenyl-propionate is a long-acting microcrystalline preparation which, when given by intramuscular or subcutaneous injection, is e?ective for four weeks. Testosterone enantate is another long-acting intramuscular preparation. Mesterolone is an e?ective oral androgen and is less hepatoxic: it does not inhibit pituitary gonadotrophic production and hence spermatogenesis is unimpaired. Testosterone undecanoate is also an e?ective oral form.... androgen

The state in which there is an abnormal number of CHROMOSOMES: for example, DOWN’S (DOWN) SYNDROME and TURNER’S SYNDROME.... aneuploidy

Aneurine is an alternative name for vitamin B1. (See THIAMINE.)... aneurine

A method of treating blockage or narrowing of a blood vessel by recanalising the vessel – that is, inserting a balloon into the constriction to reopen it. The technique is used to treat a narrowed artery in the heart or a limb. About 65 per cent of patients treated bene?t, but when symptoms persist or recur the procedure may be repeated. There is a small risk of damage to the vessel or valve. New procedures under development include the use of lasers, cutting drills and suction to remove the deposits of ATHEROMA blocking the arteries.... angioplasty

Anhidrosis is an abnormal diminution in the secretion of sweat. This may be caused by disease or by a congenital defect.... anhidrosis

This means inequality in the size of erythrocytes (red blood cells); it occurs in many forms but is prominent in megaloblastic ANAEMIA.... anisocytosis

The joint between the leg bones (TIBIA and FIBULA) above, and the TALUS (the Roman dice-bone) below. It is a very strong joint with powerful ligaments binding the bones together at either side, and bony projections from the leg bones, which form large bosses on either side, called the outer and inner malleoli, extending about 12 mm (half an inch) below the actual joint. Two common injuries near the ankle are a sprain, on the inner side, consisting of tearing of the internal ligament; and fracture of the ?bula (Pott’s fracture) on the outer side. (See also JOINTS, DISEASES OF.)... ankle

See ANCYLOSTOMIASIS.... ankylostoma

Any drug or treatment that eases pain. These may range from opium – the oldest and most powerful anodyne but a highly addictive substance – through ANALGESICS, to warmth and massage.... anodynes

Lacking appetite... anorectic

An individual’s inability to achieve ORGASM.... anorgasmia

Reduction of the oxygen content of the blood below normal limits.... anoxaemia

(Latin / Finnish) One who is constant / a virtuous woman Anse... ansa

See DISULFIRAM.... antabuse

Pre?x meaning before or forwards.... ante

Drugs traditionally used to treat gastrointestinal disorders, including peptic ulcer. They neutralise the hydrochloric acid secreted in the stomach’s digestive juices and relieve pain and the discomfort of DYSPEPSIA (indigestion). A large number of proprietary preparations are on sale to the public and most contain compounds of aluminium or magnesium or a mixture of the two. Other agents include activated dimethicone – an antifoaming agent aimed at relieving ?atulence; alginates, which protect against re?ux oesophagitis; and surface anaesthetics. Antacids commonly prescribed by doctors include aluminium hydroxide, magnesium carbonate and magnesium trisilicate. Sodium bicarbonate and calcium and bismuth compounds are also used, although the latter is best avoided as it may cause neurological side-effects. (See DUODENAL ULCER; STOMACH, DISEASES OF.)... antacids

The protocol which doctors and midwives follow to ensure that the pregnant mother and her FETUS are kept in good health, and that the pregnancy and birth have a satisfactory outcome. The pregnant mother is seen regularly at a clinic where, for example, her blood pressure is checked, the growth and development of her child-to-be are carefully assessed, and any problem or potential problems dealt with. Most antenatal care deals with normal pregnancies and is supervised by general practitioners and midwives in primary-care clinics. If any serious problems are identi?ed, the mother can be referred to specialists’ clinics in hospitals. (See PREGNANCY AND LABOUR.)... antenatal care

An adjective describing an event before labour starts in pregnancy (see PREGNANCY AND LABOUR).... antepartum

The term applied to the forward tilting of an organ, especially of the UTERUS.... anteversion

Substances which cause the death or expulsion of parasitic worms such as hook, tape and threadworms (see TAENIA; ENTEROBIASIS).... anthelmintics

ARRHYTHMIA is a variation in the normal rhythm of the heartbeat. Management of the condition requires accurate diagnosis of the type, and ELECTROCARDIOGRAPHY is vital in this process (see HEART, DISEASES OF). Drug treatment is usually part of the management, and antiarrhythmic drugs can be divided clinically into those that act on supraventricular arrhythmias, those that act on both supraventricular and ventricular arrythmias, and those that act on ventricular arrythmias. Respective examples are VERAPAMIL, DISOPYRAMIDE and LIDOCAINE. This large group of drugs can also be classi?ed according to their effects on the electrical reactions of active myocardial cells. The many drugs available are described in the British National Formulary.... antiarrhythmic drugs

A group of drugs, which include ANTIBIOTICS, used to treat infections caused by BACTERIA. Drugs include CEPHALOSPORINS and cephamycins, TETRACYCLINES, AMINOGLYCOSIDES, MACROLIDES, and antituberculous compounds.... antibacterial drugs

Any compound that inhibits the activity of CHOLINESTERASE, thus permitting ACETYLCHOLINE to continue its function of transmitting nerve impulses. Drugs with anticholinesterase properties include distigmine, NEOSTIGMINE and PHYSOSTIGMINE.... anticholinesterase

An agent that kills or inhibits fungi, and, in my usage here, an herb that inhibits either a dermatomycosis like ringworm or athlete’s foot, or one that inhibits Candida albicans either externally as a douche or internally as a systemic antifungal. (Examples: Nystatin, griseofulvin, Tabebuia.)... antifungal

These widely used drugs include a range of different preparations which relieve DEPRESSION. All the antidepressants available at the time of writing are more or less equally e?ective. In studies where patients agree to take either antidepressants or identical dummy PLACEBO pills (without knowing which), at least two-thirds of those who receive antidepressants feel much better within three months, while fewer than one-third of those on placebos recover naturally in the same period. In general these drugs are useful for severe and moderate depression including postnatal illness; they are not e?ective in milder forms of depression although they may be tried for a short time if other therapies have failed.

The most widely prescribed type of antidepressants are the tricyclics, so-called because their molecular structure includes three rings. The other commonly used types are named after the actions they have on chemicals in the brain: the SELECTIVE SEROTONIN-REUPTAKE INHIBITORS (SSRIS) and the MONOAMINE OXIDASE INHIBITORS (MAOIS) – see also below. All types of antidepressant work in similar ways. Tricyclic antidepressants have cured depression in millions of people, but they can cause unpleasant side-effects, particularly in the ?rst couple of weeks. These include SEDATION, dry mouth, excessive sweating, CONSTIPATION, urinary problems, and impotence (inability to get an erection). Up to half of all people prescribed tricyclic drugs cannot tolerate the side-effects and stop treatment before their depression is properly treated. More seriously, tricyclics can upset the rhythm of the heart in susceptible people and should never be given in the presence of heart disease.

The SSRIs are newer, coming into wide use in the late 1980s. They increase the levels in the brain of the chemical messenger SEROTONIN, which is thought to be depleted in depression. Indeed, the SSRIs are as e?ective as tricyclics and, although they can cause nausea and excessive sweating at ?rst, they generally have fewer side-effects. Their main disadvantage, however, is that they cost much more than the most commonly used tricyclic, amitriptyline. On the other hand, they are more acceptable to many patients and they cause fewer drop-outs from treatment – up to a quarter rather than a half. The money saved by completed, successful treatment may outweigh the prescribing costs. SSRIs have been reported as associated with an increased risk of suicide.

Another group of antidepressants, the MAOIs, have been in use since the late 1950s.

They are stimulants, rather than sedatives, and are particularly helpful for people who are physically and mentally slowed by depression. They work well but have one big disadvantage – a dangerous interaction with certain foods and other drugs, causing a sudden and very dangerous increase in blood pressure. People taking them must carry an information card explaining the risk and listing the things that they should avoid. Because of this risk, MAOIs are not used much now, except when other treatments have failed. A new MAOI, moclobemide, which is less likely to interact and so cause high blood pressure, is now available.

LITHIUM CARBONATE is a powerful antidepressant used for intractable depression. It should be used under specialist supervision as the gap between an e?ective dose and a toxic one is narrow.

St John’s Wort is a popular herbal remedy which may be e?ective, but which is handicapped by di?erences of strength between di?erent preparations or batches. It can interact with a number of conventional drugs and so needs to be used cautiously and with advice.

In general, antidepressants work by restoring the balance of chemicals in the brain. Improved sleep and reduced anxiety are usually the ?rst signs of improvement, particularly among people taking the more sedative tricyclic drugs. Improvement in other symptoms follow, with the mood starting to lift after about two weeks of treatment. Most people feel well by three months, although a few residual symptoms, such as slowness in the mornings, may take longer to clear up. People taking antidepressants usually want to stop them as soon as they feel better; however, the risk of relapse is high for up to a year and most doctors recommend continuing the drugs for around 4–6 months after recovery, with gradual reduction of the dose after that.

Withdrawal reactions may occur including nausea, vomiting, headache, giddiness, panic or anxiety and restlessness. The drugs should be withdrawn gradually over about a month or longer (up to six months in those who have been on maintenance treatment).

A wide range of antidepressant drugs is described in the British National Formulary. Examples include:

Tricyclics: amitryptyline, imipramine, doxepin.

MAOIs: phenelzine, isocarboxazid.

SSRIs: citalopram, ?uoxetine, paraxtene. (Antidepressant drugs not in these three

groups include ?upenthixol, mertazapine and venlafaxine.)... antidepressant drugs

Antihistamine drugs antagonise the action of HISTAMINE and are therefore of value in the treatment of certain allergic conditions (see ALLERGY). They may be divided into those with a central action (e.g. ?upheniramine and cyclizine) and those such as loratidine and terfenadine with almost no central action. Antihistamines are also of some value in the treatment of vasomotor RHINITIS (see also under NOSE, DISORDERS OF); they reduce rhinorrhoea and sneezing but are usually less e?ective in relieving nasal congestion. All antihistamines are useful in the treatment of URTICARIA and certain allergic skin rashes, insect bites and stings, as well as in the treatment of drug allergies. Chlorpheniramine or promethazine injections are useful in the emergency treatment of angio-oedema (see under URTICARIA) and ANAPHYLAXIS.

There is little evidence that any one antihistamine is superior to another, and patients vary considerably in their response to them. The antihistamines di?er in their duration of action and in the incidence of side-effects such as drowsiness. Most are short-acting, but some (such as promethazine) work for up to 12 hours. They all cause sedation but promethazine, trimeprazine and dimenhydrinate tend to be more sedating while chlorpheniramine and cyclizine are less so, as are astemizole, oxatomide and terfenadine. Patients should be warned that their ability to drive or operate machinery may be impaired when taking these drugs, and that the effects of ALCOHOL may be increased.... antihistamine drugs

Acting against heat or inflammation... antiphlogistic

An agent that limits or decreases inflammation; an anti­inflammatory or antihistamine.... antiphlogistine

See NEUROLEPTICS.... antipsychotic drugs

A condition that causes inflammation and pain in the joints and muscles... antirheumatic

Acting against scurvy... antiscorbutic

An agent that experimentally inhibits the proliferation and viability of infectious viruses. In our domain of herbal medicines, some plants will slow or inhibit the adsorption or random initial attachment of viruses, extend the lifespan of infected target cells, or speed up several aspects of immunity, including complement, antibody, and phagocytosis responses. Herbal antivirals work best on respiratory viruses such as influenza, adenoviruses, rhinoviruses, and the enteric echoviruses. Touted as useful in the alphabet group of slow viruses (HIV, EBV, CMV, etc.), they really help to limit secondary concurrent respiratory infections that often accompany immunosuppression.... antiviral

Antrostomy is the operation in which an opening is made through the nose into the maxillary ANTRUM.... antrostomy

Antrum means a natural hollow or cavity. The maxillary antrum is now known as the maxillary SINUS. The mastoid antrum is situated in the mastoid process, the mass of bone felt behind the ear. It may become the seat of an ABSCESS in cases of suppuration of the middle ear (see EAR, DISEASES OF). The pyloric antrum is the part of the stomach immediately preceding the PYLORUS.... antrum

Drugs for the relief of anxiety. They will induce sleep when given in large doses at night, and so are HYPNOTICS as well. Conversely, most hypnotics will sedate when given in divided doses during the day. Prescription of these drugs is widespread but physical and psychological DEPENDENCE occurs as well as TOLERANCE to their effects, especially among those with personality disorders or who abuse drugs and alcohol. This is particularly true of the BARBITURATES which are now limited in their use, but also applies to the BENZODIAZEPINES, the most commonly used anxiolytics and hypnotics. Withdrawal syndromes may occur if drug treatment is stopped too abruptly; hypnotic sedatives and anxiolytics should therefore not be prescribed indiscriminately, but reserved for short courses. Among the anxiolytics are the widely used benzodiazepines, the rarely used barbiturates, and the occasionally prescribed drugs such as BUSPIRONE and beta blockers like OXPRENOLOL (see BETA-ADRENOCEPTORBLOCKING DRUGS).... anxiolytics

See also REGURGITATION. This is the back ?ow of blood through the AORTIC VALVE of the HEART into the left ventricle, caused by an incompetent valve. The failure to close may be caused by a congenital defect or by damage from disease. The defect may be cured by surgical replacement of the damaged valve with an arti?cial valve. (See HEART, DISEASES OF.)... aortic incompetence

The valve that controls the ?ow of blood from the AORTA to the left ventricle of the HEART.... aortic valve

Secretory glands, especially found in the armpit and groin, that secrete oily sweat derived from shed cell cytoplasm, and which contain aromatic compounds that possess emotional information for those nearby. Examples: The smell of fear, the scent released after orgasm, the odor released by annually-frustrated Chicago Cubs fans.... apocrine

Love... apricot

Absence of FEVER.... apyrexia

See under EYE, DISORDERS OF.... arcus senilis

A condition (described originally by Dr Argyll Robertson) in which the pupils contract when the eyes converge on a near object, but fail to contract when a bright light falls on the eye. It is found in several diseases, especially in locomotor ataxia and neurosyphilis, an advanced manifestation of SYPHILIS.... argyll robertson pupil

Argyria, or argyriosis, means the e?ect produced by taking silver salts over a long period, and consists of a deep duskiness of the skin, especially of the exposed parts.... argyria

Chemically, molecules containing one or more benzene rings, but in our usage, plant compounds which, upon contact to the air, form gases which can be smelled: volatile oils. (Examples: menthol, Peppermint oil.)... aromatics

Maranta and Sagittaria species

Description: The arrowroot is an aquatic plant with arrow-shaped leaves and potatolike tubers in the mud.

Habitat and Distribution: Arrowroot is found worldwide in temperate zones and the tropics. It is found in moist to wet habitats.

Edible Parts: The rootstock is a rich source of high quality starch. Boil the rootstock and eat it as a vegetable.... arrowroot

See ARTIFACT.... artefact

Animals characterised by several jointed legs and a hard outer exoskeleton, eg, spiders, ticks, mites and insects (the group that includes mosquitoes).... arthropod

An endoscopic instrument (see ENDOSCOPE) that enables the operator to see inside a joint cavity and, if necessary, take a biopsy or carry out an operation.... arthroscope

Surgical exploration of a joint to examine the contents or to drain PUS in SEPTIC ARTHRITIS.... arthrotomy

Articular means anything connected with a joint: for example, articular rheumatism.... articular

Articulation is a term employed in two senses in medicine, meaning either the enunciation of words and sentences, or the type of contact between the surfaces of joints – these surfaces are called articular surfaces.... articulation

The name applied to two cartilages in the LARYNX.... arytenoid

Exorcism, Purification, Protection ... asafoetida

Not septic; free from septic material technique.... aseptic technique

Saraca asoca

Caesalpiniaceae

San:Asoka, Gatasokah;

Hin:Asok, Asoka; Ben:Ashok; Mal:Asokam;

Tam: Asogam;

Kan:Asokada, Aksunkara;

Tel: Asokamu, Vanjalamu

Importance: Ashoka, the sacred tree of Hindus and Buddhists, possesses varied medicinal uses. The bark is useful in dyspepsia, fever, dipsia, burning sensation, visceromegaly, colic, ulcers, menorrhagia, metropathy, leucorrhoea and pimples. The leaf juice mixed with cumin seeds is used for treating stomachalagia. The floweres are considered to be uterine tonic and are used in vitiated conditions of pitta, syphilis, cervical adinitis, hyperdipsia, burning sensation, haemorrhoids, dysentery, scabies in children and inflammation. The well-known Ayurvedic preparations are ”Ashokarishta” and “Ashokaghrita”. Ashokarishta is prescribed in leucorrhoea, haematuria, menorrhagia and other diseases of genitourinary system of females.

Distribution: Ashoka is found almost throughout India, except North-Western India, upto 750m. It is also found in the Andaman Islands.

Botany: Saraca asoca (Roxb.) de Wilde. syn. S. indica auct. non Linn. is a medium sized evergreen tree growing upto 9m height with numerous spreading and drooping glabrous branches. Leaves are pinnate, 30-60cm long having 2-3 pairs of lanceolate leaflets. Flowers are orange or orange yellow, arranged in dense corymbs and very fragrant. Fruits are flat black pods, leathery and compressed with 4-8 seeds/pod. Seeds are ellipsoid oblong and compressed. The bark is dark brown to grey or black with a warty surface. The thickness varies from 5mm to 10mm. The entire cut surface turns reddish on exposure to air. Polyalthia longifolia (Annonaceae) is equated with the name Asoka by some (Kapoor & Mitra, 1979; Chunekar, 1982) and is often used as an adulterant of the genuine Asoka bark or as a substitute (Warrier et al,1996).

Agrotechnology: Asoka grows well in areas with well distributed rainfall and in slightly shady areas. Asoka requires soil rich in organic mater and moisture. The best season of planting is June-July. It is also grown in summer, if irrigation facilities are available. The plant is seed propagated. Seeds are formed usually during February-April. Seeds are collected when they are ripen and fall down and are sown after soaking in water for 12 hours on the prepared beds. Seeds germinate within 20 days. The seeds are then planted in polybags. 2-month-old seedlings from the polybags are used for transplanting. Square shaped pits of 60cm depth are taken at 3m spacing and filled with topsoil, sand and dried cowdung. On this the seedlings are planted. Application of FYM at 10kg/tree/year is highly beneficial. Chemical fertilisers are not usually applied. Irrigation during summer months is essential. No serious pests or diseases are generally noted in this crop. If properly cultivated, Asoka can be cut after 20 years and the bark collected. It is cut at a height of 15cm from the soil level. If given irrigation and fertilisers, the cut wood will sprout again and harvested again after 5 years. This can be continued. When it is difficult to cut the tree, the bark can be peeled off from one side first. When the bark grows and cover that part, the other side can be peeled off. This is also continued (Prasad et al, 1997; Karshakasree, 1998).

Properties and activity: Flowers give -sitosterol, flavonoids and flavone glycosides-quercetin, kaempferol-3-O- -D- glucoside, quercetin-3-O- -D-glucoside. The anthocyanins present are pelargonidin-3, 5-diglucoside and cyanadin-3, 5-diglucoside. Bark yields catechol and sterols-(24)-24-methyl cholest-5-en-3 -ol, (22E, 24)-24-ethylcholesta-5, 22-dien-3 -ol and (24)-24-ethyl cholest-5-en-3 -ol, a wax containing n-alkanes, esters and free primary alcohols. Alcoholic extract and glycoside P2 from stem bark is oxytoxic. Aerial part is CNS active, hypothermic, CNS depressant and diuretic. Stem bark is anticancerous, has spasmodic action on rabbit intestine and cardiotonic action in frog and dog. Seed is antifungal. Stem bark is astringent, antileucorrhoeic, antibilious and uterine sedative. Flower is uterine tonic, antidiabetic and antisyphilitic. Stem bark and flower is antibilious (Husain et al, 1992).... ashoka

Asparaginase is an ENZYME that breaks down the amino acid (see AMINO ACIDS), asparagine. This is of no signi?cance to most cells in the body as they can make asparagine from simpler constituents. Certain tumours, however, are unable to do this; therefore, if they cannot receive ready-made supplies of the amino acid, they die. This property is utilised to treat acute lymphoblastic LEUKAEMIA.... asparaginase

(English) From the aspen tree Aspin, Aspine, Aspina, Aspyn, Aspyna, Aspyne... aspen

A group of fungi including the common moulds. Several of these are capable of infecting the lungs and producing a disease resembling pulmonary TUBERCULOSIS.... aspergillus

See “geriatric assessment”.... assessment

See “residential care services”; “assisted living facility”.... assisted living

The act of intentionally killing oneself with the assistance of another who provides the knowledge, means or both.... assisted suicide

(Further information about the subject and the terms used can be found at http:// www.hfea.gov.uk/glossary)

This technique is used when normal methods of attempted CONCEPTION or ARTIFICIAL INSEMINATION with healthy SEMEN have failed. In the UK, assisted-conception procedures are governed by the Human Fertilisation & Embryology Act 1990, which set up the Human Fertilisation & Embryology Authority (HFEA).

Human Fertilisation & Embryology Act 1990 UK legislation was prompted by the report on in vitro fertilisation produced by a government-appointed committee chaired by Baroness Warnock. This followed the birth, in 1978, of the ?rst ‘test-tube’ baby.

This Act allows regulation monitoring of all treatment centres to ensure that they carry out treatment and research responsibly. It covers any fertilisation that uses donated eggs or sperm (called gametes) – for example, donor insemination or embryos (see EMBRYO) grown outside the human body (known as licensed treatment). The Act also covers research on human embryos with especial emphasis on foolproof labelling and immaculate data collection.

Human Fertilisation & EmbryologyAuthority (HFEA) Set up by the UK government following the Warnock report, the Authority’s 221 members inspect and license centres carrying out fertilisation treatments using donated eggs and sperm. It publishes a code of practice advising centres on how to conduct their activities and maintains a register of information on donors, patients and all treatments. It also reviews routinely progress and research in fertility treatment and the attempted development of human CLONING. Cloning to produce viable embryos (reproductive cloning) is forbidden, but limited licensing of the technique is allowed in specialist centres to enable them to produce cells for medical treatment (therapeutic cloning).

In vitro fertilisation (IVF) In this technique, the female partner receives drugs to enhance OVULATION. Just before the eggs are released from the ovary (see OVARIES), several ripe eggs are collected under ULTRASOUND guidance or through a LAPAROSCOPE. The eggs are incubated with the prepared sperm. About 40 hours later, once the eggs are fertilised, two eggs (three in special circumstances) are transferred into the mother’s UTERUS via the cervix (neck of the womb). Pregnancy should then proceed normally. About one in ?ve IVF pregnancies results in the birth of a child. The success rate is lower in women over 40.

Indications In women with severely damaged FALLOPIAN TUBES, IVF o?ers the only chance of pregnancy. The method is also used in couples with unexplained infertility or with male-factor infertility (where sperms are abnormal or their count low). Women who have had an early or surgically induced MENOPAUSE can become pregnant using donor eggs. A quarter of these pregnancies are multiple – that is, produce twins or more. Twins and triplets are more likely to be premature. The main danger of ovarian stimulation for IVF is hyperstimulation which can cause ovarian cysts. (See OVARIES, DISEASES OF.)... assisted conception

A term signifying a relationship between two or more events or variables. Events are said to be associated when they occur more frequently together than one would expect by chance. Association does not necessarily imply a causal relationship. Statistical significance testing enables a researcher to determine the likelihood of observing the sample relationship by chance if in fact no association exists in the population that was sampled. The terms “association” and “relationship” are often used interchangeably.... association

Love... aster

Asthenopia means a sense of weakness in the eyes, coming on when they are used. As a rule it is due to long-sightedness, slight in?ammation, or weakness of the muscles that move the eyes. (See VISION.)... asthenopia

The principle of inheritance of disease or bodily characters from grandparents or remoter ancestors, the parents not having been affected by these.... atavism

(African) The last daughter born Audie, Audy, Audey, Audee, Audlin, Audney, Audlin, Audea, Audeah... audi

The testing of hearing.... audiometry

Relating to the ear.... aural

Autogenous means self-generated and is the term applied to products which arise within the body. It is applied to bacterial vaccines manufactured from the organisms found in discharges from the body and used for the treatment of the person from whom the bacteria were derived.... autogenous

A collection of conditions in which the body’s immune system (see IMMUNITY) attacks its own tissues, identifying them as foreign substances. Genetic factors may play a part in this abnormal function, but the causes are not clear. The disorder may affect one organ (organ-speci?c) or type of cell, or several (non-organspeci?c). Among the autoimmune disorders are ADDISON’S DISEASE; autoimmune haemolytic anaemia and pernicious anaemia (see under ANAEMIA); autoimmune chronic active HEPATITIS; DIABETES MELLITUS; MYASTHENIA GRAVIS; RHEUMATOID ARTHRITIS; and SYSTEMIC LUPUS ERYTHEMATOSUS (SLE).

Treatment Any major de?ciencies, such as thyroxin or insulin lack, should be corrected. The activity of the immune system should then be reduced. CORTICOSTEROIDS and, in more severe cases, strong immunosuppressant drugs – AZATHIOPRINE, CYCLOPHOSPHAMIDE or METHOTREXATE – should be administered. Treatment is di?cult because of the need to control the autoimmune condition without damaging the body’s ability to combat other diseases.... autoimmune disorders

Literally means ‘self-poisoning’. Any condition of poisoning brought about by substances formed in or by the body.... autointoxication

The disintegration and softening of dead cells brought about by enzymes (see ENZYME) in the cells themselves.... autolysis

The perceived ability to control, cope with and make personal decisions about how one lives on a daily basis, according to one’s own rules and preferences.... autonomy

Without a blood supply. Avascular necrosis is the death of a tissue because the blood supply has been cut o?.... avascular

Oats, oatmeal, oatstraw (Avena sativa).

Plant Part Used: Seeds (oat grain), fruiting tops.

Dominican Medicinal Uses: Oats are traditionally boiled in water to make oatmeal or an oatmeal-like beverage and taken orally for high cholesterol, to stimulate lactation, for nutrition and strength and to relieve menopausal hot flashes.

Safety: Oats are commonly consumed and generally regarded as safe. They have shown low potential for allergic reaction in gluten-sensitive individuals.

Contraindications: In patients with celiac disease, oats may cause gastrointestinal irritation, but they have been shown to be well-tolerated in recent clinical studies.

Drug Interactions: Lovastatin and statin drugs (impaired absorption of HMG-CoA reductase inhibitors).

Clinical Data: The following effects of oats or oat extracts have been investigated in human clinical trials: anti-diabetic, cholesterol-lowering, hypoglycemic, hypocholesterolemic, smoking cessation (grain extract or oat bran); antihyperlipidemic, antihypertensive, reduced heart disease risk, stimulation of bile acid secretion and synthesis, tolerance in celiac patients (whole-grain and oat bran); anti-skin irritant, burn wound-healing, itch reduction (topical oil-based preparation).

* See entry for Avena in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... avena

A form of psychological treatment in which such an unpleasant response is induced to his or her psychological aberration that the patient decides to give it up. Thus the victim of alcoholism is given a drug that makes the subsequent drinking of alcoholic liquors so unpleasant, by inducing nausea and vomiting, that he or she decides to give up drinking. (See ALCOHOL; DISULFIRAM.) Aversion therapy may help in the treatment of alcoholism, drug addiction, sexual deviations such as transvestism, and compulsive gambling.... aversion therapy

The upper angle formed by a leaf or branch with a stem. Things that pop out in the axils are called AXILLARY.... axil

Azotaemia means the presence of UREA and other nitrogenous bodies in greater concentration than normal in the blood. The condition is generally associated with advanced types of kidney disease (see KIDNEYS, DISEASES OF).... azotaemia

Carbolic acid, or phenol, was the precursor of all ANTISEPTICS. It paralyses and then destroys most forms of life, particularly organisms such as bacteria. It has been superseded by less penetrative and harmful antiseptics.... carbolic acid

A drug that curbs the action of an ENZYME in the blood controlling the production of carbonic acid or bicarbonate from CARBON DIOXIDE (CO2). Called carbonic anhydrase, the enzyme is present in ERYTHROCYTES and it has a key part in maintaining the acid-base balance in the blood. Inhibiting drugs include ACETAZOLAMIDE and DORZOLAMIDE, and these are used as weak DIURETICS to reduce the increased intraocular pressure in ocular hypertension or open-angle GLAUCOMA (see EYE, DISORDERS OF).... carbonic anhydrase inhibitor

A geographic area defined and served by a health programme or institution, such as a hospital or community health centre, which is delineated on the basis of such factors as population distribution, natural geographic boundaries, and transportation accessibility. By definition, all residents of the area needing the services of the programme are usually eligible for them, although eligibility may also depend on additional criteria.... catchment area

See STROKE.... cerebrovascular accident

Chelating agents are compounds that will render an ion (usually a metal) biologically inactive by incorporating it into an inner ring structure in the molecule. (Hence the name, from the Greek chele = claw.) When the complex formed in this way is harmless to the body and is excreted in the urine, such an agent is an e?ective way of ridding the body of toxic metals such as mercury. The main chelating agents are DIMERCAPROL, PENICILLAMINE, desferrioxamine and sodium calciumedetate, used for example, in iron poisoning.... chelating agents

One of the bile acids (see BILE), used in the treatment of cholesterol gall-stones for patients with mild symptoms when other modern techniques are unsuitable. (See GALL-BLADDER, DISEASES OF.)... chenodeoxycholic acid

This is responsible for the sharp taste associated with citrus fruits, such as lemons and limes, and other fruits such as currants and raspberries. Although chemically di?erent from, it is similar in action and appearance to tartaric acid, obtained from grapes and other fruits, and similar to malic acid, found in apples and pears.... citric acid

A MEDICAL AUDIT carried out by health professionals.... clinical audit

A narrowing of the AORTA in the vicinity of the insertion of the ductus arteriosus. It is a congenital abnormality but may not be discovered until well into childhood or adolescence. The diagnosis is easily made by discovering a major di?erence between the blood pressure in the arms and that of the legs. If untreated it leads to hypertension and heart failure, but satisfactory results are now obtained from surgical treatment, preferably in infancy. Paediatricians screen for coarctation by feeling for femoral pulses, which are absent or weak in this condition.... coarctation of the aorta

A method for treating babies who suffer from alveolar collapse in the lung as a result of HYALINE MEMBRANE DISEASE (see also RESPIRATORY DISTRESS SYNDROME).... continuous positive airways pressure

A technique of dilating atheromatous obstructions (see ATHEROMA) in CORONARY ARTERIES by inserting a catheter with a balloon on the end into the affected artery (see also CATHETERS). It is passed through the blockage (guided by X-ray FLUOROSCOPY) and in?ated. The procedure can be carried out through a percutaneous route.... coronary angioplasty

An antiandrogen. It inhibits the effects of androgens (see ANDROGEN) at receptor level and is therefore useful in the treatment of prostate cancer (see PROSTATE, DISEASES OF), ACNE, HIRSUTISM in women and in the treatment of severe hypersexuality and sexual deviation in men. The drug can have serious side-effects. (See OESTROGENS.)... cyproterone acetate

See SLEEP.... dreams

A brief episode affecting the nervous system that causes the person to fall suddenly. There is no loss of consciousness. The loss of tone in the muscles, responsible for the fall, may persist for several hours; in such cases moving the patient or applying pressure to the soles of the feet may restore muscle tone. In most cases, however, recovery is immediate. The cause is probably a temporary interference with the blood supply to the brain. In others there may be some disturbance of the vestibular apparatus which controls the balance of the body. (See EAR, DISEASES OF; TRANSIENT ISCHAEMIC ATTACKS OR EPISODES (TIA, TIE).)... drop attack

See DEPENDENCE.... drug addiction

The blood vessel in the fetus through which blood passes from the pulmonary artery to the aorta, thereby bypassing the lungs, which do not function during intra-uterine life. (See CIRCULATORY SYSTEM OF THE BLOOD.) The ductus normally ceases to function soon after birth and within a few weeks is converted into a ?brous cord. Occasionally this obliteration does not occur: a condition known as patent ductus arteriosus. This is one of the more common congenital defects of the heart, and one which responds particularly well to surgical treatment. Closure of the duct can also be achieved in some cases by the administration of indomethacin. (See HEART, DISEASES OF.)... ductus arteriosus

Three acids – arachidonic, linolenic and tinoleic – which are essential for life, but which the body cannot produce. They are found in natural vegetable and ?sh oils and their functions are varied. EFAs have a vital function in fat metabolism and transfer and they are also precursors of PROSTAGLANDINS.... essential fatty acids

(See also HEART.) The right coronary artery arises from the right aortic sinus and passes into the right atrio-ventricular groove to supply the right ventricle, part of the intraventricular septum and the inferior part of the left ventricle. The left coronary artery arises from the left sinus and divides into an anterior descending branch which supplies the septum and the anterior and apical parts of the heart, and the circum?ex branch which passes into the left atrio-ventricular groove and supplies the lateral posterior surfaces of the heart. Small anastomoses exist between the coronary arteries and they have the potential of enlarging if the blood-?ow through a neighbouring coronary artery is compromised. Coronary artery disease is damage to the heart caused by the narrowing or blockage of these arteries. It commonly presents as ANGINA PECTORIS or acute myocardial infarction (see HEART, DISEASES OF).... coronary arteries

Weakness in the muscles that support the bony arches of the foot. The result is ?at feet, a condition that can adversely affect a person’s ability to walk and run normally.... fallen arches

See ALVEOLITIS.... fibrosing alveolitis

The systematic comparison, in monetary terms, of all the costs and benefits of proposed alternative schemes with a view to determining: which scheme or combination of schemes will contribute most to the achievement of predetermined objectives at a fixed level of investment; or the magnitude of the benefit that can result from schemes requiring the minimum investment. The resources required per unit of benefit must be determined, account being taken of the fact that costs and benefits accrue with time. For example, the cost of establishing a home and community care programme might be compared with the total cost of building residential facilities. Cost-benefit analysis can also be applied to specific medical tests and treatments.... cost-benefit analysis

A psychoanalytic technique in which the therapist encourages the patient to follow up a speci?c line of thought and ideas as they enter his or her consciousness.... free association

See GABA.... gamma aminobutyric acid

This is a structured, multi-disciplinary process for assessing and improving the health consequences of projects and policies in the non-health sector. It combines a range of qualitative and quantitative evidence in preparing conclusions. Applications of the assessments include appraisal of national policies, local urban planning, and the progress of transport, water and agricultural projects.... health impact assessment

A systematic procedure for determining the nature and extent of problems experienced by a specified population that affect their health, either directly or indirectly. Needs assessment makes use of epidemiological, sociodemographic and qualitative methods to describe health problems and their environmental, social, economic and behavioural determinants. See also “geriatric assessment”.... health needs assessment

Nearly two-thirds of people aged over 70 have some degree of hearing impairment (see DEAFNESS). Hearing aids are no substitute for de?nitive treatment of the underlying cause of poor hearing, so examination by an ear, nose and throat surgeon and an audiologist is sensible before a hearing aid is issued (and is essential before one can be given through the NHS). The choice of aid depends on the age, manipulative skills, and degree of hearing impairment of the patient and the underlying cause of the deafness. The choice of hearing aid for a deaf child is particularly important, as impaired hearing can hinder speech development.

Electronic aids consist, essentially, of a microphone, an ampli?er, and an earphone. In postaural aids the microphone and ampli?er are contained in a small box worn behind the ear or attached to spectacles. The earphone is on a specially moulded earpiece. Some patients ?nd it di?cult to manipulate the controls of an aid worn behind the ear, and they may be better o? with a device worn on the body. Some hearing aids are worn entirely within the ear and are very discreet. They are particularly useful for people who have to wear protective headgear such as helmets.

The most sophisticated aids sit entirely within the ear canal so are virtually invisible. They may be tuned so that only the frequencies the wearer cannot hear are ampli?ed.

Many have a volume control and a special setting for use with telephone and in rooms ?tted with an inductive coupler that screens out background noise.

In making a choice therefore from the large range of e?ective hearing aids now available, the expert advice of an ear specialist must be obtained. The RNID (Royal National Institute for Deaf People) provides a list of clinics where such a specialist can be consulted. It also gives reliable advice concerning the purchase and use of hearing aids – a worthwhile function, as some aids are very expensive.... hearing aids

An ABSCESS arising in the space between the RECTUM and ischial bone (see ISCHIUM) and often resulting in a FISTULA. It may occur spontaneously or be secondary to an anal ?ssure, thrombosed HAEMORRHOIDS or other anal disease. The disorder is painful and usually accompanied by fever. Treatment is by a combination of antibiotics and surgery.... ischiorectal abscess

A synthetically produced agent with the same properties as LUTEINISING HORMONERELEASING HORMONE (LHRH).... lhrh analogue

An unsaturated fatty acid occurring widely in the glycerides of plants. It is an essential nutrient for mammals, including humans.... linoleic acid

The uncoordinated movements and unsteady lurching gait that occurs in the tertiary stage of untreated SYPHILIS.... locomotor ataxia

Podophyllum peltatum. N.O. Berberidaceae.

Synonym: May Apple, Racoonberry, Wild Lemon.

Habitat: A common plant in the United States and Canada, the root is imported into this country in large quantities for medicinal purposes.

Features ? The rhizome (as the part used should more strictly be termed) is reddish- brown in colour, fairly smooth, and has knotty joints at distances of about two inches. The fracture shows whitish and mealy.

American Mandrake is an entirely different plant from White Bryony or English Mandrake, dealt with elsewhere. Preparations of the rhizome of the American Mandrake are found in practice to be much more effective than those of the resin. This is one of the many confirmations of one of the basic postulates of herbal medicine—the nearer we can get to natural conditions the better the results. Therapeutic principles are never the same when taken from their proper environment.

Podophyllum is a very valuable hepatic, and a thorough but slow-acting purgative. Correctly compounded with other herbs it is wonderfully effective in congested conditions of the liver, and has a salutary influence on other parts of the system, the glands in particular being helped to normal functioning. Although apparently unrecognised in Coffin's day, the modern natural healer highly appreciates the virtues of this medicine and has many uses for it.

As American Mandrake is so powerful in certain of its actions, and needs such skillful combination with other herbs, it should not be used by the public without the advice of one experienced in prescribing it to

individual needs.... mandrake, american

The study of the structural changes that diseases cause in the body, in particular those which can be seen with the naked eye at POST-MORTEM EXAMINATION.... morbid anatomy

A set of techniques used when the variation in several variables has to be studied simultaneously. In statistics, any analytic method that allows the simultaneous study of two or more independent variables.... multivariate analysis

The most common of naturally occurring fatty acids, being present in most fats and oils in the form of triglyceride. It is used in the preparation of OINTMENTS, but not eye ointments.... oleic acid

A treatment for a stenosed (restricted) coronary artery (see ARTERIES). A balloon-tipped catheter (see CATHETERS) is passed through an incision in the skin of the chest into the artery of the HEART that has developed stenosis (narrowing). The balloon is aligned with the stenosed section and then in?ated to dilate the coronary artery and allow the blood to ?ow more freely.... percutaneous transluminal coronary angioplasty

A yellow crystalline solid substance which is used as a ?xative for tissues being prepared for examination under a microscope; it is also used as a dye.... picric acid

See “durable power of attorney”.... power of attorney

This artery arises from the brachial artery at the level of the neck of the radius. It passes down the forearm to the wrist, where it is easily palpated laterally. It then winds around the wrist to the palm of the hand to supply the ?ngers. (See ARTERIES.)... radial artery

See RNA.... ribonucleic acid

The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences.... risk assessment

The process of analysing and comparing, on a single scale, the expected positive (benefits) and negative (risks, costs) results of an action, or lack of an action.... risk-benefit analysis

See INFANTILE SPASMS.... salaam attacks

Known colloquially as SADS, this is a disorder in which an affected individual’s mood changes with the seasons. He or she is commonly depressed in winter, picking up again in the spring. The diagnosis is controversial and its prevalence is not known. The mood-change is probably related to light, with MELATONIN playing a key role. (See also MENTAL ILLNESS.)... seasonal affective disorder syndrome

A gold compound given by deep intramuscular injection in the treatment of RHEUMATOID ARTHRITIS in children and adults. Known as a second-line or disease-modifying antirheumatoid drug, its therapeutic e?ect may take up to six months to achieve a full response. If this fails to happen, the drug should be stopped. If the patient responds, treatment may be continued at increasingly long intervals (up to four weeks) for as long as ?ve years. Gold treatment is particularly useful for palindromic arthritis in which the disease comes and goes.... sodium aurothiomalate

See under ANAESTHESIA.... spinal anaesthesia

See Anís de estrella.... star anise

A term applied to a condition in which slowness of the PULSE is associated with attacks of unconsciousness, and which is due to ARRHYTHMIA of the cardiac muscle or even complete heart block. Usually the heart returns to normal rhythm after a short period, but patients who suffer from the condition are commonly provided with a PACEMAKER to maintain normal cardiac function (see also CARDIAC PACEMAKER).... stokes-adams syndrome

A branch of the external carotid artery that is the main vessel supplying blood to the temple and scalp.... temporal artery

A group of powerful CYTOTOXIC (anticancer) drugs used to treat acute LEUKAEMIA, LYMPHOMA and some solid tumours such as breast and lung cancers. Originally derived from the periwinkle plant, the latest vinca alkaloid (VINORELBINE) is a semi-synthetic drug. These alkaloids, which are given intravenously, have potentially serious side-effects on the nervous system and also suppress the production of MYELOID cells in the bone marrow.... vinca alkaloids

The term applied in the UK to the admission of a mentally ill person to a psychiatric unit with his or her agreement. Patients with mental illnesses that may endanger their own safety or that of others can be compulsorily admitted using special legal powers – this is traditionally called ‘sectioning’. (See MENTAL ILLNESS.)... voluntary admission

A long canal, the digestive tract, from the mouth to the anus, through which food passes in the process of digestion and absorption. ... alimentary tract

(Acute). Sudden unexplained colicky pain with distension in a healthy person justifies immediate attention by a doctor or suitably trained practitioner. Persistent tenderness, loss of appetite, weight and bowel action should be investigated. Laxatives: not taken for undiagnosed pain. Establish accurate diagnosis.

Treatment. See entries for specific disorders. Teas, powders, tinctures, liquid extracts, or essential oils – see entry of appropriate remedy.

The following are brief indications for action in the absence of a qualified practitioner. Flatulence (gas in the intestine or colon), (Peppermint). Upper right pain due to duodenal ulcer, (Goldenseal). Inflamed pancreas (Dandelion). Gall bladder, (Black root). Liver disorders (Fringe Tree bark). Lower left – diverticulitis, colitis, (Fenugreek seeds). Female organs, (Agnus Castus). Kidney disorders, (Buchu). Bladder, (Parsley Piert). Hiatus hernia (Papaya, Goldenseal). Peptic ulcer, (Irish Moss). Bilious attack (Wild Yam). Gastro-enteritis, (Meadowsweet). Constipation (Senna). Acute appendicitis, pain central, before settling in low right abdomen (Lobelia). Vomiting of blood, (American Cranesbill). Enlargement of abdominal glands is often associated with tonsillitis or glandular disease elsewhere which responds well to Poke root. As a blanket treatment for abdominal pains in general, old-time physicians used Turkey Rhubarb (with, or without Cardamom seed) to prevent griping.

Diet: No food until inflammation disperses. Slippery Elm drinks. ... abdominal pain

See: SERUM SICKNESS. ... anaphylactic shock

Monkshood. Wolfsbane. Aconitum napellus L. French: Aconit napel. German: Wolfswurz. Italian: Aconito napello. Spanish: Caro di Venere. Part used: dried roots.

Action. Cardio-active; slows the heart via the vagus nerve. Antibacterial, antiviral, antifungal.

Uses: Used in conventional medicine for many years as a heart relaxant, to lower blood pressure and relieve capillary engorgement, but internal use now discontinued in the UK. Facial and inter-costal neuralgia. Pains of rheumatism, lumbago and arthritis (liniment).

Pains of arthritis and gout: Tincture Aconite 2; Tincture Colchicum 1. 10 drops thrice daily. (Dr Rudolf F. Weiss, “Herbal Medicine”, Beaconsfield)

Preparations: Tincture: Dose: 2-5 drops, thrice daily. Practitioner only. Alternative dosage sometimes used in fevers: 5 drops in 100ml water: 1 teaspoon hourly – until temperature falls or improvement is noted.

Standardised product: Aconitysat (Buerger): 5-10 drops or more. Liniment. 1.3 parts tincture to 100 parts Witch Hazel.

Note: Widely used in its homoeopathic preparation. Pharmacy only sale. ... aconite

Pink disease. The term was once confined to children of teething age who were believed to be allergic to mercury in teething, worm and dusting powders, and ointments containing mercury. The term is now increasingly used for mercury poisoning in all ages, in one of its many forms: atmospheric pollution, cereal grains, fish living in polluted waters, escape of vaporised mercury from teeth fillings, cassettes, camera mechanism, etc.

Symptoms: sweat rash, photophobia (intolerance of bright light on the iris of the eye), wasting, rapid heart beat, weakness, swollen ankles, diminished reflexes.

Alternatives. Assist the liver in its task to eliminate poisons, and to cleanse the lymph system.

Adults: Gotu Kola, Sarsaparilla, German Chamomile: teas.

Young children: German Chamomile tea: sips, freely – as much as well tolerated. ... acrodynia

Anise. Pimpinella anisum. German: Anis. French: Anis. Italian: Anice. Spanish: Simiente de anis. Chinese: Huai-hsiang.

Malayan: Jira-manis. Dried ripe fruits.

Action: Carminative, Expectorant, Antispasmodic, Oestrogenic, Anti-parasitic.

Uses: Flatulence, dry coughs, whooping cough, tracheitis, bronchitis. Externally for scabies and lice infestation.

Preparations: Tea. 2 crushed seeds to each cup boiling water, taken hot. Spirit BPC (1949): 0.3-1.2ml in water or honey when necessary. For acidity, bad breath, infant spasms. Anise oil BP, dose: 0.05-0.2ml. ... aniseed

Leopard’s Bane. Wolf’s Bane. Arnica Montana L. German: Wolferlei, Arnika. French: Arnica, Aronique. Spanish: Arnica. Italian: Arnica, Polmonaria di Montagna. Dried flowerheads.

Action: external use only.

Uses: Bruises and contusions where skin is unbroken. Severe bruising after surgical operation. Neuralgia, sprains, rheumatic joints, aches and pains after excessive use as in sports and gardening.

Combination, in general use: 1 part Tincture Arnica to 10 parts Witch Hazel water as a lotion. Contra- indications: broken or lacerated skin.

Preparations: Compress: handful flowerheads to 1 pint boiling water. Saturate handtowel or suitable material in mixture and apply.

Tincture. 1 handful (50g) flowerheads to 1 pint 70 per cent alcohol (say Vodka) in wide-necked bottle. Seal tight. Shake daily for 7 days. Filter. Use as a lotion or compress: 1 part tincture to 20 parts water. Weleda Lotion. First aid remedy to prevent bruise developing.

Nelson’s Arnica cream.

Ointment. Good for applying Arnica to parts of the body where tincture or lotion is unsuitable. 2oz flowers and 1oz leaves (shredded or powdered) in 16oz lard. Moisten with half its weight of distilled water. Heat together with the lard for 3-4 hours and strain. For wounds and varicose ulcers.

Wet Dressing. 2 tablespoons flowers to 2 litres boiling water. For muscular pain, stiffness and sprains. Tincture. Alternative dosage: a weak tincture can be used with good effect, acceptable internally: 5 drops tincture to 100ml water – 1 teaspoon hourly or two-hourly according to severity of the case.

Widely used in Homoeopathic Medicine.

First used by Swiss mountaineers who chewed the leaves to help prevent sore and aching limbs.

Note: Although no longer used internally in the UK, 5-10 drop doses of the tincture are still favoured by some European and American physicians for anginal pain and other acute heart conditions; (Hawthorn for chronic).

Pharmacy only sale. ... arnica

See: ABSCESS. ... breast, abscess

Inflammatory condition of the bronchial tubes caused by cold and damp or by a sudden change from a heated to a cold atmosphere. Other causes: viral or bacterial infection, irritating dust and fumes, colds which ‘go down to the chest’.

Symptoms: short dry cough, catarrh, wheezing, sensation of soreness in chest; temperature may be raised. Most cases run to a favourable conclusion but care is necessary with young children and the elderly. Repeated attacks may lead to a chronic condition.

Alternatives. Teas – Angelica, Holy Thistle, Elecampane leaves, Fenugreek seeds (decoction), Hyssop, Iceland Moss, Mouse Ear, Mullein, Nasturtium, Plantain, Wild Violet, Thyme, White Horehound, Wild Cherry bark (decoction), Lobelia, Liquorice, Boneset. With fever, add Elderflowers.

Tea. Formula. Equal parts: Wild Cherry bark, Mullein, Thyme. Mix. 1 heaped teaspoon to cup water simmered 5 minutes in closed vessel. 1 cup 2-3 times daily. A pinch of Cayenne assists action.

Irish Moss (Carragheen) – 1 teaspoon to cup water gently simmered 20 minutes. It gels into a viscous mass. Cannot be strained. Add honey and eat with a spoon, as desired.

Tablets/capsules. Iceland Moss. Lobelia. Garlic. Slippery Elm.

Prescription No 1. Morning and evening and when necessary. Thyme 2; Lungwort 2; Lobelia 1. OR Prescription No 2. Morning and evening and when necessary. Iceland Moss 2; Wild Cherry bark 1; Thyme 2.

Doses:– Powders: one-third teaspoon (500mg) or two 00 capsules. Liquid Extracts: 30-60 drops. Tinctures: 1-2 teaspoons.

Practitioner. Alternatives:–

(1) Tincture Ipecacuanha BP (1973). Dose, 0.25-1ml.

(2) Tincture Grindelia BPC (1949). Dose, 0.6-1.2ml.

(3) Tincture Belladonna BP (1980). Dose, 0.5-2ml.

Black Forest Tea (traditional). Equal parts: White Horehound, Elderflowers and Vervain. One teaspoon to each cup boiling water; infuse 5-15 minutes; drink freely.

Topical. Chest rub: Olbas oil, Camphorated oil. Aromatherapy oils:– Angelica, Elecampane, Mullein, Cajeput, Lemon, Eucalyptus, Lavender, Mint, Onion, Pine, Thyme.

Aromatherapy inhalants: Oils of Pine, Peppermint and Hyssop. 5 drops of each to bowl of hot water.

Inhale: head covered with a towel to trap steam.

Diet: Low salt, low fat, high fibre. Halibut liver oil. Wholefoods. Avoid all dairy products. Supplements. Vitamins A, C, D, E. ... bronchitis, acute

May follow inflammation of the liver from a number of causes, the most common being a manifestation of amoebic dysentery. Through blood infection it may appear on the surface of the liver or other organs.

Symptoms: pain under the right lower rib which may be referred to the right shoulder or under shoulder blades.

Treatment. Official treatment is aspiration or opening-up the abscess followed by drainage. Whether or not this is necessary, alternative anti-bacterials such as Myrrh, Goldenseal, Echinacea and Blue Flag may be used with good effect.

Alternatives. Teas: Milk Thistle. Grape leaves. 1 heaped teaspoon to each cup of water, thrice daily. Decoctions: Echinacea, Blue Flag, Goldenseal, Parsley root. One heaped teaspoon to each cup water gently simmered 20 minutes. Half a cup thrice daily.

Tablets/capsules: Blue Flag, Echinacea. Goldenseal. Wild Yam. Devil’s Claw.

Tinctures. Formula. Fringe Tree 3; Meadowsweet 2; Goldenseal 1. One to two 5ml teaspoons, thrice daily.

Practitioner. Ipecacuanha contains emetine which is specific for liver abscess; at the same time it is effective as an anti-amoebic-dysentery agent. Where dysentery is treated with Ipecacuanha liver abscess is rare. Tincture Ipecacuanha BP (1973). Dose: 0.25-1ml.

Diet. Fat-free. Dandelion coffee. Vitamins B6, C and K. Lecithin.

Treatment by or in liaison with a general medical practitioner. ... liver – abscess

In medical terms, a temporary loss or impairment of consciousness that occurs in some forms of epilepsy, typically generalized absence (petit mal) seizures in childhood.... absence

A drug that is used to treat type 2 diabetes mellitus.

Acarbose acts on enzymes in the intestines, inhibiting the digestion of starch and therefore slowing the rise in blood glucose levels after a carbohydrate meal.... acarbose

The 11th cranial nerve. Unlike the other cranial nerves, most of the accessory nerve originates from the spinal cord. The small part of the nerve that originates from the brain supplies many muscles of the palate, pharynx (throat), and larynx (voice box). Damage to this part of the nerve may cause difficulty in speaking and swallowing. The spinal part of the nerve supplies large muscles of the neck and back, notably the sternomastoid and trapezius. Damage to the spinal fibres of the nerve paralyses these muscles.... accessory nerve

An analgesic drug more commonly known as paracetamol.... acetaminophen

The part of the vestibulocochlear nerve (the 8th cranial nerve) that is concerned with hearing. It is also known as the auditory nerve.... acoustic nerve

The common abbreviation for adrenocorticotrophic hormone (also called corticotrophin). is produced by the anterior pituitary gland and stimulates the adrenal cortex (outer layer of the adrenal glands) to release various corticosteroid hormones, most importantly hydrocortisone (cortisol) but also aldosterone and androgen hormones.

production is controlled by a feedback mechanism involving both the hypothalamus and the level of hydrocortisone in the blood. levels increase in response to stress, emotion, injury, infection, burns, surgery, and decreased blood pressure.

A tumour of the pituitary gland can cause excessive production which leads to overproduction of hydrocortisone by the adrenal cortex, resulting in Cushing’s syndrome. Insufficient production results in decreased production of hydrocortisone, causing low blood pressure. Synthetic is occasionally given by injection to treat arthritis or allergy.... acth

A protein involved in muscle contraction, in which microscopic filaments of actin and another protein, myosin, slide in between each other.... actin

A projection at the front of the neck, just beneath the skin, that is formed by a prominence on the thyroid cartilage, which is part of the larynx (voice box). The Adam’s apple enlarges in males at puberty.... adam’s apple

Surgical removal of the adenoids.

An adenoidectomy is usually performed on a child with abnormally large adenoids that are causing recurrent infections of the middle ear or air sinuses.

The operation may be performed together with tonsillectomy.... adenoidectomy

See ACTH.... adrenocorticotrophic hormone

Requiring oxygen to live, function, and grow.

Humans and many other forms of life are dependent on oxygen for “burning” foods to produce energy (see metabolism).

In contrast, many bacteria thrive without oxygen and are described as anaerobic.... aerobic

Sudden pain in a tooth brought on by a change in surrounding air pressure. Flying at a high altitude in a lowered atmospheric pressure can cause a pocket of air in the dental pulp to expand and irritate the nerve in the root. Aerodontalgia is more likely if there are improperly fitting fillings or poorly filled root canals.... aerodontalgia

A term used to describe a person’s mood. The 2 extremes of affect are elation and depression. A person who experiences extreme moods or changes in moods may have an affective disorder. Shallow or reduced affect may be a sign of schizophrenia or of an organic brain syndrome.... affect

A poisonous substance produced by ASPERGILLUS FLAVUS moulds, which contaminate stored foods, especially grains, peanuts, and cassava. Aflatoxin is believed to be one of the factors responsible for the high incidence of liver cancer in tropical Africa.... aflatoxin

A collective term for the passages through which air enters and leaves the lungs (see respiratory system). The term is also applied to a tube inserted into the mouth of an unconscious person to prevent the tongue from obstructing breathing.... airway

Narrowing or blockage of the respiratory passages. The obstruction may be due to a foreign body, such as a piece of food, that becomes lodged in part of the upper airway and may result in choking. Certain disorders, such as diphtheria and lung cancer, can cause obstruction. Additionally, spasm of the muscular walls of the airway, as occurs in bronchospasm (a feature of asthma), results in breathing difficulty.... airway obstruction

An inability to sit still, occasionally occurring as a side effect of an antipsychotic drug or, less commonly, as a complication of Parkinson’s disease.... akathisia

The most abundant protein in the blood plasma. Albumin is made in the liver from amino acids. It helps to retain substances (such as calcium, some hormones, and certain drugs) in the circulation by binding to them to prevent them from being filtered out by the kidneys and excreted. Albumin also regulates the movement of water between tissues and the bloodstream by osmosis. (See also albuminuria.)... albumin

A worldwide, independent, self-help organization that is operated locally by people working on a voluntary basis to overcome alcohol dependence. Regular group meetings are held in which members are encouraged to help one another stay sober by sharing their experiences openly and offering support and advice.... alcoholics anonymous

See alcohol dependence.... alcoholism

A disorder that results from the excessive production of the hormone aldosterone from one or both adrenal glands. Aldosteronism caused by an adrenal tumour is known as Conn’s syndrome. Aldosteronism may also be caused by disorders, such as heart failure or liver damage, that reduce the flow of blood through the kidneys. Reduced blood flow through the kidneys leads to overproduction of renin and angiotensin, which, in turn, leads to excessive aldosterone production.

Symptoms are directly related to the actions of aldosterone. Too much sodium is retained in the body, leading to a rise in blood pressure, and excess potassium is lost in the urine. Low potassium causes tiredness and muscle weakness and impairs kidney function, leading to thirst and overproduction of urine.

Treatment in all cases includes restriction of dietary salt and use of the diuretic drug spironolactone.

If the cause of aldosteronism is an adrenal tumour, this may be surgically removed.... aldosteronism

A bisphosphonate drug used in the treatment of osteoporosis and Paget’s disease of bone. The most common side effect is inflammation of the oesophagus, which causes heartburn or difficulty in swallowing. Other side effects can include headache and abdominal pain.... alendronic acid

Feeling like a stranger, even when among familiar people or places, and being unable to identify with a culture, family, or peer group. Alienation is common in adolescents and also occurs in people who are isolated by cultural or language differences. In some people, it may be an early symptom of schizophrenia or a personality disorder.... alienation

An antihistamine drug, also known as trimeprazine, that is used mainly to relieve itching in allergic conditions such as urticaria and atopic eczema. Alimemazine often causes drowsiness.... alimemazine

A rare genetic disorder in which a person is missing the enzyme alpha1-antitrypsin, which protects the body from damage by other enzymes.

The disease mainly affects tissues in the lungs, resulting in emphysema, and the liver, causing cirrhosis.

The effects of alpha1-antitrypsin deficiency may not become apparent until after the age of 30.

There is no cure, but symptoms can be relieved by drug treatment.

In severe cases, a liver transplant may be a possibility.... alpha-antitrypsin deficiency

A protein that is produced in the liver and gastrointestinal tract of the fetus and by some abnormal tissues in adults.

Alpha-fetoprotein (AFP) can be measured in the maternal blood from the latter part of the 1st trimester of pregnancy, and its concentration rises between the 15th and 20th weeks.

Raised levels of are associated with fetal neural tube defects, such as spina bifida or anencephaly, and certain kidney abnormalities. High levels of also occur in multiple pregnancies (see pregnancy, multiple) and threatened or actual miscarriage. levels may be unusually low if the fetus has Down’s syndrome. For this reason, measurement of blood is included in blood tests, which are used to screen pregnant women for an increased risk of Down’s syndrome.

levels are commonly raised in adults with hepatoma (see liver cancer), cancerous teratoma of the testes or ovaries, or cancer of the pancreas, stomach, or lung.

For this reason, is known as a tumour marker.

(AFP) levels can be used to monitor the results of treatment of certain cancers; increasing levels after surgery or chemotherapy may indicate tumour recurrence.

However, levels are also raised in some noncancerous conditions, including viral and alcoholic hepatitis and cirrhosis.... alpha-fetoprotein

A benzodiazepine drug used in the treatment of anxiety, panic attacks, and phobias.... alprazolam

A prostaglandin drug used, prior to surgery, to minimize the effects of congenital heart defects in newborn babies. Alprostadil is also used as a treatment for impotence. It is administered by self-injection into the penis or as a gel introduced into the urethra to produce an erection.... alprostadil

A calcium channel blocker drug used to prevent angina and to treat hypertension. Possible side effects are headaches and dizziness.... amlodipine

Artificial rupture of the amniotic membranes (breaking the “waters”) performed for induction of labour.... amniotomy

An enlarged, flask-shaped area at the end of a tubular structure or canal. There are several ampullae in the body, including at the end of the fallopian tubes, at the opening of the bile duct into the intestine, and on each of the semicircular canals of the inner ear.... ampulla

The growth of new blood vessels. Angiogenesis is the process that enables tumours to grow; cancerous cells produce chemicals (called growth factors) that stimulate new blood vessels to form near the tumour, supplying it with nutrients.... angiogenesis

Total loss of the feeling of pleasure from activities that wouldnormally give pleasure. Anhedonia is often a symptom of depression. anhidrosis Complete absence of sweating. (See also hypohidrosis.)... anhedonia

Failure of some or all of the teeth to develop.

It may be due to absence of tooth buds at birth or the result of damage to developing tooth buds by infection or other widespread disease.

If only a few teeth are missing, a bridge can fill the gap; if all the teeth are missing, a denture is needed.... anodontia

A deviation from what is accepted as normal, especially a birth defect such as a limb malformation.... anomaly

Bleeding from the vagina after the 28th week of pregnancy. Antepartum haemorrhage is most commonly due to a problem with the placenta, such as placenta praevia or placental abruption. Bleeding can also be caused by cervical erosion or other disorders of the cervix or vagina.

Admission to hospital is necessary for investigation and treatment.

Ultrasound scanning is used to diagnose problems with the placenta.

If the bleeding is severe, the woman is given a blood transfusion, and the baby is delivered immediately by caesarean section.... antepartum haemorrhage

A group of drugs used to treat diabetes mellitus, in which a lack of insulin, or resistance to its actions, results in raised blood glucose levels. A wide range of antidiabetics are used to keep the blood glucose level as close to normal as possible, and consequently reduce the risk of complications such as vascular (blood vessel) disease.

Antidiabetic drugs include insulin, which must be administered by injection, and oral hypoglycaemics such as glibenclamide and metformin. Acarbose and guar gum reduce or slow absorption of carbohydrate from the intestines after meals. Repaglinide stimulates insulin release from the pancreas for a short time and may be taken directly before meals. Rosiglitazone reduces resistance to the effects of insulin in the tissues and may be used together with other hypoglycaemics.... antidiabetic drugs

See ADH.... antidiuretic hormone

A preparation containing antibodies (also known as immunoglobulins) that combine with specific antigens (foreign proteins), usually components of microorganisms, leading to deactivation or destruction of the microorganisms.

Antiserum is usually used, along with immunization, as an emergency treatment when someone has been exposed to a dangerous infection such as rabies and has not previously been immunized.... antiserum

Impulsive, destructive behaviour that often disregards the feelings and rights of others.

People who have an antisocial personality lack a sense of guilt and cannot tolerate frustration.

They may have problems with relationships and are frequently in trouble with the law.

Behaviour therapy, and various forms of psychotherapy, may help to improve integration.

In general, the effects of this disorder decrease with age.... antisocial personality disorder

Drugs used to treat hyperthyroidism, in which the thyroid gland is overactive. They may be used as the sole treatment or before thyroid surgery. Carbimazole and propylthiouracil interfere with the production of thyroid hormone by the gland.... antithyroid drugs

An unpleasant emotional state ranging from mild unease to intense fear. Various physical symptoms are associated with anxiety; the most common include palpitations, chest pains, a feeling of tightness in the chest, and a tendency to overbreathe (see hyperventilation). Muscle tension leads to headaches and back pains. Gastrointestinal symptoms include dry mouth, bloating, diarrhoea, nausea, and difficulty in swallowing. Other symptoms include sweating, blushing, pallor, lightheadedness, and a frequent need to urinate or defaecate. Anxiety is a normal response to stressful situations and prepares the mind and body to respond effectively. However, anxiety that occurs without reason may be a symptom of an anxiety disorder or another psychological disorder such as depression.

People suffering from anxiety may be helped by counselling or psychotherapy.

If there is an underlying disorder such as depression, treatment with antianxiety drugs can help.

Antianxiety drugs are used for short-term control of symptoms but are avoided for long-term treatment because they are addictive.... anxiety

See anaemia, aplastic.... aplastic anaemia

A group of proteins that are constituents of lipoproteins, the carriers of fat in the bloodstream. Apolipoproteins are also involved in the growth and repair of nerve tissues.... apolipoprotein

An outgrowth of bone at the site of attachment of a tendon to bone. Inflammation may also occur, as in Osgood–Schlatter disease.... apophysis

A watery fluid that fills the front chamber of the eye, behind the cornea.... aqueous humour

One of the fatty acids in the body that are essential for growth.... arachidonic acid

A rare condition that is characterized by chronic inflammation and thickening of the arachnoid mater, which is the middle of the 3 meninges (the membranes that cover the brain and spinal cord).... arachnoiditis

The awakening of a person from unconsciousness or semiconsciousness.

The term is also used to describe any state of heightened awareness, such as that caused by sexual stimulation or fear.

Arousal is regulated by the reticular formation in the brainstem.... arousal

A rare tumour of the ovary that occurs in young women. The tumour is noncancerous but secretes androgen hormones (male sex hormones) that cause virilization (the development of male characteristics). Treatment is by surgical removal of the affected ovary.... arrhenoblastoma

Surgical repair of an artery (see arterial reconstructive surgery).... arterioplasty

A diagnostic technique in which the interior of a damaged joint is X-rayed after injection of a radiopaque solution.

It is being replaced by MRI, ultrasound scanning, and arthroscopy.... arthrography

See contracture.... arthrogryposis

A blood vessel that carries blood away from the heart. Systemic arteries carry blood pumped from the left ventricle of the heart to all parts of the body except the lungs. The largest systemic artery is the aorta, which emerges from the left ventricle; other major systemic arteries branch off from the aorta. The pulmonary arteries carry blood from the right ventricle to the lungs.

Arteries are tubes with thick, elastic, muscular walls able to withstand the high pressure of blood flow. The structure of arteries helps to even out the peaks and troughs of blood pressure caused by the heartbeat, so that the blood is kept flowing at a relatively constant pressure. (See also arteries, disorders of.)... artery

A form of assisted conception in which semen is introduced artificially into the uterus, instead of by sexual intercourse, with the aim of inducing pregnancy.

There are 2 types of artificial insemination: , artificial insemination with the semen of the woman’s male partner; and , insemination with a donor’s sperm. is usually used for couples who are unable to have intercourse, or if the man has a low sperm count or a low volume of ejaculate. It is also used when semen has been stored from a man prior to treatment (such as chemotherapy) that has made him sterile. is available to couples if the man is infertile or is a carrier of a genetic disease. It may also be used by a woman who wants children but has no male partner.

Insemination is timed to coincide with natural ovulation or may be combined with treatment to stimulate ovulation.... artificial insemination

Forced introduction of air into the lungs of someone who has stopped breathing (see respiratory arrest) or whose breathing is inadequate. As an emergency first-aid measure, artificial respiration can be given mouth-to-mouth or mouth-tonose, which can prevent brain damage due to oxygen deprivation; a delay in breathing for more than 6 minutes can cause death. Cardiac compressions may also be necessary if poor respiration has led to cessation of the heartbeat (see cardiopulmonary resuscitation). Artificial respiration can be continued by use of a ventilator (see ventilation).... artificial respiration

A rare developmental disorder that is usually first recognized in childhood because of difficulties with social interactions, stilted speech, and very specialized interests.

Intelligence is normal or high.

Asperger’s syndrome is considered to be an autistic spectrum disorder and is also known as pervasive developmental disorder.

Special educational support may be needed, often within mainstream education.

The condition is lifelong.... asperger’s syndrome

See azoospermia.... aspermia

Analysis or measurement of a substance to determine its presence or effects. Biological assays (bioassays) measure the responses of an animal or organ to particular substances. They can be used to assess the effects of a drug or to measure hormone levels. (See also immunoassay; radioimmunoassay.)... assay

One of a number of areas in the outer layer (cortex) of the brain that are concerned with higher levels of mental activity.

Association areas interpret information received from sensory areas and prompt appropriate responses such as voluntary movement.... association area

A type of cancerous brain tumour.

Astrocytomas are the most common type of glioma, a tumour arising from the glial (supporting) cells in the nervous system.

They most commonly develop in the cerebrum (the main mass of the brain).

Astrocytomas are classified in 4 grades (I–) according to their rate of growth and malignancy.

The most severe type is called glioblastoma multiforme.

Symptoms are similar to those of other types of brain tumour.

Diagnostic tests include CT scanning or MRI.

Treatment is with surgery and, in some cases, radiotherapy in addition.... astrocytoma

A small knot of specialized muscle cells in the right atrium of the heart. Electrical impulses from the sinoatrial node pass through the atrioventricular node and along conducting fibres to the ventricles, causing them to contract.... atrioventricular node

An affectionate bond between individuals, especially between a parent and child (see bonding), or a person and an object, as in a young child and a security blanket.

The term is also used to refer to the site at which a muscle or tendon is attached to a bone.... attachment

(ADHD) A behavioural disorder in which a child has a consistently high level of activity and/or difficulty in attending to tasks. Attention deficit hyperactivity, or hyperkinetic, disorder affects up to 1 in 20 children in the. The disorder, which is more common in boys, should not be confused with the normal boisterous conduct of a healthy child. Children with consistently show abnormal patterns of behaviour over a period of time. An affected child is likely to be restless, unable to sit still for more than a few moments, inattentive, and impulsive.

The causes of are not fully understood, but the disorder often runs in families, which suggests that genetic factors may be involved. is not, as popularly believed, a result of poor parenting or abuse.

Symptoms develop in early childhood, usually between the ages of 3 and 7, and may include inability to finish tasks; short attention span; inability to concentrate in class; difficulty in following instructions; a tendency to talk excessively, frequently interrupting other people; difficulty in waiting or taking turns; inability to play quietly alone; and physical impulsiveness. Children with may have difficulty in forming friendships. Self-esteem is often low because an affected child is frequently scolded and criticized.

Treatment includes behaviour modification techniques, both at home and at school. In some children, avoidance of certain foods or food additives seems to reduce symptoms. In severe cases, stimulant drugs, usually methylphenidate, may be prescribed. Paradoxically, the use of stimulants in reduces hyperactivity and improves concentration. In general, the condition improves by adolescence but may be followed by antisocial behaviour and drug abuse or substance abuse.... attention deficit hyperactivity disorder

The study of hearing, especially of impaired hearing that cannot be corrected by drugs or surgery.... audiology

Any chromosome that is not a sex chromosome. Of the 23 pairs of chromosomes in each human cell, 22 pairs are autosomes.... autosome

The death of cells in body tissue caused by damage to blood vessels supplying the area.

aversion therapy An outdated form of behaviour therapy in which unpleasant stimuli, such as electric shocks, are administered at the same time as an unwanted behaviour in an attempt to alter behavioural patterns.... avascular necrosis

A topical drug used to treat mild to moderate acne.... azelaic acid

A macrolide antibiotic drug used to treat infections of the skin, chest, throat, and ears.

Azithromycin is also used to treat genital infections due to chlamydia (see chlamydial infections).... azithromycin

An antibiotic used to treat some types of meningitis and infections by certain types of bacteria, including PSEUDOMONAS.... aztreonam

An abnormal swelling that occurs at the junction of arteries supplying the brain. Berry aneurysms, which are usually due to a congenital weakness, can sometimes rupture, resulting in a subarachnoid haemorrhage.

(See also aneurysm.)... berry aneurysm

A rare disorder, present from birth, in which some or all of the bile ducts fail to develop or have developed abnormally.

As a result, bile is unable to drain from the liver (see cholestasis).

Unless the atresia can be treated, secondary biliary cirrhosis will develop and may prove fatal.

Symptoms include deepening jaundice, usually beginning a week after birth, and the passing of dark urine and pale faeces.

Treatment is by surgery to bypass the ducts.

If this fails, or if the jaundice recurs, a liver transplant is the only possible treatment.... biliary atresia

The artery that runs down the inner side of the upper arm, between the armpit and the elbow.... brachial artery

Periods during which a toddler holds his or her breath, usually as an expression of pain, frustration, or anger.

The child usually becomes red or even blue in the face after a few seconds, and may faint.

Breathing quickly resumes as a natural reflex, ending the attack.

Attacks cause no damage and are usually outgrown.... breath-holding attacks

An area of the cerebral cortex (the outer layer of the brain) that is responsible for speech origination.... broca’s area

A penicillin drug containing a mixture of amoxicillin and clavulanic acid.

Because it is a more powerful antibiotic than amoxicillin alone, co-amoxiclav is used to treat infections caused by amoxicillin-resistant strains of bacteria.... co-amoxiclav

See thalassaemia.... cooley’s anaemia

Any of the main arteries of the neck and head. There are 2 common carotid arteries (left and right), each of which divides into 2 main branches (internal and external).

The left carotid arises from the aorta and runs up the neck on the left side of the trachea (windpipe). The right carotid arises from the subclavian artery (which branches off the aorta) and follows a similar route on the right side of the

neck. Just above the level of the larynx (voice-box), each carotid artery divides to form an external carotid artery and an internal carotid artery. The external arteries have multiple branches that supply most tissues in the face, scalp, mouth, and jaws; the internal arteries enter the skull to supply the brain and eyes. At the base of the brain, branches of the 2 internal carotids and the basilar artery join to form a ring of vessels called the circle of Willis. Narrowing of these vessels may be associated with transient ischaemic attack (TIA); obstruction of them causes a stroke. carpal tunnel syndrome Numbness, tingling, and pain in the thumb, index finger, and middle fingers caused by compression of the median nerve at the wrist. Symptoms may be worse at night. The condition results from pressure on the nerve where it passes into the hand via a gap (the “carpal tunnel’’) under a ligament at the front of the wrist. It is common among keyboard users. It also occurs without obvious cause in middleaged women, and is associated with pregnancy, initial use of oral contraceptives, premenstrual syndrome, rheumatoid arthritis, myxoedema, and acromegaly.

The condition often disappears without treatment.

Persistent symptoms may be treated with a corticosteroid drug injected under the ligament, or the ligament may be cut to relieve pressure on the nerve.... carotid artery

Narrowing of the coronary arteries, which supply blood to the heart, leading to damage or malfunction of the heart. The most common heart disorders due to coronary artery disease are angina pectoris and myocardial infarction (heart attack). The usual cause of narrowing of the arteries is atherosclerosis, in which fatty plaques develop on the artery linings. The vessel can become totally blocked if a blood clot forms or lodges in the narrowed area. Atherosclerosis has many interrelated causes including smoking, a high-fat diet, lack of exercise, being overweight, and raised blood cholesterol levels. Other factors include a genetic predisposition and diseases such as diabetes mellitus and hypertension.

The first symptom of coronary artery disease is frequently the chest pain of angina. Treatment is with drugs such as glyceryl trinitrate and other nitrate drugs, beta-blockers, calcium channel blockers, potassium channel activators, and vasodilator drugs. If drug treatment fails to relieve the symptoms, or there is extensive narrowing of the coronary

arteries, blood flow may be improved by balloon angioplasty or coronary artery bypass surgery.... coronary artery disease

A treatment for persistent menorrhagia (heavy menstrual blood loss) that involves endoscopic examination of the uterus (see endoscopy) and removal of the uterus lining, the endometrium, by diathermy or laser.... endometrial ablation

A rare type of aplastic anaemia characterized by severely reduced production of all types of blood cells by the bone marrow.... fanconi’s anaemia

A major blood vessel that supplies oxygenated blood to the leg. The femoral artery is formed in the pelvis from the iliac artery (the terminal branch of the aorta). It then runs from the groin, down in front of the thigh, and passes behind the knee to become the popliteal artery, which branches again to supply the lower leg.... femoral artery

Vague apprehension or tension, often associated with generalized anxiety disorder.... free-floating anxiety

A very rare inherited disease in which degeneration of nerve fibres in the spinal cord causes loss of coordinated movement and balance. Once symptoms have developed, the disease becomes progressively more severe. Treatment can help with the symptoms but cannot alter the course of the disease.... friedreich’s ataxia

A psychiatric illness characterized by chronic and persistent apprehension and tension that has no particular focus. There may also be physical symptoms such as trembling, sweating, lightheadedness, and irritability. The condition can be treated with psychotherapy or with drugs such as beta blockers, sedatives or tranquillizers that relieve symptoms but do not treat the underlying condition.

(See anxiety; anxiety disorders.)... generalized anxiety disorder

A harmless skin condition characterized by a circular, raised area of skin, which spreads outwards to form a ring.

The disorder occurs most commonly in children, usually on the hands.

The cause is unknown.

No treatment is necessary.

In most cases, the affected skin heals completely over a period of several months or years.... granuloma annulare

See myocardial infarction.... heart attack

A rare bacterial infection of the floor of the mouth.

The condition spreads to the throat, causing life-threatening swelling.

It requires immediate treatment with antibiotic drugs.... ludwig’s angina

An alternative name for methanol.... methyl alcohol

The system that produces and drains tears. The lacrimal apparatus of the eye includes the main and accessory lacrimal glands and the nasolacrimal drainage duct. The main gland lies just within the upper and outer

margin of the eye orbit and drains on to the conjunctiva. It secretes tears during crying and when the eye is irritated. The accessory gland lies within the conjunctiva, and maintains the normal tear film, secreting it directly onto the conjunctiva. Tears drain through the lacrimal puncta, tiny openings towards the inner ends of the upper and lower eyelids. The puncta are connected by narrow tubes to the lacrimal sac, which lies within the lacrimal bone on the side of the nose. Leading from the sac is the nasolacrimal duct, which opens inside the nose.... lacrimal apparatus

See antibody, monoclonal.... monoclonal antibody

See pulmonary disease, chronic obstructive.... obstructive airways disease

A condition in which the kidneys are unable to excrete normal amounts of acid made by the body.

The blood is more acidic than normal, and the urine less acidic.

Causes include kidney damage due to disease, drugs, or a genetic disorder; but in many cases the cause is unknown.

The acidosis may result in osteomalacia, kidney stones (see calculus, urinary tract), nephrocalcinosis, and hypokalaemia (an abnormally low level of potassium in the blood).... renal tubular acidosis

Blockage of an artery supplying blood to the retina, most commonly due to thrombosis or embolism, The disorder can result in permanent blindness or loss of part of the field of vision, depending on the artery affected and whether or not the condition can be treated quickly enough.... retinal artery occlusion

Separation of all or part of the placenta from the wall of the uterus before the baby is delivered. The exact cause is not known, but placental abruption is more common in women with long-term hypertension and in those who have had the condition in a previous pregnancy or who have had several pregnancies. Smoking and high alcohol intake may also contribute to the risk of placental abruption.

Symptoms usually occur suddenly and depend on how much of the placenta has separated from the wall of the uterus. They include slight to heavy vaginal bleeding, which can be severe haemorrhaging in complete separation; cramps in the abdomen or backache; severe, constant abdominal pain; and reduced fetal movements. If the bleeding does not stop, or if it starts again, it may be necessary to induce labour (see

A small placental abruption is usu-tal. In more severe

ergency caesarean section is often necessary to save the the life of the fetus. A blood transfusion required.

placenta praevia Implantation of the placenta in the lower part of the uterus, near or over the cervix. Placenta praevia occurs in about 1 in 200 pregnancies. It varies in severity from marginal placenta praevia, when the placenta reaches the edge of the cervical opening, to complete placental praevia, when the entire opening of the cervix is covered. Mild placenta praevia may have no adverse effect. More severe cases often cause painless vaginal bleeding in late pregnancy. If the bleeding is slight and the pregnancy still has several weeks to run, bed rest in hospital may be all that is necessary. The baby will probably be delivered by caesarean section at the 38th week. If the bleeding is heavy or if the pregnancy is near term, an immediate delivery is carried out. placenta, tumours of See choriocarcinoma; hydatidiform mole.... placental abruption

The feelings of distress a young child experiences when parted from his or her parents or home. This is a normal aspect of infant behaviour and usually diminishes by age 3 or 4.

In separation anxiety disorder, the reaction to separation is greater than that expected for the child’s level of development.

The anxiety may manifest as physical symptoms.

Separation anxiety disorder may be a feature of depression.... separation anxiety

A disorder in which there are episodes of temporary cessation of breathing (lasting 10 seconds or longer) during sleep.

People with sleep apnoea may not be aware of any problem during the night, but they may be sleepy during the day, with poor memory and concentration. Severe sleep apnoea is potentially serious and may lead to hypertension, heart failure, myocardial infarction, or stroke.

Obstructive sleep apnoea is the most common type and may affect anyone, but more often middle-aged men, especially those who are overweight. The most common cause is over-relaxation of the muscles of the soft palate in the pharynx, which obstructs the passage of air. Obstruction may also be caused by enlarged tonsils or adenoids. The obstruction causes snoring. If complete blockage occurs, breathing stops. This triggers the brain to restart breathing, and the person may gasp and wake briefly.

In central sleep apnoea, breathing stops because the chest and diaphragm muscles temporarily cease to work, probably due to a disturbance in the brain’s control of breathing. Causes include paralysis of the diaphragm and disorders of the brainstem. Snoring is not a main feature.People who are overweight may find losing weight helps.

Alcohol and sleeping drugs aggravate sleep apnoea.

In one treatment, air from a compressor is forced into the airway via a mask worn over the nose.

Night-time artificial ventilation may be needed.

Tonsillectomy, adenoidectomy, or surgery to shorten or stiffen the soft palate may be performed.... sleep apnoea

(TIA) A brief interruption of the blood supply to part of the brain, which causes temporary impairment of vision, speech, sensation, or movement. The episode typically lasts for several minutes or, at the most, for a few hours. TIAs are sometimes described as mini strokes, and they can be the prelude to a stroke.

TIAs may be caused by a blood clot (see embolism) temporarily blocking an artery that supplies the brain, or by narrowing of an artery as a result of atherosclerosis.

After a TIA, tests such as CT scanning, blood tests, ultrasound scanning, or angiography may be needed to determine a cause. In some cases, the heart is studied as a possible source of blood clots. Treatment is aimed at preventing stroke, which occurs within 5 years in up to one third of patients with TIA. Treatments include endarterectomy, anticoagulant drugs, or aspirin.... transient ischaemic attack

A type of antidepressant drug.

Tricyclic antidepressants prevent neurotransmitters in the brain from being reabsorbed, thereby increasing their level.

Examples are amitriptyline, clomipramine, and imipramine.... tricyclic antidepressants

The arch of bone, commonly known as the cheek bone, on either side of the skull just below the eye socket. The zygomatic arch is formed of the zygomatic and temporal bones.... zygomatic arch

1. n. any drug or chemical agent used to destroy parasitic worms (helminths), e.g. tapeworms, roundworms, and flukes, and/or remove them from the body. Anthelmintics include *albendazole, *mebendazole, *niclosamide, and *praziquantel. 2. adj. having the power to destroy or eliminate helminths.... anthelmintic

n. a drug that prevents or reduces the severity and frequency of seizures in various types of epilepsy; the term antiepileptic drug is now preferred since not all epileptic seizures involve convulsions. The choice of drug is dictated by the type of seizure and the patient’s response, and the dosage must be adjusted carefully as individuals vary in their response to these drugs and side-effects may be troublesome. Commonly used antiepileptic drugs include *carbamazepine, *lamotrigine, *phenytoin, *sodium valproate, levetiracetem, topiramate, *gabapentin, pregabalin, and oxcarbazepine. Phenobarbital is no longer commonly prescribed.

Certain anticonvulsants have shown efficacy in treating bipolar disorder and chronic pain, as in postherpetic neuralgia or *peripheral neuropathy, and can be used to prevent migraine and other primary headache syndromes.... anticonvulsant

1. adj. describing a drug that reduces *inflammation. The various groups of anti-inflammatory drugs act against one or more of the mediators that initiate or maintain inflammation. Some groups suppress only certain aspects of the inflammatory response. The main groups of anti-inflammatory drugs are the *antihistamines, the glucocorticoids (see corticosteroid), and the nonsteroidal anti-inflammatory drugs (see NSAID). 2. n. an anti-inflammatory drug.... anti-inflammatory

n. see clinical audit.... audit

Calligonum comosum

Description: The abal is one of the few shrubby plants that exists in the shady deserts. This plant grows to about 1.2 meters, and its branches look like wisps from a broom. The stiff, green branches produce an abundance of flowers in the early spring months (March, April).

Habitat and Distribution: This plant is found in desert scrub and waste in any climatic zone. It inhabits much of the North African desert. It may also be found on the desert sands of the Middle East and as far eastward as the Rajputana desert of western India.

Edible Parts: This plant’s general appearance would not indica te its usefulness to the survivor, but while this plant is flowering in the spring, its fresh flowers can be eaten. This plant is common in the areas where it is found. An analysis of the food value of this plant has shown it to be high in sugar and nitrogenous components.... abal

(Hebrew) Feminine form of Abraham; mother of a multitude; mother of nations

Abarrayne, Abarraine, Abarane, Abarayne, Abaraine, Abame, Abrahana... abarrane

(Greek) Woman of the city of Abdera

Abderah, Abderra, Abderrah, Abderia, Abderiah... abdera

(African) Woman who is delicate and flowerlike

Abedah, Abeeda, Abeida, Abyda, Abeedah, Abeidah, Abydah, Abieda, Abiedah, Abeada, Abeadah... abeba

(African) Child who is asked for Abebi, Abebie, Abeby, Abebey, Abebye, Abebee, Abebeah, Abebea... abebe

(Native American) Sight of day; dawn’s child... abedabun

(French) A breath or sigh; source of life

Abelah, Abella, Abelia, Abelya, Abellah, Abeliah, Abelyah... abela

(Greek) Woman who is manly Abellona, Abellonia, Abellonea, Abelone, Abelona... abellone

(African) Born on a Tuesday Abenah, Abeena, Abyna, Abina, Abeenah, Abynah, Abinah... abena

(African) A girl child who was prayed for

Abenie, Abeny, Abeney, Abenye, Abenea, Abeneah, Abenee... abeni

(Native American) Woman who stays at home... abeque

(Scottish) A woman from a city in northeast Scotland Aberdeene, Aberdeena, Aberdeenah, Aberdeenia, Aberdeane, Aberdean, Aberdeana, Aberdyne, Aberdyn, Aberdyna... aberdeen

(Welsh) From the mouth of the river Aberfah, Aberpha, Aberphah... aberfa

See under STOMACH, DISEASES OF; INTESTINE, DISEASES OF; DIARRHOEA; LIVER, DISEASES OF; PANCREAS, DISEASES OF; GALL-BLADDER, DISEASES OF; KIDNEYS, DISEASES OF; URINARY BLADDER, DISEASES OF; HERNIA; PERITONITIS; APPENDICITIS; TUMOUR.

Various processes that can occur include in?ammation, ulceration, infection or tumour. Abdominal disease may be of rapid onset, described as acute, or more long-term when it is termed chronic.

An ‘acute abdomen’ is most commonly caused by peritonitis – in?ammation of the membrane that lines the abdomen. If any structure in the abdomen gets in?amed, peritonitis may result. Causes include injury, in?ammation of the Fallopian tubes (SALPINGITIS), and intestinal disorders such as APPENDICITIS, CROHN’S DISEASE, DIVERTICULITIS or a perforated PEPTIC ULCER. Disorders of the GALLBLADDER or URINARY TRACT may also result in acute abdominal pain.

General symptoms of abdominal disease include:

Pain This is usually ill-de?ned but can be very unpleasant, and is termed visceral pain. Pain is initially felt near the mid line of the abdomen. Generally, abdominal pain felt high up in the mid line originates from the stomach and duodenum. Pain that is felt around the umbilicus arises from the small intestine, appendix and ?rst part of the large bowel, and low mid-line pain comes from the rest of the large bowel. If the diseased organ secondarily in?ames or infects the lining of the abdominal wall – the PERITONEUM – peritonitis occurs and the pain becomes more de?ned and quite severe, with local tenderness over the site of the diseased organ itself. Hence the pain of appendicitis begins as a vague mid-line pain, and only later moves over to the right iliac fossa, when the in?amed appendix has caused localised peritonitis. PERFORATION of one of the hollow organs in the abdomen – for example, a ruptured appendix or a gastric or duodenal ulcer (see STOMACH, DISEASES OF) eroding the wall of the gut – usually causes peritonitis with resulting severe pain.

The character of the pain is also important. It may be constant, as occurs in in?ammatory diseases and infections, or colicky (intermittent) as in intestinal obstruction.

Swelling The commonest cause of abdominal swelling in women is pregnancy. In disease, swelling may be due to the accumulation of trapped intestinal contents within the bowel, the presence of free ?uid (ascites) within the abdomen, or enlargement of one or more of the abdominal organs due to benign causes or tumour.

Constipation is the infrequent or incomplete passage of FAECES; sometimes only ?atus can be passed and, rarely, no bowel movements occur (see main entry for CONSTIPATION). It is often associated with abdominal swelling. In intestinal obstruction, the onset of symptoms is usually rapid with complete constipation and severe, colicky pain. In chronic constipation, the symptoms occur more gradually.

Nausea and vomiting may be due to irritation of the stomach, or to intestinal obstruction when it may be particularly foul and persistent. There are also important non-abdominal causes, such as in response to severe pain or motion sickness.

Diarrhoea is most commonly due to simple and self-limiting infection, such as food poisoning, but may also indicate serious disease, especially if it is persistent or contains blood (see main entry for DIARRHOEA).

Jaundice is a yellow discoloration of the skin and eyes, and may be due to disease in the liver or bile ducts (see main entry for JAUNDICE).

Diagnosis and treatment Abdominal diseases are often di?cult to diagnose because of the multiplicity of the organs contained within the abdomen, their inconstant position and the vagueness of some of the symptoms. Correct diagnosis usually requires experience, often supplemented by specialised investigations such as ULTRASOUND. For this reason sufferers should obtain medical advice at an early stage, particularly if the symptoms are severe, persistent, recurrent, or resistant to simple remedies.... abdomen, diseases of

(Welsh) One who is sacrificed Aberthah... abertha

(Indian) One who shines; a lustrous beauty Abhah... abha

(Hindi) One who is desired Abhilashah, Abhylasha, Abhylashah... abhilasha

(Arabic) One who is great Abiah... abia

(African) First child born after the grandmother has died Abibah, Abeeba, Abyba, Abeebah, Abybah, Abeiba, Abeibah, Abieba, Abiebah, Abeaba, Abeabah... abiba

(Arabic / Hebrew) She who worships or adores / having knowledge Abidah, Abeeda, Abyda, Abeedah, Abydah, Abeida, Abeidah, Abieda, Abiedah, Abeada, Abeadah... abida

(Hebrew) My father is Lord Abielah, Abiella, Abiellah, Abyela, Abyelah, Abyella, Abyellah... abiela

(Hebrew) The source of a father’s joy Abbigail, Abigael, Abigale, Abbygail, Abygail, Abygayle, Abbygayle, Abbegale, Abigayle, Abagail, Abaigael, Abaigeal, Abbey, Abbie, Abbigail, Abie, Abby, Abegayle, Abey, Abhy, Abiageal, Abichail, Avagail, Avigail, Avagale, Avigale, Avagayle, Avichayil, Abbye... abigail

(Hebrew) My father is Lord Abija, Abisha, Abishah, Abiah, Abia, Aviah, Avia... abijah

(Spanish) One who is beautiful Abilah, Abyla, Abylah... abila

(American / Hebrew) From a town in Texas / resembling grass Abalene, Abalina, Abilena, Abiline, Abileene, Abileen, Abileena, Abilyn, Abilyne, Abilyna, Abilean, Abileane, Abileana... abilene

(Yoruban) Born during a journey Abionah, Abionia, Abioniah... abiona

(Arabic) Having a fragrant scent Abeer, Abyr, Abire, Abeere, Abbir, Abhir... abir

(Hebrew) A source of strength; one who is strong

Abera, Abyra, Abyrah, Abirah, Abbira, Abeerah, Abhira... abira

(Hebrew) My father is the dew; in the Bible, the fifth wife of David Avital, Abitall, Avitall... abital

(Arabic) One who is perfectly formed; full-figured woman Abla... ablah

Royle.

Synonym: A. pindrow Spach. A. webbiana Lindl. var. pindrow Brandis. Pinus pindrow Royle.

Family: Pinaceae.

Habitat: Kashmir, Himachal Pradesh, Tehri-Garhwal and other areas of northern India, at altitudes of 2,100-3,600 m.

English: Pindrow-Fir, Silver-Fir, The West-Himalayan Low-Level Fir.

Ayurvedic: Taalisha (related sp.).

Folk: Badar, Morinda, Raisalla, Ransla.

Action: Uses similar to those of A. webbiana.

Terpenoids, flavonoids, glycosides and steroids of the leaf were found to have mast cell stabilizing action in rats. Terpenoids and flavonoids offered bronchoprotection against his- tamine challenge in guinea pigs. The ulcer protective action of petroleum ether, benzene and chloroform fraction has been attributed to steroidal contents. Terephthalic acid demethyl ester (TADE), isolated from the leaf, exhibited protection against inflammation and bronchospasm in guinea pigs. Ethanolic extract of leaves showed significant anxiolytic effects on all the paradigms of anxiety, barbiturate hypnosis potentiation.

Pindrolactone, a lanostane-based triterpene lactone, isolated from the leaves, showed mild activity against Gram-positive bacteria but exhibited potent antibacterial activity against Gram-negative bacteria E. coli.... abies pindrow

Lindl.

Synonym: A. spectabilis (D. Don) Spach.

Pinus webbiana Wall.

Family: Pinaceae.

Habitat: The Himalayas from Kashmir to Assam at altitudes of 1,600-4,000 m.

English: Indian Silver Fir, The West-Himalayan High-Level Fir, The East-Himalayan Fir.

Ayurvedic: Taalisa, Taalisapatra, Taalisha, Patraadhya, Dhaatriparni, Dhaatripatra.

Unani: Taalisapattar.

Siddha/Tamil: Taalispatri.

Folk: Badar, Chilrow, Morinda, Raisalla, Taalispatra. (Tallispatra, Taalispatri and Talespattre are also equated with the leaves of Cinnamomum tamala Nees.)

Action: Expectorant, bronchial sedative, decongestant, anticatarrhal, antiseptic, carminative.

Key application: Fir (Abies alba Miller) needle oil—in catarrhal illness of upper and lower respiratory tract (internally and externally); externally in rheumatic and neuralgic pains. Contraindicated in bronchial asthma and whooping cough. (German Commission E.)

A biflavonoid, abiesin, n-triaconta- nol, beta-sitosterol and betuloside are present in the leaves.

The essential oil from leaves contains alpha-pinene, l-limonene, delta- carene, dipentene, l-bornyl acetate and l-cardinene as major constituents.

Dosage: Needles—2-6 g powder. (API Vol. IV.)... abies webbiana

A structure or process that is not normal (typical, usual or conforming to the standard); di?ering from the usual condition of the body.... abnormal

(Italian) Feminine form of Abraham; mother of a multitude; mother of nations

Abriana, Abreana, Abryana, Abryann, Abreanne, Abrielle, Abrienne, Abriell, Abriele... abrianna

(African) Woman who emanates light... abrihet

Placental bleeding after the 24th week of pregnancy, which may result in complete or partial detachment of the placenta from the wall of the womb. The woman may go into shock. The condition is sometimes associated with raised blood pressure and PRE-ECLAMPSIA. (See also PREGNANCY AND LABOUR.)... abruptio placenta

The probability of an event in a population as contrasted with relative risk. See “relative risk”.... absolute risk

A measure of treatment effect that compares the probability (or mean) of a type of outcome in the control group with that of a treatment group.... absolute risk reduction

Any agent which attracts and sucks up gases or secretions from a wound.... absorbent

Mistreatment or neglect of an older person(s) through the intentional or unintentional behaviour of another person(s). Abuse may be collectively perpetrated or politically motivated. This abuse may be physical, psychological, sexual, financial and/or systemic. One type of abuse is usually accompanied by other types. See also “neglect”.... abuse

(Hebrew / Arabic) Feminine form of Abraham; mother of a multitude; mother of nations / lesson; example Abri, Abrah, Abree, Abria, Abbra, Abrah, Abbrah... abra

Jacq.

Synonym: Ambroma augusta Linn. f.

Family: Sterculiaceae.

Habitat: Throughout the hotter and moister parts of India, from Punjab and Uttar Pradesh, eastwards to Arunachal Pradesh, Assam, Meghalaya and Tripura, ascending to 1,200 m, southwards in Peninsular India.

English: Perennial Indian Hemp, Devil's Cotton.

Ayurvedic: Pishaacha Kaarpaasa, Pivari.

Unani: Ulat-kambal.

Siddha/Tamil: Sivapputtuti.

Folk: Kumal, Sanukapaasi.

Action: Rootbark—emmena- gogue (used for dysmenorrhoea, amenorrhoea), abortifacient, galac- totrophic.

The root contains abromine (betaine), friedelin, abromasterol, abro- masterol A, choline, beta-sitosterol, stigmasterol and octacosanol. Leaves, reported to be useful in treating uterine disorders, contain taraxerol, its acetate and lupeol.

Dosage: Leaf juice—10-20 ml. Rootbarkpowder—3-6 g. (CCRAS.)... abroma augusta

Linn.

Family: Papilionaceae; Fabaceae.

Habitat: Throughout the country, ascending to an altitude of about 1,050 m in the outer Himalayas.

English: Indian Wild Liquorice, Jequirity, Crab's Eye, Precatory Bean.

Ayurvedic: Gunjaa, Gunjaka, Chirihintikaa, Raktikaa, Chirmi- ti, Kakanti, Kabjaka, Tiktikaa, Kaakananti, Kaakchinchi. (Not to be used as a substitute for liquorice.)

Unani: Ghunghchi, Ghamchi.

Siddha/Tamil: Kunri.

Folk: Chirmiti, Ratti.

Action: Uterine stimulant, abortifa- cient, toxic. Seeds—teratogenic. A paste of seeds is applied on vitiligo patches.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India has indicated the use of seeds in baldness.

Seeds contain abrin, a toxalbumin, indole derivatives, anthocyanins, ste- rols, terpenes. Abrin causes agglutination of erythrocytes, haemolysis and enlargement of lymph glands. A non- toxic dose of abrin (1.25 mcg/kg body weight), isolated from the seeds of red var., exhibited a noticeable increase in antibody-forming cells, bone marrow cellularity and alpha-esterase-positive bone marrow cells.

Oral administration of agglutinins, isolated from the seeds, is useful in the treatment of hepatitis and AIDS.

The seed extract exhibited antischis- tosomal activity in male hamsters.

The methanolic extract of seeds inhibited the motility of human spermatozoa.

The roots contain precol, abrol, gly- cyrrhizin (1.5%) and alkaloids—abra- sine and precasine. The roots also contain triterpenoids—abruslactone A, methyl abrusgenate and abrusgenic acid.

Alkaloids/bases present in the roots are also present in leaves and stems.

A. fruticulosus Wall. Ex Wight and Arn. synonym A. pulchellus Wall., A. laevigatus E. May. (Shveta Gunjaa) is also used for the same medicinal purposes as A. precatorius.

Dosage: Detoxified seed—1-3 g powder. Root powder—3-6 g. (API Vols. I, II.)... abrus precatorius

Abuta tea is a complex type of tea, used at first only by midwives to treat different childbirth issues. Now, it is widely-appreciated due to its therapeutic value. About Abuta Tea Abuta is a high-climbing vine, originating from South Africa and being widely known for its efficiency in treating women’s ailments. The plant has woody stems and extremely long roots. Its leaves are heart-shaped and have a waxy texture. The seeds are flat, the flowers grow in panicles, whereas its fruits are bright red, turning black when they are ripened. Practitioners of nowadays medicine have been acknowledged using derivatives of some of the constituents of abuta to block neuromuscular activity during surgery. Extracts of the same plant are included in pharmaceutical products for medical applications. Abuta tea gained its reputation as the brew used by midwives, especially in South America. It is thought to help fighting hemorrhage that may threaten a miscarriage. In Indian Ayurvedic medicine, Abuta tea is believed to have anti-fertility properties. Brewing Abuta Tea Abuta tea can be intaken in the form of capsules or tincture. It can be brewed in the following way:

• boil the dried roots of the plant ( 20 to 25 minutes)
• allow the mix to steep (5 minutes)
• drink it slowly

Abuta Tea benefits Abuta Teais successfully used to:

• fight kidney stones and bladder infections
• alleviate fever
• counter jaundice
• ease symptoms of arthritis and rheumatism
• fight gonorrhea
• treat anemia

Abuta tea is given to women to help ease childbirth. It is also efficient in alleviating the unpleasant menstrual problems. Abuta Tea side effects High doses ofAbuta teacombined with other medications, may lead to respiratory problems. It is not recommended to pregnant or breastfeeding women. Abuta tea is benefic to treat a large array of diseases, being also recommended as an excellent blood depurative.... abuta tea: healing effects

Grab.

Family: Mimosaceae.

Habitat: Bihar and South India. Ayurvedic: Aadaari (related sp.) Folk: Ari, Araara.

Action: See A. torta.... acacia canescens

Linn. Sweet.

Synonym: A. indicum G. Don.

Family: Malvaceae.

Habitat: Throughout the hotter parts of India. Found as a weed in the sub-Himalayan tract and other hills up to 1,200 m.

English: Country Mallow, Flowering Maples, Chinese Bell-flowers.

Ayurvedic: Atibalaa, Kankatikaa, Rishyaproktaa.

Unani: Kanghi, Musht-ul-Ghaul, Darkht-e-Shaan.

Siddha/Tamil: Thutthi.

Folk: Kanghi, Kakahi, Kakahiyaa.

Action: Dried, whole plant— febrifuge, anthelmintic, demulcent, diuretic, anti-inflammatory (in urinary and uterine discharges, piles, lumbago). Juice of the plant— emollient. Seeds—demulcent (used in cough, chronic cystitis), laxative. Leaves—cooked and eaten for bleeding piles. Flowers— antibacterial, anti-inflammatory. Bark—astringent, diuretic. Root— nervine tonic, given in paralysis; also prescribed in strangury.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of the root in gout, polyuria and haemorrhagic diseases.

The plant contains mucilage, tannins, asparagines, gallic acid and ses- quiterpenes. Presence of alkaloids, leucoanthocyanins, flavonoids, sterols, triterpenoids, saponins and cardiac glycosides is also reported.

Asparagine is diuretic. Gallic acid is analgesic. Mucilages act by reflex, loosen cough as well as bronchial tension. Essential oil—antibacterial, antifungal.

The drug exhibits immunological activity. It augments antibody in animals. EtOH (50%) extract of A. indicum ssp. guineense Borssum, synonym A. asiaticum (Linn.) Sweet, exhibits anticancer activity.

Related sp. include: Abutilon avicen- nae Gaertn., synonym A. theophrastii

Medic.; A. fruticosum Guill. et al.; A. hirtum (Lam.) Sweet, synonym A. graveolens Wt. and Arn.; A. muticum Sweet, synonym A. glaucum Sweet; and A. polyandrum Wight and Arn., synonym A. persicum (Burm. f.) Merrill (known as Naani-khapaat, Jhinaki- khapaat, Kanghi, Makhamali-khapaat and Khaajavani-khapaat, respectively, in folk medicine).

Dosage: Root—3-6 g powder. (API Vol I.)... abutilon indicum

Willd. var. indica Benth.

Synonym: A. nilotica (Linn.) Delile subsp. indica (Benth.) Brenan.

Family: Mimosaceae.

Habitat: Throughout the drier parts of India.

English: Babul, Black Babul, Indian Gum arabic tree.

Ayurvedic: Babbuula, Babbuuri, Baavari, Aabhaa, Shuulikaa, Shitaka, Kinkiraata, Yugmakantaka, Sukshmapatra, Pitapushpaka.

Unani: Aqaaqia, Babuul, Kikar, Mughilaan, Samur.

Siddha/Tamil: Karu-velamaram, Karuvelei. Velampisin (gum).

Action: Stembark—astringent, spasmolytic, hypoglycaemic. Gum—demulcent (soothing agent for inflammatory conditions of the respiratory, digestive and urinary tracts). Pods—used in urogenital disorders. Seeds—hypoglycaemic in normal rats; no such effect in diabetic rats. Seed oil—antifungal. Flowers, pods and gum resin—used in diarrhoea and dysentery.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of stembark in acute diarrhoea and helminthiasis.

Tannin contents of the bark varies considerably (12-20%). Several poly- phenolic compounds have been reported in the bark, also in the pods. The whole pod contains 12-19% tannins and 18-27% after the removal of seeds.

The seeds of A. benthamii, A. nilotica ssp. subulata, probably same as ssp. indica, are considered hypoglycaemic. Some seed components stimulate insulin secretion by beta cells.

The gum contains galactose; l-ara- binose, l-rhamnose and aldobiouronic acids, also arabinobioses.

The flowers contain flavonoids— kaempferol-3-glucoside, iso-quercitrin and leucocyanidin.

Dosage: Stembark—20-30 g for decoction. (API Vol. I.)... acacia arabica

Buch.-Ham.

Synonym: A. polycantha willd.

Family: Mimosaceae.

Habitat: West Bengal, Bihar, western peninsula.

Ayurvedic: Shveta Khadira, Kadara, Somavalkala.

Unani: Khor, Safed Khair.

Action: Cutch is prepared from the heartwood. See A. catechu.

Acacia ferruginea DC. is also equated with Shveta Khadira.... acacia suma

(Latin) From a community of higher learning

Akademia, Academiah, Akademiah... academia

(Canadian) From the land of plenty Acadiah, Acadya, Akadia, Akadiah, Akadya... acadia

The Crown-of-thorns starfish, known for the considerable damage that it may cause to coral reefs. It seems to occur in epidemics. The spines are venom-tipped, but usually the envenomation leads only to a painful spike wound which may sometimes get infected. Multiple spikes, either in one episode, or many individual stings rarely lead to systemic symptoms, but may lead to hypersensitivity.... acanthaster planci

(Linn. f.) Willd.

Family: Mimosaceae.

Habitat: Drier regions of India, particularly Punjab, Madhya Pradesh, Uttar Pradesh, Bihar, Andhra Pradesh, Orissa and Rajasthan.

English: Cutch tree, Catechu.

Ayurvedic: Khadira, Kadara, Somavalka, Gaayatri, Dantdhaavan, Kantaki, Raktasaara (heartwood extract).

Unani: Khair, Kaat, Katthaa (heartwood extract).

Siddha/Tamil: Karunkaali (bark), Kalippakku, Kadiram. Katthakkaambu, Kaasukkatti (heartwood extract).

Action: Cutch from wood— powerful astringent (in urinary and vaginal discharge), antidiarrhoeal, haemostatic; used for treating excessive mucous discharges, haemorrhages, relaxed conditions of gums, throat and mouth, stomatitis, irritable bowel; also used as an antileprotic drug.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of dried pieces of heartwood in inflammations, skin diseases and urinary disorders, recommends its use as a blood purifier, in diseases caused by lipid disorders.

Cutch (the concentrated extract) contains tannins 2-20%, catechin 2533%, phlobatannins including cate- chutannic acid 20-50%; flavonoids including quercetin, quercitrin, fisetin; gums, resins, pigments. The gum from A. catechu is a good substitute for Gum arabic.

Seed extract—hypoglycaemic to normal albino rats, but not effective in diabetic rats. The saline extract of seeds shows leuco-agglutinating activity against leukaemic cells. It agglutinates white cells from patients with different types of leukaemia. The activity is inhibited by simple sugars. Root extract shows antibacterial and fungi- cidal activity.

The heartwood contains a hepato- protective principle—cyanidanol.

Astringent and antibacterial properties of catechu result from its high tannin content.

Gambrine in pale catechu shows hy- potensive effects.

Fisetin in black catechu and (+)- catechin in black and pale catechu may protect against liver damage; (+)- catechin is also thought to protect against experimentally induced ulcers in animals; (+)-catechin (cianidanol) is associated with fatal anaemia. Methyl- catechin, one of the major metabolites of (+)-catechin, inhibits the binding of monocytes to vascular endothelial cells; thus, the catechin found in catechu may reduce atherosclerosis. (Natural Medicines Comprehensive Database, 2007.)

Dosage: Heartwood—20-30 g for decoction. (API Vol. I.)... acacia catechu

Willd.

Synonym: A. sundra DC.

Family: Mimosaceae.

Habitat: Rajasthan, Gujarat, Maharashtra, Tamil Nadu and Andhra Pradesh on dry and rocky soils.

English: Red Cutch.

Ayurvedic: Khadira (related sp.).

Siddha/Tamil: Katthakkaambu (heartwood extract).

Folk: Laal Khair.

Action: Uses similar to those of A. catechu heartwood extract.

The bark and leaves are used for ulcerated abscesses and toothache; wood for leucoderma.

EtOH (50%) extract—spermicidal and spasmolytic.... acacia chundra

(Willd.) DC.

Synonym: A sinuata (Lour.) Merrill; A. rugata (Lamk.) Ham.

Family: Mimosaceae.

Habitat: Tropical jungles throughout India, especially in the Deccan.

Ayurvedic: Saptalaa, Shitalaa, Saatalaa, Shrivalli, Kantvalli.

Unani: Shikaakaai, Kharunb Nabti.

Siddha/Tamil: Seekai, Sigakai.

Folk: Ban-Reethaa.

Action: Febrifuge, expectorant, emetic, spasmolytic, diuretic, antidiarrhoeal. Leaves—an infusion is given in malarial fever. Pods and seeds—decoction is used to remove dandruff (known as Shikaakaai), extensively used as a detergent. An ointment is used for skin diseases. Bark—extract is used in leprosy.

The bark yields a saponin which, on hydrolysis, yields lupeol, alpha- spinasterol and acacic acid lactone. Pods also yield saponins (20.8%). Sugars identified are glucose, arabinose and rhamnose.

The leaves contain alkaloids, nicotine and colycotomine, a triterpenoid saponin and oxalic, tartaric, citric, suc- cinic and ascorbic acids.

The bark saponins are spermicidal, also haemolytic and spasmolytic. A decoction of pods relieves biliousness and acts as a purgative.

The ethanolic extract of unripe pods yields a glycosidal fraction (0.28%) which exhibits anti-inflammatory activity. It also shows significant antibacterial activity.

The plant acts as an antiseptic agent for curing sores, gums and loose teeth.

The flowers are the source of Cassie perfume.

The main constituents of the flowers are benzyl, anisic, decylic and cuminic aldehydes, as well as traces of geraniol, farnesol and linalool.... acacia concinna

(Latin) Woman from western Greece... acarnania

(Latin) In mythology, the foster mother of Romulus and Remus Accaliah, Acalia, Accalya, Acalya, Acca, Ackaliah, Ackalia... accalia

A risk that has minimal detrimental effects or for which the benefits outweigh the potential hazards.... acceptable risk

The ability of an individual or a defined population to obtain or receive appropriate health care. This involves the availability of programmes, services, facilities and records. Access can be influenced by such factors as finances (insufficient monetary resources); geography (distance to providers); education (lack of knowledge of services available); appropriateness and acceptability of service to individuals and the population; and sociological factors (discrimination, language or cultural barriers).... access

Willd.

Synonym: A. alba Willd.

Family: Mimosaceae.

Habitat: Native to West Indies; now occurring throughout India.

English: Cassie Flower, Cassie Absolute, Sweet Acacia.

Ayurvedic: Arimeda, Vitkhadira.

Unani: Vilaayati Kikar, Gandbabuul, Guyaa Babuul, Durgandh Khair.

Siddha/Tamil: Kastuurivel, Vedday- ala.

Action: Bark—astringent, demulcent, anthelmintic, antidysenteric, anti-inflammatory (used in stomatitis, ulcers, swollen gums, dental caries, bronchitis, skin diseases).

Ripe pods contain tannins and several polyphenolic compounds. Essential oil from pods—direct muscle relaxant, cardiac depressant and sedative.

Various plant parts are used in insanity, epilepsy, delirium and convulsions.

Family: Mimosaceae.

Habitat: Dry regions of the country, especially in Punjab, Rajasthan and Madhya Pradesh.

English: White Babul.

Ayurvedic: Arimeda, Arimedaka, Arimanja, Irimeda, Vitakhadir, Godhaa-skandha, Raamaka.

Unani: Kath Safed, Vilaayati Babuul, Guyaa Babuul.

Siddha/Tamil: Valval, Velvayalam.

Folk: Safed Babuul, Safed Kikar, Renvaa.

Action: Bark—bitter, demulcent and cooling; used in biliousness and bronchitis. Seeds—haemaggluti- nating activity has been reported. Leaves—antisyphilitic and antibacterial. Gum—demulcent.

EtOH (50%) extract of aerial parts— hypotensive and central nervous system depressant.

The rootbark contains leucophleol, leucophleoxol and leucoxol.... acacia leucophloea

(L.) willd.

Family: Mimosaceae.

Habitat: Throughout India; ascending to 1,700 m in the Himalayas.

Ayurvedic: Lataakhadira, Aadaari, Ari.

Siddha/Tamil: Indan, Indu. Iyak Koluntu (tender leaves).

Folk: Aila.

Action: Bark—antibilious, antiasth- matic. Leaf—stomachic, styptic (for bleeding gum), antiseptic (for scalding of urine). A decoction of young leaves is taken for body pain, headache and fever.

The bark contains tannin 9%, lupe-ol and alpha-spinasterol. Stem yields sitosterol.... acacia pennata

Willd.

Synonym: A. verek Guillem and Perr.

Family: Mimosaceae.

Habitat: Native to Sudan. Cultivated in dry parts of western India.

English: Gum arabic tree.

Ayurvedic: Shveta Babbuula.

Action: The tree yields the true Gum arabic of commerce. Mucilaginous, demulcent, emulsifying agent. Used as an ingredient in compounds for treatment of diarrhoea, catarrh.

Bechic, antihaemorrhagic, antiinflammatory. Stembark—antiinflammatory, spasmolytic. Root— used for dysentery and urinary discharges.

The gum consists mainly of arabin. It is the salt of an organic acid, arabic acid, with metals such as calcium, magnesium and potassium.

The stembark gives octacosanol, beta-amyrin, uvaol, beta-stosterol and its glucoside and erthrodiol. An alkaloid, dimethyltryptamine has been isolated from the leaves.... acacia senegal

(Roxb.) Craib.

Synonym: A. intsia willd.

A. caesia Wright and Arn. non-Willd.

Family: Mimosaceae.

Habitat: Throughout India in the dry and intermediate zones; ascending to an altitude of about 1,200 m in the Himalayas.

Ayurvedic: Aadaari, Lataa Khadira (related sp., see. A. pennata).

Siddha/Tamil: Kariyundu, Ingu.

Folk: Araar, Chilar (Punjab), Aila (Maharashtra).

Action: Flower—emmenagogue. Bark—anti-inflammatory, antiseptic (in skin diseases). Bark contains 17% tannins, triterpene alcohol, saponins of acacic acid, lupeol and a steroid, acaciol. An alkaloid, tryptamine, is present in the root and stem bark.

Various plant parts are used in cough, bronchitis, measles, tubercular fistula and in the treatment of menstrual disorders. The bark is used for washing the hair.... acacia torta

Removal of the barriers to entering and receiving services or working within any health care setting.... accessibility

A process whereby a programme of study or an institution is recognized by an external body as meeting certain predetermined standards. Accreditation is often carried out by organizations created for the purpose of assuring the public of the quality of the accredited institution or programme. The state or federal governments can recognize accreditation in lieu of, or as the basis for licensure or other mandatory approvals. Public or private payment programmes often require accreditation as a condition of payment for covered services. Accreditation may either be permanent or may be given for a specified period of time. See also “licence”.... accreditation

A standard against which facilities or programmes are evaluated to determine if they will be accredited.... accreditation standard

Acai tea is an energetic tea, which joins the benefits of several types of healthy tea with the refreshing taste of acai berries, widely known for their efficiency in weight loss diets. Acai Tea description The acai palm tree and its berries are originating from Central and South America areas. This tree grows fast and is mainly cultivated for its fruits and for the hearts of palm. The berry is pulpy and has a hard endocarp containing a large seed. The acai berry is harvested as food. The fruit is consumed in various juice blends, smoothies, sodas, liqueur or ice cream. The taste of the acai fruit is described as a mixture between red wine, berries and chocolate. The acai berries usually begin to spoil within 24 hours after being harvested, therefore, they must be quickly turned into juice, wine, or freeze dried in order to preserve their health benefits. Acai tea is usually created by mixing freeze dried acai powder or acai juice with different types of tea, such as green tea, black tea, rooibos tea and many herbal infusions. Consequently, Acai tea gathers the health benefits of the  fruits and the ones of the individual tea, that was used as base. How to prepare Acai Tea Acai Tea could be prepared hot or cold, according to each consumer taste. PreparingAcai tea hot:

• Use 1.5 tablespoons of tea per 6 ounces of water
• Heat water to 175 °F
• Steep it for 3-4 minutes ( If stronger flavor is desired, increase the amount of tea used)

Preparing Acai tea iced:

• Use 3 tablespoons of tea per 6 ounces of water
• Heat water to 175 °F (just below boiling)
• Steep it for 3-4 minutes
• After steeping, pour brewed tea over an equal amount of ice

Acai Tea benefits Acai tea has been successfully used to: o    promote cardiovascular functions o    improve digestive functions o    strengthen the immune system o    boost energy levels o    enhance power levels o    normalize cholesterol levels o    lose weight o    fight cancer Acai Tea side effects It is indicated that individuals suffering from cardiac problems or hypertension consume Acai tea in small quantities. It isn’t recommended to consume Acai tea in big quantities, especially in case of pregnancy. Acai tea is a good choice for worldwide consumers to gain energy and vitality for the entire day. It has been effectively used to treat various types of diseases and is an important ingredient in the pharmaceutical industry.... acai tea

Forsk

Family: Euphorbiaceae.

Habitat: Common in plains, as a weed in gardens; also in wastelands, especially in Bangalore and Pachmarhi.

Ayurvedic: Kuppi (smaller var.).

Folk: Daadari (Gujarat).

Action: See A. indica.

Folk: Chinnivara.

Action: Leaves—stomachic, alterative; prescribed in digestive disorders, dyspepsia, colic, diarrhoea.... acalypha ciliata

Forsk.

Family: Euphorbiaceae.

Habitat: Orissa, Tamil Nadu, Karnataka and Kerala.

English: Birch-leaved Acalypha.

Siddha/Tamil: Kuppaimeni.

Acanthospermum hispidum DC.

Family: Compositae; Asteraceae.

Habitat: Native to Brazil; found as a weed throughout the greater part of India.

Ayurvedic: Trikantaka. (Different from Gokshura; also equated with Martynia diandra, Martineacea, known as Kaakanaasaa.)

Action: Used in dermatological affections.

The essential oil (yield 0.2%) showed antibacterial and antifungal activity.... acalypha fruticosa

Linn.

Family: Euphorbiaceae.

Habitat: Occurs throughout the plains of India, ascending the hills in Orissa up to 210 m.

English: Indian Acalypha.

Ayurvedic: Kuppi, Muktavarchaa, Haritamanjari

Siddha/Tamil: Kuppaimeni.

Folk: Khokli, Kuppi, Aamaabhaaji.

Action: Antibacterial (leaf used in scabies). Plant—emetic, expectorant (used in bronchitis, asthma, pneumonia). Tincture of fresh plant is used in homoeopathy for incipient phthisis with bloody expectorations, emaciation and arterial haemorrhage.

The plant contains kaempferol; leaves and twigs contain acalyphamide and other amides, quinone, sterols, cyanogenic glycoside.

The herb causes intestinal irritation.... acalypha indica

Addition to an object of the substance of which it is comprised. An example is the growth of crystals in a ?uid, or overgrowth of bone after injury. The term also describes foreign material collecting on the surface of a body structure: for example, PLAQUE on teeth.... accretion

The degree to which a measurement (e.g. the mean estimate of a treatment effect) is true or correct. An estimate can be accurate, yet not be precise, if it is based upon an unbiased method that provides observations having great variation (i.e. not close in magnitude to each other).... accuracy

Means “oil of (plant or animal name)”; look up the plant or animal name specified for more information. The most common plant-based oils used for medicine include: coconut (coco), castor bean plant (higuereta), sesame (ajonjolí), olive (aceituna) and avocado (aguacate) oils. For certain illnesses (particularly asthma), these oils are taken by the spoonful, sometimes in combination with oils from animal sources such as snake (culebra), turtle (tortuga), shark (tiburón) and cod fish (bacalao). These animal-based oils are reportedly used by some individuals in an asthma remedy called botella de aceites which is typically given to children.... aceite de

Linn.

Family: Acanthaceae.

Habitat: Common in tidal forests along the East and West coasts; also distributed in Meghalaya and the Andamans.

English: Sea Holly.

Ayurvedic: Krishna Saraiyaka. (Blue-flowered Katasaraiyaa.)

Siddha/Tamil: Kollimulli.

Folk: Hargozaa.

Action: Decoction—antacid (used in dyspepsia with acid eructations), also diuretic (used in dropsy and bilious swellings). Aerial parts show effect on nictitating membrane. The root is a cordial attenuant and is used in debility associated with asthma, paralysis, leucorrhoea.

The air-dried plant contains an alkaloid, acanthicifoline, and a flavone.... acanthus ilicifolius

Accident and Emergency Medicine is the specialty responsible for assessing the immediate needs of acutely ill and injured people. Urgent treatment is provided where necessary; if required, the patient’s admission to an appropriate hospital bed is organised. Every part of the UK has nominated key hospitals with the appropriately trained sta? and necessary facilities to deal with acutely ill or injured patients. It is well-recognised that prompt treatment in the ?rst hour or so after an accident or after the onset of an acute illness – the so-called ‘golden hour’ – can make the di?erence between the patient’s recovery and serious disability or death.

A&E Medicine is a relatively new specialty in the UK and there are still inadequate numbers of consultants and trainees, despite an inexorable rise in the number of patients attending A&E departments. With a similar rise in hospital admissions there is often no bed available immediately for casualties, resulting in backlogs of patients waiting for treatment. A major debate in the specialty is about the likely need to centralise services by downgrading or closing smaller units, in order to make the most e?cient use of sta?.

See www.baem.org.uk... accident and emergency medicine

(French) Born into nobility; highborn woman Acelin, Asceline, Ascelin... aceline

See ASPIRIN.... acetylsalicyclic acid

(Navajo) One who is the protector... achaana

A condition in which there is a failure to relax of the muscle ?bres around the opening of the gullet, or oesophagus, into the stomach. (See OESOPHAGUS, DISEASES OF.)... achalasia of the cardia

(Celtic) In mythology, a loving sister who died of grief when her brother died Achalle, Achal, Achale... achall

A dry, one-seeded fruit, without a predictable opening and formed from a single carpel. It usually one of many, like an unshelled Sunflower seed.... achene

Linn.

Synonym: A. lanulosa Nutt.

Family: Compositae; Asteraceae.

Habitat: The western Himalayas from Kashmir to Kumaon.

English: Milfoil, Yarrow, Thousand Leaf.

Unani: Biranjaasif. National Formulary of Unani Medicine also equates Leonurus cardica Linn. (Labiatae) with Biranjaasif.

Folk: Gandana, Rojmari.

Action: Anti-inflammatory, anti- spasmodic (used in cold, flatulent colic, heartburn), emmenagogue, cicatrizant, antidysenteric, anti- haemorrhagic, antipyretic, diaphoretic, diuretic, urinary antiseptic.

Key application: In dyspeptic ailments, such as mild, spastic discomforts of the gastrointestinal tract. As astringent, antispasmodic, choleretic, antibacterial. (German Commission E.) As diaphoretic. (The British Herbal Pharmacopoeia.) Internally for feverish conditions, common cold and digestive complaints; topically for slow-healing wounds and skin inflammations. (The British Herbal Compendium.)

The plant contains flavonoids, alkaloids (achilleine), polyacetylenes, triterpenes, coumarins, tannins, salicylic acid, a volatile oil containing linalool, camphor, sabinene, chamazu- lene and other azulenes.

Sesquiterpene lactones are bitter and tonic. Achilleine helps arrest internal and external bleeding. Flavonoids contribute to the antispasmodic action.

The flavonoid apigenin is anti-inflammatory, antiplatelet and spasmolytic. Alkaloids and bases are anti- inflammatory. Alkaloid betoncine is haemostatic. Salicylic acid is anti- inflammatory. Chamazulene is anti- inflammatory and antiallergenic. (Natural Medicines Comprehensive Database, 2007.)

An extract of the plant was found to be rich in luteolin or luteolin 7- glucoside and can be used for the treatment of hyperpigmentation of skin.... achillea millefolium

See Bija.... achiote

(Greek) In mythology, the personification of sadness and misery... achlys

Loss of colour – for example, DEPIGMENTATION of the SKIN or of the iris of the EYE.... achromia

(Hebrew) Bracelet for the ankle Achsa... achsah

Linn.

Synonym: Manilkara zapota (Linn.) P. van Royan Manilkara achras (Mill.) Fosberg Sapota achras Mill.

Family: Sapotaceae.

Habitat: Native to Central America. Cultivated chiefly in Maharashtra, Tamil Nadu and West Bengal.

English: Sapota, Sapodilla Plum, Chicle.

Unani: Sapotaa, Cheeku.

Siddha/Tamil: Shimai eluppai.

Action: Fruit—antibilious. Seed— diuretic. Fruit and bark—febrifuge.

The bark contains latex (20-25% of which consists of gutta-percha-like substance); also contains tannin (11.8%). The seeds contain quercitol.

Chewing gum consists of approximately 20% chicle, plus sugar, corn syrup and flavourings.... achras zapota

Linn.

Family: Amaranthaceae.

Habitat: Throughout the tropical and subtropical regions, up to an altitude of 2,100 m, in the southern Andaman Islands.

English: Prickly Chaff Flower.

Ayurvedic: Apaamaarga, Chirchitaa, Shikhari, Shaikharika, Adahshalya, Mayura, Mayuraka, Kharamanjari, Kharapushpaa, Pratyakpushpaa, Aaghaat, Vashira, Kanihi.

Unani: Chirchitaa.

Siddha/Tamil: Naayuruvi.

Folk: Chirchitta, Chichidaa, Latjeeraa.

Action: Astringent, pectoral (ashes of the plant used in asthma and cough), diuretic, hepatoprotective, emmenagogue. Benzene extract of the plant exhibited abortifacient activity. The flowers, ground and mixed with sugar, are given for menorrhagia. Roots—astringent, haemostatic. Seeds—emetic; used for biliousness. Essential oil— antifungal.

Key application: As astringent, emetic. (Indian Herbal Pharmacopoeia.)

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of the whole plant in lipid disorders and obesity, the root for its blood-purifying property.

The plant juice and ash are used for treating bleeding piles. An alkaline powder of the plant is used in preparing Kshaarasutra of Ayurvedic medicine, which is recommended for treating fistula-in-ano.

The whole plant contains the alkaloids achyranthine and betaine. Achy- ranthine, a water-soluble alkaloid, is reported to dilate blood vessels, lower blood pressure, decrease heart rate and increase the rate and amplitude of respiration. It also shows spasmodic effects on the rectus muscle of frog, diuretic and purgative action in albino rats.

The presence of ecdysterone and oleanolic acid is also reported in the root.

The ashes of the plant yield large quantities of potash. The seeds yield saponins and oleanolic acid and its ester.

The presence of tannins and glyco- sides is also reported in the plant.

Dosage: Whole plant—20-30 g for decoction. Root—5-10 g. (API Vols. II, III.) Ash—500 mg to 2 g. (CCRAS.)... achyranthes aspera

Blume

Family: Amaranthaceae.

Habitat: The temperate and subtropical Himalayas from Kishtwar to Sikkim at 1,200-3,200 m, Khasi hills.

Ayurvedic: Shveta Apaamaarga. (Rakta Apaamaarga is equated with Achyranthes rubra-fusca Hook. f. and A. verschaffeltii Lam., synonym Iresine herbstii Hook. f.)

Siddha/Tamil: Naayurivi.

Action: Astringent, diuretic, spasmolytic. Plant is given in whooping cough, roots in hemicrania.

A water-soluble oligosaccharide, composed of six glucose units and three mannose units, has been isolated from the roots. It enhanced immune response and prolonged survival time of mice bearing Ehrlich carcinoma.

The roots contain free oleanolic acid (0.096%) and its saponins (1.93%). An alcoholic extract of the root showed presence of amino acids, steroids, tri- terpenoids, alkaloids and coumarins. The seeds afforded achyranthin.

Extract of the plant—antimicrobial.... achyranthes bidentata

Excretion of an acid URINE.... aciduria

(Hebrew) Feminine form of Acim; God will judge Acimah, Achima, Achimah... acima

(Bruhl) Stapf.

Family: Ranunculaceae.

Habitat: The sub-alpine and alpine Himalayas of Sikkim between altitudes of 3,330 m and 4,200 m.

Ayurvedic: Vatsanaabha (related sp.).

Folk: Kaalo Bikhmo.

Action: Poisonous. (Found mixed with the roots of A.ferox and A. spicatum of commerce.)... aconitum laciniatum

Hook. f. and Thoms.

Family: Ranunculaceae.

Habitat: The Himalayas from eastern Nepal to Chumbi at altitudes of 3,600 to 4,200 m.

Ayurvedic: Vatsanaabha (related sp.).

Action: As potent as Aconitum ferox.... aconitum luridum

(Bruchl) Mukherjee.

Synonym: Aconitum balfourii Stapf.

Family: Ranunculaceae.

Habitat: The sub-alpine and alpine Himalayas between 3,300 and 3,900 m.

Ayurvedic: Vatsanaabha (related sp.).

Folk: Banwaa.

Action: Poisonous, highly toxic.

Air-dried roots contain 1.2% total alkaloids of which pseudoaconitine is 0.4%. Pseudoaconitine is biologically 1.5 times as active as aconitine. (A. atrox is a poisonous species and is one of the common constituents of Aconi- tumferox of commerce.)... aconitum atrox

Stapf ex Holmes.

Family: Ranunculaceae.

Habitat: The western Himalayas from Hazara to Kashmir and Chamba in Himachal Pradesh, between altitudes of 2,100 m and 3,600 m.

English: Indian Napellus.

Ayurvedic: Visha, Shringika-Visha, Vatsanaabha (related sp.).

Folk: Mohri, Meethaa Zahar.

Action: Sedative, antirheumatic, analgesic, antitussive, antidiar- rhoeal. Ayurvedic Formulary of India, Part I and Part II, equated A. chasmanthum with Vatsanaabha. (See A.ferox.) It has the same uses as A. ferox. The alkaloid content of the root ranges from 2.98 to 3.11%; includes chasmaconitine and chasmanthinine.

Napellus, equated with Aconitum napellus Linn., is indigenous to Central Europe (named after the Black sea port Aconis and known as Wolfsbane, Monkshood). Aconitum of homoeopathic medicine is an alkaloid obtained from the roots and stems of A. nepellus. Used as an analgesic and sedative. It contains terpenoids up to 1.2%, including aconitine and aconine.

Toxic constituents of A. napellus are aconitine, mesaconitine, hypaconi- tine, 3-acetylacoitine, lappaconitine (diterpenoid-ester alkaloids), benza- conine, benzoylaconine.

Aconitine, mesaconitine and hyp- aconitine exert widespread effects on cardiac, neural and muscle tissue by activitating sodium channels. (Natural Medicines Comprehensive Database, 2007.)

Aconitine is absorbed through mucus membranes and the skin. (Francis Brinker.) It is a cardiotoxin and interacts with antiarrhythmics, antihypertensives, Digoxin/cardiac glycosides. (Sharon M. Herr.)

Dosage: Root—10-15 mg powder. (CCRAS.)... aconitum chasmanthum

Stapf.

Family: Ranunculaceae.

Habitat: Alpine regions of Chat- tadhar and Bhalesh ranges of Bhadarwah district in Jammu and Kashmir.

Ayurvedic: Vatsanaabha (related sp.).

Folk: Bashahr-Mohra, Dudhiyaa Bish, Safed Bikh.

Action: Roots and leaves are used in rheumatism, rheumatic fever and acute headache.

The roots contain 0.9% total alkaloids, of which 0.51% is pseudoaconi- tine.... aconitum deinorrhizum

Stapf.

Family: Ranunculaceae.

Habitat: The sub-alpine and alpine zones of the Garhwal Himalayas.

Ayurvedic: Vatsanaabha (related sp.).

Folk: Bikh, Bis, Meethaa Telia.

Action: Sedative, carminative, anti-inflammatory (used for the treatment of nervous system, digestive system; rheumatism, fever).

The root alkaloids contain bishati- sine, bishaconitine, falconitine and mithaconitine. Treatment with cow's milk reduces cardiotoxic effect of the root. cardiac depression. Topically, aconi- tine has analgesic, anti-inflammatory and anaesthetic activity.... aconitum falconeri

D. Don.

Synonym: A. bisma (Buch.-Ham.) Rapaics.... aconitum palmatum

Stapf.

Family: Ranunculaceae.

Habitat: The alpine zone of the Himalayas of Sikkim and Chumbi. Principal source of Bikh or Bish of Kolkata market. English: Nepal Aconite. Ayurvedic: Vatsanaabha (related sp.).

Action: Antipyretic, analgesic.

The roots yield 1.75% of alkaloids which contain mainly pseudoaconitine and bikhaconitine.... aconitum spicatum

Soland. ex Ait.

Family: Araceae.

Habitat: Native to Japan, occasionally met within Sikkim at an altitude of 1,800 m, in Khasi Hills up to 1,500 m.

Ayurvedic: Haimavati (white var. of Vachaa).

Action: Antispasmodic (used in abdominal colic). See A. calamus.... acorus gramineus

Wall. ex Royle.

Family: Ranunculaceae.

Family: Ranunculaceae.

Habitat: The alpine Himalayas from Sikkim to Garhwal and Assam.

English: Indian Aconite, Wolfsbane, Monkshood.

Ayurvedic: Vatsanaabha, Visha, Amrita, Vajraanga, Sthaavaravisha, Vatsanaagaka, Shrangikavisha, Garala.

Unani: Bish, Bishnaag.

Siddha/Tamil: Vasanaavi, Karunaab- hi.

Folk: Bacchanaag, Bish, Mithaa Zahar, Telia Visha.

Action: Narcotic, sedative, antilepro- tic, anti-inflammatory. Extremely poisonous. (Roots possess depressant activity, but after mitigation in cow's milk for 2-3 days, they exhibit stimulant activity.)

Key application: In neuralgia. (Aconitum napellus L. has been listed by German Commission E among unapproved herbs.)

The root contains diterpenoid alkaloids, which act as a powerful poison that affects the heart and central nervous system. Aconitine has a shortlived cardiotonic action followed by

Habitat: Cultivated at Manali and Rahla in Himachal Pradesh. Also found in northwestern Himalayas at altitudes ranging from 2,000 to 4,000 m.

English: Atis Root, Aconite.

Ayurvedic: Ativishaa, Arunaa, Vishaa, Shuklakandaa, Bhanguraa, Ghunapriyaa, Ghunavallabhaa, Kaashmiraa, Shishubhaishajyaa (indicating its use in paediatrics), Vishwaa.

Unani: Atees.

Siddha/Tamil: Athividayam.

Folk: Patis.

Action: Often regarded as non- poisosnous, antiperiodic, anti- inflammatory, astringent (used in cough, diarrhoea, dyspepsia), tonic (used after fevers), febrifuge, antispasmodic (used in irritability of stomach and abdominal pains).

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of the dried, tuberous root in emesis and helminthi- asis.

The roots yield 0.79% of total alkaloids, of which atisin is 0.4%. Atisine is much less toxic than aconitine and pseudoaconitine. (The inert character of the plant is well known to the hill people, who often use it as a vegetable.) The plant possesses potent immuno- stimulant properties.

Dosage: Root—0.6-2.08 g. (API Vol. I.)... aconitum heterophyllum

A severe manifestation of infection with the Human immunodeficiency virus (HIV).... acquired immune deficiency syndrome (aids)

(Greek) One who overindulges Acrasiah, Akrasia, Acrasy, Acrasey, Acrasi, Acrasie, Acrasee, Acrasea, Acraseah, Acrasye... acrasia

An aniline derivative, this is an orange-red crystalline powder, readily soluble in water, with strong antiseptic powers.... acriflavine

ACTH is the commonly used abbreviation for CORTICOTROPIN.... acth (adrenocorticotrophic hormone)

See ASH.... action on smoking and health

A family of research methodologies which pursue action (or change) and research (or understanding) at the same time.... action research

Linn.

Synonym: A. acuminata Wall. ex Royle

Family: Ranunculaceae.

Habitat: Native to Europe; grows in temperate Himalayas from Hazara to Bhutan.

English: Baneberry Grapewort.

Folk: Visha-phale (Kannada).

Action: Root—antirheumatic, anti-inflammatory, nerve sedative, emetic, purgative; used in the treatment of rheumatic fever, lumbago, scrofula, nervous disorders, chorea.

The plant is reported to contain trans-aconitic acid, which shows a strong cytostatic action. Its Me ether is active against Ehrlich's ascites tumours.

In folk medicine, roots are used in cases of ovarian neuralgia, uterine tenderness and sub-involution. They are adulterant of the roots of Helleborus niger. Berries are poisonous; used topically for skin diseases. The toxic constituent is protoanemonin (lactone). It is irritant to mucous membrane.... actaea spicata

Kuhn.

Synonym: A. australis (L. f.) Link. A. radiata (Sw.) Link. A. dichotoma Kuhn.

Family: Adiantaceae.

Habitat: Throughout India, especially common in Kumaon Hills and the Nilgiris, below an altitude of 1,200 m.

English: Peacocks tail.

Ayurvedic: Mayurshikhaa, Madhu- chhadaa, Sahastrahi, Vahrishikhaa.

Action: Styptic, antibacterial, antipyretic.

The stems and leaves contain rutin, a styptic active principle. Anthelmintic activity, attributed to the fern, was not observed in experiments on mice.

Dosage: Root—3-5 g powder. (CCRAS.)... actiniopteris dichotoma

Meissn.

Synonym: A. angustifolia Nees.

Family: Lauraceae.

Habitat: The western Ghats, Orissa and Sikkim up to 1,500 m.

Siddha/Tamil: Thali, Paratathali.

Folk: Pisaa (Maharashtra).

Action: Infusion of leaves—urinary tract disinfectant, antidiabetic, spasmolytic.

The leaves contain a very small amount of an amorphous alkaloid. They also contain beta-sitosterol, hen- triacontanone, hentriacontanol and quercetin-3-rhamnoside and hydrocarbons.

The bark gives an alkaloid, actino- daphnine.

The roots contain a flavanone glycoside.... actinodaphne hookeri

The process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.... active ageing

A concept of functioning – activities of daily living are basic activities that are necessary to independent living, including eating, bathing and toileting. This concept has several assessment tools to determine an individual’s ability to perform the activity with or without assistance. See related “instrumental activities of daily living (IADL)”.... activities of daily living (adl)

A trained staff member who is responsible for leisure activities in a health care programme. Activity coordinators develop programmes for people based on individual abilities and interests.... activity coordinator

Care that is generally provided for a short period of time to treat a new illness or a flare-up of an existing condition. This type of care may include treatment at home, short-term hospital stays, professional care, surgery, X-rays and scans, as well as emergency medical services.... acute care / acute health care

A disease which is characterized by a single or repeated episode of relatively rapid onset and short duration from which the patient usually returns to his/her normal or previous state or level of activity. An acute episode of a chronic disease (for example, an episode of diabetic coma in a patient with diabetes) is often treated as an acute disease.... acute disease / illness

See ALTE.... acute life-threatening event (alte)

Formerly known as adult respiratory distress syndrome. A form of acute respiratory failure in which a variety of di?erent disorders give rise to lung injury by what is thought to be a common pathway. The condition has a high mortality rate (about 70 per cent); it is a complex clinical problem in which a disproportionate immunological response plays a major role. (See IMMUNITY.)

The exact trigger is unknown, but it is thought that, whatever the stimulus, chemical mediators produced by cells of the immune system or elsewhere in the body spread and sustain an in?ammatory reaction. Cascade mechanisms with multiple interactions are provoked. CYTOTOXIC substances (which damage or kill cells) such as oxygen-free radicals and PROTEASE damage the alveolar capillary membranes (see ALVEOLUS). Once this happens, protein-rich ?uid leaks into the alveoli and interstitial spaces. SURFACTANT is also lost. This impairs the exchange of oxygen and carbon dioxide in the lungs and gives rise to the clinical and pathological picture of acute respiratory failure.

The typical patient with ARDS has rapidly worsening hypoxaemia (lack of oxygen in the blood), often requiring mechanical ventilation. There are all the signs of respiratory failure (see TACHYPNOEA; TACHYCARDIA; CYANOSIS), although the chest may be clear apart from a few crackles. Radiographs show bilateral, patchy, peripheral shadowing. Blood gases will show a low PaO2 (concentration of oxygen in arterial blood) and usually a high PaCO2 (concentration of carbon dioxide in arterial blood). The lungs are ‘sti?’ – they are less e?ective because of the loss of surfactant and the PULMONARY OEDEMA.

Causes The causes of ARDS may be broadly divided into the following:... acute respiratory distress syndrome (ards)

Absence of the digits.... adactyly

(Hebrew) Ornament; beautiful addition to the family Adda, Adaya, Ada... adah

(Scottish) From the oak-tree ford Adaire, Adaira, Adairia, Athdara, Athdare, Athdaria, Athdair, Athdaire, Athdairia, Athdaira... adair

(Italian / German) One who is noble / a highly valued promise Adalgise, Adelgise, Adelvice, Adalgysa, Adalgyse... adalgisa

(German) A noble she-wolf... adalwolfa

Love, Happiness... adam & eve roots

(African) A beautiful child; regal and majestic

Adamah, Adamma, Adammah... adama

(Hebrew) Feminine form of Adam; of the earth

Adamia, Adamiah, Adaminah, Adamynah, Adameena, Adamine, Adaminna, Addie, Adameenah, Adamiena, Adamienah, Adameina, Adameinah, Adameana, Adameanah... adamina

(African) Her father’s daughter; a father’s pride

Adana, Adanah, Adannah, Adanya, Adanyah... adanna

(African) Her mother’s daughter; a mother’s pride

Adane, Adayne, Adaine, Adayn, Adain, Adaen, Adaene... adanne

(Ibo) A good woman... adaoma

Permanent fixtures or alterations to a home to help someone get about or manage better (distinguished from ‘aids’ or ‘equipment’, which are more portable).... adaptation (of residence)

Housing that has been specially built for, or changed to a certain standard to accommodate people with disabilities.... adapted living facility / housing

(Greek / Arabic) Beautiful girl / chaste one; virgin

Adair, Adare, Adaire, Adayre, Adarah, Adarra, Adaora, Adar, Adra, Athdara... adara

A group of snakes with a wide geographical distribution. Belong to the family Elapidae. Also known as vipers.... adder

Healing ... adders tongue

(Welsh) Woman of beauty Addien, Addienne, Adiena, Adiene, Adien, Adienna, Addienna... addiena

(Hebrew) One who is adorned; voluptuous

Addine, Addyn, Addyne... addin

(English) Daughter of Adam Addeson, Addyson, Adison, Adisson, Adyson... addison

The cause of Addison’s disease (also called chronic adrenal insu?ciency and hypocortisolism) is a de?ciency of the adrenocortical hormones CORTISOL, ALDOSTERONE and androgens (see ANDROGEN) due to destruction of the adrenal cortex (see ADRENAL GLANDS). It occurs in about 1 in 25,000 of the population. In the past, destruction of the adrenal cortex was due to TUBERCULOSIS (TB), but nowadays fewer than 20 per cent of patients have TB while 70 per cent suffer from autoimmune damage. Rare causes of Addison’s disease include metastases (see METASTASIS) from CARCINOMA, usually of the bronchus; granulomata (see GRANULOMA); and HAEMOCHROMATOSIS. It can also occur as a result of surgery for cancer of the PITUITARY GLAND destroying the cells which produce ACTH (ADRENOCORTICOTROPHIC HORMONE)

– the hormone which provokes the adrenal cortex into action.

Symptoms The clinical symptoms appear slowly and depend upon the severity of the underlying disease process. The patient usually complains of appetite and weight loss, nausea, weakness and fatigue. The skin becomes pigmented due to the increased production of ACTH. Faintness, especially on standing, is due to postural HYPOTENSION secondary to aldosterone de?ciency. Women lose their axillary hair and both sexes are liable to develop mental symptoms such as DEPRESSION. Acute episodes – Addisonian crises – may occur, brought on by infection, injury or other stressful events; they are caused by a fall in aldosterone levels, leading to abnormal loss of sodium and water via the kidneys, dehydration, low blood pressure and confusion. Patients may develop increased tanning of the skin from extra pigmentation, with black or blue discoloration of the skin, lips, mouth, rectum and vagina occurring. ANOREXIA, nausea and vomiting are common and the sufferer may feel cold.

Diagnosis This depends on demonstrating impaired serum levels of cortisol and inability of these levels to rise after an injection of ACTH.

Treatment consists in replacement of the de?cient hormones. HYDROCORTISONE tablets are commonly used; some patients also require the salt-retaining hormone, ?udrocortisone. Treatment enables them to lead a completely normal life and to enjoy a normal life expectancy. Before surgery, or if the patient is pregnant and unable to take tablets, injectable hydrocortisone may be needed. Rarely, treated patients may have a crisis, perhaps because they have not been taking their medication or have been vomiting it. Emergency resuscitation is needed with ?uids, salt and sugar. Because of this, all patients should carry a card detailing their condition and necessary management. Treatment of any complicating infections such as tuberculosis is essential. Sometimes DIABETES MELLITUS coexists with Addison’s disease and must be treated.

Secondary adrenal insu?ciency may occur in panhypopituitarism (see PITUITARY GLAND), in patients treated with CORTICOSTEROIDS or after such patients have stopped treatment.... addison’s disease

(Teutonic) One of noble cheer Adula, Adulla, Addulla, Adulah, Addullah... addula

(Irish) Little fire shining brightly Adeene, Adean, Adeane, Adein, Adeine, Adeyn, Adeyne... adeen

(German) Of the nobility; serene; of good humor

Adele, Adelia, Adella, Adelle, Adalene, Adelie, Adelina, Adali, Adalheida, Adilene, Adelaide, Adalaide, Adalaid, Adalayde, Adelaid, Adelayde, Adelade, Ada, Adelajda, Adelicia, Adelinda, Adeline, Adelheid, Adelheide, Adelisa, Adelise, Adelita, Adelynn, Adelyte, Adalicia, Ady, Adalina, Adaline, Adaliz, Adalyn, Addie... adela

(Greek) Beloved sister Adelfa, Adelphe, Adelphie... adelpha

... adenitis means inflammation of a gland.

A pre?x denoting relation to a GLAND or glands.... adeno

A non-malignant tumour arising from the EPITHELIUM and made up of ADIPOSE TISSUE and glandular tissues (see GLAND).... adenolipoma

Linn.

Adansonia digitata Linn.

Family: Bombacaceae.

Habitat: Native to tropical Africa; common along the west coast of India.

English: Baobab, Monkey Bread tree, African calabash.

Ayurvedic: Sheet-phala, Ravanaam- likaa, Gorakshi, Panchparni.

Unani: Gorakh Imli.

Siddha/Tamil: Papparapuli.

Folk: Gorakh Imli; Gorakh Chinchaa.

Action: Cooling, refrigerant (allays burning sensation). Leaves— diaphoretic (used as a prophylactic against fevers). Fruit—antidysen- teric, antiseptic, antihistaminic.

The fruit pulp is a source of vitamin C (175.0-445.4 mg/100 g); dried pulp contains calcium and vitamin B1. Furfural (9.6%) is obtained after distillation of the fruit. In Africa, dried leaves provide much of the dietary calcium. Aqueous extract of the bark is used for treating sickle cell anaemia.

An infusion of the leaves and flowers is given in respiratory disorders. (Powdered leaves prevented crisis in asthma induced by histamine in guinea pigs.) Dried fruit pulp also gives relief in bronchial asthma, allergic dermatitis and urticaria.

Family: Leguminosae; Mimosaceae.

Habitat: The western Ghats, the Andamans and sub-Himalayan tract; also cultivated.

English: Coral Wood, Red Wood.

Ayurvedic: Rakta Kanchana, Rakta Kambala.

Siddha/Tamil: Anai-gundumani.

Folk: Ghumchi (bigger var.).

Action: Astringent and styptic (used in diarrhoea, haemorrhage from the stomach, haematuria), anti-inflammatory (in rheumatic affections, gout). Seeds— anticephalgic; also used for the treatment of paralysis. A decoction is given in pulmonary affections.

The seed contains an anti-inflammatory active principle, O-acetyletha- nolamine. The leaves contain octa- cosanol, dulcitol, glucosides of beta- sitosterol and stigmasterol. The bark contains sitgmasterol glucoside.... adenanthera pavonina

A compound comprising the chemical substances adenine, ribose and phosphates. The chemical bonds of the phosphates contain energy needed for cell METABOLISM that occurs when muscle cells contract. This energy is made available when ATP breaks up to form other chemical groupings – adenosine diphosphate (ADP) and adenosine monophosphate (AMP). The energy needed for recombining AMP and ADP to form ATP is produced by the breakdown of carbohydrates or other constituencies of food.... adenosine triphosphate (atp)

Viruses (see VIRUS) containing double-stranded DNA; these cause around 5 per cent of clinically recognised respiratory illnesses. Of the 40 or so known types, only a few have been properly studied to establish how they produce disease. Adenoviruses cause fever and in?ammation of the respiratory tract and mucous membranes of the eyes – symptoms resembling those of the common cold. They also cause ENTERITIS, haemorrhagic CYSTITIS and life-threatening infections in newborn babies. Infections are generally benign and self-limiting, and treatment is symptomatic and supportive, although the elderly and people with chronic chest conditions may develop secondary infections which require antibiotic treatment.... adenoviruses

(African) One who wears a crown of honor

Adeolah, Adeolla, Adeollah... adeola

(Hebrew) One who protects her loved ones... aderes

(Welsh) Birdlike child Aderyne, Aderin, Aderine... aderyn

(Yoruban) The passage is open; acceptance

Adesinah, Adesine, Adeseena, Adesyna, Adeseenah, Adesynah, Adesiena, Adesienah, Adeseina, Adeseinah, Adeseana, Adeseanah... adesina

(African) Princess; child of royalty Adetouna... adetoun

(Swahili) A child of glory Adhamah, Adhamma, Adhammah... adhama

(Arabic) Maiden; the name of the second-brightest star in the constellation Canis Major

Adharah, Adharra, Adharrah... adhara

(Teutonic) Lovely and happy woman

Adhella, Adhell, Adhele, Adhela... adhelle

(African) Daughter born after sunset... adhiambo

(Hindi) A learned woman Adhitta, Adhittah, Adhitah, Adhyta, Adhytah, Adhytta, Adhyttah... adhita

(Swahili / English) Gift from God / wealthy; prosperous Adea, Adiah, Addia, Adya, Adeah... adia

(American) The night’s falling reveals the angels’ beauty Adyana, Adianna, Adianah, Adyanna... adiana

Nees.

Synonym: A. zeylanica Medic. Justicia adhatoda Linn.

Family: Acanthaceae.

Habitat: Throughout India, up to an altitude of 1,300 m.

English: Malabar Nut, Vasaca.

Ayurvedic: Vaasaa, Vaasaka, Vaasikaa, Simhaasya, Simhaparni, Simhavadanaa, Vaajidanta, Vrisha, Aataruushaka.

Unani: Arusaa.

Siddha/Tamil: Aadaathodai.

Folk: Vasaakaa.

Action: Expectorant (used in bronchial, asthmatic and pulmonary affections), antispasmodic, febrifuge.

Key application: As bronchodilatory, expectorant. (Indian Herbal Pharmacopoeia.) The Ayurvedic Pharmacopoeia of India indicates its use in dyspnoea.

The chief quinazoline alkaloid vas- icine is reported in all parts of the plant, the highest being in inflorescence. It is a bitter bronchodilator, respiratory stimulant, hypotensive, cardiac depressant, uterotonic and aborti- facient. An aqueous solution of va- sicinone hydrochloride, when studied in mice and dogs, was found to potentiate the bronchodilatory activity of aminophylline, also that of isopre- naline. Vasicinone exhibited smooth- muscle-relaxant properties of airways.

Alkaloids present in the plant showed significant protection against allergin-induced bronchial obstruction in guinea pigs.

The leaves are found to activate the digestive enzyme trypsin.

An extract of the leaves showed significant antifungal activity against ringworm.

Adhatoda beddomei C.B. Clarke, found in Kerala, is considered to be more powerful and active than A. vasi- ca. Fresh leaf juice is used in haemoptysis and menorrhagia, also as an antiasthmatic.

Jacobinia tinctoria Henl. is equated with the red-flowered var. of Vaasaa.

Dosage: Leaf—10-20 ml juice. Dried leaves—10-20 g for deoction. Root—3-6 g powder. (API Vols. I, IV)... adhatoda vasica

(Native American) One who brings peace

Adianka, Adyanca, Adyanka... adianca

Linn.

Synonym: A. emarginatum Bedd.

Family: Adiantaceae.

Habitat: North Kanara and the Nilgiri and Palni hills at higher elevations.

Ayurvedic: Hansapadi (related sp.).

Action: Rhizomes—decoction abortifacient. Astringent and emetic. Emollient in coughs and diseases of the chest; sudorific.... adiantum aethiopicum