Indigestion... dyspepsia

Usually defined as the passage of three or more liquid motions within 24 hours. However, for exclusivelybreast-fed infants this may not be satisfactory and the definition is usually based upon what the mother considers to be diarrhoea.... diarrhoea

A specific infectious disease caused by virulent strains of a Bacillus... diphtheria

A failure of the adaptive mechanisms of an organism to counteract adequately, normally or appropriately to stimuli and stresses to which the organism is subjected, resulting in a disturbance in the function or structure of some part of the organism. This definition emphasizes that disease is multifactorial and may be prevented or treated by changing any or a combination of the factors. Disease is a very elusive and difficult concept to define, being largely socially defined. Thus, criminality and drug dependence are presently seen by some as diseases, when they were previously considered to be moral or legal problems.... disease

Difficult or painful menstruation... dysmenorrhoea

Taraxacum officinale

Description: Dandelion leaves have a jagged edge, grow close to the ground, and are seldom more than 20 centimeters long. Its flowers are bright yellow. There are several dandelion species.

Habitat and Distribution: Dandelions grow in open, sunny locations throughout the Northern Hemisphere.

Edible Parts: All parts are edible. Eat the leaves raw or cooked. Boil the roots as a vegetable. Roots roasted and ground are a good coffee substitute. Dandelions are high in vitamins A and C and in calcium.

Other Uses: Use the white juice in the flower stems as glue.... dandelion

Dead scarf-skin separating in small flakes... dandruff

Soothing... demulcent

Irritation or inflammation of the skin... dermatitis

The process of determining health status and the factors responsible for producing it. It may be applied to an individual, family, group or community. The term is applied both to the process of determination and to its findings. See also “principal diagnosis”.... diagnosis

Having congenital pouches of the type found in many organs, particularly the colon, that are benign, but, being little cul-de-sacs, are likely to become inflamed from time to time. Diverticulitis is the term for inflamed diverticula.... diverticulosis

Severe diarrhea, usually from a colon infection, and containing blood and dead mucus membrane cells.... dysentery

Abnormal tissue growth...classically midway between hyperplasia (overgrowth) and neoplasia.... dysplasia

Difficulty or pain while passing urine... dysuria

A zoonotic disease caused by the spirochaete Borrelia burgdorferi and other species of the genus. Common in Europe and the USA and transmi tted by Ixodid ticks.... lyme disease

An old name for PLAGUE.... black death

An illness due to a specific infectious agent or its toxic products which arises through transmission of that agent or its products from a reservoir to a susceptible host - either directly, through the agencyof an intermediate plant or animal host, vector, or the inanimate environment.... communicable disease

Around one in 100 people suffers from coeliac disease, a condition in which the small INTESTINE fails to digest and absorb food, but many have no or few symptoms and remain undiagnosed. The intestinal lining is permanently sensitive to the protein gliadin (an insoluble and potentially toxic PEPTIDE protein) which is contained in GLUTEN, a constituent of the germ of wheat, barley and rye. As bread or other grain-based foods are a regular part of most people’s diet, the constant presence of gluten in the intestine of sufferers of coeliac disease causes atrophy of the digestive and absorptive cells of the intestine. Children are usually diagnosed when they develop symptoms such as vomiting, diarrhoea, lethargy, ANAEMIA, swollen abdomen and pale, frothy, foul-smelling faeces with failure to thrive. The diagnosis is usually made by a positive blood antibody test such as antiendomysial antibodies. However, because there may be an occasional false positive result, the ‘gold standard’ is to obtain a biopsy of the JEJUNUM through a tiny metal capsule that can be swallowed, a specimen taken, and the capsule retrieved. Though coeliac disease was long thought to occur in childhood, a second peak of the disorder has recently been identi?ed among people in their 50s.

Not all sufferers from coeliac disease present with gastrointestinal symptoms: doctors, using screening techniques, have increasingly identi?ed large numbers of such people. This is important because researchers have recently discovered that untreated overt and silent coeliac disease increases the risk of sufferers developing osteoporosis (brittle bone disease – see BONE, DISORDERS OF) and cancer. The osteoporosis develops because the bowel fails to absorb the CALCIUM essential for normal bone growth. Because those with coeliac disease lack the enzyme LACTASE, which is essential for digesting milk, they avoid milk – a rich source of calcium.

The key treatment is a strict, lifelong diet free of gluten. As well as returning the bowel lining to normal, this diet results in a return to normal bone density. People with coeliac disease, or parents or guardians of affected children, can obtain help and guidance from the Coeliac Society of the United Kingdom. (See also MALABSORPTION SYNDROME; SPRUE.)... coeliac disease

See SUDDEN INFANT DEATH SYNDROME (SIDS).... cot death

A state of weakness.... debility

Impairment of hearing, which affects about 2 million adults in the UK. In infants, permanent deafness is much less common: about 1–2 per 1,000. It is essential, however, that deafness is picked up early so that appropriate treatment and support can be given to improve hearing and/or ensure that the child can learn to speak.

In most people, deafness is a result of sensorineural hearing impairment, commonly known as nerve deafness. This means that the abnormality is located in the inner ear (the cochlea), in the auditory nerve, or in the brain itself. The prevalence of this type of hearing impairment rises greatly in elderly people, to the extent that more than 50 per cent of the over-70s have a moderate hearing impairment. In most cases no de?nite cause can be found, but contributory factors include excessive exposure to noise, either at work (e.g. shipyards and steelworks) or at leisure (loud music). Anyone who is exposed to gun?re or explosions is also likely to develop some hearing impairment: service personnel, for example.

Conductive hearing impairment is the other main classi?cation. Here there is an abnormality of the external or middle ear, preventing the normal transmission of sound waves to the inner ear. This is most commonly due to chronic otitis media where there is in?ammation of the middle ear, often with a perforation of the ear drum. It is thought that in the majority of cases this is a sequela of childhood middle-ear disease. Many preschool children suffer temporary hearing loss because of otitis media with e?usion (glue ear). Wax does not interfere with hearing unless it totally obstructs the ear canal or is impacted against the tympanic membrane. (See also EAR; EAR, DISEASES OF.)

Treatment Conductive hearing impairment can, in many cases, be treated by an operation on the middle ear or by the use of a hearing aid. Sensorineural hearing impairments can be treated only with a hearing aid. In the UK, hearing aids are available free on the NHS. Most NHS hearing aids are ear-level hearing aids – that is, they ?t behind the ear with the sound transmitted to the ear via a mould in the external ear. Smaller hearing aids are available which ?t within the ear itself, and people can wear such aids in both ears. The use of certain types of hearing aid may be augmented by ?ttings incorporated into the aid which pick up sound directly from television sets or from telephones, and from wire loop systems in halls, lecture theatres and classrooms. More recently, bone-anchored hearing aids have been developed where the hearing aid is attached directly to the bones of the skull using a titanium screw. This type of hearing aid is particularly useful in children with abnormal or absent ear canals who cannot therefore wear conventional hearing aids. People with hearing impairment should seek audiological or medical advice before purchasing any of the many types of hearing aid available commercially. Those people with a hearing impairment which is so profound (‘stone deaf’) that they cannot be helped by a hearing aid can sometimes now be ?tted with an electrical implant in their inner ear (a cochlear implant).

Congenital hearing loss accounts for a very small proportion of the hearing-impaired population. It is important to detect at an early stage as, if undetected and unaided, it may lead to delayed or absent development of speech. Otitis media with e?usion (glue ear) usually resolves spontaneously, although if it persists, surgical intervention has been the traditional treatment involving insertion of a ventilation tube (see GROMMET) into the ear drum, often combined with removal of the adenoids (see NOSE, DISORDERS OF). Recent studies, however, suggest that in many children these operations may provide only transient relief and make no di?erence to long-term outcome.

Advice and information on deafness and hearing aids may be obtained from the Royal National Institute for Deaf People and other organisations.... deafness

An aqueous extract of one or a few herbs ; a common method for preparing tea (té) or tizana; typically 2 teaspoons of dried plant material (1/4 cup if fresh) are boiled in hot water, either in a covered pot to trap volatile oils or with the cover removed so that the water boils off for a more concentrated brew; typically, roots and woody, fibrous plant matter are boiled for a longer period of time and flowers or leaves are boiled for a shorter period of time because less time is needed to extract their properties; most Dominican herbal remedies are prepared as decoctions; see also infusion and té.... decoction

A fall in the water content of the body. Sixty per cent of a man’s body weight is water, and 50 per cent of a woman’s; those proportions need to be maintained within quite narrow limits to ensure proper functioning of body tissues. Body ?uids contain a variety of mineral salts (see ELECTROLYTES) and these, too, must remain within narrow concentration bands. Dehydration is often accompanied by loss of salt, one of the most important minerals in the body.

The start of ‘dehydration’ is signalled by a person becoming thirsty. In normal circumstances, the drinking of water will relieve thirst and serious dehydration does not develop. In a temperate climate an adult will lose 1.5 litres or more a day from sweating, urine excretion and loss of ?uid through the lungs. In a hot climate the loss is much higher – up to 10 litres if a person is doing hard physical work. Even in a temperate climate, severe dehydration will occur if a person does not drink for two or three days. Large losses of ?uid occur with certain illnesses – for example, profuse diarrhoea; POLYURIA in diabetes or kidney failure (see KIDNEYS, DISEASES OF); and serious blood loss from, say, injury or a badly bleeding ULCER in the gastrointestinal tract. Severe thirst, dry lips and tongue, TACHYCARDIA, fast breathing, lightheadedness and confusion are indicative of serious dehydration; the individual can lapse into COMA and eventually die if untreated. Dehydration also results in a reduction in output of urine, which becomes dark and concentrated.

Prevention is important, especially in hot climates, where it is essential to drink water even if one is not thirsty. Replacement of salts is also vital, and a diet containing half a teaspoon of table salt to every litre of water drunk is advisable. If someone, particularly a child, suffers from persistent vomiting and diarrhoea, rehydration therapy is required and a salt-andglucose rehydration mixture (obtainable from pharmacists) should be taken. For those with severe dehydration, oral ?uids will be insu?cient and the affected person needs intravenous ?uids and, sometimes, admission to hospital, where ?uid intake and output can be monitored and rehydration measures safely controlled.... dehydration

(DTs) A distinct neurologic disorder suffered by late-in­the-game alcoholics, characterized by sensory confusion (is it red or sour, hot or loud, smelly or wet, am I thinking or screaming); part of the problem is the result of diminished myelination of nerves and decreased brain antioxidant insulation (cholesterol), with nerve impulses “shorting out” across temporary synapses. It sounds ugly.... delirium tremens

Also known as dengue fever, breakbone fever, and dandy fever, dengue is endemic and epidemic in tropical and subtropical regions. It is an acute infection caused by a ?avivirus (family togaviridae) transmitted by mosquitoes – especially Aedes aegypti. Incubation period is 5–8 days, and is followed by abrupt onset of symptoms: fever, facial ERYTHEMA with intense itching (which spreads throughout the body), sore throat, running eyes, and painful muscles and joints are common accompaniments. The symptoms subside within a few days and are frequently succeeded by a relapse similar to the ?rst. Further relapses may occur, and joint pains continue for some months. In uncomplicated dengue the mortality rate is virtually zero. Diagnosis is by virus isolation or demonstration of a rising antibody-concentration in the acute phase of infection. There is no speci?c treatment, but mild analgesics can be used to relieve the pains, and calamine lotion the itching. Prevention can be achieved by reduction of the mosquito-vector population.

Dengue haemorrhagic fever This is a more severe form of the disease which usually occurs in young children; it is largely con?ned to the indigenous population(s) of south-east Asia. It is accompanied by signi?cant complications and mortality. Immunological status of the host is considered important in pathogenesis.... dengue

Removing the odour... deodorant

A rare disease, possibly caused by an autoimmune reaction, in which muscle in?ammation and weakness is associated with a characteristic heliotrope ERYTHEMA of the face and backs of the hands. In adults it may be associated with underlying malignancy. Tissue changes are similar to those in POLYMYOSITIS.... dermatomyositis

Depression is a word that is regularly misused. Most people experience days or weeks when they feel low and fed up (feelings that may recur), but generally they get over it without needing to seek medical help. This is not clinical depression, best de?ned as a collection of psychological symptoms including sadness; unhappy thoughts characterised by worry, poor self-image, self-blame, guilt and low self-con?dence; downbeat views on the future; and a feeling of hopelessness. Su?erers may consider suicide, and in severe depression may soon develop HALLUCINATIONS and DELUSIONS.

Doctors make the diagnosis of depression when they believe a patient to be ill with the latter condition, which may affect physical health and in some instances be life-threatening. This form of depression is common, with up to 15 per cent of the population suffering from it at any one time, while about 20 per cent of adults have ‘medical’ depression at some time during their lives – such that it is one of the most commonly presenting disorders in general practice. Women seem more liable to develop depression than men, with one in six of the former and one in nine of the latter seeking medical help.

Manic depression is a serious form of the disorder that recurs throughout life and is manifested by bouts of abnormal elation – the manic stage. Both the manic and depressive phases are commonly accompanied by psychotic symptoms such as delusions, hallucinations and a loss of sense of reality. This combination is sometimes termed a manic-depressive psychosis or bipolar affective disorder because of the illness’s division into two parts. Another psychiatric description is the catch-all term ‘affective disorder’.

Symptoms These vary with the illness’s severity. Anxiety and variable moods are the main symptoms in mild depression. The sufferer may cry without any reason or be unresponsive to relatives and friends. In its more severe form, depression presents with a loss of appetite, sleeping problems, lack of interest in and enjoyment of social activities, tiredness for no obvious reason, an indi?erence to sexual activity and a lack of concentration. The individual’s physical and mental activities slow down and he or she may contemplate suicide. Symptoms may vary during the 24 hours, being less troublesome during the latter part of the day and worse at night. Some people get depressed during the winter months, probably a consequence of the long hours of darkness: this disorder – SEASONAL AFFECTIVE DISORDER SYNDROME, or SADS – is thought to be more common in populations living in areas with long winters and limited daylight. Untreated, a person with depressive symptoms may steadily worsen, even withdrawing to bed for much of the time, and allowing his or her personal appearance, hygiene and environment to deteriorate. Children and adolescents may also suffer from depression and the disorder is not always recognised.

Causes A real depressive illness rarely has a single obvious cause, although sometimes the death of a close relative, loss of employment or a broken personal relationship may trigger a bout. Depression probably has a genetic background; for instance, manic depression seems to run in some families. Viral infections sometimes cause depression, and hormonal disorders – for example, HYPOTHYROIDISM or postnatal hormonal disturbances (postnatal depression) – will cause it. Di?cult family or social relations can contribute to the development of the disorder. Depression is believed to occur because of chemical changes in the transmission of signals in the nervous system, with a reduction in the neurochemicals that facilitate the passage of messages throughout the system.

Treatment This depends on the type and severity of the depression. These are three main forms. PSYCHOTHERAPY either on a one-to-one basis or as part of a group: this is valuable for those whose depression is the result of lifestyle or personality problems. Various types of psychotherapy are available. DRUG TREATMENT is the most common method and is particularly helpful for those with physical symptoms. ANTIDEPRESSANT DRUGS are divided into three main groups: TRICYCLIC ANTIDEPRESSANT DRUGS (amitriptyline, imipramine and dothiepin are examples); MONOAMINE OXIDASE INHIBITORS (MAOIS) (phenelzine, isocarboxazid and tranylcypromine are examples); and SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) (?uoxetine – well known as Prozac®, ?uvoxamine and paroxetine are examples). For manic depression, lithium carbonate is the main preventive drug and it is also used for persistent depression that fails to respond to other treatments. Long-term lithium treatment reduces the likelihood of relapse in about 80 per cent of manic depressives, but the margin between control and toxic side-effects is narrow, so the drug must be carefully supervised. Indeed, all drug treatment for depression needs regular monitoring as the substances have powerful chemical properties with consequential side-effects in some people. Furthermore, the nature of the illness means that some sufferers forget or do not want to take the medication. ELECTROCONVULSIVE THERAPY (ECT) If drug treatments fail, severely depressed patients may be considered for ECT. This treatment has been used for many years but is now only rarely recommended. Given under general anaesthetic, in appropriate circumstances, ECT is safe and e?ective and may even be life-saving, though temporary impairment of memory may occur. Because the treatment was often misused in the past, it still carries a reputation that worries patients and relatives; hence careful assessment and counselling are essential before use is recommended.

Some patients with depression – particularly those with manic depression or who are a danger to themselves or to the public, or who are suicidal – may need admission to hospital, or in severe cases to a secure unit, in order to initiate treatment. But as far as possible patients are treated in the community (see MENTAL ILLNESS).... depression

Diabetes mellitus is a condition characterised by a raised concentration of glucose in the blood due to a de?ciency in the production and/or action of INSULIN, a pancreatic hormone made in special cells called the islet cells of Langerhans.

Insulin-dependent and non-insulindependent diabetes have a varied pathological pattern and are caused by the interaction of several genetic and environmental factors.

Insulin-dependent diabetes mellitus (IDDM) (juvenile-onset diabetes, type 1 diabetes) describes subjects with a severe de?ciency or absence of insulin production. Insulin therapy is essential to prevent KETOSIS – a disturbance of the body’s acid/base balance and an accumulation of ketones in the tissues. The onset is most commonly during childhood, but can occur at any age. Symptoms are acute and weight loss is common.

Non-insulin-dependent diabetes mellitus (NIDDM) (maturity-onset diabetes, type 2 diabetes) may be further sub-divided into obese and non-obese groups. This type usually occurs after the age of 40 years with an insidious onset. Subjects are often overweight and weight loss is uncommon. Ketosis rarely develops. Insulin production is reduced but not absent.

A new hormone has been identi?ed linking obesity to type 2 diabetes. Called resistin – because of its resistance to insulin – it was ?rst found in mice but has since been identi?ed in humans. Researchers in the United States believe that the hormone may, in part, explain how obesity predisposes people to diabetes. Their hypothesis is that a protein in the body’s fat cells triggers insulin resistance around the body. Other research suggests that type 2 diabetes may now be occurring in obese children; this could indicate that children should be eating a more-balanced diet and taking more exercise.

Diabetes associated with other conditions (a) Due to pancreatic disease – for example, chronic pancreatitis (see PANCREAS, DISORDERS OF); (b) secondary to drugs – for example, GLUCOCORTICOIDS (see PANCREAS, DISORDERS OF); (c) excess hormone production

– for example, growth hormone (ACROMEGALY); (d) insulin receptor abnormalities; (e) genetic syndromes (see GENETIC DISORDERS).

Gestational diabetes Diabetes occurring in pregnancy and resolving afterwards.

Aetiology Insulin-dependent diabetes occurs as a result of autoimmune destruction of beta cells within the PANCREAS. Genetic in?uences are important and individuals with certain HLA tissue types (HLA DR3 and HLA DR4) are more at risk; however, the risks associated with the HLA genes are small. If one parent has IDDM, the risk of a child developing IDDM by the age of 25 years is 1·5–2·5 per cent, and the risk of a sibling of an IDDM subject developing diabetes is about 3 per cent.

Non-insulin-dependent diabetes has no HLA association, but the genetic in?uences are much stronger. The risks of developing diabetes vary with di?erent races. Obesity, decreased exercise and ageing increase the risks of disease development. The risk of a sibling of a NIDDM subject developing NIDDM up to the age of 80 years is 30–40 per cent.

Diet Many NIDDM diabetics may be treated with diet alone. For those subjects who are overweight, weight loss is important, although often unsuccessful. A diet high in complex carbohydrate, high in ?bre, low in fat and aiming towards ideal body weight is prescribed. Subjects taking insulin need to eat at regular intervals in relation to their insulin regime and missing meals may result in hypoglycaemia, a lowering of the amount of glucose in the blood, which if untreated can be fatal (see below).

Oral hypoglycaemics are used in the treatment of non-insulin-dependent diabetes in addition to diet, when diet alone fails to control blood-sugar levels. (a) SULPHONYLUREAS act mainly by increasing the production of insulin;

(b) BIGUANIDES, of which only metformin is available, may be used alone or in addition to sulphonylureas. Metformin’s main actions are to lower the production of glucose by the liver and improve its uptake in the peripheral tissues.

Complications The risks of complications increase with duration of disease.

Diabetic hypoglycaemia occurs when amounts of glucose in the blood become low. This may occur in subjects taking sulphonylureas or insulin. Symptoms usually develop when the glucose concentration falls below 2·5 mmol/l. They may, however, occur at higher concentrations in subjects with persistent hyperglycaemia – an excess of glucose – and at lower levels in subjects with persistent hypo-glycaemia. Symptoms include confusion, hunger and sweating, with coma developing if blood-sugar concentrations remain low. Re?ned sugar followed by complex carbohydrate will return the glucose concentration to normal. If the subject is unable to swallow, glucagon may be given intramuscularly or glucose intravenously, followed by oral carbohydrate, once the subject is able to swallow.

Although it has been shown that careful control of the patient’s metabolism prevents late complications in the small blood vessels, the risk of hypoglycaemia is increased and patients need to be well motivated to keep to their dietary and treatment regime. This regime is also very expensive. All risk factors for the patient’s cardiovascular system – not simply controlling hyperglycaemia – may need to be reduced if late complications to the cardiovascular system are to be avoided.

Diabetes is one of the world’s most serious health problems. Recent projections suggest that the disorder will affect nearly 240 million individuals worldwide by 2010 – double its prevalence in 1994. The incidence of insulin-dependent diabetes is rising in young children; they will be liable to develop late complications.

Although there are complications associated with diabetes, many subjects live normal lives and survive to an old age. People with diabetes or their relatives can obtain advice from Diabetes UK (www.diabetes.org.uk).

Increased risks are present of (a) heart disease, (b) peripheral vascular disease, and (c) cerebrovascular disease.

Diabetic eye disease (a) retinopathy, (b) cataract. Regular examination of the fundus enables any abnormalities developing to be detected and treatment given when appropriate to preserve eyesight.

Nephropathy Subjects with diabetes may develop kidney damage which can result in renal failure.

Neuropathy (a) Symmetrical sensory polyneuropathy; damage to the sensory nerves that commonly presents with tingling, numbness of pain in the feet or hands. (b) Asymmetrical motor diabetic neuropathy, presenting as progressive weakness and wasting of the proximal muscles of legs. (c) Mononeuropathy; individual motor or sensory nerves may be affected. (d) Autonomic neuropathy, which affects the autonomic nervous system, has many presentations including IMPOTENCE, diarrhoea or constipation and postural HYPOTENSION.

Skin lesions There are several skin disorders associated with diabetes, including: (a) necrobiosis lipoidica diabeticorum, characterised by one or more yellow atrophic lesions on the legs;

(b) ulcers, which most commonly occur on the feet due to peripheral vascular disease, neuropathy and infection. Foot care is very important.

Diabetic ketoacidosis occurs when there is insu?cient insulin present to prevent KETONE production. This may occur before the diagnosis of IDDM or when insu?cient insulin is being given. The presence of large amounts of ketones in the urine indicates excess ketone production and treatment should be sought immediately. Coma and death may result if the condition is left untreated.

Symptoms Thirst, POLYURIA, GLYCOSURIA, weight loss despite eating, and recurrent infections (e.g. BALANITIS and infections of the VULVA) are the main symptoms.

However, subjects with non-insulindependent diabetes may have the disease for several years without symptoms, and diagnosis is often made incidentally or when presenting with a complication of the disease.

Treatment of diabetes aims to prevent symptoms, restore carbohydrate metabolism to as near normal as possible, and to minimise complications. Concentration of glucose, fructosamine and glycated haemoglobin in the blood are used to give an indication of blood-glucose control.

Insulin-dependent diabetes requires insulin for treatment. Non-insulin-dependent diabetes may be treated with diet, oral HYPOGLYCAEMIC AGENTS or insulin.

Insulin All insulin is injected – mainly by syringe but sometimes by insulin pump – because it is inactivated by gastrointestinal enzymes. There are three main types of insulin preparation: (a) short action (approximately six hours), with rapid onset; (b) intermediate action (approximately 12 hours); (c) long action, with slow onset and lasting for up to 36 hours. Human, porcine and bovine preparations are available. Much of the insulin now used is prepared by genetic engineering techniques from micro-organisms. There are many regimens of insulin treatment involving di?erent combinations of insulin; regimens vary depending on the requirements of the patients, most of whom administer the insulin themselves. Carbohydrate intake, energy expenditure and the presence of infection are important determinants of insulin requirements on a day-to-day basis.

A new treatment for diabetes, pioneered in Canada and entering its preliminary clinical trials in the UK, is the transplantation of islet cells of Langerhans from a healthy person into a patient with the disorder. If the transplantation is successful, the transplanted cells start producing insulin, thus reducing or eliminating the requirement for regular insulin injections. If successful the trials would be a signi?cant advance in the treatment of diabetes.

Scientists in Israel have developed a drug, Dia Pep 277, which stops the body’s immune system from destroying pancratic ? cells as happens in insulin-dependent diabetes. The drug, given by injection, o?ers the possibility of preventing type 1 diabetes in healthy people at genetic risk of developing the disorder, and of checking its progression in affected individuals whose ? cells are already perishing. Trials of the drug are in progress.... diabetes mellitus

A drug which induces perspiration... diaphoretic

The process of natural change in a cell from simple to complex and performing a particular function.... differentiation

Peucedanum graveolens. N.O. Compositae.

Synonym: Dill Fruit, Dill Seed, Eneldo.

Habitat: Waste places ; also seen growing wild in gardens.

Features ? Stem erect, smooth, channeled, covered with exuded glaucous matter. Leaves alternate, twice pinnate. Flowers in June, terminal umbels. Fruits very small, compressed oval, marked on back in three ridges, with three dark lines (oil cells) between. Taste is distinctive, but recalls caraway.

The Indian Dill differs from our European variety in the essential oil contained in the seeds.

Part used ? Dried ripe fruits.

Action: Carminative, stomachic, diaphoretic.

The well-known and widely used Dillwater is a sound remedy for children's digestive disorders, particularly wind in stomach or bowels. Dose, 1 to 8 drachms. The oil is also given in 1 to 5 drop doses.... dill

Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner, or within the range, considered to be normal for a human being. The term disability reflects the consequences of impairment in terms of functional performance and activity by the individual. Disabilities thus represent disturbances at the level of the person. See also “handicap”; “impairment”.... disability

Description of part of the body that is furthest from the heart.... distal

Promoting the flow of urine... diuretic

Sensation of imbalance of a stable relationship with the immediate environment... dizziness

An antibiotic of the tetracycline class also used to suppress malarial parasites and has variable effects against the liver stages of Plasmodium falciparum.... doxycycline

An application to the body of a jet of ?uid via a pipe or tube. It may be used to clean any part of the body but is used most commonly with reference to the vagina (although used as a method of contraception it is ine?ective).... douche

An excessive accumulation of clear or watery fluid in any of the tissues or cavities of the body... dropsy

A sensation of weakness and sweating after a meal in patients who have undergone GASTRECTOMY. Rapid emptying of the stomach and the drawing of ?uid from the blood into the intestine has been blamed, but the exact cause is unclear.... dumping syndrome

This disorder is related to gastric ulcer (see STOMACH, DISEASES OF), both being a form of chronic peptic ulcer. Although becoming less frequent in western communities, peptic ulcers still affect around 10 per cent of the UK population at some time. Duodenal ulcers are 10–15 times more common than gastric ulcers, and occur in people aged from 20 years onwards. The male to female ratio for duodenal ulcer varies between 4:1 and 2:1 in di?erent communities. Social class and blood groups are also in?uential, with duodenal ulcer being more common among the upper social classes, and those of blood group O.

Causes It is likely that there is some abrasion, or break, in the lining membrane (or mucosa) of the stomach and/or duodenum, and that it is gradually eroded and deepened by the acidic gastric juice. The bacterium helicobacter pylori is present in the antrum of the stomach of people with peptic ulcers; 15 per cent of people infected with the bacterium develop an ulcer, and the ulcers heal if H. pylori is eradicated. Thus, this organism has an important role in creating ulcers. Mental stress may possibly be a provocative factor. Smoking seems to accentuate, if not cause, duodenal ulcer, and the drinking of alcohol is probably harmful. The apparent association with a given blood group, and the fact that relatives of a patient with a peptic ulcer are unduly likely to develop such an ulcer, suggest that there is some constitutional factor.

Symptoms and signs Peptic ulcers may present in di?erent ways, but chronic, episodic pain lasting several months or years is most common. Occasionally, however, there may be an acute episode of bleeding or perforation, or obstruction of the gastric outlet, with little previous history. Most commonly there is pain of varying intensity in the middle or upper right part of the abdomen. It tends to occur 2–3 hours after a meal, most commonly at night, and is relieved by some food such as a glass of milk; untreated it may last up to an hour. Vomiting is unusual, but there is often tenderness and sti?ness (‘guarding’) of the abdominal muscles. Con?rmation of the diagnosis is made by radiological examination (‘barium meal’), the ulcer appearing as a niche on the ?lm, or by looking at the ulcer directly with an endoscope (see FIBREOPTIC ENDOSCOPY). Chief complications are perforation of the ulcer, leading to the vomiting of blood, or HAEMATEMESIS; or less severe bleeding from the ulcer, the blood passing down the gut, resulting in dark, tarry stools (see MELAENA).

Treatment of a perforation involves initial management of any complications, such as shock, haemorrhage, perforation, or gastric outlet obstruction, usually involving surgery and blood replacement. Medical treatment of a chronic ulcer should include regular meals, and the avoidance of fatty foods, strong tea or co?ee and alcohol. Patients should also stop smoking and try to reduce the stress in their lives. ANTACIDS may provide symptomatic relief. However, the mainstay of treatment involves four- to six-week courses with drugs such as CIMETIDINE and RANITIDINE. These are H2 RECEPTOR ANTAGONISTS which heal peptic ulcers by reducing gastric-acid output. Of those relapsing after stopping this treatment, 60–95 per cent have infection with H. pylori. A combination of BISMUTH chelate, amoxycillin (see PENICILLIN; ANTIBIOTICS) and METRONIDAZOLE – ‘triple regime’ – should eliminate the infection: most physicians advise the triple regime as ?rst-choice treatment because it is more likely to eradicate Helicobacter and this, in turn, enhances healing of the ulcer or prevents recurrence. Surgery may be necessary if medical measures fail, but its use is much rarer than before e?ective medical treatments were developed.... duodenal ulcer

This is the beginning of the small intestines, and it empties the stomach. It is 9 or 10 inches long, holds about the same amount of food as the digestive antrum or bottom of the stomach, and, through a papilla or sphincter, squirts a mixture of bile and pancreatic juices onto the previous stomach contents. These juices neutralize the acidic chyme; the pancreatic alkali and bile acids form soap to emulsify and aid fat digestion; and the duodenum walls secrete additional fluids and enzymes to admix with the pancreatic enzymes to initiate the final upper digestive investment. The duodenal wall secretes blood hormones to excite the brain, and gallbladder and pancreas secretions, and, if overwhelmed, can inhibit the stomach from sending anything else down for a while, until they can catch all their collective breath.... duodenum

Dyslexia is di?culty in reading or learning to read. It is always accompanied by di?culty in writing, and particularly by diffculties in spelling. Reading diffculties might be due to various factors – for example, a general learning problem, bad teaching or understimulation, or a perceptive problem such as poor eyesight. Speci?c dyslexia (‘word blindness’), however, affects 4–8 per cent of otherwise normal children to some extent. It is three times more common in boys than in girls, and there is often a family history. The condition is sometimes missed and, when a child has di?culty with reading, dyslexia should be considered as a possible cause.

Support and advice may be obtained from the British Dyslexia Association.... dyslexia

Dyspareunia means painful or di?cult COITUS. In women the cause may be physical – for example, due to local in?ammation or infection in the vagina – or psychological; say, a fear of intercourse. In men the cause is usually physical, such as prostatitis (see PROSTATE, DISEASES OF) or a tight foreskin (see PREPUCE).... dyspareunia

Difficulty or pain in speaking... dysphonia

Difficulty in breathing... dyspnoea

Difficult parturition... dystocia

A serious African viral haemorrhagic fever harboured by monkeys. Named after the city of Marburg in Germany where a serious outbreak occurred amongst laboratory workers handling the tissues of African Green (Vervet) monkeys.... marburg disease

See MUSCLES, DISORDERS OF – Myopathy.... muscular dystrophy

A canal connecting vas efferens to cirrus.... vas deferens

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

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

Bornholm disease, also known as devil’s grip, and epidemic myalgia, is an acute infective disease due to COXSACKIE VIRUSES. It is characterised by the abrupt onset of pain around the lower margin of the ribs, headache, and fever; it occurs in epidemics, usually during warm weather, and is more common in young people than in old. The illness usually lasts seven to ten days. It is practically never fatal. The disease is named after the island of Bornholm in the Baltic, where several epidemics have been described.... bornholm disease

Brittle Bone Disease is another name for OSTEOGENESIS IMPERFECTA.... brittle bone disease

See COMPRESSED AIR ILLNESS.... caisson disease

A zoonotic protozoan disease endemic to parts of Latin America and caused by Trypanosmoma cruzi with reduviid (Triatomid or assassin) bugs as the vectors.... chagas’ disease

A hereditary disorder of blood coagulation which can only be distinguished from HAEMOPHILIA by laboratory tests. It is so-called after the surname of the ?rst case reported in this country. About one in every ten patients clinically diagnosed as haemophiliac has in fact Christmas disease. It is due to lack in the blood of Factor IX (see COAGULATION).... christmas disease

A group of diseases affecting CONNECTIVE TISSUE. The term is really outdated since there is no evidence that collagen is primarily involved. Fibrinoid NECROSIS and VASCULITIS are two ‘characteristics’, and autoimmunity reaction may occur in the connective tissue. The latter affects blood vessels and causes secondary damage in the connective tissue. Such conditions are sometimes described as collagen vascular diseases, examples being RHEUMATOID ARTHRITIS, SYSTEMIC LUPUS ERYTHEMATOSUS (SLE), and SCLERODERMA.... collagen diseases

See EYE, DISORDERS OF.... dacryocystitis

In?ammation of a ?nger or toe.... dactylitis

A psychological disorder, also called hysterical conversion, in which the affected individual presents with striking neurological symptoms – such as weakness, paralysis, sensory disturbances or memory loss – for which no organic cause can be identi?ed. Up to 4 per cent of patients attending neurological outpatient clinics have been estimated as having conversion disorders. The disorder remains controversial, with theories about its cause unsupported by controlled research results. In clinical practice the physician’s experience and intuition are major factors in diagnosis. It has been suggested that the physical symptoms represent guilt about a physical or emotional assault on someone else. Treatment using a COGNITIVE BEHAVIOUR approach may help those with conversion disorders.... conversion disorder

(English) Of the day’s eye; resembling a flower

Daisee, Daisey, Daisi, Daisie, Dasie, Daizy, Daysi, Deysi, Deyzi, Daizie, Daizi, Daisha, Daesgesage, Daisea, Daiseah, Daizee, Dazea, Dazeah

... daisy

Turnera aphrodisiaca. N.O. Turneraceae.

Habitat: Central America.

Features ? Leaves alternate, wedge-shaped, hairy, shortly stalked, serrate, revolute. Aromatic, rather fig-like taste.

Part used ? Leaves.

Action: Aphrodisiac, tonic.

Used for its aphrodisiac qualities and general tonic effect on the nervous system. The 1 ounce to 1 pint infusion may be taken in wineglass doses thrice daily.... damiana

This drug inhibits pituitary gonadotrophin secretion (see PITUITARY GLAND; GONADOTROPHINS) and is used in the treatment of ENDOMETRIOSIS, MENORRHAGIA and GYNAECOMASTIA. The dose is usually of the order of 100 mg twice daily and side-effects may include nausea, dizziness, ?ushing and skeletal muscle pain. It is mildly androgenic (see ANDROGEN).... danazol

A muscle-relaxing drug, indicated for chronic severe spasticity (see SPASTIC) of voluntary muscle such as may occur after a STROKE or in CEREBRAL PALSY and MULTIPLE SCLEROSIS (MS). Unlike most other relaxants, it acts directly on the muscle, thus producing fewer centralnervous-system side-effects. It is contraindicated if liver function is impaired, and is not recommended for children or for acute muscle spasm. It may cause drowsiness, resulting in impaired performance at skilled tasks and driving.... dantrolene

One of the most e?ective drugs in the treatment of LEPROSY. An antibacterial drug, its use may cause nausea and vomiting; occasionally, it may harm nerves, the liver, and red blood cells. During treatment, blood tests are done to check on liver function and the number of red cells in the blood.

The drug is also used to treat dermatitis herpetiformis, a rare skin disorder.... dapsone

The proportion of deaths in a specified population. The death rate is calculated by dividing the number of deaths in a population in a year by the midyear resident population. Death rates are often expressed as the number of deaths per 100 000 persons. The rate may be restricted to deaths in specific age, race, sex, or geographic groups or deaths from specific causes of death (specific rate), or it may be related to the entire population (crude rate).... death rate

The surgical removal of foreign material and damaged tissue from a wound.... debridement

Relieving congestion, as of the mucous membrane... decongestant

A change in structure or in chemical composition of a tissue or organ, by which its vitality is lowered or its function interfered with. Degeneration is of various kinds, the chief being fatty, where cells become invaded by fat globules; calcareous, where calcium is deposited in tissue so that it becomes chalky in consistency; and mucoid, where it becomes semi-lique?ed.

Causes of degeneration are, in many cases, very obscure. In some cases heredity plays a part, with particular organs – for example, the kidneys – tending to show ?broid changes in successive generations. Fatty, ?broid, and calcareous degenerations are part of the natural change in old age; defective nutrition may bring them on prematurely, as may excessive and long-continued strain upon an organ like the heart. Various poisons, such as alcohol, play a special part in producing the changes, and so do the poisons produced by various diseases, particularly SYPHILIS and TUBERCULOSIS.... degeneration

The breaking open of a wound that is partly healed, usually after surgery.... dehiscence

A feeling of having already experienced an event which the person is doing or seeing at the moment. French for ‘already seen’, déjà vu is quite common but no satisfactory explanation for the phenomenon has yet been discovered.... déjà vu

The ?nal expulsion of the child in the act of birth. (See PREGNANCY AND LABOUR.)... delivery

A condition of altered consciousness in which there is disorientation (as in a confusional state), incoherent talk and restlessness but with hallucination, illusions or delusions also present.

Delirium (confusion) In some old people, acute confusion is a common e?ect of physical illness. Elderly people are often referred to as being ‘confused’; unfortunately this term is often inappropriately applied to a wide range of eccentricities of speech and behaviour as if it were a diagnosis. It can be applied to a patient with the early memory loss of DEMENTIA – forgetful, disorientated and wandering; to the dejected old person with depression, often termed pseudo-dementia; to the patient whose consciousness is clouded in the delirium of acute illness; to the paranoid deluded sufferer of late-onset SCHIZOPHRENIA; or even to the patient presenting with the acute DYSPHASIA and incoherence of a stroke. Drug therapy may be a cause, especially in the elderly.

Delirium tremens is the form of delirium most commonly due to withdrawal from alcohol, if a person is dependent on it (see DEPENDENCE). There is restlessness, fear or even terror accompanied by vivid, usually visual, hallucinations or illusions. The level of consciousness is impaired and the patient may be disorientated as regards time, place and person.

Treatment is, as a rule, the treatment of causes. (See also ALCOHOL.) As the delirium in fevers is due partly to high temperature, this should be lowered by tepid sponging. Careful nursing is one of the keystones of successful treatment, which includes ensuring that ample ?uids are taken and nutrition is maintained.... delirium

The powerful triangular muscle attached above to the collar-bone and shoulder-blade, and below, by its point, to the humerus, nearly halfway down the outer side of the upper arm. Its action is to raise the arm from the side, and it covers and gives roundness to the shoulder. (See also MUSCLE.)... deltoid

The study of populations, especially with reference to size and density, fertility, mortality, growth, age distribution, migration and vital statistics, and the interaction of all of these with social and economic conditions.... demography

An acquired and irreversible deterioration in intellectual function. Around 10 per cent of people aged over 65 and 20 per cent of those aged 75 or over are affected to some extent. The disorder is due to progressive brain disease. It appears gradually as a disturbance in problem-solving and agility of thought which may be considered to be due to tiredness, boredom or DEPRESSION. As memory failure develops, the affected person becomes bewildered, anxious and emotional when dealing with new surroundings and complex conversations. In professional skilled workers this is frequently ?rst recognised by family and friends. Catastrophic reactions are usually brief but are commonly associated with an underlying depression which can be mistaken for progressive apathy. The condition progresses relentlessly with loss of recent memory extending to affect distant memory and failure to recognise even friends and family. Physical aggression, unsocial behaviour, deteriorating personal cleanliness and incoherent speech commonly develop. Similar symptoms to those in dementia can occur in curable conditions including depression, INTRACRANIAL tumours, SUBDURAL haematoma, SYPHILIS, vitamin B1 de?ciency (see APPENDIX 5: VITAMINS) and repeated episodes of cerebral ISCHAEMIA. This last may lead to multi-infarct dementia.

Treatment If organic disease is identi?ed, it should, where possible, be treated; otherwise the treatment of dementia is alleviation of its symptoms. The affected person must be kept clean and properly fed. Good nursing care in comfortable surroundings is important and sedation with appropriate drugs may be required. Patients may eventually need institutional care. (See ALZHEIMER’S DISEASE.)... dementia

Destruction of the fatty MYELIN sheath around nerve ?bres (see NERVE: NEURON(E)) which interferes with the nerve function. It can occur after injury to the nerve, but is particularly associated with MULTIPLE SCLEROSIS (MS).... demyelination

A branching ULCER on the surface of the cornea of the eye, caused by HERPES SIMPLEX infection.... dendritic ulcer

Any liquid, paste or powder used for cleansing the teeth.... dentifrice

See TEETH.... dentine

See TEETH.... dentition

A plate or frame bearing false teeth. It may be complete (replacing all the teeth in one jaw) or partial.... denture

See DNA.... deoxyribonucleic acid

Physical or psychological reliance on a substance or an individual. A baby is naturally dependent on its parents, but as the child develops, this dependence lessens. Some adults, however, remain partly dependent, making abnormal demands for admiration, love and help from parents, relatives and others.

The dependence that most concerns modern society is one in which individuals become dependent on or addicted to certain substances such as alcohol, drugs, tobacco (nicotine), caffeine and solvents. This is often called substance abuse. Some people become addicted to certain foods or activities: examples of the latter include gambling, computer games and use of the Internet.

The 28th report of the World Health Organisation Expert Committee on Drug Dependence in 1993 de?ned drug dependence as: ‘A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behaviour. Psychological dependence occurs when the substance abuser craves the drug’s desirable effects. Physical dependence occurs when the user has to continue taking the drug to avoid distressing withdrawal or abstinence symptoms. Thus, determinants and the problematic consequences of drug dependence may be biological, psychological or social and usually interact.’

Di?erent drugs cause di?erent rates of dependence: TOBACCO is the most common substance of addiction; HEROIN and COCAINE cause high rates of addiction; whereas ALCOHOL is much lower, and CANNABIS lower again. Smoking in the western world reached a peak after World War II with almost 80 per cent of the male population smoking. The reports on the link between smoking and cancer in the early 1960s resulted in a decline that has continued so that only around a quarter of the adult populations of the UK and USA smokes. Globally, tobacco consumption continues to grow, particularly in the developing world with multinational tobacco companies marketing their products aggressively.

Accurate ?gures for illegal drug-taking are hard to obtain, but probably approximately 4 per cent of the population is dependent on alcohol and 2 per cent on other drugs, both legal and illegal, at any one time in western countries.

How does dependence occur? More than 40 distinct theories or models of drug misuse have been put forward. One is that the individual consumes drugs to cope with personal problems or diffculties in relations with others. The other main model emphasises environmental in?uences such as drug availability, environmental pressures to consume drugs, and sociocultural in?uences such as peer pressure.

By contrast to these models of why people misuse drugs, models of compulsive drug use – where individuals have a compulsive addiction

– have been amenable to testing in the laboratory. Studies at cellular and nerve-receptor levels are attempting to identify mechanisms of tolerance and dependence for several substances. Classical behaviour theory is a key model for understanding drug dependence. This and current laboratory studies are being used to explain the reinforcing nature of dependent substances and are helping to provide an explanatory framework for dependence. Drug consumption is a learned form of behaviour. Numerous investigators have used conditioning theories to study why people misuse drugs. Laboratory studies are now locating the ‘reward pathways’ in the brain for opiates and stimulants where positive reinforcing mechanisms involve particular sectors of the brain. There is a consensus among experts in addiction that addictive behaviour is amenable to e?ective treatment, and that the extent to which an addict complies with treatment makes it possible to predict a positive outcome. But there is a long way to go before the mechanisms of drug addiction are properly understood or ways of treating it generally agreed.

Effects of drugs Cannabis, derived from the plant Cannabis sativa, is a widely used recreational drug. Its two main forms are marijuana, which comes from the dried leaves, and hashish which comes from the resin. Cannabis may be used in food and drink but is usually smoked in cigarettes to induce relaxation and a feeling of well-being. Heavy use can cause apathy and vagueness and may even cause psychosis. Whether or not cannabis leads people to using harder drugs is arguable, and a national debate is underway on whether its use should be legalised for medicinal use. Cannabis may alleviate the symptoms of some disorders – for example, MULTIPLE SCLEROSIS (MS) – and there are calls to allow the substance to be classi?ed as a prescribable drug.

About one in ten of Britain’s teenagers misuses volatile substances such as toluene at some time, but only about one in 40 does so regularly. These substances are given o? by certain glues, solvents, varnishes, and liquid fuels, all of which can be bought cheaply in shops, although their sale to children under 16 is illegal. They are often inhaled from plastic bags held over the nose and mouth. Central-nervous-system excitation, with euphoria and disinhibition, is followed by depression and lethargy. Unpleasant effects include facial rash, nausea and vomiting, tremor, dizziness, and clumsiness. Death from COMA and acute cardiac toxicity is a serious risk. Chronic heavy use can cause peripheral neuropathy and irreversible cerebellar damage. (See SOLVENT ABUSE (MISUSE).)

The hallucinogenic or psychedelic drugs include LYSERGIC ACID DIETHYLAMIDE (LSD) or acid, magic mushrooms, ecstasy (MDMA), and phencyclidine (PCP or ‘angel’ dust, mainly used in the USA). These drugs have no medicinal uses. Taken by mouth, they produce vivid ‘trips’, with heightened emotions and perceptions and sometimes with hallucinations. They are not physically addictive but can cause nightmarish bad trips during use and ?ashbacks (vivid reruns of trips) after use, and can probably trigger psychosis and even death, especially if drugs are mixed or taken with alcohol.

Stimulant drugs such as amphetamine and cocaine act like adrenaline and speed up the central nervous system, making the user feel con?dent, energetic, and powerful for several hours. They can also cause severe insomnia, anxiety, paranoia, psychosis, and even sudden death due to convulsions or tachycardia. Depression may occur on withdrawal of these drugs, and in some users this is su?ciently deterrent to cause psychological dependence. Amphetamine (‘speed’) is mainly synthesised illegally and may be eaten, sni?ed, or injected. Related drugs, such as dexamphetamine sulphate (Dexedrine), are prescribed pills that enter the black market. ECSTASY is another amphetamine derivative that has become a popular recreational drug; it may have fatal allergic effects. Cocaine and related drugs are used in medicine as local anaesthetics. Illegal supplies of cocaine (‘snow’ or ‘ice’) and its derivative, ‘crack’, come mainly from South America, where they are made from the plant Erythroxylon coca. Cocaine is usually sni?ed (‘snorted’) or rubbed into the gums; crack is burnt and inhaled.

Opiate drugs are derived from the opium poppy, Papaver somniferum. They are described as narcotic because they induce sleep. Their main medical use is as potent oral or injectable analgesics such as MORPHINE, DIAMORPHINE, PETHIDINE HYDROCHLORIDE, and CODEINE. The commonest illegal opiate is heroin, a powdered form of diamorphine that may be smoked, sni?ed, or injected to induce euphoria and drowsiness. Regular opiate misuse leads to tolerance (the need to take ever larger doses to achieve the same e?ect) and marked dependence. A less addictive oral opiate, METHADONE HYDROCHLORIDE, can be prescribed as a substitute that is easier to withdraw.

Some 75,000–150,000 Britons now misuse opiates and other drugs intravenously, and pose a huge public-health problem because injections with shared dirty needles can carry the blood-borne viruses that cause AIDS/HIV and HEPATITIS B. Many clinics now operate schemes to exchange old needles for clean ones, free of charge. Many addicts are often socially disruptive.

For help and advice see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP – National Dugs Helpline.

(See ALCOHOL and TOBACCO for detailed entries on those subjects.)... dependence

Dermographism, or factitious URTICARIA, refers to transient ERYTHEMA and wealing caused by trauma to the skin.... dermographism

See CYSTS.... dermoid cyst

An agent that purifies blood... depurative

An agent which binds to heavy metals, used in the treatment of iron poisoning and THALASSAEMIA.... desferrioxamine

A CORTICOSTEROIDS derivative. As an antiin?ammatory agent it is approximately 30 times as e?ective as cortisone and eight times as e?ective as prednisolone. On the other hand, it has practically none of the salt-retaining properties of cortisone.... dexamethasone

A condition in which a person’s heart is situated on the right of the chest in a mirror image of its usual position. This may be associated with similar inversion of the abdominal organs – situs inversus.... dextrocardia

Another name for puri?ed grape sugar or glucose. A common constituent of intravenous ?uids.... dextrose

Diabetes insipidus is a relatively rare condition and must be di?erentiated from DIABETES MELLITUS which is an entirely di?erent disease.

It is characterised by excessive thirst and the passing of large volumes of urine which have a low speci?c gravity and contain no abnormal constituents. It is either due to a lack of the antidiuretic hormone normally produced by the HYPOTHALAMUS and stored in the posterior PITUITARY GLAND, or to a defect in the renal tubules which prevents them from responding to the antidiuretic hormone VASOPRESSIN. When the disorder is due to vasopressin insu?ciency, a primary or secondary tumour in the area of the pituitary stalk is responsible for one-third of cases. In another one-third of cases there is no apparent cause, and such IDIOPATHIC cases are sometimes familial. A further one-third of cases result from a variety of lesions including trauma, basal MENINGITIS and granulomatous lesions in the pituitary-stalk area. When the renal tubules fail to respond to vasopressin this is usually because of a genetic defect transmitted as a sex-linked recessive characteristic, and the disease is called nephrogenic diabetes insipidus. Metabolic abnormalities such as HYPERCALCAEMIA and potassium depletion render the renal tubule less sensitive to vasopressin, and certain drugs such as lithium and tetracycline may have a similar e?ect.

If the disease is due to a de?ciency of vasopressin, treatment should be with the analogue of vasopressin called desmopressin which is more potent than the natural hormone and has less pressor activity. It also has the advantage in that it is absorbed from the nasal mucosa and so does not need to be injected.

Nephrogenic diabetes insipidus cannot be treated with desmopressin. The urine volume can, however, usually be reduced by half by a thiazide diuretic (see THIAZIDES).... diabetes insipidus

A procedure used to ?lter o? waste products from the blood and remove surplus ?uid from the body in someone who has kidney failure (see KIDNEYS, DISEASES OF). The scienti?c process involves separating crystalloid and COLLOID substances from a solution by interposing a semi-permeable membrane between the solution and pure water. The crystalloid substances pass through the membrane into the water until a state of equilibrium, so far as the crystalloid substances are concerned, is established between the two sides of the membrane. The colloid substances do not pass through the membrane.

Dialysis is available as either haemodialysis or peritoneal dialysis.

Haemodialysis Blood is removed from the circulation either through an arti?cial arteriovenous ?stula (junction) or a temporary or permanent internal catheter in the jugular vein (see CATHETERS). It then passes through an arti?cial kidney (‘dialyser’) to remove toxins (e.g. potassium and urea) by di?usion and excess salt and water by ultra?ltration from the blood into dialysis ?uid prepared in a ‘proportionator’ (often referred to as a ‘kidney machine’). Dialysers vary in design and performance but all work on the principle of a semi-permeable membrane separating blood from dialysis ?uid. Haemodialysis is undertaken two to three times a week for 4–6 hours a session.

Peritoneal dialysis uses the peritoneal lining (see PERITONEUM) as a semi-permeable membrane. Approximately 2 litres of sterile ?uid is run into the peritoneum through the permanent indwelling catheter; the ?uid is left for 3–4 hours; and the cycle is repeated 3–4 times per day. Most patients undertake continuous ambulatory peritoneal dialysis (CAPD), although a few use a machine overnight (continuous cycling peritoneal dialysis, CCPD) which allows greater clearance of toxins.

Disadvantages of haemodialysis include cardiovascular instability, HYPERTENSION, bone disease, ANAEMIA and development of periarticular AMYLOIDOSIS. Disadvantages of peritoneal dialysis include peritonitis, poor drainage of ?uid, and gradual loss of overall e?ciency as endogenous renal function declines. Haemodialysis is usually done in outpatient dialysis clinics by skilled nurses, but some patients can carry out the procedure at home. Both haemodialysis and peritoneal dialysis carry a relatively high morbidity and the ideal treatment for patients with end-stage renal failure is successful renal TRANSPLANTATION.... dialysis

Diamorphine is another name for HEROIN.... diamorphine

Sweating... diaphoresis

The shaft of a long bone.... diaphysis

The relaxation of a hollow organ. The term is applied in particular to the HEART, to indicate the resting period between the beats (systole), while blood is ?owing into the organ.... diastole

The pressure exerted by the blood against the arterial wall during DIASTOLE. This is the lowest blood pressure in the cardiac cycle. A normal reading of diastolic pressure in a healthy adult at rest is 70 mm Hg. (See HEART.)... diastolic pressure

A process by which electric currents can be passed into the deeper parts of the body so as to produce internal warmth and relieve pain; or, by using powerful currents, to destroy tumours and diseased parts bloodlessly. The form of electricity used consists of high-frequency oscillations, the frequency of oscillation ranging from 10 million to 25,000 million oscillations per second. The current passes between two electrodes placed on the skin.

The so-called ultra-short-wave diathermy (or short-wave diathermy, as it is usually referred to) has replaced the original long-wave diathermy, as it is produced consistently at a stable wave-length (11 metres) and is easier to apply. In recent years microwave diathermy has been developed, which has a still higher oscillating current (25,000 million cycles per second, compared with 500 million for short-wave diathermy).

When the current passes, a distinct sensation of increasing warmth is experienced and the temperature of the body gradually rises; the heart’s action becomes quicker; there is sweating with increased excretion of waste products. The general blood pressure is also distinctly lowered. The method is used in painful rheumatic conditions, both of muscles and joints.

By concentrating the current in a small electrode, the heating effects immediately below this are very much increased. The diathermy knife utilises this technique to coagulate bleeding vessels and cauterise abnormal tissue during surgery.... diathermy

An archaic term meaning constitutional or inherited state giving an individual a predisposition towards a disease, a group of diseases or a structural or metabolic abnormality. An example is HAEMOPHILIA, a bleeding disorder.... diathesis

See TRANQUILLISERS; BENZODIAZEPINES.... diazepam

The three processes by which the body incorporates food are digestion, ABSORPTION, and ASSIMILATION. In digestion, food is softened and converted into a form soluble in the watery ?uids of the body; or, in the case of fat, into minute globules. The substances formed are then absorbed from the bowels and carried throughout the body by the blood. In assimilation, these substances, deposited from the blood, are used by the various tissues for their growth and repair.... digestion

One of a number of drugs known as CARDIAC GLYCOSIDES. They increase the contractility of heart muscle, depress the conducting tissue while increasing myocardial excitability, and increase activity of the VAGUS nerve. Digoxin is usually given orally for the treatment of atrial FIBRILLATION and heart failure. The adverse effects of overdosage (which occur more commonly in people with HYPOKALAEMIA, the elderly, and those with renal failure – see KIDNEYS, DISEASES OF) are vomiting, DYSRHYTHMIA, muscle weakness, and visual disturbances. The ELECTROCARDIOGRAM (ECG) has a characteristic appearance.... digoxin

The mixture of food and drink consumed by an individual. Variations in morbidity and mortality between population groups are believed to be due, in part, to di?erences in diet. A balanced diet was traditionally viewed as one which provided at least the minimum requirement of energy, protein, vitamins and minerals needed by the body. However, since nutritional de?ciencies are no longer a major problem in developed countries, it seems more appropriate to consider a ‘healthy’ diet as being one which provides all essential nutrients in su?cient quantities to prevent de?ciencies but which also avoids health problems associated with nutrient excesses.

Major diet-related health problems in prosperous communities tend to be the result of dietary excesses, whereas in underdeveloped, poor communities, problems associated with dietary de?ciencies predominate. Excessive intakes of dietary energy, saturated fats, sugar, salt and alcohol, together with an inadequate intake of dietary ?bre, have been linked to the high prevalence of OBESITY, cardiovascular disease, dental caries, HYPERTENSION, gall-stones (see GALL-BLADDER, DISEASES OF), non-insulindependent DIABETES MELLITUS and certain cancers (e.g. of the breast, endometrium, intestine and stomach) seen in developed nations. Health-promotion strategies in these countries generally advocate a reduction in the intake of fat, particularly saturated fat, and salt, the avoidance of excessive intakes of alcohol and simple sugars, an increased consumption of starch and ?bre and the avoidance of obesity by taking appropriate physical exercise. A maximum level of dietary cholesterol is sometimes speci?ed.

Undernutrition, including protein-energy malnutrition and speci?c vitamin and mineral de?ciencies, is an important cause of poor health in underdeveloped countries. Priorities here centre on ensuring that the diet provides enough nutrients to maintain health.

In healthy people, dietary requirements depend on age, sex and level of physical activity. Pregnancy and lactation further alter requirements. The presence of infections, fever, burns, fractures and surgery all increase dietary energy and protein requirements and can precipitate undernutrition in previously well-nourished people.

In addition to disease prevention, diet has a role in the treatment of certain clinical disorders, for example, obesity, diabetes mellitus, HYPERLIPIDAEMIA, inborn errors of metabolism, food intolerances and hepatic and renal diseases. Therapeutic diets increase or restrict the amount and/or change the type of fat, carbohydrate, protein, ?bre, vitamins, minerals and/or water in the diet according to clinical indications. Additionally, the consistency of the food eaten may need to be altered. A commercially available or ‘homemade’ liquid diet can be used to provide all or some of a patient’s nutritional needs if necessary. Although the enteral (by mouth) route is the preferred route for feeding and can be used for most patients, parenteral or intravenous feeding is occasionally required in a minority of patients whose gastrointestinal tract is unavailable or unreliable over a period of time.

A wide variety of weight-reducing diets are well publicised. People should adopt them with caution and, if in doubt, seek expert advice.... diet

Dietitians apply dietetics, the science of nutrition, to the feeding of groups and individuals in health and disease. Their training requires a degree course in the nutritional and biological sciences. The role of the dietitian can be divided as follows.

Preventive By liaising with health education departments, schools and various groups in the community. They plan and provide nutrition education programmes including in-service training and the production of educational material in nutrition. They are encouraged to plan and participate in food surveys and research projects which involve the assessment of nutritional status.

Therapeutic Their role is to advise patients who require speci?c dietary therapy as all or part of their treatment. They teach patients in hospitals to manage their own dietary treatment, and ensure a supportive follow-up so that patients and their families can be seen to be coping with the diet. Therapeutic dietitians further advise catering departments on the adaptation of menus for individual diets and on the nutritional value of the food supplied to patients and sta?. They advise social-services departments so that meals-on-wheels provision has adequate nutritional value.

Industry The advice of dietitians is sought by industry in the production of product information literature, data sheets and professional leaflets for manufacturers of ordinary foods and specialist dietetic food. They give advice to the manufacturers on nutritional and dietetic requirements of their products.... dietetics

An analgesic drug with similar e?cacy to CODEINE.... dihydrocodeine

Commonly referred to as D and C, a gynaecological operation to scrape away the lining of the UTERUS (ENDOMETRIUM). The procedure may be used to diagnose and treat heavy bleeding from the womb (ENDOMETRIOSIS) as well as other uterine disorders. It can be used to terminate a pregnancy or to clean out the uterus after a partial miscarriage. D and C is increasingly being replaced with a LASER technique using a hysteroscope – a type of ENDOSCOPE.... dilatation and curettage

(1) A muscle which has the action of increasing the diameter of an organ or vessel.

(2) A drug which usually acts by relaxing smooth muscle to increase the diameter of blood vessels, the bronchial tree, or other organs.

(3) An instrument used to increase the diameter of an ori?ce or organ, either to treat a stricture or to allow surgical access.... dilator

One of the CALCIUM-CHANNEL BLOCKERS, e?ective in most types of ANGINA; however, it should not be given to patients with heart failure. A longer-acting version of the drug can be used in HYPERTENSION.... diltiazem

A term used in the measurement of the refractive or focusing power of lenses; one dioptre is the power of a lens with a focal distance of one metre and is the unit of refractive power. As a stronger lens has a greater refractive power, this means that the focal distance will be shorter. The strength in dioptres therefore is the reciprocal of the focal length expressed in metres.... dioptre

Also known as cophentrope or Lomotil®. When mixed with ATROPINE sulphate, it is used as tretament for adult patients with DIARRHOEA, particularly if chronic. It has no antibacterial properties but is sometimes used to treat traveller’s diarrhoea.... diphenoxylate

Extensive PARALYSIS on both sides of the body but affecting the legs more than the arms.... diplegia

Double vision. It is due to some irregularity in action of the muscles which move the eyeballs, in consequence of which the eyes are placed so that rays of light from one object do not fall upon corresponding parts of the two retinae, and two images are produced. It is a symptom of several nervous diseases, and often a temporary attack follows an injury to the eye, intoxication, or some febrile disease like DIPHTHERIA.... diplopia

A morbid and insatiable craving for ALCOHOL.... dipsomania

The release of a patient from a provider’s care, usually referring to the date at which a patient checks out of a hospital.... discharge

Having a lethal effect upon germs... disinfectant

Substances that destroy micro-organisms, thus preventing them from causing infections. The name is usually applied to powerful chemicals that are also capable of destroying tissue and so are used only to sterilise inanimate surfaces. ANTISEPTICS are used to cleanse living tissues.... disinfectants

One of the ANTIARRHYTHMIC DRUGS given by intravenous injection after myocardial infarction to restore supraventricular and ventricular arrhythmias to normal, particularly when patients have not responded to lidocaine (lignocaine). It can impair the contractility of heart muscle and it does have an antimuscarinic e?ect (see ANTIMUSCARINE); consequently its administration has to be undertaken with care, especially in patients with GLAUCOMA or enlargement.... disopyramide

Orientation in a clinical sense includes a person’s awareness of time and place in relation to him- or herself and others, the recognition of personal friends and familiar places, and the ability to remember at least some past experience and to register new data. It is therefore dependent on the ability to recall all learned memories and make e?ective use of memory. Disorientation can be the presenting feature of both DELIRIUM (confusion) and DEMENTIA; delirium is reversible, developing dramatically and accompanied by evidence of systemic disease, while dementia is a gradually evolving, irreversible condition.... disorientation

Killing of infectious agents outside the body by chemical or physical means directly applied. 1. Concurrent disinfection is the application of disinfective measures as soon as possible after the discharge of infectious material from the body of an infected person, or after the soiling of articles with such infectious discharges. All personal contact with such discharges or articles being prevented prior to such disinfection. 2. Terminal disinfection is application of disinfective measures after the patient has been removed by death or to a hospital, or has ceased to be a source of infection, or after isolation practices have been discontinued. Terminal disinfection is rarely practised; terminal cleaning generally suffices along with airing and sunning of rooms, furniture and bedding. It is necessary only for diseases spread by indirect contact; steam sterilisation of bedding was considered desirable after smallpox (now eradicated).... disinfection

(1) The cutting of tissue to separate the structural components for identi?cation or removal during an operation or the study of anatomy.

(2) Dissection of an artery involves tearing of the inner part of the wall, allowing blood to track through the media occluding the origins of smaller arteries and often leading to vessel rupture (see also ARTERIES).... dissection

Spread of the disease throughout the body, usually through the blood.... disseminated

A drug used to treat PSORIASIS. It is usually very e?ective, being applied normally for short contact periods of up to 1 hour. Dithranol can cause severe skin irritation so must be used with care and at appropriate concentrations. Hands should be thoroughly washed after use.... dithranol

The presence of numerous diverticula (sacs or pouches) in the lining of the COLON accompanied by spasmodic lower abdominal pain and erratic bowel movements. The sacs may become in?amed causing pain (see DIVERTICULITIS).... diverticular disease

In?ammation of diverticula (see DIVERTICULUM) in the large intestine. It is characterised by pain in the left lower side of the abdomen, which has been aptly described as ‘left-sided appendicitis’ as it resembles the pain of appendicitis but occurs in the opposite side of the abdomen. The onset is often sudden, with fever and constipation. It may, or may not, be preceded by DIVERTICULOSIS. Treatment consists of rest, no solid food but ample ?uid, and the administration of tetracycline. Complications are unusual but include ABSCESS formation, perforation of the colon, and severe bleeding.... diverticulitis

Dopamine is one of the CATECHOLAMINES and a precursor of NORADRENALINE. Its highest concentration is in that portion of the brain known as the basal nuclei (see BRAIN) where its function is to convey inhibitory in?uences to the extrapyramidal system. There is good evidence that dopamine de?ciency is one of the causative factors in PARKINSONISM.

Dopamine is given by intravenous infusion as treatment for cardiogenic shock in cardiac infarction or cardiac surgery.... dopamine

A scienti?c study in which di?erent patients receive a di?erent drug, the same drug at a different dose, or a placebo – with neither the investigators assessing the outcome nor the subjects being treated knowing which of these the latter are receiving. The aim is to remove any hint of bias due to the investigators’ or patients’ preferences or preconceptions. The results are analysed after all the data have been collected and the code has been broken. Trials should have a separate supervising committee, the members of which know the code but do not take part in the study. Their job is to check the results at intervals so they can stop the trial if one arm of treatment is clearly better than another. Otherwise, it would be unethical to continue. (See INTERVENTION STUDY.)... double blind trial

A successful and widely used antitumour drug. It is used in the treatment of acute LEUKAEMIA, LYMPHOMA, and various forms of sarcoma and CANCER, including cancer of the bladder. (See CYTOTOXIC.)... doxorubicin

See SQUINT.... double vision

See APPENDIX 1: BASIC FIRST AID.... drowning

An agent that is used therapeutically to treat diseases. It may also be defined as any chemical agent and/or biological product or natural product that affects living processes... drug

The name applied to a passage leading from a gland into some hollow organ, or on to the surface of the body, by which the secretion of the gland is discharged: for example, the pancreatic duct and the bile duct opening into the duodenum, and the sweat ducts opening on the skin surface.... duct

See SPEECH DISORDERS.... dumbness

A general term applied when weakness or incoordination of the speech musculature prevents clear pronunciation of words. The individual’s speech may sound as if it is slurred or weak. It may be due to damage affecting the centres in the brain which control movements of the speech muscles, or damage to the muscles themselves.

Examples of dysarthria may be found in strokes, CEREBRAL PALSY and the latter stages of PARKINSONISM, MULTIPLE SCLEROSIS (MS) and MOTOR NEURONE DISEASE (MND). Whatever the cause, a speech therapist can assess the extent of the dysarthria and suggest exercises or an alternative means of communication.... dysarthria

A condition commonly seen when the brain’s PARIETAL LOBE is diseased or injured, in which an individual ?nds it hard to carry out simple mathematical calculations.... dyscalculia

Abnormal movements of the muscles resulting from disorder of the brain. Movements are uncoordinated and involuntary and occur in facial as well as limb muscles. They include athetosis (writhing movements), CHOREA (jerking movements predominate), choreoathetosis (a combined type), myoclonus (spasms), tics and tremors.... dyskinesia

Di?culty in swallowing. This may be caused by narrowing of the oesophagus because of physical disease such as cancer or injury. Disturbance to the nervous control of the swallowing mechanism – for example, in STROKE or MOTOR NEURONE DISEASE (MND) – can also cause dysphagia.... dysphagia

Dysphasia is the term used to describe the dif?culties in understanding language and in self-expression, most frequently after STROKE or other brain damage. When there is a total loss in the ability to communicate through speech or writing, it is known as global aphasia. Many more individuals have a partial understanding of what is said to them; they are also able to put their own thoughts into words to some extent. The general term for this less severe condition is dysphasia. Individuals vary widely, but in general there are two main types of dysphasia. Some people may have a good understanding of spoken language but have di?culty in self-expression; this is called expressive or motor dysphasia. Others may have a very poor ability to understand speech, but will have a considerable spoken output consisting of jargon words; this is known as receptive or sensory dysphasia. Similar diffculties may occur with reading, and this is called DYSLEXIA (a term more commonly encountered in the di?erent context of children’s reading disability). Adults who have suffered a stroke or another form of brain damage may also have di?culty in writing, or dysgraphia. The speech therapist can assess the ?ner diagnostic pointsand help them adjust to the effects of the stroke on communication. (See SPEECH THERAPY.)

Dysphasia may come on suddenly and last only for a few hours or days, being due to a temporary block in the circulation of blood to the brain. The effects may be permanent, but although the individual may have di?culty in understanding language and expressing themselves, they will be quite aware of their surroundings and may be very frustrated by their inability to communicate with others.

Further information may be obtained from Speakability.... dysphasia

See APRAXIA.... dyspraxia

Dystonia refers to a type of involuntary movement characterised by a sustained muscle contraction, frequently causing twisting and repetitive movements or abnormal postures, and caused by inappropriate instructions from the brain. It is sometimes called torsion spasm, and may be synonymous with ATHETOSIS when the extremities are involved. Often the condition is of unknown cause (idiopathic), but an inherited predisposition is increasingly recognised among some cases. Others may be associated with known pathology of the brain such as CEREBRAL PALSY or WILSON’S DISEASE.

The presentation of dystonia may be focal (usually in adults) causing blepharospasm (forceful eye closure), oromandibular dystonia (spasms of the tongue and jaw), cranial dystonia/Meige syndrome/Brueghel’s syndrome (eyes and jaw both involved), spastic or spasmodic dysphonia/laryngeal dystonia (strained or whispering speech), spasmodic dysphagia (di?culty swallowing), spasmodic torti/latero/ ante/retrocollis (rotation, sideways, forward or backward tilting of the neck), dystonic writer’s cramp or axial dystonia (spasms deviating the torso). Foot dystonia occurs almost exclusively in children and adolescents. In adults, the condition usually remains focal or involves at most an adjacent body part. In children, it may spread to become generalised. The condition has always been considered rare, but commonly is either not diagnosed or mistakenly thought to be of psychological origin. It may, in fact, be half as common as MULTIPLE SCLEROSIS (MS). Similar features can occur in some subjects treated with major tranquillising drugs, in whom a predisposition to develop dystonia may be present.

One rare form, called dopa-responsive dystonia, can be largely abolished by treatment with LEVODOPA. Particularly in paediatric practice this drug will often be tried on a child with dystonia.... dystonia

Dystrophy means defective or faulty nutrition, and is a term applied to a group of developmental changes occurring in the muscles, independently of the nervous system (see MUSCLES, DISORDERS OF). The best-known form is progressive muscular dystrophy, a group of hereditary disorders characterised by symmetrical wasting and weakness, with no sensory loss. There are three types: Duchenne (usually occurring in boys within the ?rst three years of life); limb girdle (occurring in either sex in the second or third decade); and facio-scapulohumeral (either sex, any age). The three types have di?erent prognoses, but may lead to severe disability and premature death, often from respiratory failure. The third type progresses very slowly, however, and is compatible with a long life.

Diagnosis may be con?rmed by ELECTROMYOGRAPHY (EMG) or muscle biopsy. Although genetic research is pointing to possible treatment or prevention, at present no e?ective treatment is known, and deterioration may occur with excessive con?nement to bed. Physio-therapeutic and orthopaedic measures may be necessary to counteract deformities and contractures, and may help in coping with some disabilities.... dystrophy

Eye drops and ointment are used extensively in the treatment of eye disease. They should be used as instructed by the prescribing physician. Most can be used for one month after the bottle has been opened but should then be discarded and a repeat prescription obtained if necessary. Any eye drops or ointment can have side-effects, and any di?culty with them should be referred to the prescribing physician.... eye drops

A contagious disease due to infection with coxsackie A16 virus (see COXSACKIE VIRUSES). Most common in children, the incubation period is 3–5 days. It is characterised by an eruption of blisters on the palms and the feet (often the toes), and in the mouth. The disease

has no connection with foot and mouth disease in cattle, deer, pigs and sheep.... hand, foot and mouth disease

A potentially serious disease of the newborn, characterised by haemolytic ANAEMIA (excessive destruction of red blood cells) and JAUNDICE. If severe, it may be obvious before birth because the baby becomes very oedematous (see OEDEMA) and develops heart failure – so-called hydrops fetalis. It may ?rst present on the ?rst day of life as jaundice and anaemia. The disease is due to blood-group incompatibility between the mother and baby, the commoneset being rhesus incompatibility (see BLOOD GROUPS). In this condition a rhesus-negative mother has been previously sensitised to produce rhesus antibodies, either by the delivery of a rhesus-positive baby, a miscarriage or a mismatched blood transfusion. These antibodies cross over into the fetal circulation and attack red blood cells which cause HAEMOLYSIS.

Treatment In severely affected fetuses, a fetal blood transfusion may be required and/or the baby may be delivered early for further treatment. Mild cases may need observation only, or the reduction of jaundice by phototherapy alone (treatment with light, involving the use of sunlight, non-visible ULTRAVIOLET light, visible blue light, or LASER).

Whatever the case, the infant’s serum BILIRUBIN – the bilirubin present in the blood – and its HAEMOGLOBIN concentration are plotted regularly so that treatment can be given before levels likely to cause brain damage occur. Safe bilirubin concentrations depend on the maturity and age of the baby, so reference charts are used.

High bilirubin concentrations may be treated with phototherapy; extra ?uid is given to prevent dehydration and to improve bilirubin excretion by shortening the gut transit time. Severe jaundice and anaemia may require exchange TRANSFUSION by removing the baby’s blood (usually 10 millilitres at a time) and replacing it with rhesus-negative fresh bank blood. Haemolytic disease of the newborn secondary to rhesus incompatibility has become less common since the introduction of anti-D (Rho) immunoglobulin. This antibody should be given to all rhesus-negative women at any risk of a fetomaternal transfusion, to prevent them from mounting an antibody response. Anti-D is given routinely to rhesus-negative mothers after the birth of a rhesus-positive baby, but doctors should also give it after threatened abortions, antepartum haemorrhages, miscarriages, and terminations of pregnancy.

Occasionally haemolytic disease is caused by ABO incompatibility or that of rarer blood groups.... haemolytic disease of the newborn

A disease of humans or animals resulting from an infection.... infectious disease

The ?brous disc that acts as a cushion between the bony vertebrae (see SPINAL COLUMN), enabling them to rotate and bend one on another. The disc tends to degenerate with age and may get ruptured and displaced – prolapsed or slipped disc – as a result of sudden strenuous action. Prolapsed disc occurs mainly in the lower back; it is more common in men than in women, and in the 30–40 age group.... intervertebral disc

Infection by the Gram negative rod, Legionella pneumophila and other species of the Genus. Often presents as an atypical pneumonia. Outbreaks have been reported from various countries.... legionnaire’s disease

Also called mucocutaneous lymph node syndrome, this disorder of unknown origin occurs mainly in children under ?ve and was ?rst described in Japan. It is characterised by high fever, conjunctivitis (see under EYE, DISORDERS OF), skin rashes and swelling of the neck glands. After about two weeks the skin from ?ngertips and toes may peel. The disease may last for several weeks before spontaneously resolving. It is possible that it is caused by an unusual immune response to INFECTION (see IMMUNITY).

Arteritis is a common complication and can result in the development of coronary artery aneurysms (see ANEURYSM) in up to 60 per cent of those affected. These aneurysms and even myocardial infarction (see HEART, DISEASES OF – Coronary thrombosis) are often detected after the second week of illness. The disease can be hard to diagnose as it mimics many childhood viral illnesses, especially in its early stages. The incidence in the UK is over 3 per 100,000 children under ?ve years of age.

Treatment Because of the danger of coronary artery disease, prompt treatment is important. This is with intravenous IMMUNOGLOBULINS and low-dose aspirin. To be e?ective, treatment must start in the ?rst week or so of the illness – a time when it is most di?cult to diagnose.... kawasaki disease

Learning disability, previously called mental handicap, is a problem of markedly low intellectual functioning. In general, people with learning disability want to be seen as themselves, to learn new skills, to choose where to live, to have good health care, to have girlfriends or boyfriends, to make decisions about their lives, and to have enough money to live on. They may live at home with their families, or in small residential units with access to work and leisure and to other people in ordinary communities. Some people with learning disabilities, however, also have a MENTAL ILLNESS. Most can be treated as outpatients, but a few need more intensive inpatient treatment, and a very small minority with disturbed behaviour need secure (i.e. locked) settings.

In the United Kingdom, the 1993 Education Act refers to ‘learning diffculties’: generalised (severe or moderate), or speci?c (e.g. DYSLEXIA, dyspraxia [or APRAXIA], language disorder). The 1991 Social Security (Disability Living Allowance) Regulations use the term ‘severely mentally impaired’ if a person suffers from a state of arrested development or incomplete physical development of the brain which results in severe impairment of intelligence and social functioning. This is distinct from the consequences of DEMENTIA. Though ‘mental handicap’ is widely used, ‘learning disability’ is preferred by the Department of Health.

There is a distinction between impairment (a biological de?cit), disability (the functional consequence) and handicap (the social consequence).

People with profound learning disability are usually unable to communicate adequately and may be seriously movement-impaired. They are totally dependent on others for care and mobility. Those with moderate disability may achieve basic functional literacy (recognition of name, common signs) and numeracy (some understanding of money) but most have a life-long dependency for aspects of self-care (some fastenings for clothes, preparation of meals, menstrual hygiene, shaving) and need supervision for outdoor mobility.

Children with moderate learning disability develop at between half and three-quarters of the normal rate, and reach the standard of an average child of 8–11 years. They become independent for self-care and public transport unless they have associated disabilities. Most are capable of supervised or sheltered employment. Living independently and raising a family may be possible.

Occurrence Profound learning disability affects about 1 in 1,000; severe learning disability 3 in 1,000; and moderate learning disability requiring special service, 1 per cent. With improved health care, survival of people with profound or severe learning disability is increasing.

Causation Many children with profound or severe learning disability have a diagnosable biological brain disorder. Forty per cent have a chromosome disorder – see CHROMOSOMES (three quarters of whom have DOWN’S (DOWN) SYNDROME); a further 15 per cent have other genetic causes, brain malformations or recognisable syndromes. About 10 per cent suffered brain damage during pregnancy (e.g. from CYTOMEGALOVIRUS (CMV) infection) or from lack of oxygen during labour or delivery. A similar proportion suffer postnatal brain damage from head injury – accidental or otherwise – near-miss cot death or drowning, cardiac arrest, brain infection (ENCEPHALITIS or MENINGITIS), or in association with severe seizure disorders.

Explanations for moderate learning disability include Fragile X or other chromosome abnormalities in a tenth, neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE), fetal alcohol syndrome and other causes of intra-uterine growth retardation. Genetic counselling should be considered for children with learning disability. Prenatal diagnosis is sometimes possible. In many children, especially those with mild or moderate disability, no known cause may be found.

Medical complications EPILEPSY affects 1 in 20 with moderate, 1 in 3 with severe and 2 in 3 with profound learning disability, although only 1 in 50 with Down’s syndrome is affected. One in 5 with severe or profound learning disability has CEREBRAL PALSY.

Psychological and psychiatric needs Over half of those with profound or severe – and many with moderate – learning disability show psychiatric or behavioural problems, especially in early years or adolescence. Symptoms may be atypical and hard to assess. Psychiatric disorders include autistic behaviour (see AUTISM) and SCHIZOPHRENIA. Emotional problems include anxiety, dependence and depression. Behavioural problems include tantrums, hyperactivity, self-injury, passivity, masturbation in public, and resistance to being shaved or helped with menstrual hygiene. There is greater vulnerability to abuse with its behavioural consequences.

Respite and care needs Respite care is arranged with link families for children or sta?ed family homes for adults where possible. Responsibility for care lies with social services departments which can advise also about bene?ts.

Education Special educational needs should be met in the least restrictive environment available to allow access to the national curriculum with appropriate modi?cation and support. For older children with learning disability, and for young children with severe or profound learning disability, this may be in a special day or boarding school. Other children can be provided for in mainstream schools with extra classroom support. The 1993 Education Act lays down stages of assessment and support up to a written statement of special educational needs with annual reviews.

Pupils with learning disability are entitled to remain at school until the age of 19, and most with severe or profound learning disability do so. Usually those with moderate learning disability move to further education after the age of 16.

Advice is available from the Mental Health Foundation, the British Institute of Learning Disabilities, MENCAP (Royal Society for Mentally Handicapped Children and Adults), and ENABLE (Scottish Society for the Mentally Handicapped).... learning disability

A duct that goes through the nasolacrimal canal in the palatine bone of the SKULL. The duct drains the tears from the lacrimal (tear) glands into the NOSE.... nasolacrimal duct

Otherwise known as the blind spot of the EYE, the disc is the beginning of the optic nerve – the point where nerve ?bres from the retina’s rods and cones (the light- and colour-sensitive cells) leave the eyeball.... optic disc

See DUCTUS ARTERIOSUS.... patent ductus arteriosus

(PID) Also called salpingitis, the term is applied to infections of the fallopian tubes that follow or are concurrent with uterine and cervical infections. Gonorrhea and Chlamydia are the most common organisms, and the infection is usually begun through sexual contact, although metabolic imbalances, subtler systemic infections like a slow virus, the local insult of herpes or candidiasis, the sequela of medication or recreational drugs, birth control pills, even an IUD...all can alter the vaginal flora and induce inflammation sufficient to allow an endogenous organism to start the infection. PID after birth, on the other hand, is usually the result of staph or strep infections infecting injured membranes.... pelvic inflammatory disease

A substantial reduction in the volume of SENSORY information impinging on the body – for instance, sitting in a dark, silent room. Prolonged deprivation is potentially harmful as the body needs constant stimulation in order to function normally. The main input organs are the eyes, ears, skin and nose. The absence of sensations disorients a person and results in neurological dysfunction. Some interrogation techniques involve sensory deprivation to ‘soften up’ the individual being questioned.... sensory deprivation

Any type of pleasurable sexual practice which society regards as abnormal. Deviation may be related to the activity, such as EXHIBITIONISM or sadomasochistic sex (see SADISM; MASOCHISM); or to the sexual object, for example, shoes or clothes (fetishism). Di?erent cultures have di?erent values, and treatment is probably not required unless the deviation is antisocial or harmful to the participant(s). Aversion therapy, or the conditioning of a person’s behaviour, may help if treatment is considered necessary.... sexual deviation

A measure of the amount by which each value deviates from the mean; equal to the square root of the variance, i.e. the square root of the average of the squared deviations from the mean. It is the most commonly used measure of dispersion of statistical data.... standard deviation

Also known as orofacial DYSKINESIA, this is characterised by involuntary chewing and grimacing, usually the result of years of taking ANTIPSYCHOTIC DRUGS, particularly in the elderly when these drugs are sometimes used to sedate troublesome patients.... tardive dyskinesia

This is the bodies’ main lymph collecting vessel. It starts in the little collecting bladder in the abdomen (the cisterna chyli), moves up the center of the body in front of the spinal chord, alongside the esophagus and aorta to the neck, where it drains into the left subclavian vein. It drains the lymph from the entire body, except the head, right thorax and arm, which collects lymph separately and drains into the right subclavian vein. Lacking the ability to contract and expand, the thoracic duct relies on its valves and the kinetic energy of breathing and nearby arterial pumping to drain lymph upwards.... thoracic duct

Another name for TRIGEMINAL NEURALGIA due to some affection of the ?fth cranial nerve, and characterised by pain – situated somewhere about the temple, forehead, face, or jaw – and sometimes by SPASM in the muscles of the affected region.... tic douloureux

One of a variety of procedures for collecting and diverting URINE from its customary channel of excretion following surgical removal of the bladder for disease, usually cancer. The ureters (see URETER) may be implanted in the large bowel, or a reservoir or small pouch may be fashioned using a section of small or large INTESTINE. In the latter method the pouch is emptied through a small STOMA using a catheter (see CATHETERS), thus dispensing with the need for a urinary drainage bag.... urinary diversion

An inherited defect of the HEART. The septum (partition) separating the two ventricles is pierced by a hole which, if large, results in blood being diverted to the LUNGS at a greater pressure than normal. This may lead to irreversible PULMONARY HYPERTENSION, which early surgical intervention (repair of the septal defect) should prevent. A quarter of patients with VSD have other cardiac defects. Half of the defects seal themselves spontaneously.... ventricular septal defect

DEMENTIA was traditionally divided into presenile and senile types; this is increasingly recognised as an arbitrary division of a condition in which there is a general and often slow decline in mental capabilities. Around 10 per cent of people over 65 years of age and 20 per cent over 75 are affected by dementing illness, but people under 65 may also be affected. Treatable causes such as brain tumour, head injury, ENCEPHALITIS and alcoholism are commoner in younger people. Other causes such as cerebrovascular disease – which is a major factor, especially among older people – or ALZHEIMER’S DISEASE are not readily treatable, although ANTIHYPERTENSIVE DRUGS for the former disorder may help, and symptomatic treatment for both is possible.

Individuals with dementia suffer a gradual deterioration of memory and of the ability to grasp what is happening around them. They often cover up their early failings and the condition may ?rst become apparent as a result of emotional outbursts or uncharacteristic behaviour in public. Eventually personal habits and speech deteriorate and they become thoroughly confused and di?cult to look after. Treatment is primarily a matter of ameliorating the symptoms, coupled with a sympathetic handling of the sufferer and the relatives. Admission to hospital or nursing home may be necessary if relatives are unable to look after the patient at home. (See also MEDICINE OF THE AGEING.)... senile dementia

A congenital abnormality of the HEART affecting about 260 babies in every 100,000, in which there is a hole in the septum – the dividing wall – between the left and right sides of the heart. The effects of the defect depend upon its size and position. A defect in the wall between the atria (upper chambers of the heart) is called an atrial septal defect, and that between the ventricles, a ventricular septal defect – the most common form (25 per cent of all defects). Both defects allow blood to circulate from the left side of the heart, where pressures are highest, to the right. This abnormal ?ow of blood is described as a ‘shunt’ and the result is that too much blood ?ows into the lungs. PULMONARY HYPERTENSION occurs and, if the shunt is large, heart failure may develop. A small septal defect may not need treatment but a large one will need to be repaired surgically.... septal defect

See DROP WRIST.... wrist-drop

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

“Death is often, at the start, in a particular organ, i.e. local. If the part can be saved in time life may be preserved. At the approach of death the value of a particular organ strikes one forcibly. There may be no need for constitutional medication. The one suffering part may be the whole case. In many chronic cases certain organs claim and must have special attention.” (Dr J. Compton Burnet)

Most important of such organs are the heart, which can be sustained by a few grains of Cayenne; the brain (Ginkgo, Skullcap, Kola); stomach (Peppermint); liver (Dandelion); spleen (New Jersey tea). See: LIFE DROPS.

When all desire for food has ceased, sips of honey-water or Balm tea sweetened with honey offer a comforting and sustaining support. ... death

Chronic inflammation and ulceration of the gut, especially the terminal ileum from changes in the gut blood vessels. Commences with ulceration which deepens, becomes fibrotic and leads to stricture. Defective immune system. Resistance low. May be associated with eye conditions and Vitamin B12 deficiency.

Symptoms: malaise, bloody alternating diarrhoea and constipation; right side colicky abdominal pain worse after meals; flatulence, loss of weight and appetite. Intestinal obstruction can usually be palpated. Blood count. A blood count high in whites indicates an abscess – a serious condition which may require surgical repair during which segments of the gut may have to be removed. Malignant change rare. Differential diagnosis. Ulcerative colitis, appendicitis, appendix abscess, irritable bowel syndrome.

Cracks or ulcers at corners of the mouth may be a good marker of Crohn’s Disease.

Treatment. Select one of the following. Herbal treatment offers a safe alternative to steroids by inducing remission in acute exacerbation. Good responses have been observed from the anti-bacterials Wild Yam and Goldenseal. Fenugreek seeds are of special value. Comfrey (tissue regeneration). Irish Moss.

Teas: Chamomile, Comfrey leaves, Hops, Marshmallow leaves, Meadowsweet, Shepherd’s Purse (Dr A. Vogel), Lobelia. Silverweed and Cranesbill are excellent for internal bleeding; Poke root for intestinal ulceration.

Decoction. Fenugreek seeds: 2 teaspoons to large cup water simmered gently 10 minutes. 1 cup freely. The seeds also should be consumed.

Tablets/capsules. Wild Yam, Fenugreek, Ginger, Goldenseal, Lobelia, Slippery Elm.

Powders. Formula. Wild Yam 2; Meadowsweet 2; Goldenseal 1. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.

Liquid Extracts. (1) Formula. Wild Yam 1, Echinacea 2. 30-60 drops in water thrice daily. Or, (2) Formula: Turkey Rhubarb 2, Goldenseal 1, Caraway half. 20-30 drops in water thrice daily.

Tinctures. Formula. Bayberry 2, Goldenseal 1, Cardamoms 1. Dose: One to two 5ml teaspoons thrice daily.

Ispaghula seeds. 2-4 teaspoons thrice daily.

Tea Tree oil Suppositories. Insertion at night.

Diet. Bland, little fibre, Slippery Elm gruel. Irish Moss preparations. Increase fluid intake. Reject: broccoli, tomatoes, lima, Soya, Brussels sprouts, pinto beans, cocoa, chocolate, cow’s milk, peas, onions, turnips, radishes. Accept fish oils.

Addenbrookes Hospital, Cambridge. Reject foods containing wheat and all dairy produce.

Supplements. Vitamins A, B12, C, Calcium, Iron, Magnesium, Potassium, Zinc.

Study. In a study carried out by UK researchers (1993) food allergies were found to be the most common cause of the disease. Results suggested that dietary changes may be as effective as corticosteroids in easing symptoms. The most common allergens were corn, wheat, milk, yeast, egg, potato, rye, tea, coffee, apples, mushrooms, oats, chocolate. An elemental diet with a formula of nutrients (E028, produced by Hospital Supplies, Liverpool) was used in trials. (The Lancet, 6.11.1993)

Notes. Crohn’s Disease is associated with Erythema nodosum, more frequently recognised in childhood. A frequent cause is cow’s milk intolerance. Smoking adds to the risk of Crohn’s disease.

In susceptible people, the food additives titanium dioxide and aluminosilicates may evoke a latent inflammatory response resulting in Crohn’s disease, ulcerative colitis or bowel cancer. These chemicals may be found in the intestinal lymphoid aggregations in gut mucosa. (Jonathan Powell, Gastro-intestinal Laboratory, St Thomas’s Hospital, London) (Titanium dioxide rarely occurs naturally but is added to confectionery, drinking water and anti-caking agents.) ... crohn’s disease

One third of those taking tranquillisers become addicted. One of the problems of psychological dependence is the discomfort of withdrawal symptoms.

Symptoms. Tremors, restlessness, nausea and sleep disturbance. The greater potency of the drug, the higher the rebound anxiety. Many drugs create stress, weaken resistance to disease, tax the heart and raise blood sugar levels.

Drugs like Cortisone cause bone loss by imperfect absorption of calcium. Taken in the form of milk and dairy products, calcium is not always absorbed. Herbs to make good calcium loss are: Horsetail, Chickweed, Slippery Elm, Spinach, Alfalfa.

Agents to calm nerves and promote withdrawal may augment a doctor’s prescription for reduction of drug dosage, until the latter may be discontinued. Skullcap and Valerian offer a good base for a prescription adjusted to meet individual requirements.

Alternatives. Teas: German Chamomile, Gotu Kola, Hops, Lime flowers, Hyssop, Alfalfa, Passion flower, Valerian, Mistletoe, Oats, Lavender, Vervain, Motherwort. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; half-1 cup thrice daily.

Decoctions: Valerian, Devil’s Claw, Siberian Ginseng, Lady’s Slipper. Jamaica Dogwood, Black Cohosh.

Tablets/capsules. Motherwort, Dogwood, Valerian, Skullcap, Passion flower, Mistletoe, Liquorice. Powders. Formulae. Alternatives. (1) Combine equal parts Valerian, Skullcap, Mistletoe. Or, (2) Combine Valerian 1; Skullcap 2; Asafoetida quarter. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily. Formula No 2 is very effective but offensive to taste and smell.

Practitioner. Tincture Nucis vom. once or twice daily, as advised.

Aloe Vera gel (or juice). Russians tested this plant on rabbits given heavy drug doses and expected to die. Their survival revealed the protective property of this plant: dose, 1 tablespoon morning and evening. Aromatherapy. Sniff Ylang Ylang oil. Lavender oil massage for its relaxing and stress-reducing properties.

Diet. Avoid high blood sugar levels by rejecting alcohol, white flour products, chocolate, sugar, sweets and high cholesterol foods.

Supplements. Daily. Multivitamins, Vitamin B-complex, B6, Vitamin C 2g, Minerals: Magnesium, Manganese, Iron, Zinc. Change of lifestyle. Stop smoking. Yoga.

Notes. “Do not withdraw: insulin, anticoagulants, epileptic drugs, steroids, thyroxin and hormone replacement therapy (the endocrine glands may no longer be active). Long-term tranquillisers e.g., Largactil or any medicament which has been used for a long period. Patients on these drugs are on a finely-tuned medication the balance of which may be easily disturbed.” (Simon Mills, FNIMH)

Counselling and relaxation therapy.

The Committee on Safety of Medicines specifically warns against the abrupt cessation of the Benzodiazepines and similar tranquillisers because of the considerable risk of convulsions. ... drug dependence

The Thatcher Finger. Fibrosis of the palm of the hand leading to deformity. Inability to straighten the ring and little finger due to fixed flexion. A tightened sinew. High serum fat levels are present, the disease affecting men from the age of 20 and women after the menopause.

“It is believed that oxidation of the lipids by free radicals (which are also present in high numbers in patients who have Dupuytren’s contracture) produces toxins which kill fibroblast cells in the palmar fascia. The surrounding tissue overreacts by producing many more fibroblasts, a bit like callous formation after a wound. The rapid increase in fibrous tissue leads to the contracture. This explains why the contracture is so common among patients with diabetes, epilepsy and alcoholism – serum lipid levels are raised in all these groups . . . However, the disorder occurs only if the patient has a genetic predisposition to the disease.” (Mr Paul Sanderson, Orthopaedic Surgeon, Wrightington Hospital, Wigan, in the Journal of Bone and Joint Surgery, Nov. 1992)

Treatment. Directed towards prevention. Same as for HYPERLIPIDAEMIA.

DWARF BEAN. See: FRENCH BEAN.

DWARF ELDER. Danewort. Ground Elder. Sambucus ebulus L. French: Petit sureau. German:

Attichwurzel. Spanish: Sauro enano. Italian: Ebbio. Part used: leaves. Action: expectorant, diaphoretic, diuretic, purgative.

Uses: Dropsy, kidney and bladder torpor, rheumatism.

Combine, equal parts Dwarf Elder, Greater Plantain and Parsley Piert for gravel.

Combine, equal parts Dwarf Elder, Wild Carrot, Broom and Motherwort for oedema of heart origin. Combine, equal parts Dwarf Elder and Celery seeds for polymyalgia and rheumatism. (W.T. Hewitt, FNIMH)

Preparations: Thrice daily.

Tea. 2 teaspoons leaves to each cup boiling water; infuse 10 minutes. Half-1 cup.

Tincture. 1 part in 5 parts 45 per cent alcohol. Macerate 8 days. Decant. 5-10ml (1-2 teaspoons). ... dupuytren’s contracture

Leprosy. Progressive infection by Mycobacterium leprae. Two forms: (1) tuberculoid; infection of the nerve endings and membranes of the nose, with loss of feeling and pale patches on the body. (2) Lepromatous; with inflamed thickened painful red skin exacerbated by ulceration, fever, neuritis and orchitis. Distorted lips and loss of nasal bone as infection progresses.

Symptoms: numbness, nerves may swell like iron rods. Infected nerves kill all sensation. In endemic areas, pins and needles in hands may call attention to it. A disease of nerves rather than skin. NOTIFIABLE DISEASE.

Many laymen and practitioners will never have seen a case. In the absence of modern medicine some good can be achieved by traditional remedies. Ancient Hindu and Chinese records refer to the use of Gotu Kola (internally and externally). Dr C.D. de Granpre? (1888) refers. (Martindale 27; p.441)

Oil of Chaulmoogra was used up to one hundred years ago before introduction of modern drugs. It fell into dis-use until discovered by a Director of Health in the Philippine Islands during World War I when he used it successfully in combination with camphor. In South America, where the disease is still active, Sarsaparilla has a long traditional reputation. Walnut oil is used as a dressing, in China. An anti- staphylococcal fraction has been isolated from the seeds of Psoralea corylifolia for use in leprosy. (Indian Journal of Pharmacy 26: 141, 1964)

Tea. Gotu Kola. Half a teaspoon to each cup boiling water; infuse 15 minutes. Drink freely. Stronger infusions may be used externally to cleanse ulceration.

Decoction. Combine: Sarsaparilla 1; Gotu Kola 1; Echinacea 2. Half an ounce to 1 pint water gently simmered 20 minutes. Dose: Half a cup 3 times daily.

Formula. Echinacea 2; Sarsaparilla 1; Gotu Kola 2. Dose. Powders 500mg. Liquid Extracts 3-5ml. Tinctures 5-10ml. Thrice daily.

Note: Antibody-positive cases of AIDS are vulnerable to leprosy, both diseases being caused by a similar bacterium.

To be treated by infectious diseases specialist. ... hansen’s disease

An infection caused by a tapeworm Echinococcus granulosis, which infests cattle, foxes, sheep and especially dogs from which it finds its way into humans by contaminated food. Eggs pass through the wall of the gut to develop in body tissue as a hydatid cyst. Many years may pass before symptoms reveal its presence. Surgical operation is the only effective cure although certain vermifuges, taken from time to time, create in the intestine an inhospitable environment for the parasite: Wormwood, Malefern, Fennel, Pumpkin seeds; given in capsule or powder form. Such worms deplete reserves of Vitamin B12 and may cause megaloblastic anaemia.

Supplementation. Vitamin B12.

HYDRAGOGUE. A herbal cathartic that causes watery evacuation and drastic purgation. White Bryony, American Mandrake. (Practitioner use only) ... hydatid disease

(Lymphadenoma. Lymphogranulomatosis). Chronic enlargement of the lymph nodes often together with that of the liver, spleen and bone marrow. Affects more males than females, 30- 40 years. High white blood cell count. Cancer of the lymph vessels. Follows a typical clinical course with anaemia until necrosis supervenes. The disease is suspected by a combination of enlargement of lymph nodes (especially the neck), severe itching and unexplained fever. Symptoms vary according to part of the body affected.

Symptoms. Hard rubbery glands are general, chiefly detected under the arm and groin. Enlarged nodes may compress nearby structures to produce nerve pains. Weight loss. Accumulation of fluid in lungs and abdomen. Obstruction of bile duct leads to jaundice. Patient may be prone to shingles. High fever heralds approaching fatality. Blood count, bone marrow aspiration and node biopsy confirm. Tubercula glands may simulate Hodgkin’s disease.

Some success reported by the use of the Periwinkle plant. (vinca rosea – Vinchristine) Wm Boericke, M.D. refers to Figwort as a powerful agent in Hodgkin’s disease.

Alternatives. Although there is no known cure, emphasis on the cortex of the adrenal gland may reduce skin irritation and pain in the later stages (Gotu Kola, Liquorice, Sarsaparilla). To arrest wasting and constitutional weakness: Echinacea. Anti-pruritics, alteratives and lymphatics are indicated.

Tea. Formula. Equal parts, Nettles, Gotu Kola, Red Clover. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 3 or more times daily.

Decoction. Formula. Equal parts – Yellow Dock, Queen’s Delight, Echinacea. 1 teaspoon to each cup water gently simmered 20 minutes. Half-1 cup 3 or more times daily.

Tablets/capsules. Poke root. Blue Flag root. Echinacea. Mistletoe.

Powders. Formula. Echinacea 2; Poke root 1; Bladderwrack 1. Dose: 500mg (two 00 capsules or one- third teaspoon) 3 or more times daily.

Tinctures. Mixture. Parts: Echinacea 2; Goldenseal quarter; Thuja quarter; Poke root half; Periwinkle 1. Dose: 1-2 teaspoons, 3 or more times daily. Where active inflammation is present – add Wild Yam 1. External. Castor oil packs to abdomen.

Treatment by a general medical practitioner or hospital specialist.

HOLISTIC MEDICINE. A school of thought which regards disease as a manifestation of an inner disturbance of the vital force, and not merely abnormality of certain groups of nerves, muscles, veins, or even the mind itself. Article 43 of Dr Samuel Hahnemann’s Organon of the Healing Art describes it:

“No organ, no tissue, no cell, no molecule is independent of the activities of the others but the life of each one of these elements is merged into the life of the whole. The unit of human life cannot be the organ, the tissue, the cell, the molecule, the atom, but the whole organism, the whole man.”

Holistic medicine relates disease to a patient’s personality, posture, diet, emotional life, and lifestyle. Treatment will be related to body, mind and spirit. It encourages a positive psychological response to the disease from which a patient suffers. For instance, its gentle approach to cancer embraces stress control, meditation, forms of visualisation and other life-enhancing skills.

Diet may be vegetarian, even vegan.... hodgkin’s disease

Inner ear disorder. Constriction of cerebral blood vessels (vasospasm) increases pressure of fluids in the balancing mechanism. Ages 40-60; more in men.

Etiology. Obscure; though cases may be traced to auto-toxaemia, Vitamin B deficiency, menstruation, malaria drugs (chloroquine).

Symptoms: dizziness, nausea, vomiting, tinnitus, sound distortions, heavy sweating, loss of hearing; usually in one ear only. Early diagnosis essential for effective treatment. This may mean reference to a department of otolaryngology or otoneurology.

Treatment. Antispasmodics. Nervines. Sometimes a timely diuretic reduces severity – Uva Ursi, Dandelion root, Wild Carrot.

Alternatives. Current European practice: Betony, German Chamomile, Passion flower, Hawthorn, Hops, Feverfew, White Willow.

Tea. Combine, equal parts: Valerian, Wild Carrot, Agrimony. 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup every 2 hours during attack; thrice daily thereafter.

Decoction. Mistletoe: 2 teaspoons to each cup cold water steeped overnight. Bring to boil. Allow to cool. Half-1 cup, as above.

Tablets/capsules. Feverfew, Mistletoe, Prickly Ash.

Formula. Ginkgo 2; Dandelion 1; Black Cohosh 1. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Feverfew tincture. See: FEVERFEW.

Dr J. Christopher: inject into ears, at night, few drops oil of Garlic (or contents of Garlic capsule).

Cider vinegar. 2 teaspoons to glass water: as desired.

Aromatherapy. Inhalants: Eucalyptus or Rosemary oils.

Diet: gluten-free, low salt; good responses observed. High fibre. Avoid dairy products and chocolate. Vitamins: B-complex, B1; B2; B6; E; F. Brewer’s yeast, Niacin.

Minerals: Calcium. Magnesium. Phosphorus. Dolomite. ... meniere’s disease

(Sir James Paget, 1814-99) Osteitis deformans. Chronic inflammation of bone at focal points (Pagetic sites), often widespread. Chronic. Progressive softening followed by thickening with distortion. Renewal of new bone outstrips absorption of old bone. Enlargement of the skull (‘Big head’) and of the long bones. Broadened pelvis, distorted spine (kyphosis) from flattened vertebra. Male predominence. Over 40 years. Spontaneous fractures possible. Paget’s disease and diabetes may be associated in the same family.

Some authorities believe cause is vitamin and mineral deficiency – those which promote bone health being calcium and magnesium (dolomite). Supplementation helps cases but evidence confirms that some pet-owners are at risk – a virus from cats and dogs possibly responsible. The prime candidate is one exposed to canine distemper. Dogs are involved twice as much as cats. The virus is closely related to the measles virus in humans.

Symptoms. Limbs deformed, hot during inflammatory stage. Headaches. Dull aching pain in bones. Deafness from temporal bone involvement. Loss of bone rigidity. Bowing of legs.

Surgical procedures may be necessary. Appears to be a case for immunisation of dogs against distemper.

Alternatives. Black Cohosh, Boneset, Cramp bark, Bladderwrack, German Chamomile, Devil’s Claw, Helonias, Oat husks, Prickly Ash, Sage, Wild Yam.

Tea. Oats (mineral nutrient for wasting diseases) 2; Boneset (anti-inflammatory) 1; Valerian (mild analgesic) 1; Liquorice quarter. Mix. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.

Decoction. Cramp bark 1; White Willow 2. Mix. 4 heaped teaspoons to 1 pint (500ml) water gently simmered 20 minutes. Dose: half-1 cup thrice daily.

Tablets/capsules. Cramp bark, Devil’s Claw, Echinacea, Helonias, Prickly Ash, Wild Yam.

Formula. Devil’s Claw 1; Black Cohosh 1; Valerian 1; Liquorice quarter. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Action enhanced when taken in cup of Fenugreek tea. Thrice daily. Every 2 hours acute cases.

Practitioner’s analgesic. Tincture Gelsemium: 10 drops in 100ml water. Dose: 1 teaspoon every 2 hours (inflammatory stage).

Topical. Comfrey root poultice.

Diet. High protein, low salt, low fat. Oily fish.

Supplements. Daily. Vitamin C (500mg); Vitamin D (1000mg); Calcium citrate (1 gram); Dolomite (1 gram); Beta-Carotene (7500iu). Kelp. ... paget’s disease

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

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

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

See NEUROLEPTICS.... antipsychotic drugs

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

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

The channel running from the gall-bladder (see LIVER) to the DUODENUM; carries BILE.... bile duct

A type of mental illness typi?ed by mood swings between elation (mania) and depression (see MENTAL ILLNESS).... bipolar disorder

See CONGENITAL.... birth defects

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

An individual who donates his or her own blood for use in patients of compatible blood group who require transfusion.... blood donor

Bone is not an inert sca?olding for the human body. It is a living, dynamic organ, being continuously remodelled in response to external mechanical and chemical in?uences and acting as a large reservoir for calcium and phosphate. It is as susceptible to disease as any other organ, but responds in a way rather di?erent from the rest of the body.

Bone fractures These occur when there is a break in the continuity of the bone. This happens either as a result of violence or because the bone is unhealthy and unable to withstand normal stresses.

SIMPLE FRACTURES Fractures where the skin remains intact or merely grazed. COMPOUND FRACTURES have at least one wound which is in communication with the fracture, meaning that bacteria can enter the fracture site and cause infection. A compound fracture is also more serious than a simple fracture because there is greater potential for blood loss. Compound fractures usually need hospital admission, antibiotics and careful reduction of the fracture. Debridement (cleaning and excising dead tissue) in a sterile theatre may also be necessary.

The type of fracture depends on the force which has caused it. Direct violence occurs when an object hits the bone, often causing a transverse break – which means the break runs horizontally across the bone. Indirect violence occurs when a twisting injury to the ankle, for example, breaks the calf-bone (the tibia) higher up. The break may be more oblique. A fall on the outstretched hand may cause a break at the wrist, in the humerus or at the collar-bone depending on the force of impact and age of the person. FATIGUE FRACTURES These occur after the bone has been under recurrent stress. A typical example is the march fracture of the second toe, from which army recruits suffer after long marches. PATHOLOGICAL FRACTURES These occur in bone which is already diseased – for example, by osteoporosis (see below) in post-menopausal women. Such fractures are typically crush fractures of the vertebrae, fractures of the neck of the femur, and COLLES’ FRACTURE (of the wrist). Pathological fractures also occur in bone which has secondary-tumour deposits. GREENSTICK FRACTURES These occur in young children whose bones are soft and bend, rather than break, in response to stress. The bone tends to buckle on the side opposite to the force. Greenstick fractures heal quickly but still need any deformity corrected and plaster of Paris to maintain the correction. COMPLICATED FRACTURES These involve damage to important soft tissue such as nerves, blood vessels or internal organs. In these cases the soft-tissue damage needs as much attention as the fracture site. COMMINUTED FRACTURES A fracture with more than two fragments. It usually means that the injury was more violent and that there is more risk of damage to vessels and nerves. These fractures are unstable and take longer to unite. Rehabilitation tends to be protracted. DEPRESSED FRACTURES Most commonly found in skull fractures. A fragment of bone is forced inwards so that it lies lower than the level of the bone surrounding it. It may damage the brain beneath it.

HAIR-LINE FRACTURES These occur when the bone is broken but the force has not been severe enough to cause visible displacement. These fractures may be easily missed. Symptoms and signs The fracture site is usually painful, swollen and deformed. There is asymmetry of contour between limbs. The limb is held uselessly. If the fracture is in the upper

limb, the arm is usually supported by the patient; if it is in the lower limb then the patient is not able to bear weight on it. The limb may appear short because of muscle spasm.

Examination may reveal crepitus – a bony grating – at the fracture site. The diagnosis is con?rmed by radiography.

Treatment Healing of fractures (union) begins with the bruise around the fracture being resorbed and new bone-producing cells and blood vessels migrating into the area. Within a couple of days they form a bridge of primitive bone across the fracture. This is called callus.

The callus is replaced by woven bone which gradually matures as the new bone remodels itself. Treatment of fractures is designed to ensure that this process occurs with minimal residual deformity to the bone involved.

Treatment is initially to relieve pain and may involve temporary splinting of the fracture site. Reducing the fracture means restoring the bones to their normal position; this is particularly important at the site of joints where any small displacement may limit movement considerably.

with plaster of Paris. If closed traction does not work, then open reduction of the fracture may

be needed. This may involve ?xing the fracture with internal-?xation methods, using metal plates, wires or screws to hold the fracture site in a rigid position with the two ends closely opposed. This allows early mobilisation after fractures and speeds return to normal use.

External ?xators are usually metal devices applied to the outside of the limb to support the fracture site. They are useful in compound fractures where internal ?xators are at risk of becoming infected.

Consolidation of a fracture means that repair is complete. The time taken for this depends on the age of the patient, the bone and the type of fracture. A wrist fracture may take six weeks, a femoral fracture three to six months in an adult.

Complications of fractures are fairly common. In non-union, the fracture does not unite

– usually because there has been too much mobility around the fracture site. Treatment may involve internal ?xation (see above). Malunion means that the bone has healed with a persistent deformity and the adjacent joint may then develop early osteoarthritis.

Myositis ossi?cans may occur at the elbow after a fracture. A big mass of calci?ed material develops around the fracture site which restricts elbow movements. Late surgical removal (after 6–12 months) is recommended.

Fractured neck of FEMUR typically affects elderly women after a trivial injury. The bone is usually osteoporotic. The leg appears short and is rotated outwards. Usually the patient is unable to put any weight on the affected leg and is in extreme pain. The fractures are classi?ed according to where they occur:

subcapital where the neck joins the head of the femur.

intertrochanteric through the trochanter.

subtrochanteric transversely through the upper end of the femur (rare). Most of these fractures of the neck of femur

need ?xing by metal plates or hip replacements, as immobility in this age group has a mortality of nearly 100 per cent. Fractures of the femur shaft are usually the result of severe trauma such as a road accident. Treatment may be conservative or operative.

In fractures of the SPINAL COLUMN, mere damage to the bone – as in the case of the so-called compression fracture, in which there is no damage to the spinal cord – is not necessarily serious. If, however, the spinal cord is damaged, as in the so-called fracture dislocation, the accident may be a very serious one, the usual result being paralysis of the parts of the body below the level of the injury. Therefore the higher up the spine is fractured, the more serious the consequences. The injured person should not be moved until skilled assistance is at hand; or, if he or she must be removed, this should be done on a rigid shutter or door, not on a canvas stretcher or rug, and there should be no lifting which necessitates bending of the back. In such an injury an operation designed to remove a displaced piece of bone and free the spinal cord from pressure is often necessary and successful in relieving the paralysis. DISLOCATIONS or SUBLUXATION of the spine are not uncommon in certain sports, particularly rugby. Anyone who has had such an injury in the cervical spine (i.e. in the neck) should be strongly advised not to return to any form of body-contact or vehicular sport.

Simple ?ssured fractures and depressed fractures of the skull often follow blows or falls on the head, and may not be serious, though there is always a risk of damage which is potentially serious to the brain at the same time.

Compound fractures may result in infection within the skull, and if the skull is extensively broken and depressed, surgery is usually required to check any intercranial bleeding or to relieve pressure on the brain.

The lower jaw is often fractured by a blow on the face. There is generally bleeding from the mouth, the gum being torn. Also there are pain and grating sensations on chewing, and unevenness in the line of the teeth. The treatment is simple, the line of teeth in the upper jaw forming a splint against which the lower jaw is bound, with the mouth closed.

Congenital diseases These are rare but may produce certain types of dwar?sm or a susceptibility to fractures (osteogenesis imperfecta).

Infection of bone (osteomyelitis) may occur after an open fracture, or in newborn babies with SEPTICAEMIA. Once established it is very di?cult to eradicate. The bacteria appear capable of lying dormant in the bone and are not easily destroyed with antibiotics so that prolonged treatment is required, as might be surgical drainage, exploration or removal of dead bone. The infection may become chronic or recur.

Osteomalacia (rickets) is the loss of mineralisation of the bone rather than simple loss of bone mass. It is caused by vitamin D de?ciency and is probably the most important bone disease in the developing world. In sunlight the skin can synthesise vitamin D (see APPENDIX 5: VITAMINS), but normally rickets is caused by a poor diet, or by a failure to absorb food normally (malabsorbtion). In rare cases vitamin D cannot be converted to its active state due to the congenital lack of the speci?c enzymes and the rickets will fail to respond to treatment with vitamin D. Malfunction of the parathyroid gland or of the kidneys can disturb the dynamic equilibrium of calcium and phosphate in the body and severely deplete the bone of its stores of both calcium and phosphate.

Osteoporosis A metabolic bone disease resulting from low bone mass (osteopenia) due to excessive bone resorption. Su?erers are prone to bone fractures from relatively minor trauma. With bone densitometry it is now possible to determine individuals’ risk of osteoporosis and monitor their response to treatment.

By the age of 90 one in two women and one in six men are likely to sustain an osteoporosis-related fracture. The incidence of fractures is increasing more than would be expected from the ageing of the population, which may re?ect changing patterns of exercise or diet.

Osteoporosis may be classi?ed as primary or secondary. Primary consists of type 1 osteoporosis, due to accelerated trabecular bone loss, probably as a result of OESTROGENS de?ciency. This typically leads to crush fractures of vertebral bodies and fractures of the distal forearm in women in their 60s and 70s. Type 2 osteoporosis, by contrast, results from the slower age-related cortical and travecular bone loss that occurs in both sexes. It typically leads to fractures of the proximal femur in elderly people.

Secondary osteoporosis accounts for about 20 per cent of cases in women and 40 per cent of cases in men. Subgroups include endocrine (thyrotoxicosis – see under THYROID GLAND, DISEASES OF, primary HYPERPARATHYROIDISM, CUSHING’S SYNDROME and HYPOGONADISM); gastrointestinal (malabsorption syndrome, e.g. COELIAC DISEASE, or liver disease, e.g. primary biliary CIRRHOSIS); rheumatological (RHEUMATOID ARTHRITIS or ANKYLOSING SPONDYLITIS); malignancy (multiple MYELOMA or metastatic CARCINOMA); and drugs (CORTICOSTEROIDS, HEPARIN). Additional risk factors for osteoporosis include smoking, high alcohol intake, physical inactivity, thin body-type and heredity.

Individuals at risk of osteopenia, or with an osteoporosis-related fracture, need investigation with spinal radiography and bone densitometry. A small fall in bone density results in a large increase in the risk of fracture, which has important implications for preventing and treating osteoporosis.

Treatment Antiresorptive drugs: hormone replacement therapy – also valuable in treating menopausal symptoms; treatment for at least ?ve years is necessary, and prolonged use may increase risk of breast cancer. Cyclical oral administration of disodium etidronate – one of the bisphosphonate group of drugs – with calcium carbonate is also used (poor absorption means the etidronate must be taken on an empty stomach). Calcitonin – currently available as a subcutaneous injection; a nasal preparation with better tolerance is being developed. Calcium (1,000 mg daily) seems useful in older patients, although probably ine?ective in perimenopausal women, and it is a safe preparation. Vitamin D and calcium – recent evidence suggests value for elderly patients. Anabolic steroids, though androgenic side-effects (masculinisation) make these unacceptable for most women.

With established osteoporosis, the aim of treatment is to relieve pain (with analgesics and physical measures, e.g. lumbar support) and reduce the risk of further fractures: improvement of bone mass, the prevention of falls, and general physiotherapy, encouraging a healthier lifestyle with more daily exercise.

Further information is available from the National Osteoporosis Society.

Paget’s disease (see also separate entry) is a common disease of bone in the elderly, caused by overactivity of the osteoclasts (cells concerned with removal of old bone, before new bone is laid down by osteoblasts). The bone affected thickens and bows and may become painful. Treatment with calcitonin and bisphosphonates may slow down the osteoclasts, and so hinder the course of the disease, but there is no cure.

If bone loses its blood supply (avascular necrosis) it eventually fractures or collapses. If the blood supply does not return, bone’s normal capacity for healing is severely impaired.

For the following diseases see separate articles: RICKETS; ACROMEGALY; OSTEOMALACIA; OSTEOGENESIS IMPERFECTA.

Tumours of bone These can be benign (non-cancerous) or malignant (cancerous). Primary bone tumours are rare, but secondaries from carcinoma of the breast, prostate and kidneys are relatively common. They may form cavities in a bone, weakening it until it breaks under normal load (a pathological fracture). The bone eroded away by the tumour may also cause problems by causing high levels of calcium in the plasma.

EWING’S TUMOUR is a malignant growth affecting long bones, particularly the tibia (calfbone). The presenting symptoms are a throbbing pain in the limb and a high temperature. Treatment is combined surgery, radiotherapy and chemotherapy.

MYELOMA is a generalised malignant disease of blood cells which produces tumours in bones which have red bone marrow, such as the skull and trunk bones. These tumours can cause pathological fractures.

OSTEOID OSTEOMA is a harmless small growth which can occur in any bone. Its pain is typically removed by aspirin.

OSTEOSARCOMA is a malignant tumour of bone with a peak incidence between the ages of ten and 20. It typically involves the knees, causing a warm tender swelling. Removal of the growth with bone conservation techniques can often replace amputation as the de?nitive treatment. Chemotherapy can improve long-term survival.... bone, disorders of

See BREECH PRESENTATION.... breech delivery

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

The processes by which cells multiply. Mitosis is the most common form of cell division, giving rise todaughter cells identical to the parent cells.

Meiosis produces egg (see ovum) and sperm cells that differ from their parent cells in that they have only half the normal number of chromosomes.... cell division

A complication of childbirth (see childbirth, complications of) in which the mother’s pelvis is too narrow in proportion to the size of the baby’s head.... cephalopelvic disproportion

Any disease affecting an artery in, and supplying blood to, the brain: for example, atherosclerosis (narrowing of the arteries) or defects or weaknesses in arterial walls causing aneurysm (a balloon-like swelling in an artery).

The disease may eventually cause a cerebrovascular accident, which commonly leads to a stroke.

Extensive narrowing of blood vessels throughout the brain can be a cause of dementia.... cerebrovascular disease

One of a number of drugs subject to restricted use because of their potential for abuse. They include

opiates such as cocaine and morphine, amfetamine drugs, and barbiturate drugs. controlled trial A method of testing the effectiveness of new treatments or comparing different treatments. In a typical controlled drug trial, 2 comparable groups of patients suffering from the same illness are given courses of apparently identical treatment. However, only one group receives the new treatment; the second control group is given a placebo. Alternatively, the control group may be given an established drug that is already known to be effective. After a predetermined period, the 2 groups are assessed medically. Controlled trials must be conducted “blind’’ (the patients do not know which treatment they are receiving). In a “double-blind’’ trial, neither the patients nor the doctors who assess them know who is receiving which treatment. contusion Bruising to the skin and underlying tissues from an injury. convalescence The recovery period following an illness or surgery during which the patient regains strength before returning to normal activities.... controlled drug

Various forms of group judgement in which a group (or panel) of experts interacts in assessing an intervention and formulating findings by vote or other informal or formal means, involving such techniques as the nominal group and Delphi techniques.... consensus development

Also called regional enteritis or regional ileitis, this is a nonspecific inflammatory disease of the upper and lower intestine that forms granulated lesions. It is usually a chronic condition, with acute episodes of diarrhea, abdominal pain, loss of appetite, and loss of weight. It may affect the stomach or colon, but the most common sites are the duodenum and the lowest part of the small intestine, the lower ileum. The standard treatment is, initially, anti-inflammatory drugs, with surgical resectioning often necessary. The disease is autoimmune, and sufferers share the same tissue type (HLA-B27) as those who acquire ankylosing spondylitis.... crohn’s disease

The tube that runs from the gall-bladder (see LIVER) and joins up with the hepatic duct (formed from the bile ducts) to form the common BILE DUCT. The BILE produced by the liver cells is drained through this system and enters the small intestine to help in the digestion of food.... cystic duct

Chemicals used to kill cancerous cells. Most cytotoxic drugs also kill normal cells. There is a delicate balance between killing enough cancer cells and not so many normal cells.... cytotoxic drugs

A CYTOTOXIC antibiotic drug principally used for treating cancers such as acute LEUKAEMIA and LYMPHOMA in children. It is given intravenously and treatment normally takes place in hospital. The drug was previously known as actinomycin D. Side-effects are potentially serious.... dactinomycin

(French) Resembling the yellow flower

Daffodill, Daffodille, Dafodil, Dafodill, Dafodille, Daff, Daffodyl, Dafodyl, Dafodyll, Daffi, Daffie, Daffey, Daffee, Daffea, Daffeah... daffodil

Disability adjusted life years.... daly

See CONTROLLED DRUGS.... dangerous drugs

Datura metel

Solanaceae

San: Dhustura Hin.: Kaladhatura

Ben: Dhatura Mal: Ummam Kan; Dattura

Tam: Vellummattai

Tel: Tellavummetta

Importance: Downy datura or thorn apple is an erect branched under shrub whose intoxicating and narcotic properties have been made use of by man from ancient time. The plant and fruit are spasmolytic, anticancerous and anthelmintic. Leaves and seeds are inhaled in whooping cough, asthma and other respiratory diseases. Root, leaf and seed are febrifuge, antidiarrhoeal, anticatarrhal and are used in insanity, cerebral complications and skin diseases. Leaf is antitumour, antirheumatic and vermicide. Flower is antiasthamatic, anaesthetic and is employed in swellings and eruptions on face. Fruit juice is used in earache and seed decoction in ophthalmia. For the rheumatic swellings of joints, lumbago, sciatica and neuralgia, warm leaf smeared with an oil is used as a bandage or sometimes the leaf is made into a poultice and applied. The root boiled with milk is used in insanity. It is also an ingredient in the ayurvedic preparation Kanakasva used in bronchial troubles, and the Unani formulations “Roghan dhatura” used as a massage oil for the paralysed part. The alkaloids of pharmaceutical interest present in the plant are hyoscyamine, hyoscine and meteloidine. Datura is the chief commercial source of hyoscine available from natural source. Hyoscine, in the form of hyoscine hydrobromide, is used as a pre-anaesthetic in surgery, child birth, ophthalmology and prevention of motion sickness. It is also employed in the relief of withdrawal symptoms in morphine and alcoholic addiction, paralysis agitans, post- encephaletic parkinsonianism and to allay sexual excitement. Hyoscyamine and its salt hyoscyamine sulphate and hyoscyamine hydrobromide are used in delerium, tremour, menia and parkinsonianism (Kaul and Singh, (1995).

Distribution: Datura is distributed throughout the world, particularly the warmer regions. Datura stramonium is indigenous to India. Out of 15 species reported from different parts of the world, only 10 are known to occur in India. They are found commonly in wastelands, gardens and roadsides. They are distributed in rich localities under semi -arid and arid regions of Punjab, Haryana, Rajastan, and Gujarat; the Central Plateau of Andhra Pradesh and Maharastra and the southern peninsular region of Tamil Nadu. Datura innoxia is indigenous to Mexico and is distributed in Latin American countries. A wealth of genetic stock on genotypes and varieties are maintained in several research institutes in Germany, Bulgaria, USSR and Poland.

Botany: The genus Datura, belonging to the family solanaceae, consists of annual and perennial herbs, shrubs and trees. Three species,viz, Datura metel Linn., D. stramonium Linn. and D. innoxia Mill. are medicinally important. D. innoxia mill. and D. metel Linn. (var. alba, and var, fastuosa) are the choice drug plants, rich in hyoscine. D. metel Linn. is the most common in India. The names, D. metel Linn., D. fastuosa Linn., D. alba Nees., D. fastuosa Linn. var. alba (Nees) C.B. Clarke and D. metel Linn. var. fastuosa (Linn.) Safford are synonymously used by many workers. Two varieties are often noted in D. metel Linn., namely the white flowered var. alba and purple flowered var. fastuosa. D. metel Linn. is an erect succulent branched undershrub divaricate often purplish branches and ovate pubescent leaves which are oblique at the base of lamina. Flowers are large, solitary, short pedicelled, purplish outside and white inside. Fruits are sub-globose capsules covered all over with numerous, fleshy prickles, irregularly breaking when mature. Seeds are numerous, smooth, yellowish brown. (warrier et al, 1994).

Agrotechnology: Datura grows well in a wide range of climate from tropical to temperate conditions.

The plant thrives best in areas of low rainfall where winter and monsoon rains are followed by long dry periods. Areas with annual rainfall below 1000mm with mean temperature of 10-15oC in winter and 27 - 28oC in May-June are ideal. The crop cannot stand frost, high rainfall or high temperature in the plains in May-June. It grows on majority of soils, however, alkaline or neutral clay loam soil or those tending to saline-alkaline reaction rich in organic matter are ideal for vigorous growth. The clayey, acidic, water-logged or moisture deficient soils do not suit this crop.

The plant is propagated by seeds but it is characterised by poor and often erratic seed germination which can be improved either by leaching out the inhibitor from the seeds or by alternate freezing and thawing of seeds. The optimum season for raising the crop is Rabi in tropical and subtropical areas while Kharif in temperate areas. The seeds can be broadcast - sown or seedlings can be raised in nursery and then transplanted. Seed rate is 7-8 kg/ha for broadcasting and 2-3 kg/ha. for transplanting. The field is ploughed and disced adequately to produce fine seed bed. In the case of direct seeding, seeds are drilled in rows taken 45-60 cm apart. The plants are thinned to keep a spacing of 30-45 cm at the time of first weeding. In the case of transplanting 4-6 weeks old seedlings are planted at 45-60 x 30-45 cm spacing. The field should be irrigated immediately after sowing or planting if soil moisture is inadequate. Thereafter 3-4 irrigations may be given if sufficient rainfall is not received. Application of organic manure at 10-15 t/ha and fertilisers at 60:40:40 kg N, P2O5 and K2O/ha is recommended for the crop for better growth and yield N may be applied in 3-4 equal split doses at planting and after each weeding which is required 2-3 times during the growing season. Application of micronutrients is reported to improve the alkaloid contents. No major insect pest is known to attack this crop. However, leaf spot, wilt and mosaic diseases cause damage to this crop. Leaf spot is caused by Alternaria tennuissima (Nees) Wiltshire and characterised by brown round to oval spots, becoming necrotic at later stage which leads to withering and dropping of leaves. Wilt is caused by Sclerotium rolfsii Sace; it starts with dropping of leaves and finally wilting of the entire plant. Root and foot wilt, caused by Corticium solani, appears as damping off of seedlings and mature plants. Datura distortion mosaic is characterised by yellowing of the veins followed by inward rolling and distortion of leaves with a reduction in plant size. For reducing the impact of these diseases, field sanitation, use of resistant varieties, crop rotation for 3-4 years and fungicide application should be resorted to. For the purpose of leaf and top, harvesting is done as soon as flowering starts. Entire top containing leaves and twigs is cut, dried in shade and stored in gunny bags. For seed and fruit, fully grown fruits, still green are picked 2-3 times before final harvest when the entire plant is cut from the base and dried in the open. The dried fruits are then thrashed with a stick to separate the seeds. The seed yield is 1-1.5 t/ha. (Husain, 1993; Kaul and Singh, 1995)

Properties and activity: The alkaloids hyoscyamine and hyoscine (scopolamine) and meteloidine are found in all parts of the plant. The total alkaloid content is 0.26 - 0.42 % Fruits contain daturaolone and daturadiol while roots contain additionally ditigloyloxy tropane derivatives, tigloidine, apohyoscine, norhyoscine, norhyocyamine, cusiohygrine and tropine. Other alkaloids isolated from the plant are apohyoscyamine, DL-scopolamine, normeteloidine, tigloylputrescine, scopine, nortigloidine, tropine, psuedo valeroidine, fastudine, fastunine, fastusinine, 7-hydroxy-3, 6-ditigloyloxytropane (2) datura nolone and fastusic acid. The physiological effects of hyoscyamine are qualitatively the same as those of its recemic derivative atropine. This is relatively more active in its paralysing affect on nerve endings and less active in its stimulant action on the central nervous system. The sedative and hypnotic action of hyoscyamine is weaker than that of hyoscine. Atropine has a stimulant action on the central nervous system and depresses the nerve endings to the secretary glands and plain muscles. The plant or the different alkaloids have narcotic, anthelmintic, spasmolytic anaesthetic, sedative, ophthalmic, anticancerous, antitumour, antirheumatic, antiasthmatic, antidiarrhoeal and anticatarrhal activities. (Thakur et al, 1989).... datura

The process of removal of the amino group, NH2, from amino acids not required for building up body PROTEIN. This is carried out mainly in the liver by means of an enzyme, deaminase. The fatty acid residue is either burnt up to yield energy, or is converted into glucose.... deamination

See TEETH, DISORDERS OF – Caries of the teeth.... decay, dental

The unit of hearing. One decibel is the least intensity of sound at which a given note can be heard. The usual abbreviation for decibel is dB.... decibel

The soft coat which lines the interior of the womb during pregnancy and which is cast o? at birth.... decidua

If deaths from accidents are excluded, this term means the unexpected death of an apparently healthy person. CARDIAC ARREST is the most common cause of sudden death. Older people (35 years or above) who suffer cardiac arrest commonly have coronary artery disease (see HEART, DISEASES OF) with restriction or stoppage of blood supply to part of the heart which causes INFARCTION (heart attack). Irregularity of the heartbeat (cardiac ARRHYTHMIA) is another cause. MYOCARDITIS, PNEUMONIA and STROKE can also result in sudden death, as can ASTHMA, anaphylactic shock (see ANAPHYLAXIS), ruptured aortic ANEURYSM and SUICIDE, the incidence of which is rising, especially among young people, and is over 4,000 a year in the UK.

Sudden death sometimes occurs in infants, usually in the ?rst year of life: this is called SUDDEN INFANT DEATH SYNDROME (SIDS) or, colloquially, cot death, the possible causes of which are an ongoing subject for research and debate.

When a person dies unexpectedly the event must be reported to a CORONER, who has the power to decide whether an AUTOPSY is necessary.... death, sudden

The failure of the heart to maintain full and adequate circulation.... decompensation

Decubitus refers to the positions taken up in bed by patients suffering from various conditions such as pneumonia, PERITONITIS, or severe exhaustion. Such patients are liable to develop bed sores, or decubitus ulcer (see ULCER).... decubitus

Any point in the nervous system at which nerve ?bres cross from one side to the other: for example, the decussation of the pyramidal tracts in the medulla (see BRAIN), where the motor ?bres from one side of the brain cross to the other side of the spinal cord.... decussation

Opening the bowels. (See CONSTIPATION; DIARRHOEA.)... defaecation

An umbrella description for a wide variety of conditions in which there is increased deterioration of the structure or function (or both) of the body. Ageing causes a steady degeneration of many tissues and organs – for example, wrinkling of the skin, CATARACT and poor neuromuscular coordination. In degenerative disorders the changes occur earlier in life. The nervous system, muscles, arteries, joints and eyes are all susceptible. Specialised tissues are replaced by CONNECTIVE TISSUE. The commonest example in the nervous system is ALZHEIMER’S DISEASE, which causes dementia; while in HUNTINGTON’S CHOREA, a genetic disorder, dementia is accompanied by incoordination of movements.... degenerative disorders

Deglutition means the act of swallowing. (See CHOKING.)... deglutition

Delhi boil is a form of chronic body sore occurring in Eastern countries, caused by a protozoan parasite, Leishmania tropica. (See LEISHMANIASIS.)... delhi boil

Behaviour by a young person that would be judged a crime if carried out by an adult. Delinquency may also include non-criminal activities – for example, running away from home, missing school lessons, drug or alcohol abuse, and unruly behaviour in public places. Delinquency is now a serious social problem in the UK, especially in deprived areas, and it is increasingly accompanied by alcohol and drug abuse.... delinquency

(Greek) A petite woman; half Demie, Demee, Demy, Demey, Demye, Demia, Demiana, Demiane, Demianne, Demianna, Demiann, Demea, Demeah... demi

Interruption of the nerve supply to an organ or other structure.... denervation

1 The lower portion of a fraction used to calculate a rate or ratio. In a rate, the denominator is usually the population at risk. 2 For a performance measure, the sample of cases that will be observed (e.g. the number of patients discharged alive with a confirmed diagnosis of acute myocardial infarction, excluding patients with bleeding or other specified conditions). See “numerator”.... denominator

Decay of teeth... dental caries

See TEETH, DISORDERS OF.... dental emergencies

See DENTAL SURGEON.... dentist

Substances which remove or lessen objectionable odours. Some, which have a powerful odour, simply cover other smells, but the most e?ective act by giving o? oxygen, so as to convert the objectionable substances into simple and harmless ones.

Varieties Volatile oils of plants, such as eucalyptus and turpentine, chlorine water and chlorinated lime, peroxide of hydrogen and charcoal have been used as deodorants. There are now many commercial products available.... deodorants

Dermabrasion, or ‘skin planing’, is a method of removing the super?cial layers of the skin, useful in the treatment of tattoos and acne scars.... dermabrasion

Dermatoglyphics is the study of the patterns made by the ridges and crevices of the hands and the soles of the feet.... dermatoglyphics

In essence, this is the study of the skin. As well as being an organ in its own right, the skin is a stage on which other organs as well as the emotions most visibly play out their roles. Changes in its blood vessels – and hence blood ?ow through the skin – may indicate a major immunological response to a range of potential factors (see SKIN, DISEASES OF).... dermatology

(1) Embryological tissue which has developed from the somites to become the dermis and subcutaneous tissue. The cutaneous area that is derived from each dermatome is supplied by a single dorsal spinal nerve root.

(2) A surgical instrument for removing very thin slices of skin for grafting.... dermatome

Mould fungi belonging to the genera Microsporum, Trichophyton or Epidermophyton. Cause tinea or ringworm.... dermatophyte

An intramuscular injection of a drug that gives a slow, steady release of its active chemicals into the bloodstream. Release of the drug is slowed by the inclusion of substances such as oil or wax. The release of the active drug can be made to last for hours, days, or weeks.

A depot injection is useful for patients who may not take their medication correctly.

It also prevents the necessity of giving a series of injections over a short period.

Hormonal contraceptives (see contraception, hormonal methods of), corticosteroid drugs, and antipsychotic drugs may be given by depot injection.

Side effects may arise due to the uneven release of the drug into the bloodstream.... depot injection

A term used if a baby or young child has not achieved new abilities within the normal time range. Normally, new abilities and new patterns of behaviour appear at given ages, and existing patterns of behaviour change and sometimes disappear (see child development).

Delays vary in severity and may affect the development of hand–eye coordination, walking, listening, language, speech, or social interaction. Delay may first be noticed by parents or detected during a routine developmental check.

There are many causes of developmental delay. A child who is late in most aspects of development usually has a generalized problem. This may be due to severe visual or hearing impairment, limited intellectual abilities (see learning difficulties), or damage to the brain before, during, or after birth.

Specific areas of delay may occur in movement and walking. Often there is no serious cause. However, specific causes may include muscular dystrophy and spina bifida. Delay in developing manipulative skills is often due to lack of adequate stimulation.

A lack of response to sound may be due to deafness. Autism is a rare cause of unresponsiveness to the human voice although hearing is normal. A hearing problem may cause delayed speech. Twins are often late talkers. Any generalized difficulty with muscle control can affect speech production; this may occur in children with cerebral palsy. Damage to, or structural defects of, the speech muscles, larynx (voice box), or mouth may also cause speech difficulties, as may any disorder affecting the speech area of the brain (see aphasia; dysarthria; dysphonia; speech disorders). Delay in bladder and bowel control have many possible causes (see encopresis; enuresis; soiling).

A child who shows signs of developmental delay should undergo a full assessment by a paediatrician.... developmental delay

A synthetic form of the female sex hormone oestrogen, occasionally used to treat prostate cancer (see prostate, cancer of) and, in postmenopausal women only, breast cancer. Common side effects include nausea, oedema, and breast enlargement (gynaecomastia) in men.... diethylstilbestrol

A division, such as a finger or toe, located at the end of a limb.... digit

(1) A muscle that lowers or ?attens a part of the body.

(2) The name given to a nerve by whose stimulation motion, secretion, or some other function is restrained or prevented: for example, the depressor nerve of the heart slows the beating of this organ.... depressor

A group of chemical substances produced illegally whose properties and effects are similar to those of drugs of abuse. They may be derived from narcotic ANALGESICS, AMPHETAMINES or HALLUCINOGENS. Ecstasy is a widely used designer drug and has caused deaths among teenagers. Designer drugs are potentially dangerous, especially if taken with alcohol.... designer drugs

The scaling-o? of the super?cial layer of the epidermis (see SKIN).... desquamation

Separation of the retina from the choroid in the EYE. It may be due to trauma or be secondary to tumour or in?ammation of the choroid, and causes blindness in the affected part of the retina. It can be treated surgically using PHOTOCOAGULATION.... detached retina

Variation from normal. Often used to describe unusual sexual behaviour.... deviance

Scabiosa succisa. N.O. Compositae.

Synonym: Ofbit.

Habitat: Heaths and pastures.

Features ? Stem up to eighteen inches, slender, hairy, well-branched. Leaves opposite, oval-lanceolate, slightly serrate, nearly sessile ; root leaves stalked, ovoid, smooth at margins. Flowers dark purple, on long stalk, florets bunched together.

The common name is derived from the root. which appears to have been bitten off at the end, with which vandalism "the devil" is credited.

Part used ? Herb.

Action: Demulcent, diaphoretic.

Included in formulae for coughs and feverish conditions generally. A 1 ounce to 1 pint infusion may be taken warm in wineglassful doses frequently.... devil's bit

The name given to a group of polysaccharides ?rst discovered in sugar-beet preparations which had become infected with certain bacteria. A homogenous preparation of dextran, with a consistent molecular weight and free from PROTEIN, is in appropriate clinical circumstances used as a substitute for plasma for TRANSFUSION purposes. Dextran is often used as an immediate transfusion measure to treat severe bleeding or certain types of shock until properly cross-matched blood is available. A blood sample for cross-matching must be taken before intravenous dextran is given.... dextran

Properly diabetes mellitus, it is a disease characterized by high blood sugar levels and sugar in the urine. Diabetes is really several disorders, generally broken down into juvenile onset and adult onset. The first, currently called insulin-dependent diabetes mellitus (IDDM or Type I), is somewhat hereditary, and results from inadequate synthesis of native insulin or sometimes from auto-immunity or a virus, and occurs most frequently in tissue-types HLA, DR3, and DR4. These folks tend to be lean. The other main group is known as non-insulin-dependent diabetes mellitus (NIDDM or Type II). It is caused by a combination of heredity, constitution, and lifestyle, where high blood sugar and high blood fats often occur at the same time, and where hyperglycemic episodes have continued for so many years that fuel-engorged cells start to refuse glucose, and the person is termed insulin resistant. These folks are usually overweight, tend to have fatty plaques in their arteries, and usually have chunky parents.... diabetes

The diaphragm is the thin, dome-shaped muscular partition which separates the cavity of the abdomen from that of the chest. It is of great importance in respiration, playing the chief part in ?lling the lungs. During deep respiration its movements are responsible for 60 per cent of the total amount of air breathed, and in the horizontal posture, or in sleep, an even greater percentage.

The description ‘diaphragm’ is also used for the hemispherical rubber (‘dutch’) cap used in conjunction with a chemical spermicide as a contraceptive. It ?ts over the neck of the uterus (cervix) inside the vagina. (See CONTRACEPTION.)... diaphragm

A mixture of enzymes obtained from malt. These enzymes have the property of converting starch into sugar. Diastase is used in the preparation of predigested starchy foods, and in the treatment of DYSPEPSIA, particularly that due to inability to digest starch adequately. It is also used for the conversion of starch to fermentable sugars in the brewing and fermentation industries.... diastase

The term applied to symmetrical CONJOINED TWINS with two separate heads.... dicephalus

Skin test used to determine the immune s tatus to scarlet fever.... dick test

A condition in which the PULSE occurs as a beat each time the heart contracts. A dicrotic wave is naturally present in a tracing of any pulse as recorded by an instrument for the purpose, but in health it is imperceptible to the ?nger. In fevers, a dicrotic pulse is a serious sign in which the heart continues to beat violently while the small blood vessels have lost their tone.... dicrotism

Didanosine (ddI, DDI) is a nucleoside reverse transcriptase inhibitor used to treat progressive or advanced HIV infection (see AIDS/HIV). Preferably it should be given in combination with other antiretroviral drugs. This drug has a range of potentially serious side-effects such as pancreatitis (see PANCREAS, DISEASES OF), peripheral NEUROPATHY, DIABETES MELLITUS and liver failure. Its use requires monitoring and patients taking it should receive counselling.... didanosine

An e?ective insecticide toxic to a wide range of insects. It attacks the insects’ nervous system and is more toxic to humans than DDT (see DICHLORODIPHENYL TRICHLOROETHANE), so must therefore be handled with care. Its use in the UK is restricted.... dieldrin

Part of the forebrain (see BRAIN).... diencephalon

A list of the possible diagnoses that might explain a patient’s symptoms and signs, and from which the correct DIAGNOSIS will be extracted after further investigations.... differential diagnosis

Improving digestion... digestive

The right of individuals to be treated with respect as persons in their own right.... dignity

See DOCUSATE SODIUM.... dioctyl sodium sulphosuccinate

A widely used antihistamine (see ANTIHISTAMINE DRUGS) with sedative effects.... diphenhydramine

A group of spherical bacterial organisms which usually occur in pairs: for example, pneumococci. (See BACTERIA.)... diplococcus

The layer of spongy bone which intervenes between the compact outer and inner tables of the skull.... diploë

An adjective describing cells, nuclei or organisms in which every chromosome – apart from the Y sex one – is represented twice.... diploid

The term applied to a FETUS which has two faces instead of one.... diprosopus

The amputation of a bone by cutting through the joint of which the bone forms a part.... disarticulation

An anatomical term describing a rounded ?attened structure. Examples are the cartilagenous disc positioned between two vertebrae (see SPINAL COLUMN) and the optic disc (see EYE).... disc

Removing tumours... discutient

The destruction of insect pests, especially lice, whether on the person or in dwelling-places.... disinfestation

A term used in psychological medicine to describe the mental process of attaching to one object, painful emotions associated with another object.... displacement

See MULTIPLE SCLEROSIS (MS).... disseminated sclerosis

A psychiatric term describing the process whereby an individual separates his or her ideas and thoughts from consciousness, thus allowing them to function independently. The result may be that the individual holds contrary views on the same subject.... dissociation

A collection of psychological disorders in which a particular mental function becomes cut o? from a person’s mind. Hysterical AMNESIA is one example, when the person forgets his or her personal history but can still absorb and talk about new events. Other examples are FUGUE, depersonalisation (detachment from self and environment), and MULTIPLE PERSONALITY DISORDER.... dissociative disorder

Injuries to joints of such a nature that the ends of the opposed bones are forced more or less out of connection with one another. Besides displacement of the bones, there is bruising of the tissues around them, and tearing of the ligaments which bind the bones together.

Dislocations, like fractures (see BONE, DISORDERS OF), are divided into simple and compound, the bone in the latter case being forced through the skin. This seldom occurs, since the round head of the bone has not the same power to wound as the sharp end of a broken bone. Dislocations are also divided according to whether they are (1) congenital, i.e. present at birth in consequence of some malformation, or (2) acquired at a later period in consequence of injury, the great majority falling into the latter class. The reduction of a dislocated joint is a skilled procedure and should be done by an appropriately trained professional.... dislocations

An increase in the production of urine. This may result from increased ?uid intake, decreased levels of antidiuretic hormone, renal disease, or the use of drugs (see DIURETICS).... diuresis

Substances which increase urine and solute production by the KIDNEYS. They are used in the treatment of heart failure, HYPERTENSION, and sometimes for ASCITES secondary to liver failure. They may work by extra-renal or renal mechanisms.

The potential side-effects of diuretics are HYPOKALAEMIA, DEHYDRATION, and GOUT (in susceptible individuals).

Extra-renal mechanisms (a) Inhibiting release of antidiuretic hormone (e.g. water, alcohol); (b) increased renal blood ?ow (e.g. dopamine in renal doses).

Renal mechanisms (a) Osmotic diuretics act by ‘holding’ water in the renal tubules and preventing its reabsorption (e.g. mannitol); (b) loop diuretics prevent sodium, and therefore water, reabsorption (e.g. FRUSEMIDE); (c) drugs acting on the cortical segment of the Loop of Henle prevent sodium reabsorption, but are ‘weaker’ than loop diuretics (e.g. THIAZIDES); (d) drugs acting on the distal tubule prevent sodium reabsorption by retaining potassium

(e.g. spironalactone).... diuretics

A pouch or pocket leading o? a main cavity or tube. The term is especially applied to protrusions from the intestine, which may be present either at the time of birth as a developmental peculiarity, or which develop in numbers upon the large intestine during the course of life.... diverticulum

Two people born at the same time to the same parents after fertilisation of two separate oöcytes (see OÖCYTE). They may be of di?erent sexes and are no more likely to resemble each other than any other sibling pairs.... dizygotic twins

See LEAD POISONING – Treatment.... dmsa

A cardiac stimulant drug of the inotropic sympathomimetic group (see SYMPATHOMIMETIC DRUGS), dobutamine acts on sympathetic receptors in cardiac muscle, increasing the contractility and hence improving the cardiac output but with little e?ect on the cardiac rate. It is particularly useful in cardiogenic shock. It must be given by intravenous infusion. (See also HEART.)... dobutamine

A member of the group of antitumour drugs known as TAXANES, docetaxel is used to treat advanced or metastatic cancer arising in the breast (see BREASTS, DISEASES OF). It is also used to treat non-small cancer of the LUNGS. The NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (NICE) has recommended that both docetaxel and PACLITAXEL should be available for the treatment of advanced breast cancer where initial anticancer CHEMOTHERAPY (including one of the ANTHRACYCLINES) has failed or is inappropriate.... docetaxel

The academic title granted to someone who has a university degree higher than a master’s degree. Some UK universities grant a medical doctorate (MD) for a research thesis of approved standard. In Britain, ‘doctor’ is also the title given to a quali?ed medical practitioner registered by the General Medical Council, usually after he or she has obtained a bachelor’s degree or a diploma in medicine and surgery. In the UK a doctor has to spend a year of supervised practice in a recognised hospital post before he or she is registered as fully quali?ed, but specialists have to obtain further training and higher quali?cations before they can be accredited and therefore practise as specialists in the NHS. General practitioners must complete a three-year vocational training course before practising as an independent GP. In Britain, surgical specialists are customarily addressed as ‘Mr’. Other countries have di?erent regulations.... doctor

A faecal-softening agent used to treat constipation in old people. It can be given orally or as a rectal suppository.... docusate sodium

Distichiasis is the term applied to the condition in which there are two complete rows of eyelashes in one eyelid (or in both).... distichiasis

The frequency and pattern of health-related characteristics and events in a population.... distribution

A drug used for the symptomatic treatment of mild to moderate DEMENTIA only in ALZHEIMER’S DISEASE. Around four in ten patients may bene?t by a reduction in the rate of cognitive and non-cognitive deterioration.... donepezil

Use of the SEMEN of an anonymous donor to produce fertilisation in cases of INFERTILITY where the male partner has OLIGOSPERMIA or IMPOTENCE. The donor is chosen for ethnic and physiognomic similarity to the male partner and is screened for transmissible diseases

(e.g. HIV, syphilis, hepatitis, gonorrhoea, and genetic disorders). Insemination is performed at the time of ovulation by introducing the semen into the upper vagina. Semen may be fresh or have been stored frozen in liquid nitrogen. (See ARTIFICIAL INSEMINATION.)... donor insemination

A precursor of DOPAMINE and NORADRENALINE. Levodopa is a drug used in the treatment of PARKINSONISM. It can cross the blood–brain barrier and increase the concentration of dopamine in the basal ganglia. It also inhibits prolactin secretion and may be used to treat GALACTORRHEA.... dopa

(Adjective: dorsal.) The back or posterior part of an organ or structure. The dorsum of the hand is the opposite surface to the palm.... dorsum

A carbonic anhydrase-inhibitor drug restricted to use in patients with raised intraocular pressure in ocular hypertension or open-angle GLAUCOMA. It can be used alone or as an adjunct to a topical beta blocker (see BETA-ADRENOCEPTOR-BLOCKING DRUGS).... dorzolamide

Dracontiasis, or dracunculiasis, is a nematode infection caused by Dracunculus medinensis (guinea-worm). The major clinical problem is secondary infection of the worm track, causing CELLULITIS, SYNOVITIS, epididymo-ORCHITIS, periarticular FIBROSIS, and ARTHRITIS; TETANUS is a potentially lethal complication. CHEMOTHERAPY is unsatisfactory and the time-honoured method of extracting the female adult by winding it around a matchstick remains in use. Surgical treatment may be necessary. Ultimate prevention consists of removing Cyclops spp. from drinking water.... dracontiasis

Many factors in?uence the activity with which drugs operate. Among the factors which affect the necessary quantity are age, weight, sex, idiosyncrasy, genetic disorders, habitual use, disease, fasting, combination with other drugs, the form in which the drug is given, and the route by which it is given.

Normally, a young child requires a smaller dose than an adult. There are, however, other factors than age to be taken into consideration. Thus, children are more susceptible than adults to some drugs such as MORPHINE, whilst they are less sensitive to others such as ATROPINE. The only correct way to calculate a child’s dose is by reference to texts supplying a recommended dose in milligrams per kilogram. However, many reference texts simply quote doses for certain age-ranges.

Old people, too, often show an increased susceptibility to drugs. This is probably due to a variety of factors, such as decreased weight; diminished activity of the tissues and therefore diminished rate at which a drug is utilised; and diminished activity of the KIDNEYS resulting in decreased rate of excretion of the drug.

Weight and sex have both to be taken into consideration. Women require slightly smaller doses than men, probably because they tend to be lighter in weight. The e?ect of weight on dosage is partly dependent on the fact that much of the extra weight of a heavy individual is made up of fatty tissue which is not as active as other tissues of the body. In practice, the question of weight seldom makes much di?erence unless the individual is grossly over- or underweight.

Idiosyncrasy occasionally causes drugs administered in the ordinary dose to produce unexpected effects. Thus, some people are but little affected by some drugs, whilst in others, certain drugs – for example, psychoactive preparations such as sedatives – produce excessive symptoms in normal or even small doses. In some cases this may be due to hypersensitivity, or an allergic reaction, to the drug, which is a possibility that must always be borne in mind

(e.g. with PENICILLIN). An individual who is known to be allergic to a certain medication is strongly advised to carry a card to this e?ect, and always to inform medical and dental practitioners and/or a pharmacist before accepting a new prescription or buying an over-the-counter preparation.

Habitual use of a drug is perhaps the in?uence that causes the greatest increase in the dose necessary to produce the requisite e?ect. The classical example of this is with OPIUM and its derivatives.

Disease may modify the dose of medicines. This can occur in several ways. Thus, in serious illnesses the patient may be more susceptible to drugs, such as narcotics, that depress tissue activity, and therefore smaller doses must be given. Again, absorption of the drug from the gut may be slowed up by disease of the gut, or its e?ect may be enhanced if there is disease of the kidneys, interfering with the excretion of the drug.

Fasting aids the rapidity of absorption of drugs, and also makes the body more susceptible to their action. Partly for this reason, as well as to avoid irritation of the stomach, it is usual to prescribe drugs to be taken after meals, and diluted with water.

Combination of drugs is to be avoided if possible as it is often di?cult to assess what their combined e?ect may be. In some cases they may have a mutually antagonistic e?ect, which means that the patient will not obtain full bene?t. Sometimes a combination may have a deleterious e?ect.

Form, route and frequency of administration Drugs are now produced in many forms, though tablets are the most common and, usually, convenient. In Britain, medicines are given by mouth whenever possible, unless there is some degree of urgency, or because the drug is either destroyed in, or is not absorbed from, the gut. In these circumstances, it is given intravenously, intra-muscularly or subcutaneously. In some cases, as in cases of ASTHMA or BRONCHITIS, the drug may be given in the form of an inhalant (see INHALANTS), in order to get the maximum concentration at the point where it is wanted: that is, in the lungs. If a local e?ect is wanted, as in cases of diseases of the skin, the drug is applied topically to the skin. In some countries there is a tendency to give medicines in the form of a suppository which is inserted in the rectum.

Recent years have seen developments whereby the assimilation of drugs into the body can be more carefully controlled. These include, for example, what are known as transdermals, in which drugs are built into a plaster that is stuck on the skin, and the drug is then absorbed into the body at a controlled rate. This method is now being used for the administration of GLYCERYL TRINITRATE in the treatment of ANGINA PECTORIS, and of hyoscine hydrobromide in the treatment of MOTION (TRAVEL) SICKNESS. Another is a new class of implantable devices. These are tiny polymers infused with a drug and implanted just under the skin by injection. They can be tailored so as to deliver drugs at virtually any rate – from minutes to years. A modi?cation of these polymers now being investigated is the incorporation of magnetic particles which allow an extra burst of the incorporated drug to be released in response to an oscillating magnetic ?eld which is induced by a magnetic ‘watch’ worn by the patient. In this way the patient can switch on an extra dose of drug when this is needed: insulin, for instance, in the case of diabetics. In yet another new development, a core of drug is enclosed in a semi-permeable membrane and is released in the stomach at a given rate. (See also LIPOSOMES.)... dosage

A drug used in the treatment of depression, particularly when the patient needs sedation. (See ANTIDEPRESSANT DRUGS.)... dothiepin

See SLEEP.... dreams

Another term for sickle-cell anaemia (see ANAEMIA), which is characterised by the presence in the blood of red blood corpuscles that are sickle-like in shape. The anaemia is a severe one and a?icts black people and to a lesser extent people of Mediterranean background.... drepanocytosis

See WOUNDS.... dressings

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

See ALCOHOL; DEPENDENCE.... drunkenness

An X-linked recessive disorder (that is, the abnormal gene is carried on the X chromosome). This means that the disease occurs almost exclusively in males, as its presence in a female is counteracted by the normal gene likely to be in her other X chromosome. The disorder is characterised by progressive muscular weakness and wasting. It is the most common form of muscular dystrophy, ocurring in 30 per 100,000 live male births, often – but not always – in families with other members having the disorder.

The disease usually appears within the ?rst three years of life, beginning in the pelvic girdle and lower limbs and later spreading to the shoulder girdle. The calf muscles become bulky (pseudohypertrophy). The weakness gives rise to a characteristic waddling gait and, when rising from the supine position, the child rolls on to his face and then uses his arms to push himself up. Death usually occurs by the middle of the second decade from respiratory infections. Prenatal screening of female carriers using gene probes is increasingly available. (See DYSTROPHY; MUSCLES, DISORDERS OF – Myopathy.)... duchenne muscular dystrophy

Any one of certain glands in the body the secretion of which goes directly into the bloodstream and so is carried to di?erent parts of the body. These glands – the pituitary, thyroid, parathyroid, adrenal and reproductive – are also known as the ENDOCRINE GLANDS. Some glands may be both duct glands and ductless glands. For example, the PANCREAS manufactures a digestive juice which passes by a duct into the small intestine. It also manufactures, by means of special cells, a substance called INSULIN which passes straight into the blood.... ductless gland

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

The outermost and strongest of the three membranes or meninges which envelop the brain and spinal cord. In it run vessels which nourish the inner surface of the skull. (See BRAIN.)... dura mater

An elliptical ring of steel to which is attached a dial and moving index. It is used to test the strength of the muscles of the forearm, being squeezed in the hand, and registering the pressure in pounds or kilograms.... dynamometer

Constipation due to retention of FAECES in the rectum. This retention is the outcome of irregular habits, which damp down the normal re?ex causing defaecation.... dyschezia

Presently a term referring to inadequate synthesis of blood proteins by the liver, especially clotting factors. Formerly the term described an improper balance between blood and lymph in an organ or a whole person. Archaically, it referred to an imbalance between the four humors: blood, phlegm, yellow bile, and the postulated black bile.... dyscrasia

A type of muscular dystrophy (see MUSCLES, DISORDERS OF) in which the affected person has weakness and wasting of the muscles, particularly those in the face and neck. Other effects are CATARACT, ptosis (see EYE, DISORDERS OF), baldness and malfunctioning of the endocrine system (see ENDOCRINE GLANDS). Both sexes may be affected by this inherited disorder.... dystrophia myotonica

Arcus senilis The white ring or crescent which tends to form at the edge of the cornea with age. It is uncommon in the young, when it may be associated with high levels of blood lipids (see LIPID).

Astigmatism (See ASTIGMATISM.)

Blepharitis A chronic in?ammation of the lid margins. SEBORRHOEA and staphylococcal infection are likely contributors. The eyes are typically intermittently red, sore and gritty over months or years. Treatment is di?cult and may fail. Measures to reduce debris on the lid margins, intermittent courses of topical antibiotics, steroids or systemic antibiotics may help the sufferer.

Blepharospasm Involuntary closure of the eye. This may accompany irritation but may also occur without an apparent cause. It may be severe enough to interfere with vision. Treatment involves removing the source of irritation, if present. Severe and persistent cases may respond to injection of Botulinum toxin into the orbicularis muscle.

Cataract A term used to describe any opacity in the lens of the eye, from the smallest spot to total opaqueness. The prevalence of cataracts is age-related: 65 per cent of individuals in their sixth decade have some degree of lens opacity, while all those over 80 are affected. Cataracts are the most important cause of blindness worldwide. Symptoms will depend on whether one or both eyes are affected, as well as the position and density of the cataract(s). If only one eye is developing a cataract, it may be some time before the person notices it, though reading may be affected. Some people with cataracts become shortsighted, which in older people may paradoxically ‘improve’ their ability to read. Bright light may worsen vision in those with cataracts.

The extent of visual impairment depends on the nature of the cataracts, and the ?rst symptoms noticed by patients include di?culty in recognising faces and in reading, while problems watching television or driving, especially at night, are pointers to the condition. Cataracts are common but are not the only cause of deteriorating vision. Patients with cataracts should be able to point to the position of a light and their pupillary reactions should be normal. If a bright light is shone on the eye, the lens may appear brown or, in advanced cataracts, white (see diagram).

While increasing age is the commonest cause of cataract in the UK, patients with DIABETES MELLITUS, UVEITIS and a history of injury to the eye can also develop the disorder. Prolonged STEROID treatment can result in cataracts. Children may develop cataracts, and in them the condition is much more serious as vision may be irreversibly impaired because development of the brain’s ability to interpret visual signals is hindered. This may happen even if the cataracts are removed, so early referral for treatment is essential. One of the physical signs which doctors look for when they suspect cataract in adults as well as in children is the ‘red re?ex’. This is observable when an ophthalmoscopic examination of the eye is made (see OPHTHALMOSCOPE). Identi?cation of this red re?ex (a re?ection of light from the red surface of the retina –see EYE) is a key diagnostic sign in children, especially young ones.

There is no e?ective medical treatment for established cataracts. Surgery is necessary and the decision when to operate depends mainly on how the cataract(s) affect(s) the patient’s vision. Nowadays, surgery can be done at any time with limited risk. Most patients with a vision of 6/18 – 6/10 is the minimum standard for driving – or worse in both eyes should

E

bene?t from surgery, though elderly people may tolerate visual acuity of 6/18 or worse, so surgery must be tailored to the individual’s needs. Younger people with a cataract will have more demanding visual requirements and so may opt for an ‘earlier’ operation. Most cataract surgery in Britain is now done under local anaesthetic and uses the ‘phaco-emulsi?cation’ method. A small hole is made in the anterior capsule of the lens after which the hard lens nucleus is liqui?ed ultrasonically. A replacement lens is inserted into the empty lens bag (see diagram). Patients usually return to their normal activities within a few days of the operation. A recent development under test in the USA for children requiring cataract operations is an intra-ocular ?exible implant whose magnifying power can be altered as a child develops, thus precluding the need for a series of corrective operations as happens now.

Chalazion A ?rm lump in the eyelid relating to a blocked meibomian gland, felt deep within the lid. Treatment is not always necessary; a proportion spontaneously resolve. There can be associated infection when the lid becomes red and painful requiring antibiotic treatment. If troublesome, the chalazion can be incised under local anaesthetic.

Conjunctivitis In?ammation of the conjunctiva (see EYE) which may affect one or both eyes. Typically the eye is red, itchy, sticky and gritty but is not usually painful. Redness is not always present. Conjunctivitis can occasionally be painful, particularly if there is an associated keratitis (see below) – for example, adenovirus infection, herpetic infection.

The cause can be infective (bacteria, viruses or CHLAMYDIA), chemical (e.g. acids, alkalis) or allergic (e.g. in hay fever). Conjunctivitis may also be caused by contact lenses, and preservatives or even the drugs in eye drops may cause conjunctival in?ammation. Conjunctivitis may addtionally occur in association with other illnesses – for example, upper-respiratory-tract infection, Stevens-Johnson syndrome (see ERYTHEMA – erythema multiforme) or REITER’S SYNDROME. The treatment depends on the cause. In many patients acute conjunctivitis is self-limiting.

Dacryocystitis In?ammation of the lacrimal sac. This may present acutely as a red, painful swelling between the nose and the lower lid. An abscess may form which points through the skin and which may need to be drained by incision. Systemic antibiotics may be necessary. Chronic dacryocystitis may occur with recurrent discharge from the openings of the tear ducts and recurrent swelling of the lacrimal sac. Obstruction of the tear duct is accompanied by watering of the eye. If the symptoms are troublesome, the patient’s tear passageways need to be surgically reconstructed.

Ectropion The lid margin is everted – usually the lower lid. Ectropion is most commonly associated with ageing, when the tissues of the lid become lax. It can also be caused by shortening of the skin of the lids such as happens with scarring or mechanical factors – for example, a tumour pulling the skin of the lower lid downwards. Ectropion tends to cause watering and an unsightly appearance. The treatment is surgical.

Entropion The lid margin is inverted – usually the lower lid. Entropion is most commonly associated with ageing, when the tissues of the lid become lax. It can also be caused by shortening of the inner surfaces of the lids due to scarring – for example, TRACHOMA or chemical burns. The inwardly directed lashes cause irritation and can abrade the cornea. The treatment is surgical.

Episcleritis In?ammation of the EPISCLERA. There is usually no apparent cause. The in?ammation may be di?use or localised and may affect one or both eyes. It sometimes recurs. The affected area is usually red and moderately painful. Episcleritis is generally not thought to be as painful as scleritis and does not lead to the same complications. Treatment is generally directed at improving the patient’s symptoms. The in?ammation may respond to NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) or topical CORTICOSTEROIDS.

Errors of refraction (Ametropia.) These will occur when the focusing power of the lens and cornea does not match the length of the eye, so that rays of light parallel to the visual axis are not focused at the fovea centralis (see EYE). There are three types of refractive error: HYPERMETROPIA or long-sightedness. The refractive power of the eye is too weak, or the eye is too short so that rays of light are brought to a focus at a point behind the retina. Longsighted people can see well in the distance but generally require glasses with convex lenses for reading. Uncorrected long sight can lead to headaches and intermittent blurring of vision following prolonged close work (i.e. eye strain). As a result of ageing, the eye becomes gradually long-sighted, resulting in many people needing reading glasses in later life: this normal process is known as presbyopia. A particular form of long-sightedness occurs after cataract extraction (see above). MYOPIA(Short sight or near sight.) Rays of light are brought to a focus in front of the retina because the refractive power of the eye is too great or the eye is too short. Short-sighted people can see close to but need spectacles with concave lenses in order to see in the distance. ASTIGMATISMThe refractive power of the eye is not the same in each meridian. Some rays of light may be focused in front of the retina while others are focused on or behind the retina. Astigmatism can accompany hypermetropia or myopia. It may be corrected by cylindrical lenses: these consist of a slice from the side of a cylinder (i.e. curved in one meridian and ?at in the meridian at right-angles to it).

Keratitis In?ammation of the cornea in response to a variety of insults – viral, bacterial, chemical, radiation, or mechanical trauma. Keratitis may be super?cial or involve the deeper layers, the latter being generally more serious. The eye is usually red, painful and photophobic. Treatment is directed at the cause.

Nystagmus Involuntary rhythmic oscillation of one or both eyes. There are several causes including nervous disorders, vestibular disorders, eye disorders and certain drugs including alcohol.

Ophthalmia In?ammation of the eye, especially the conjunctiva (see conjunctivitis, above). Ophthalmia neonatorum is a type of conjunctivitis that occurs in newborn babies. They catch the disease when passing through an infected birth canal during their mother’s labour (see PREGNANCY AND LABOUR). CHLAMYDIA and GONORRHOEA are the two most common infections. Treatment is e?ective with antibiotics: untreated, the infection may cause permanent eye damage.

Pinguecula A benign degenerative change in the connective tissue at the nasal or temporal limbus (see EYE). This is visible as a small, ?attened, yellow-white lump adjacent to the cornea.

Pterygium Overgrowth of the conjunctival tissues at the limbus on to the cornea (see EYE). This usually occurs on the nasal side and is associated with exposure to sunlight. The pterygium is surgically removed for cosmetic reasons or if it is thought to be advancing towards the visual axis.

Ptosis Drooping of the upper lid. May occur because of a defect in the muscles which raise the lid (levator complex), sometimes the result of ageing or trauma. Other causes include HORNER’S SYNDROME, third cranial nerve PALSY, MYASTHENIA GRAVIS, and DYSTROPHIA MYOTONICA. The cause needs to be determined and treated if possible. The treatment for a severely drooping lid is surgical, but other measures can be used to prop up the lid with varying success.

Retina, disorders of The retina can be damaged by disease that affects the retina alone, or by diseases affecting the whole body.

Retinopathy is a term used to denote an abnormality of the retina without specifying a cause. Some retinal disorders are discussed below. DIABETIC RETINOPATHY Retinal disease occurring in patients with DIABETES MELLITUS. It is the commonest cause of blind registration in Great Britain of people between the ages of 20 and 65. Diabetic retinopathy can be divided into several types. The two main causes of blindness are those that follow: ?rst, development of new blood vessels from the retina, with resultant complications and, second, those following ‘water logging’ (oedema) of the macula. Treatment is by maintaining rigid control of blood-sugar levels combined with laser treatment for certain forms of the disease – in particular to get rid of new blood vessels. HYPERTENSIVE RETINOPATHY Retinal disease secondary to the development of high blood pressure. Treatment involves control of the blood pressure (see HYPERTENSION). SICKLE CELL RETINOPATHY People with sickle cell disease (see under ANAEYIA) can develop a number of retinal problems including new blood vessels from the retina. RETINOPATHY OF PREMATURITY (ROP) Previously called retrolental ?broplasia (RLF), this is a disorder affecting low-birth-weight premature babies exposed to oxygen. Essentially, new blood vessels develop which cause extensive traction on the retina with resultant retinal detachment and poor vision. RETINAL ARTERY OCCLUSION; RETINAL VEIN OCCLUSION These result in damage to those areas of retina supplied by the affected blood vessel: the blood vessels become blocked. If the peripheral retina is damaged the patient may be completely symptom-free, although areas of blindness may be detected on examination of ?eld of vision. If the macula is involved, visual loss may be sudden, profound and permanent. There is no e?ective treatment once visual loss has occurred. SENILE MACULAR DEGENERATION (‘Senile’ indicates age of onset and has no bearing on mental state.) This is the leading cause of blindness in the elderly in the western world. The average age of onset is 65 years. Patients initially notice a disturbance of their vision which gradually progresses over months or years. They lose the ability to recognise ?ne detail; for example, they cannot read ?ne print, sew, or recognise people’s faces. They always retain the ability to recognise large objects such as doors and chairs, and are therefore able to get around and about reasonably well. There is no e?ective treatment in the majority of cases. RETINITIS PIGMENTOSAA group of rare, inherited diseases characterised by the development of night blindness and tunnel vision. Symptoms start in childhood and are progressive. Many patients retain good visual acuity, although their peripheral vision is limited. One of the characteristic ?ndings on examination is collections of pigment in the retina which have a characteristic shape and are therefore known as ‘bone spicules’. There is no e?ective treatment. RETINAL DETACHMENTusually occurs due to the development of a hole in the retina. Holes can occur as a result of degeneration of the retina, traction on the retina by the vitreous, or injury. Fluid from the vitreous passes through the hole causing a split within the retina; the inner part of the retina becomes detached from the outer part, the latter remaining in contact with the choroid. Detached retina loses its ability to detect light, with consequent impairment of vision. Retinal detachments are more common in the short-sighted, in the elderly or following cataract extraction. Symptoms include spots before the eyes (?oaters), ?ashing lights and a shadow over the eye with progressive loss of vision. Treatment by laser is very e?ective if caught early, at the stage when a hole has developed in the retina but before the retina has become detached. The edges of the hole can be ‘spot welded’ to the underlying choroid. Once a detachment has occurred, laser therapy cannot be used; the retina has to be repositioned. This is usually done by indenting the wall of the eye from the outside to meet the retina, then making the retina stick to the wall of the eye by inducing in?ammation in the wall (by freezing it). The outcome of surgery depends largely on the extent of the detachment and its duration. Complicated forms of detachment can occur due to diabetic eye disease, injury or tumour. Each requires a specialised form of treatment.

Scleritis In?ammation of the sclera (see EYE). This can be localised or di?use, can affect the anterior or the posterior sclera, and can affect one or both eyes. The affected eye is usually red and painful. Scleritis can lead to thinning and even perforation of the sclera, sometimes with little sign of in?ammation. Posterior scleritis in particular may cause impaired vision and require emergency treatment. There is often no apparent cause, but there are some associated conditions – for example, RHEUMATOID ARTHRITIS, GOUT, and an autoimmune disease affecting the nasal passages and lungs called Wegener’s granulomatosis. Treatment depends on severity but may involve NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), topical CORTICOSTEROIDS or systemic immunosuppressive drugs.

Stye Infection of a lash follicle. This presents as a painful small red lump at the lid margin. It often resolves spontaneously but may require antibiotic treatment if it persists or recurs.

Sub-conjunctival haemorrhage Haemorrhage between the conjunctiva and the underlying episclera. It is painless. There is usually no apparent cause and it resolves spontaneously.

Trichiasis Inward misdirection of the lashes. Trichiasis occurs due to in?ammation of or trauma to the lid margin. Treatment involves removal of the patient’s lashes. Regrowth may be prevented by electrolysis, by CRYOTHERAPY to the lid margin, or by surgery.

For the subject of arti?cial eyes, see under PROSTHESIS; also GLAUCOMA, SQUINT and UVEITIS.... eye, disorders of

An indexed computer or printed source that provides information, in the form of guidelines for diagnosis, treatment and care indications, about older persons, or other authoritative information (for example, a computer database on drug indications, contraindications and interactions).... factual database

As a result of ANAEMIA, interference with blood or nerve supply, or because of the action of various poisons, body cells may undergo abnormal changes accompanied by the appearance in their substance of fat droplets.... fatty degeneration

See ROUGHAGE.... fibre, dietary

A group of drugs, also known as thrombolytics, with the ability to break down the protein FIBRIN, the prime constituent of blood clots (see THROMBUS; THROMBOSIS). They are used to disperse blood clots that have formed in the vessels of the circulatory system. The group includes STREPTOKINASE, alteplase and reteplase. The drugs work by activating PLASMINOGEN to form PLASMIN which degrades ?brin and breaks up the blood clot (see COAGULATION).... fibrinolytic drugs

A congenital disorder in which the rectum, and sometimes the lower part of the colon, lack the ganglion cells that control the intestine’s rhythmic contractions. The affected area becomes narrowed and blocks the movement of faecal material.

The disease is rare and tends to run in families. It occurs about 4 times more often in boys. Symptoms, which include constipation and bloating, usually develop in the first few weeks of life, but may become evident in infancy or early childhood. The child usually has a poor appetite and may fail to grow properly.

A barium X-ray examination can show the narrowed segment of the intestine.

A biopsy may be taken.

Treatment of Hirschsprung’s disease involves removing the narrowed segment and rejoining the normal intestine to the anus.... hirschsprung’s disease

See IUD.... intrauterine contraceptive device

The most common type of motor neuron disease; also known as amyotrophic lateral sclerosis.... lou gehrig’s disease

One of a group of proteins that are combined with lipids in the plasma. Low density lipoproteins (LDLs) are involved in the transport of

cholesterol in the bloodstream. An excess of LDLs (see hyperlipidaemias) is associated with atherosclerosis. (See also high density lipoprotein.)... low density lipoprotein

See CYSTIC FIBROSIS.... fibrocystic disease of the pancreas

A rare disease in which areas of bone are replaced by ?brous tissue (see CONNECTIVE TISSUE). This renders the bone fragile and liable to fracture. It may involve only one bone – usually the thigh bone or FEMUR – or several bones. This latter form of the disease may be accompanied by pigmentation of the skin and the early onset of PUBERTY.... fibrous dysplasia

A technique for ?xating specimens of tissue, involving a minimum of chemical and physical alteration. The histological specimen is immersed in a chemical, isopentane, which has been cooled in liquid air to a temperature just below 200 °C. This preserves the tissue instantly without large ice crystals forming – these would result in structural damage. The specimen is then dehydrated in a vacuum for three days, after which it can be examined using a MICROSCOPE.... freeze drying

A complete summary of the frequencies of the values or categories of a variable. Often displayed in a two-column table: the left column lists the individual values or categories, the right column indicates the number of observations in each category.... frequency distribution

A statutory body set up by the Dentists Act which maintains a register of dentists (see DENTAL SURGEON), promotes high standards of dental education, and oversees the professional conduct of dentists. Membership comprises elected and appointed dentists and appointed lay members. Like other councils responsible for registering health professionals, the General Dental Council now comes under the umbrella of the new Council for Regulatory Excellence, a statutory body. (See APPENDIX 7: STATUTORY ORGANISATIONS.)... general dental council

See DENTAL SURGEON.... general dental services

A medicinal drug that is sold under its o?cial (generic) name instead of its proprietary (patented brand) name. NHS doctors are advised to prescribe generic drugs where possible as this enables any suitable drug to be dispensed, saving delay to the patient and sometimes expense to the NHS. (See APPROVED NAMES FOR MEDICINES.)... generic drug

These are caused when there are mutations or other abnormalities which disrupt the code of a gene or set of GENES. These are divided into autosomal (one of the 44 CHROMOSOMES which are not sex-linked), dominant, autosomal recessive, sex-linked and polygenic disorders.

Dominant genes A dominant characteristic is an e?ect which is produced whenever a gene or gene defect is present. If a disease is due to a dominant gene, those affected are heterozygous – that is, they only carry a fault in the gene on one of the pair of chromosomes concerned. A?ected people married to normal individuals transmit the gene directly to one-half of the children, although this is a random event just like tossing a coin. HUNTINGTON’S CHOREA is due to the inheritance of a dominant gene, as is neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE) and familial adenomatous POLYPOSIS of the COLON. ACHONDROPLASIA is an example of a disorder in which there is a high frequency of a new dominant mutation, for the majority of affected people have normal parents and siblings. However, the chances of the children of a parent with the condition being affected are one in two, as with any other dominant characteristic. Other diseases inherited as dominant characteristics include spherocytosis, haemorrhagic telangiectasia and adult polycystic kidney disease.

Recessive genes If a disease is due to a recessive gene, those affected must have the faulty gene on both copies of the chromosome pair (i.e. be homozygous). The possession of a single recessive gene does not result in overt disease, and the bearer usually carries this potentially unfavourable gene without knowing it. If that person marries another carrier of the same recessive gene, there is a one-in-four chance that their children will receive the gene in a double dose, and so have the disease. If an individual sufferer from a recessive disease marries an apparently normal person who is a heterozygous carrier of the same gene, one-half of the children will be affected and the other half will be carriers of the disease. The commonest of such recessive conditions in Britain is CYSTIC FIBROSIS, which affects about one child in 2,000. Approximately 5 per cent of the population carry a faulty copy of the gene. Most of the inborn errors of metabolism, such as PHENYLKETONURIA, GALACTOSAEMIA and congenital adrenal hyperplasia (see ADRENOGENITAL SYNDROME), are due to recessive genes.

There are characteristics which may be incompletely recessive – that is, neither completely dominant nor completely recessive – and the heterozygotus person, who bears the gene in a single dose, may have a slight defect whilst the homozygotus, with a double dose of the gene, has a severe illness. The sickle-cell trait is a result of the sickle-cell gene in single dose, and sickle-cell ANAEMIA is the consequence of a double dose.

Sex-linked genes If a condition is sex-linked, affected males are homozygous for the mutated gene as they carry it on their single X chromosome. The X chromosome carries many genes, while the Y chromosome bears few genes, if any, other than those determining masculinity. The genes on the X chromosome of the male are thus not matched by corresponding genes on the Y chromosome, so that there is no chance of the Y chromosome neutralising any recessive trait on the X chromosome. A recessive gene can therefore produce disease, since it will not be suppressed by the normal gene of the homologous chromosome. The same recessive gene on the X chromosome of the female will be suppressed by the normal gene on the other X chromosome. Such sex-linked conditions include HAEMOPHILIA, CHRISTMAS DISEASE, DUCHENNE MUSCULAR

DYSTROPHY (see also MUSCLES, DISORDERS OF – Myopathy) and nephrogenic DIABETES INSIPIDUS.

If the mother of an affected child has another male relative affected, she is a heterozygote carrier; half her sons will have the disease and half her daughters will be carriers. The sister of a haemophiliac thus has a 50 per cent chance of being a carrier. An affected male cannot transmit the gene to his son because the X chromosome of the son must come from the mother; all his daughters, however, will be carriers as the X chromosome for the father must be transmitted to all his daughters. Hence sex-linked recessive characteristics cannot be passed from father to son. Sporadic cases may be the result of a new mutation, in which case the mother is not the carrier and is not likely to have further affected children. It is probable that one-third of haemophiliacs arise as a result of fresh mutations, and these patients will be the ?rst in the families to be affected. Sometimes the carrier of a sex-linked recessive gene can be identi?ed. The sex-linked variety of retinitis pigmentosa (see EYE, DISORDERS OF) can often be detected by ophthalmoscopic examination.

A few rare disorders are due to dominant genes carried on the X chromosome. An example of such a condition is familial hypophosphataemia with vitamin-D-resistant RICKETS.

Polygenic inheritance In many inherited conditions, the disease is due to the combined action of several genes; the genetic element is then called multi-factorial or polygenic. In this situation there would be an increased incidence of the disease in the families concerned, but it will not follow the Mendelian (see MENDELISM; GENETIC CODE) ratio. The greater the number of independent genes involved in determining a certain disease, the more complicated will be the pattern of inheritance. Furthermore, many inherited disorders are the result of a combination of genetic and environmental in?uences. DIABETES MELLITUS is the most familiar of such multi-factorial inheritance. The predisposition to develop diabetes is an inherited characteristic, although the gene is not always able to express itself: this is called incomplete penetrance. Whether or not the individual with a genetic predisposition towards the disease actually develops diabetes will also depend on environmental factors. Diabetes is more common in the relatives of diabetic patients, and even more so amongst identical twins. Non-genetic factors which are important in precipitating overt disease are obesity, excessive intake of carbohydrate foods, and pregnancy.

SCHIZOPHRENIA is another example of the combined effects of genetic and environmental in?uences in precipitating disease. The risk of schizophrenia in a child, one of whose parents has the disease, is one in ten, but this ?gure is modi?ed by the early environment of the child.... genetic disorders

See THYROID GLAND, DISEASES OF.... graves’ disease

A hospital unit equipped and sta?ed to nurse patients who require a high level of technically supported care. Patients are usually moved to such units when they have made satisfactory progress in an INTENSIVE THERAPY UNIT (ITU) and do not require the one-to-one nursing necessary in ITUs. Patients who have undergone major surgery are often transferred from the recovery ward to a high dependency unit until they are well enough to be cared for in a standard ward.... high dependency unit

A form of ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) found in premature infants and some of those born by CAESAREAN SECTION, characterised by the onset of di?culty in breathing a few hours after birth. Most require extra oxygen and many need mechanical ventilation for a few days or even weeks. Recovery is the rule, although the most severely affected may die or suffer damage from oxygen lack. In this condition the ALVEOLITIS and the ?ner BRONCHIOLES of the lungs are lined with a dense membrane. The cause of the condition is a de?ciency of SURFACTANT in the lung passages which adversely affects gas exchanges in the alveoli.

Treatment includes the full gamut of neonatal intensive care, as well as speci?c therapy with PULMONARY SURFACTANT.... hyaline membrane disease

Disease induced by a physician: most commonly a drug-induced disease.... iatrogenic disease

This contains such an excess of fats that acetone and other KETONE bodies appear in the urine. The diet is sometimes used in the treatment of EPILEPSY and chronic infections of the urinary tract by Escherichia coli; butter, cream, eggs and fat meat are allowed, whilst sugar, bread and other carbohydrates are cut out as far as possible.... ketogenic diet

A large, ?at, triangular muscle in the back.... latissimus dorsi

Manic depression, or CYCLOTHYMIA, is a form of MENTAL ILLNESS characterised by alternate attacks of mania and depression.... manic depression

Obstruction of the larynx is potentially dangerous in adults but can sometimes be life-threatening in infants and children. Stridor – noisy, di?cult breathing – is a symptom of obstruction. There are several causes, including congenital abnormalities of the larynx. Others are in?ammatory conditions such as acute laryngitis (see below), acute EPIGLOTTITIS and laryngo-tracheo-bronchitis (croup – see below); neurological abnormalities; trauma; and inhalation of foreign bodies.

Laryngitis In?ammation of the mucous membrane of the larynx and vocal chords may be acute or chronic. The cause is usually an infection, most commonly viral, although it may be the result of secondary bacterial infection, voice abuse or irritation by gases or chemicals. ACUTE LARYNGITIS may accompany any form of upper-respiratory-tract infection. The main symptom is hoarseness and often pain in the throat. The voice becomes husky or it may be lost. Cough, breathing diffculties and sometimes stridor may occur. Acute airway obstruction is unusual following laryngitis but may occasionally occur in infants (see laryngotracheo-bronchitis, below).

Treatment Vapour inhalations may be soothing and reduce swelling. Usually all that is needed is rest and analgesics such as paracetamol. Rarely, airway intervention – either ENDOTRACHEAL INTUBATION or TRACHEOSTOMY – may be necessary if severe airway obstruction develops (see APPENDIX 1: BASIC FIRST AID). A?ected patients should rest their voice and avoid smoking.

Chronic laryngitis can result from repeated attacks of acute laryngitis; excessive use of the voice – loud and prolonged, singing or shouting; tumours, which may be benign or malignant; or secondary to diseases such as TUBERCULOSIS and SYPHILIS.

Benign tumours or small nodules, such as singer’s nodules, may be surgically removed by direct laryngoscopy under general anaesthetic; while cancer of the larynx may be treated either by RADIOTHERAPY or by SURGERY, depending on the extent of the disease. Hoarseness may be the only symptom of vocal-chord disturbance or of laryngeal cancer: any case which has lasted for six weeks should be referred for a specialist opinion.

Laryngectomy clubs are being established

A laryngoscopic view of the interior of the larynx.

throughout the country to support patients following laryngectomy. Speech therapists provide speech rehabilitation.... larynx, disorders of

The individual with this psychiatric disorder has two or more di?erent personalities, often contrasting. The dominant personality at the time determines the behaviour and attitude of the individual, who customarily seems not to know about the other personality – or personalities. The switch from one personality to another is abrupt and the mental condition of the di?ering personalities is usually normal. It is possible that child abuse is a factor in the disorder, which is treated by psychotherapy. The classic multiple personality was the ?ctional form of Dr Jekyll and Mr Hyde.... multiple personality disorder

Congenital abnormalities resulting from the failure of the NEURAL TUBE to form normally. The resulting conditions include SPINA BIFIDA, MENINGOCELE and defects in the bones of the SKULL.... neural tube defects

The symmetrical clustering of values around a central location. The properties of a normal distribution include: (1) it is a continuous, symmetrical distribution: both tails extend to infinity; (2) the arithmetic mean, mode and median are identical; and (3) its shape is completely determined by the mean and standard deviation.... normal distribution

An infectious or other disease required to be notified to the relevant State Government Authorityfor entry onto the Notifiable Diseases Register.... notifiable disease

A mental-health problem which will be experienced at some time by up to 3 per cent of adults. The main feature is the occurrence of spontaneous intrusive thoughts that cause intense anxiety. Many of these thoughts prompt urges, or compulsions, to carry out particular actions in order to reduce the anxiety. One of the commonest obsessions is a fear of dirt and contamination that prompts compulsive cleaning or repeated and unnecessary handwashing. (See MENTAL ILLNESS.)... obsessive compulsive disorder

A collection of disorders in which some part of the body’s internal chemistry (see METABOLISM; CATABOLISM) is disrupted. Some of these disorders arise from inherited de?ciencies in which a speci?c ENZYME is absent or abnormal, or does not function properly. Other metabolic disorders occur because of malfunctions in the endocrine system (see ENDOCRINE GLANDS). There may be over- or underproduction of a hormone involved in the control of metabolic activities: a prime example is DIABETES MELLITUS – a disorder of sugar metabolism; others include CUSHING’S SYNDROME; hypothyroidism and hyperthyroidism (see THYROID GLAND, DISEASES OF); and insulinoma (an insulin-producing tumour of the pancreas). The bones can be affected by metabolic disorders such as osteoporosis, osteomalacia (rickets) and Paget’s disease (see under BONE, DISORDERS OF). PORPHYRIAS, HYPERLIPIDAEMIA, HYPERCALCAEMIA and gout are other examples of disordered metabolism.

There are also more than 200 identi?ed disorders described as inborn errors of metabolism. Some cause few problems; others are serious threats to an individual’s life. Individual disorders are, fortunately, rare – probably one child in 10,000 or 100,000; overall these inborn errors affect around one child in 1,000. Examples include GALACTOSAEMIA, PHENYLKETONURIA, porphyrias, TAY SACHS DISEASE and varieties of mucopolysaccharidosis, HOMOCYSTINURIA and hereditary fructose (a type of sugar) intolerance.... metabolic disorders

A disease that started as, or became, impairment of structure or tissue. The smoker may have coughing and shortness of breath for years, and suffer from functional disorders; when the smoker gets emphysema, it is an organic disease.... organic disease

See PAGET’S DISEASE OF BONE.... osteitis deformans

A group of disorders of unknown origin. Certain cells in the neurological system’s MOTOR nerves degenerate and die. Upper and lower motor neurones may be affected but sensory cells retain their normal functions. Three types of MND are identi?ed: amyotrophic lateral sclerosis (AML – 50 per cent of patients); progressive muscular atrophy (25 per cent), in which the prognosis is better than for AML; and bulbar palsy (25 per cent). Men are affected more than women, and the disorder affects about seven people in every 100,000. Those affected develop progressive weakness and wasting of their muscles. The diagnosis is con?rmed with various tests including the measurement of electrical activity in muscles, electromyography, muscle BIOPSY, blood tests and X-ray examination of the spine. There is no medical treatment: patients need physical and psychological support with aids to help them overcome disabilities. The Motor Neurone Disease Association provides excellent advice and help for sufferers and their relatives. (See APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP.)... motor neurone disease (mnd)

See PSITTACOSIS.... parrot disease

Facilitation of the drainage of secretions from dilated bronchi of the LUNGS. The patient lies on an inclined plane, head downwards, and is encouraged to cough up as much secretion from the lungs as possible. The precise position depends on which part of the lungs is affected. It may need to be carried out for up to three hours daily in divided periods. It is of particular value in BRONCHIECTASIS and lung abscess (see LUNGS, DISEASES OF).... postural drainage

A collection of industrial diseases which provide those with a disease legal entitlement to welfare bene?ts. Examples are DEAFNESS from excessive noise in the workplace; ANTHRAX from farming; PNEUMOCONIOSIS from industrially generated dust (coal mining); and LEAD POISONING from the handling of chemicals. (See also OCCUPATIONAL HEALTH, MEDICINE AND DISEASES.)... prescribed diseases

A government-initiated, countrywide, telephone-based helpline which enables members of the public with a potential emergency or inquiry about health to receive counselling over the telephone. They can then be advised on the most appropriate course of action: perhaps an urgent visit to the nearest Accident & Emergency department, a non-urgent visit to the general practitioner, or even self-medication. The intention is to reduce the high workloads of GPs and A&E departments without endangering patients. NHS Direct is expected to be enhanced to provide:

links to community pharmacies and social services.

access to NHS Direct information via the Internet and information points in public sites.

publication of a guide on health care for dispatch to callers.... nhs direct

A radiological technique for detecting osteoporosis (see BONE, DISORDERS OF) in which a beam of X-rays is directed at the bone-area under investigation – normally the spine and hip – and the CALCIUM density measured. If the calcium content is low, preventive treatment can be started to reduce the likelihood of fractures occurring.... quantitative digital radiography

See MEIOSIS.... reduction division

A graph in which each dot represents paired values for two continuous variables, with the X axis representing one variable and the Y axis representing the other; used to display the relationship between two variables; also called a scattergram.... scatter diagram

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

The narrowing of the blood vessels in the legs and, less commonly, in the arms. Blood ?ow is restricted, with pain occurring in the affected area. If the blood supply is seriously reduced, GANGRENE of the tissues supplied by the affected vessel(s) may occur and the limb may need to be amputated. The common cause is ATHEROSCLEROSIS which may be brought on by HYPERTENSION, excessively fatty diet, poorly controlled DIABETES MELLITUS or smoking – the latter being the biggest risk factor, with 90 per cent of affected patients having been moderate to heavy smokers. Stopping smoking is essential; adequate exercise and a low-fat diet are important measures. Surgery may be required.... peripheral vascular disease

Condition in which the individual fails to learn from experience or to adapt to changes. The outcome is impaired social functioning and personal distress. There are three broad overlapping groups. One group is characterised by eccentric behaviour with paranoid or schizoid overtones. The second group shows dramatic and emotional behaviour with self-centredness and antisocial behaviour as typical components of the disorder. In the third group, anxiety and fear are the main characteristics, which are accompanied by dependency and compulsive behaviour. These disorders are not classed as illnesses but psychotherapy and behavioural therapy may help. The individuals affected are notoriously resistant to any help that is o?ered, tending to blame other people, circumstances or bad luck for their persistent diffculties. (See MENTAL ILLNESS; MULTIPLE PERSONALITY DISORDER; MUNCHAUSEN’S SYNDROME.)... personality disorder

A condition of the hip in children, due to death and fragmentation of the epiphysis (or spongy extremity) of the head of the femur. The cause is not known. The disease occurs in the 4–10 year age-group, with a peak between the ages of six and eight; it is ten times more common in boys than girls, and is bilateral in 10 per cent of cases. The initial sign is a lurching gait with a limp, accompanied by pain. Treatment consists of limiting aggressive sporting activity which may cause intact overlying CARTILAGE to loosen. Where there are no mechanical symptoms and MRI scanning shows that the cartilage is intact, only minor activity modi?cation may be necesssary – but for several months or even years. Any breach in the cartilage is dealt with at ARTHROSCOPY by ?xing or trimming any loose ?aps. Eventually the disease burns itself out.... perthes’ disease

A rare condition in which wasting of the skin and the bones, IMPOTENCE, and loss of hair (ALOPECIA) occur as a result of destruction of the PITUITARY GLAND.... simmonds’ disease

The popular name for a PROLAPSED INTERVERTEBRAL DISC. (See also SPINAL COLUMN; SCIATICA.)... slipped disc

The SPINAL COLUMN is built up of a series of bones, known as vertebrae, placed one upon the other. Between these vertebrae lies a series of thick discs of ?bro-cartilage known as intervertebral discs. Each disc consists of an outer portion known as the anulus ?brosus, and an inner core known as the nucleus pulposus. The function of these discs is to give ?exibility and resiliency to the spinal column and to act as bu?ers against undue jarring. In other words, they are most e?cient shock-absorbers. They may, however, PROLAPSE, or protrude, between the two adjacent vertebrae. If this should happen they press on the neighbouring spinal nerve and cause pain. As the most common sites of protrusion are between the last two lumbar vertebrae and between the last lumbar vertebra and the sacrum, this means that the pain occurs in the back, causing LUMBAGO, or down the course of the sciatic nerve causing SCIATICA. The prolapse is most likely to occur in middle age, which suggests that it may be associated with degeneration of the disc involved, but it can occur in early adult life as well. It usually occurs when the individual is performing some form of exercise which involves bending or twisting, as in gardening. The onset of pain may be acute and sudden, or gradual and more chronic in intensity. (See also INTERVERTEBRAL DISC.)

Treatment varies, depending (amongst other things) on the severity of the condition. In the acute phase, rest in bed is advisable, along with ANALGESICS. Later, exercise and physiotherapy are helpful, and in some cases manipulation of the spine brings relief by allowing the herniated, or prolapsed, disc to slip back into position. The injection of a local anaesthetic into the spine (epidural ANAESTHESIA) is yet another measure that often helps the more chronic cases. If those measures fail, surgery to remove the prolapsed disc may be necessary, but the patient’s condition should be carefully reviewed before surgery is considered since success is not certain. An alternative form of treatment is the injection into the disc of chymopapain, an ENZYME obtained from the paw-paw, which dissolves the disc.... prolapsed intervertebral disc

A degenerative condition of the SPINAL CORD which most commonly occurs as a complication of PERNICIOUS ANAEMIA. The motor and sensory nerves in the cord are damaged, causing spasticity of the limbs and an unsteady gait. Treatment is with vitamin B12 (see APPENDIX 5: VITAMINS).... subacute combined degeneration of the cord

An inherited recessive condition in which there is abnormal accumulation of lipids (see LIPID) in the BRAIN. The result is blindness, mental retardation and death in early childhood. The disease can usually be prevented by genetic counselling in those communities in which the disease is known to occur.... tay sachs disease

A commonly used device for measuring people’s exposure to RADIATION. It contains activated sodium ?uoride which luminesces in proportion to the radiation dose to which it is exposed.... thermoluminescent dosimeter

Thought is a mental activity by which people reason, solve problems, form judgements and communicate with each other by speech, writing and behaviour. Disturbances of thought are re?ected in how a person communicates: the normal logic of thought is broken up and a person may randomly move from one subject to another. SCHIZOPHRENIA is a mental illness characterised by thought disorder. Confusion, DEMENTIA, DEPRESSION and MANIA are other conditions in which thought disorders may be a marked feature. (See also MENTAL ILLNESS.)... thought disorders

This may occur in adults as ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS), or in newborn children, when it is also known as HYALINE MEMBRANE DISEASE. The adult syndrome consists of PULMONARY OEDEMA of non-cardiac origin. The process begins when tissue damage stimulates the autonomic nervous system, releases vasoactive substances, precipitates complement activation, and produces abnormalities of the clotting cascade – the serial process that leads to clotting of the blood (see COAGULATION). The activation of complement causes white cells to lodge in the pulmonary capillaries where they release substances which damage the pulmonary endothelium.

Respiratory distress syndrome is a complication of SHOCK, systemic SEPSIS and viral respiratory infections. It was ?rst described in 1967, and – despite advances with assisted ventilation

– remains a serious disease with a mortality of more than 50 per cent. The maintenance of adequate circulating blood volume, peripheral PERFUSION, acid-base balance and arterial oxygenation is important, and assisted ventilation should be instituted early.

In newborns the mechanism is diferent, being provoked by an inability of the lungs to manufacture SURFACTANT.... respiratory distress syndrome

A drug that increases the amount of URIC ACID excreted in the URINE. Among the drugs used are PROBENECID or a sulfa derivative. Uricosurics are used to treat GOUT and other disorders which cause raised blood-uric-acid concentrations.... uricosuric drug

See SEXUALLY TRANSMITTED DISEASES (STDS).... venereal diseases

The list of disorders resulting in poor or dim vision is huge. Disturbance of vision can result from an uncorrected refractive error, disease or injury of the cornea, iris, lens, vitreous, retina, choroid or sclera of the EYE. It may also result from disease or injury to the structures comprising the visual pathway from the retina to the occipital cortex (see VISION – Pathway of light from the eye to the brain) and from lesions of the structures around the eye – for example, swollen lids, drooping eyelids. (See EYE, DISORDERS OF.)... vision, disorders of

Inadequate sexual response may be due to a lack of sexual desire (LIBIDO) or to an inadequate performance; or it may be that there is a lack of satisfaction or ORGASM. Lack of sexual desire may be due to any generalised illness or endocrine disorder, or to the taking of drugs that antagonise endocrine function (see ENDOCRINE GLANDS). Disorders of performance in men can occur during arousal, penetration and EJACULATION. In the female, DYSPAREUNIA and VAGINISMUS are the main disorders of performance. DIABETES MELLITUS can cause a neuropathy which results in loss of erection. IMPOTENCE can follow nerve damage from operations on the PROSTATE GLAND and lower bowel, and can be the result of neurological diseases affecting the autonomic system (see NERVOUS SYSTEM). Disorders of satisfaction include, in men, impotence, emission without forceful ejaculation and pleasureless ejaculation. In women such disorders range from the absence of the congestive genital response to absence of orgasm. Erectile dysfunction in men can sometimes be treated with SILDENAFIL CITRATE (Viagra®), a drug that recent research suggests may also be helpful to women with reduced libido and/or inability to achieve orgasm.

Sexual dysfunction may be due to physical or psychiatric disease, or it may be the result of the administration of drugs. The main group of drugs likely to cause sexual problems are the ANTICONVULSANTS, the ANTIHYPERTENSIVE DRUGS, and drugs such as metoclopramide that induce HYPERPROLACTINAEMIA. The benzodiazepine TRANQUILLISERS can reduce libido and cause failure of erection. Tricyclic ANTIDEPRESSANT DRUGS may cause failure of erection and clomipramine may delay or abolish ejaculation by blockade of alpha-adrenergic receptors. The MONOAMINE OXIDASE INHIBITORS (MAOIS) often inhibit ejaculation. The PHENOTHIAZINES reduce sexual desire and arousal and may cause di?culty in maintaining an erection. The antihypertensive drug, methyldopa, causes impotence in over 20 per cent of patients on large doses. The beta-adrenoceptorblockers and the DIURETICS can also cause impotence. The main psychiatric causes of sexual dysfunction include stress, depression and guilt.... sexual dysfunction

Epidemic jaundice. A severe form of leptospirosis caused by such serovars as Leptospira icterrohaemorrhagiae.... weil’s disease

These may be of physical or psychological origin – or a combination of both. Di?culties may arise at various stages of development: due to problems during pregnancy; at birth; caused by childhood illnesses; or as a result of delayed development. Congenital defects such as CLEFT PALATE or lip may make speech unintelligible until major surgery is performed, thus discouraging talking and delaying development. Recurrent ear infections may make hearing dif?cult; the child’s experience of speech is thus limited, with similar results. Childhood DYSPHASIA occurs if the language-development area of the BRAIN develops abnormally; specialist education and SPEECH THERAPY may then be required.

Dumbness is the inability to pronounce the sounds that make up words. DEAFNESS is the most important cause, being due to a congenital brain defect, or acquired brain disease, such as tertiary SYPHILIS. When hearing is normal or only mildly impaired, dumbness may be due to a structural defect such as tongue-tie or enlarged tonsils and adenoids, or to ine?cient voice control, resulting in lisping or lalling. Increased tension is a common cause of STAMMERING; speech disorders may occasionally be of psychological origin.

Normal speech may be lost in adulthood as a result of a STROKE or head injury. Excessive use of the voice may be an occupational hazard; and throat cancer may require a LARYNGECTOMY, with subsequent help in communication. Severe psychiatric disturbance may be accompanied by impaired social and communication skills. (See also VOICE AND SPEECH.)

Treatment The underlying cause of the problem should be diagnosed as early as possible; psychological and other specialist investigations should be carried out as required, and any physical defect should be repaired. People who are deaf and unable to speak should start training in lip-reading as soon as possible, and special educational methods aimed at acquiring a modulated voice should similarly be started in early childhood – provided by the local authority, and continued as required. Various types of speech therapy or PSYCHOTHERAPY may be appropriate, alone or in conjunction with other treatments, and often the ?nal result may be highly satisfying, with a good command of language and speech being obtained.

Help and advice may be obtained from AFASIC (Unlocking Speech and Language).... speech disorders

Another term for a bowel movement to expel wastes from the body. Also applies to a colostomy where faeces are voided through an artificial opening. ... defecation

Treatment same as for irritable bowel or diarrhoea. ... delhi belly

A herb of strong cleaning properties such as Soapwort for use on the skin. Balmony, Southernwood, Marigold, Chickweed, Goldenseal, Daisy. ... detergent

See: FOXGLOVE. ... digitalis

See: REFLUX. ... gastro-oesophageal reflux disease

Technically, those diseases occurring in the area of the globe situated between the Tropic of Cancer and the Tropic of Capricorn: pertaining to the sun. They include many ‘exotic’ infections – many of them parasitic in origin – which fall under the umbrella of ‘TROPICAL MEDICINE’. However, disease in the tropics is far broader than this and includes numerous other infections, many of them with a viral or bacterial basis: for example, the viral hepatidises, streptococcal and pneumococcal infections, and tuberculosis. The prevalence of other diseases, such as rheumatic cardiac disease, cirrhosis, heptocellular carcinoma (‘hepatoma’), and various nutrition-related problems, is also much increased in most areas of the tropics. With people from developed countries increasingly travelling to worldwide destinations for business and holiday, the ‘importation’ of tropical diseases to temperate climates should be borne in mind when people fall ill.

The following diseases and conditions are treated under their separate dictionary entries: ANCYLOSTOMIASIS; BERIBERI; BLACKWATER FEVER; CHOLERA; DENGUE; DRACONTIASIS; DYSENTERY; ELEPHANTIASIS; FILARIASIS; HEAT STROKE; LEISHMANIASIS; LEPROSY; LIVER, DISEASES OF; MALARIA; ORIENTAL SORE; PLAGUE; PRICKLY HEAT; SCHISTOSOMIASIS; SLEEPING SICKNESS; STRONGYLOIDIASIS; SUNBURN; YAWS; YELLOW FEVER.... tropical diseases

The kidneys are responsible for the excretion of many waste products, chiefly urea from the blood. They maintain the correct balance of salts and water. Any of the individual kidney disorders may interfere with these important functions. See: ABSCESS (kidney). BRIGHT’S DISEASE. CARDIAC DROPS. RENAL FLUID RETENTION. GRAVEL. HYDRONEPHROSIS. NEPHROSIS. PROTEINURIA. PYELITIS. RENAL COLIC. RETENTION OF URINE. STONE IN THE KIDNEY. SUPPRESSION OF URINE. URAEMIA. ... kidney disorders

A variety of drugs with di?ering actions are available for the treatment of peptic ulcer, the composite title covering gastric ulcer (see STOMACH, DISEASES OF) and DUODENAL ULCER. Peptic ulceration may also involve the lower OESOPHAGUS, and after stomach surgery the junction of the stomach and small intestine.

The drugs used in combination are:

The receptor antagonists, which reduce the output of gastric acid by histamine H2receptor blockade; they include CIMETIDINE, FAMOTIDINE and RANITIDINE.

ANTIBIOTICS to eradicate Helicobacter pylori infection, a major cause of peptic ulceration. They are usually used in combination with one of the PROTON-PUMP INHIBITORS and include clarithomycin, amoxacillin and metronidazole.

BISMUTH chelates.

The prostaglandin analogue misoprostol has antisecretory and protective properties.

Proton-pump inhibitors omeprazole, lansoprazole, pantaprazole and rabeprazole, all of which inhibit gastric-acid secretion by blocking the proton pump enzyme system.... ulcer healing drugs

Degenerative changes in the growth centres of bones in children due to calcium or other mineral deficiency. Herbs rich in calcium, iron, and magnesium are indicated. (Horsetail, Chamomile, Plantain, Silverweed, Nettles, Mullein, etc)

Selenium 50mcg and Vitamin E 400iu are recommended by Jonathan Wright MD, for decreasing the pain of disease, decreasing over 3 months. (Health Update USA, June 1990) ... osgood schlatter disease

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

(Thromboangiitis obliterans). An inflammatory condition of blood vessels of the legs, tobacco said to be the causative factor. Confined to men, especially Jews.

Symptoms. Intermittent claudication. Affected parts of the leg are much paler than others, the condition regressing to ulceration and possible gangrene. Inflammation of nerves, veins and arteries may lead to clot formation (thrombosis).

Treatment. Stop smoking. Vasodilator herbs.

Alternatives. Cayenne (minute doses), Bayberry, Lime flowers, Lobelia, Prickly Ash, Wahoo bark, Mistletoe, Skullcap, Cactus.

BHP (1983) recommends: Angelica root, Hawthorn berry, Wild Yam.

Decoction. Formula. Equal parts: Hawthorn, Mistletoe, Valerian. 2 teaspoons to two cups water gently simmered 10 minutes. Dose half-1 cup thrice daily, and when necessary.

Tablets/capsules. Alternatives. Prickly Ash 100mg. Hawthorn 200mg. Wild Yam 200mg. Dosage as on bottles.

Powders. Formula. Equal parts: Hawthorn, Wild Yam, Prickly Ash. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Bayberry, Hawthorn, Prickly Ash. Dose: 1-2 teaspoons thrice daily. Practitioner. Tincture Gelsemium BPC (1973). 0.3ml (5 drops) when necessary for relief of pain.

Diet. Low fat, low salt, high fibre.

Supplements. Daily. Vitamin E 1000-1500iu. Vitamin B-complex. Magnesium, Calcium.

Exercise. Physiotherapy exercise. From the sitting position raise legs to horizontal; rest for a few minutes. Lie down and raise legs to 45 degrees; rest for a few minutes. Reverse movements resting each time to equalise the circulation. (Brenda Cooke FNIMH) ... buerger’s disease

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

A psychiatric disorder in which a person suffers intense anxiety about an imagined defect in part of his or her body.... body dysmorphic disorder

A rare skin disorder that sometimes becomes cancerous. A flat, regular-shaped, patch of red, scaly skin forms, most commonly on the face or hands. The diseased skin is removed surgically or destroyed by freezing or cauterization.... bowen’s disease

The irreversible cessation of all functions of the brain, including the brainstem. (See also death.)... brain death

The cause of: coronary occlusion, coronary blockage, coronary thrombosis. A heart attack occurs when a coronary artery becomes blocked by swellings composed, among other things, of cholesterol. Such swellings may obstruct the flow of blood leading to a blood clot (thrombus). Cholesterol is a major cause of CHD.

Coronary thrombosis is more common in the West because of its preference for animal fats; whereas in the East fats usually take the form of vegetable oils – corn, sunflower seed, sesame, etc. Fatty deposits (atheroma) form in the wall of the coronary artery, obstructing blood-flow. Vessels narrowed by atheroma and by contact with calcium and other salts become hard and brittle (arterio-sclerosis) and are easily blocked. Robbed of oxygen and nutrients heart muscle dies and is replaced by inelastic fibrous (scar) tissue which robs the heart of its maximum performance.

Severe pain and collapse follow a blockage. Where only a small branch of the coronary arterial tree is affected recovery is possible. Cause of the pain is lack of oxygen (Vitamin E). Incidence is highest among women over 40 who smoke excessively and who take The Pill.

The first warning sign is breathlessness and anginal pain behind the breastbone which radiates to arms and neck. Sensation as if the chest is held in a vice. First-line agent to improve flow of blood – Cactus.

For cholesterol control target the liver. Coffee is a minor risk factor.

Measuring hair calcium levels is said to predict those at risk of coronary heart disease. Low hair concentrations may be linked with poor calcium metabolism, high aortic calcium build-up and the formation of plagues. (Dr Allan MacPherson, nutritionist, Scottish Agricultural College, Ayr, Scotland)

Evidence has been advanced that a diagonal ear lobe crease may be a predictor for coronary heart disease. (American Journal of Cardiology, Dec. 1992)

Tooth decay is linked to an increased risk of coronary heart disease and mortality, particularly in young men. (Dr Frank De Stefano, Marshfield Medical Research Foundation, Wisconsin, USA) Treatment. Urgency. Send for doctor or suitably qualified practitioner. Absolute bedrest for 3 weeks followed by 3 months convalescence. Thereafter: adapt lifestyle to slower tempo and avoid undue exertion. Stop smoking. Adequate exercise. Watch weight.

Cardiotonics: Motherwort, Hawthorn, Mistletoe, Rosemary. Ephedra, Lily of the Valley, Broom.

Cardiac vasodilators relax tension on the vessels by increasing capacity of the arteries to carry more blood. Others contain complex glycosides that stimulate or relax the heart at its work. Garlic is strongly recommended as a preventative of CHD.

Hawthorn, vasodilator and anti-hypertensive, is reputed to dissolve deposits in thickened and sclerotic arteries BHP (1983). It is believed to regulate the balance of lipids (body fats) one of which is cholesterol.

Serenity tea. Equal parts: Motherwort, Lemon Balm, Hawthorn leaves or flowers. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup freely.

Decoction. Combine equal parts: Broom, Lily of the Valley, Hawthorn. 1-2 teaspoons to each cup water gently simmered 20 minutes. Half-1 cup freely.

Tablets/capsules. Hawthorn, Motherwort, Cactus, Mistletoe, Garlic.

Practitioner. Formula. Hawthorn 20ml; Lily of the Valley 10ml; Pulsatilla 5ml; Stone root 5ml; Barberry 5ml. Tincture Capsicum 1ml. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or honey.

Prevention: Vitamin E – 400iu daily.

Diet. See: DIET – HEART AND CIRCULATION.

Supplements. Daily. Vitamin C, 2g. Vitamin E possesses anti-clotting properties, 400iu. Broad spectrum multivitamin and mineral including chromium, magnesium selenium, zinc, copper.

Acute condition. Strict bed-rest; regulate bowels; avoid excessive physical and mental exertion. Meditation and relaxation techniques dramatically reduce coronary risk. ... coronary heart disease

Another name for glomerulonephritis.... bright’s disease

(CO) A colourless, odourless gas. Carbon dioxide is present in small amounts in the air and is an important by-product of metabolism in cells. It is produced by the breakdown of substances such as carbohydrates and fats to produce energy, and is carried in the blood to the lungs and exhaled. Carbon dioxide helps to control the rate of respiration: when a person exercises, CO2 levels in the blood rise, causing the person to breathe more rapidly in order to expel carbon dioxide and to take in more oxygen.

When it is compressed and cooled to -75ºC, carbon dioxide becomes solid dry ice, which is used in cryosurgery.... carbon dioxide

See pulmonary disease, chronic obstructive.... chronic obstructive pulmonary disease

A compound analgesic containing paracetamol and dihydrocodeine.... co-dydramol

A laxative drug used to treat constipation in the terminally ill who are often constipated as a side effect of opioid analgesic drugs. Dantron may colour the urine red.... dantron

The state of being without a functioning cerebrum, the main controlling part of the brain. It occurs if the brainstem is severed, which effectively isolates the cerebrum.... decerebrate

(DIC) A type of bleeding disorder in which abnormal clotting leads to depletion of coagulation factors in the blood; the consequence may be severe spontaneous bleeding.... disseminated intravascular coagulation

A drug that acts as a deterrent to drinking alcohol.

It is prescribed for people who request help for alcohol dependence.

Treatment is usually combined with a counselling programme.

Disulfiram slows down the clearance of alcohol in the body, causing flushing, headache, nausea, dizziness, and palpitations.

Symptoms may start within 10 minutes of drinking alcohol and can last for hours.

Occasionally, large amounts of alcohol taken during treatment can cause unconsciousness; a person taking the drug should carry a warning card.... disulfiram

See primary teeth.... deciduous teeth

See bedsores.... decubitus ulcer

See thrombosis, deep vein.... deep vein thrombosis

A fixed, irrational idea not shared by others and not responding to reasoned argument. The idea in a paranoid delusion involves persecution or jealousy. For instance, a person may falsely believe that he or she is being poisoned (see paranoia). Persistent delusions are a sign of serious mental illness, most notably schizophrenia and manic–depressive illness. (See also hallucination; illusion.)... delusion

The science or profession concerned with the teeth and their supporting structures. Most dentists work in general dental practice; others practise in a specialized branch of dentistry.

Dentists in general practice undertake all aspects of dental care. They may refer patients to a consultant in one of the specialized branches of dentistry, such as orthodontics, prosthetics, endodontics, and periodontics. Dental hygienists carry out

scaling (removal of calculi) and advise on oral hygiene methods.... dentistry

A state of feeling unreal, in which there is a sense of detachment from self and surroundings.

Depersonalization is often accompanied by derealization.

It is rarely serious and usually comes on suddenly and may last for moments or for hours.

Depersonalization most often occurs in people with anxiety disorders.

Other causes include drugs and temporal lobe epilepsy.... depersonalization

A chemical hair remover, such as barium sulphide, used in the form of a cream or paste for cosmetic reasons and to treat hirsutism.... depilatory

Feeling that the world has become unreal.

It usually occurs together with depersonalization and may be caused by fatigue, hallucinogenic drugs, or disordered brain function.... derealization

The inner layer of the skin.... dermis

A technique, used in behaviour therapy for treating phobias, in which the patient is gradually exposed to the cause of the fear.... desensitization

A growth, usually in the abdominal wall.

The tumour is hard, with a well-defined edge.

The tumours occur most frequently in women who have had children.

They may also arise at the sites of old surgical incisions.

Surgical removal is the usual treatment.... desmoid tumour

A synthetic form of ADH (antidiuretic hormone) that is used to treat diabetes insipidus and bed-wetting (see enuresis).... desmopressin

A progestogen drug used with ethinylestradiol as an ingredient of some combined oral contraceptives.

Desogestrel is reported to have a slightly higher risk of venous thromboembolism than older drugs. Side effects of desogestrel include weight changes and fluid retention. There may also be nausea, vomiting, headache, depression, and breast tenderness.... desogestrel

A central nervous system stimulant (see amfetamine drugs; stimulant drugs) sometimes used to treat narcolepsy. It is also used in children with attention deficit hyperactivity disorder. Because of its stimulant properties, dexamfetamine has become a drug of abuse. With prolonged use, the stimulant effects lessen and a higher dose must be taken to produce the same effect.... dexamfetamine

A nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and stiffness in arthritis and to hasten recovery following injury. Side effects may include nausea, abdominal pain, and peptic ulcer. ... diclofenac

A condition in which a body cavity, tube, or opening is enlarged or stretched due to normal physiological processes or because of disease.

The term dilatation also refers to procedures for achieving such enlargement, as in dilatation and curettage.... dilatation

A silicone-based substance, also known as simeticone, that is used in barrier creams and as an antifoaming agent in antacid preparations.... dimeticone

A drug that reduces the stickiness of platelets in the blood and thereby helps to prevent the formation of abnormal blood clots within arteries. Dipyridamole is used with aspirin or warfarin to prevent the formation of clots following heart-valve surgery. It may also be given to people who have had a recent myocardial infarction or undergone a coronary artery bypass. Dipyridamole may also reduce the frequency of transient ischaemic attacks. Possible adverse may include headache, flushing, and dizziness.... dipyridamole

Hashimoto’s thyroiditis. Inflammation of the Thyroid gland with increase of fibrous tissue and intrusion of excess white blood cells. Forerunner of myxoedema. It is an auto-immune disorder resulting in thyroid damage. Middle-aged women prone. Painless swelling.

Alternatives. Treatment. Echinacea is the key remedy.

Others indicated: Red Clover flower, Blue Flag root, Horsetail, Poke root, Bladderwrack. May be taken singly, as available.

Tea: Combine Bladderwrack 2; Echinacea 2; Horsetail 1. 1-2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup thrice daily.

Tinctures. Combine: Bladderwrack 2; Echinacea 2; Horsetail 1. Dose: one to two 5ml teaspoons in water thrice daily.

Diet. Iodised salt. Avoid cabbage which contains a factor which depresses the thyroid gland. Supplementation. Vitamin A. B-complex. Kelp. ... hashimoto’s disease

Heart disease arising from abnormal development. Some cases are hereditary, others due to drugs taken during pregnancy. Many owe their origin to illnesses of the mother such as German measles. Structural abnormalities of the heart take different forms but whatever the case, when under abnormal pressure and stress, all may derive some small benefit from the sustaining properties of Hawthorn berry and other phytomedicines.

Alternatives. To sustain.

Teas. Lime flowers, Motherwort, Buckwheat, Hawthorn.

Tablets/capsules. Hawthorn, Mistletoe, Motherwort.

Formula. Hawthorn 2; Lily of the Valley 1; Selenicereus grandiflorus 1. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water morning and evening. ... heart disease – congenital

An amino acid present in some foods and plants. Prepared synthetically in the laboratory when used as the basic medication for Parkinson’s disease. Has enabled millions of elderly sufferers to lead a useful and less painful life with reduced muscle tension. On entering the brain the substance is known as dopamine.

In old age the concentration of L-dopa in the brain decreases. This substance is available in very high concentrations in the plant Vivia faba (broad bean). Highest concentration is found in type WH 305. Research has shown that regular eating of these golden beans can prolong life expectancy, slow down the ageing process and possibly allow a reduced dosage in medication. ... l. dopa

A term used in genetics to describe one of the ways in which a gene is passed from parent to offspring. Many characteristics are determined by a single pair of genes, 1 of each pair being inherited from each parent. A dominant gene overrides an equivalent recessive gene. For example, the gene for brown eye colour is dominant, so if a child inherits the gene for brown eyes from 1 parent and the gene for blue eyes from the other, he or she will have brown eyes. Some genetic disorders are determined by a dominant gene. Examples include Marfan’s syndrome and Huntington’s disease. The child will have the disease if he or she inherits the gene from 1 or both parents.... dominant

An antiemetic drug used to relieve nausea and vomiting associated with some gastrointestinal disorders or during treatment with certain drugs or radiotherapy. Adverse effects may include breast enlargement and secretion of milk from the breast.... domperidone

Relating to the back, located on or near the back, or describing the uppermost part of a body structure when a person is lying face-down. The opposite of dorsal is ventral.... dorsal

A term used to refer to the amount of a drug taken at a particular time, or to the amount of radiation an individual is exposed to during a session of radiotherapy. Drug dose can be expressed in terms of the weight of its active substance, the volume of liquid to be drunk, or its effects on body tissues.

The amount of radiation absorbed by body tissues during a session of radiotherapy is expressed in units called millisieverts (see radiation units).... dose

An antihypertensive drug taken to reduce high blood pressure (see hypertension). Side effects include dizziness, headache, and nausea.... doxazosin

Notifiable diseases under the Public Health (Control of Disease Act, 1984) are:–

Acute encephalitis, acute meningitis, acute poliomyelitis, anthrax, cholera, diphtheria, dysentery (amoebic and bacillary), food poisoning, infective jaundice, leprosy, leptospirosis, lassa fever, mumps, malaria, marburg disease, measles, German measles, ophthalmia neonatorum, paratyphoid fever, plague, rabies, relapsing fever, scarlet fever, smallpox, tetanus, tuberculosis, typhoid fever, typhus, viral haemorrhagic fever, whooping cough and yellow fever.

Six communicable diseases are internationally notifiable to the World Health Organisation: yellow fever, plague, cholera, smallpox, louse-borne relapsing fever, louse-borne typhus.

Notification has to be made to local and central Government authorities. Certain occupational diseases and all cases of cancer must be registered and notified.

It is required that the above diseases and certain others receive modern medical therapy in a hospital or treatment under the supervision of a qualified physician. Failure to conform may expose a practitioner, registered or unregistered, to a charge of negligence. ... notifiable diseases

See intravenous infusion.... drip

Inflammation of the duodenum (first part of the small intestine), producing vague gastrointestinal symptoms. The condition is diagnosed by oesophagogastroduodenoscopy (see gastroscopy) which is the examination of the walls of the upper digestive tract with a flexible viewing instrument. Treatment is similar to that for a duodenal ulcer (see peptic ulcer).... duodenitis

See short stature.... dwarfism

A drug derived from the female sex hormone progesterone. It is used to treat premenstrual syndrome and menstrual problems (see menstruation, disorders of). It is also given together with an oestrogen drug as hormone replacement therapy following the menopause. Dydrogesterone is sometimes prescribed for endometriosis or to prevent miscarriage. Adverse effects include swollen ankles, weight gain, breast tenderness, and nausea.... dydrogesterone

A rare disorder, also called multiple enchondromatosis, that is present from birth and characterized by the presence of multiple tumours of cartilaginous tissue within the bones of a limb.

It is caused by a failure of normal bone development from cartilage.

The bones are shortened, resulting in deformity.

Rarely, a tumour may become cancerous (see chondrosarcoma).... dyschondroplasia

Problems with writing (see learning difficulties).... dysgraphia

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

(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

A French term that is used to describe the unusual occurrence of 2 people sharing the same psychotic illness (see psychosis). Commonly, the 2 are closely related and share one or more paranoid delusions. If the sufferers

are separated, one of them almost always quickly loses the symptoms, which have been imposed by the dominant, and genuinely psychotic, partner.... folie à deux

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 hazard of divers and of others who work in or breathe compressed air or other gas mixtures. Decompression sickness is also called “the bends”, and it results from gas bubbles forming in the tissues and impeding the flow of blood. At depth, divers accumulate inert gas in their tissues from the high-pressure gas mixture that they breathe (see scubadiving medicine). Problems can usually be avoided by allowing the excess gas in their tissues to escape slowly into the lungs during controlled, slow ascent or release of pressure. If ascent is too rapid and pressure falls too quickly, gas can no longer be held within a tissue. Resulting bubbles may block blood vessels, causing symptoms such as skin itching and mottling and severe pain in and around the larger joints. Symptoms of nervous system impairment (such as leg weakness or visual disturbances) are particularly serious, as is a painful, tight feeling across the chest.

Divers with decompression sickness are immediately placed inside a recompression chamber. Pressure within the chamber is raised, causing the bubbles within the tissues to redissolve. Subsequently, the pressure in the chamber is slowly reduced, allowing the excess gas to escape safely via the lungs. If treated promptly, most divers with the “bends” make a full recovery. In serious, untreated cases, there may be long-term problems, such as paralysis.... decompression sickness

A genetic disorder in which the lack of the enzyme glucocerebrosidase leads to accumulation of a fatty substance, glucosylceramide, in the liver, spleen, bone marrow, and, sometimes, in the brain.

It is treated by regular injections of the missing enzyme.... gaucher’s disease

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

Administration of one or more brief electric shocks to the heart, usually via 2 metal plates, or paddles, placed on the chest over the heart. It is performed to return a heart’s rhythm to normal in some types of arrhythmia (irregular or rapid heartbeat), such as atrial fibrillation or ventricular fibrillation. Defibrillation can be carried out as an emergency procedure to treat ventricular fibrillation, which is a cause of cardiac arrest and most commonly occurs after a heart attack (see myocardial infarction).

It can also be used as a planned treatment, in which case it is performed under a brief general anaesthesia.

Breathing may be maintained artificially during the procedure.... defibrillation

A complication of a bone marrow transplant in which immune system cells in the transplanted marrow attack the recipient’s tissues. Graft-versus-host (GVH) disease may occur soon after transplantation or appear some months later. The first sign is usually a skin rash. This may be followed by diarrhoea, abdominal pain, jaundice, inflammation of the eyes and mouth, and breathlessness.

GVH disease can usually be prevented by administration of immunosuppressant drugs. If the disease develops, it can be treated with corticosteroid drugs and immunosuppressant drugs such as ciclosporin In some cases, however, it can be difficult to control.... graft-versus-host disease

A person who provides blood for transfusion, tissues or organs for transplantation, eggs, or semen for artificial insemination. The organs most frequently donated are kidneys, corneas, heart, lungs, liver, and pancreas. Certain organs can be donated during a person’s lifetime; some are only used following brain death. All donors should be free of cancer, serious infection (such as hepatitis B), and should not carry HIV. Organs for transplantation must be removed within a few hours of brain death, and before or immediately after the heartbeat has stopped. In some kidney transplants, the kidney is provided by a living donor, usually a relative whose body tissues match well on the basis of tissue-typing. Suitable related donors may also provide bone marrow for transplantation and sometimes skin for grafting. (See also artificial insemination; blood donation; bone marrow transplant; organ donation; transplant surgery.)... donor

One of a group of proteins that transport lipids in the blood. High levels of high density lipoprotein can help protect against atherosclerosis. (See also fats and oils; low density lipoprotein.)... high density lipoprotein

An uncommon disease in which degeneration of the basal ganglia results in chorea and dementia. Symptoms of Huntington’s disease do not usually appear until age 35–50. The disease is due to a defective gene and is inherited in an autosomal dominant manner (see genetic disorders).

The chorea usually affects the face, arms, and trunk, resulting in random grimaces and twitches, and clumsiness. Dementia takes the form of irritability, personality and behavioural changes, memory loss, and apathy.

At present, there is no cure for Huntington’s disease, and treatment is aimed at reducing symptoms with drugs.... huntington’s disease

An infectious disease that causes a widespread rash. Also known as slapped cheek disease or erythema infectiosum, fifth disease mainly affects children and is caused by a virus called parvovirus. The rash starts on the cheeks as separate, rose-red, raised spots, which subsequently converge to give the characteristic appearance. Within a few days, the rash spreads in a lacy pattern over the limbs but only sparsely on the trunk. It is often accompanied by mild fever. The rash usually clears after about 10 days. Adults, who contract the disease only rarely, may have joint pain and swelling lasting for up to 2 years. The incubation period is 7 to 14 days, and the only treatment is drugs to reduce the fever.... fifth disease

A collective term for chronic disorders affecting the small and/or large intestine that cause abdominal pain, bleeding, and diarrhoea. Crohn’s disease and ulcerative colitis are the most common types of inflammatory bowel disease.... inflammatory bowel disease

A progressive, painless disorder affecting the macula. The result is a roughly circular area of blindness that increases in size until it is large enough to obscure 2 or 3 words at reading distance. Macular degeneration does not cause total blindness as vision is retained around the edges of the visual fields. This condition is a common disorder in elderly people.

Of the 2 types of macular degeneration that may occur, one type is usually remedied by laser treatment.

There is no treatment for the other form, although the affected person may benefit from aids such as magnifying instruments.... macular degeneration

See osteopetrosis.... marble bone disease

A rare genetic disorder characterized by muscle stiffness and painful cramps that increase during exertion and afterwards. The cause is a deficiency of an enzyme in muscle cells that stimulates breakdown of the carbohydrate glycogen into the simple sugar glucose. The result is a build-up of glycogen and low levels of glucose in the muscles. Damage to the muscles occurs, causing myoglobinuria (muscle-cell pigment in the urine), which may lead to kidney failure. There is no treatment, but symptoms may be relieved by eating glucose or fructose before exercise.... mcardle’s disease

A common problem, present at birth, in which a small, hollow, wide-mouthed sac protrudes from the ileum. Symptoms only occur when the diverticulum becomes infected, obstructed, or ulcerated. The most common symptom is painless bleeding, which may be sudden and severe, making immediate blood transfusion necessary. Inflammation may cause symptoms very similar to those of acute appendicitis. Meckel’s diverticulum occasionally causes intussusception or volvulus of the small intestine. Diagnosis of Meckel’s diverticulum may be made by using technetium radionuclide scanning. If complications occur, they are treated by surgical removal of the diverticulum.... meckel’s diverticulum

The name given to a severe form of mercury poisoning that occurred in the mid-1950s, in people who had eaten polluted fish from Minamata Bay, Japan.

Many people suffered severe nerve damage and some died.... minamata disease

A group of disorders in which there is degeneration of the nerves in the central nervous system that control muscular activity. This causes weakness and wasting of the muscles. The cause is unknown.

The most common type of motor neuron disease is amyotrophic lateral sclerosis ( or Lou Gehrig’s disease). It usually affects people over the age of 50 and is more common in men. Some cases run in families. Usually, symptoms start with weakness in the hands and arms or legs, and muscle wasting. There may be irregular muscle contractions, and muscle cramps or stiffness. All four extremities are soon affected.

Progressive muscular atrophy and progressive bulbar palsy both start with patterns of muscle weakness different from but usually develop into.There are 2 types of motor neuron disease that first appear in childhood or adolescence. In most cases, these conditions are inherited. Werdnig–Hoffman disease affects infants at birth or soon afterwards. In almost all cases, progressive muscle weakness leads to death within several years. Chronic spinal muscular atrophy begins in childhood or adolescence, causing progressive weakness but not always serious disability.

There are no specific tests for motor neuron disease. Diagnosis is based on careful clinical examination by a neurologist. Tests including EMG, muscle biopsy, blood tests, myelography, CT scanning, or MRI may be performed.

The disease typically goes on to affect the muscles involved in breathing and swallowing, leading to death within 2–4 years. However, about 10 per cent of sufferers survive for 10 years.

Nerve degeneration cannot be slowed down, but physiotherapy and the use of various aids may help to reduce disability. The drug riluzole is used to extend life (or the time until mechanical ventilation is required).... motor neuron disease

See pulmonary disease, chronic obstructive.... obstructive airways disease

Degeneration of a bone just under a joint surface, causing fragments of bone and cartilage to become separated, which may cause the joint to lock. The condition commonly affects the knee and usually starts in adolescence. Symptoms include aching discomfort and intermittent swelling of the affected joint.

If a fragment has not completely separated from the bone, the joint may be immobilized in a plaster cast to allow reattachment. Loose bone or cartilage fragments in the knee are removed during arthroscopy. Disruption to the smoothness of the joint surface increases the risk of osteoarthritis.... osteochondritis dissecans

See over-the-counter drug.... otc drug

A type of anxiety disorder, characterized by recurrent panic attacks of intense anxiety and distressing physical symptoms.... panic disorder

Any disorder of the periodontium (the tissues that surround and support the teeth).... periodontal disease

See dialysis.... peritoneal dialysis

A disorder of the penis in which part of the sheath of fibrous connective tissue thickens, causing the penis to bend during erection. This commonly makes intercourse difficult and painful. Eventually, some of the penile erectile tissue may also thicken. Men over 40 are most often affected. The cause is unknown. The disease may improve without treatment. Otherwise, local injections of corticosteroid drugs or surgical removal of the thickened area and replacement with normal tissue may be carried out.... peyronie’s disease

Depression in a woman after childbirth. The cause is probably a combination of sudden hormonal changes and psychological and environmental factors. The depression ranges from an extremely common and mild, shortlived episode (“baby blues”) to a rare, severe depressive psychosis.

Most mothers first get the “blues” 4–5 days after childbirth and may feel miserable, irritable, and tearful. The cause is hormonal changes, perhaps coupled with a sense of anticlimax or an overwhelming sense of responsibility for the baby. With reassurance and support, the depression usually passes in 2–3 days. In about 10–15 per cent of women, the depression lasts for weeks and causes a constant feeling of tiredness, difficulty in sleeping, loss of appetite, and restlessness. The condition usually clears up of its own accord or is treated with antidepressant drugs.

Depressive psychosis usually starts 2–3 weeks after childbirth, causing severe mental confusion, feelings of worthlessness, threats of suicide or harm to the baby, and sometimes delusions.

Hospital admission, ideally with the baby, and antidepressant drugs are often needed.... postnatal depression

A form of anxiety that develops after a stressful or frightening event.

Common causes include natural disasters, violence, rape, torture, serious physical injury, and military combat.

Symptoms, which may develop many months after the event, include recurring memories or dreams of the event, a sense of personal isolation, and disturbed sleep and concentration.

There may be a deadening of feelings, or irritability and feelings of guilt, sometimes building up to depression.

Most people recover, in time, with emotional support and counselling.... post-traumatic stress disorder

An aspect of dentistry concerned with the prevention of tooth decay and gum disease.

It consists of the encouragement of good oral hygiene, fluoride treatment, and scaling.... preventive dentistry

A disorder of the blood vessels in which exposure to cold causes the small arteries supplying the fingers and toes to contract suddenly. This cuts off blood flow to the digits, which become pale. The fingers are more often affected than the toes. The cause is unknown, but young women are most commonly affected.

On exposure to cold, the digits turn white due to lack of blood. As sluggish blood flow returns, the digits become blue; when they are warmed and normal blood flow returns, they turn red. During an attack, there is often tingling, numbness, or a burning feeling in the affected fingers or toes. In rare cases, the artery walls gradually thicken, permanently reducing blood flow. Eventually painful ulceration or even gangrene may develop at the tips of the affected digits.

Diagnosis is made from the patient’s history. Treatment involves keeping the hands and feet as warm as possible. Vasodilator drugs or calcium channel blockers may be helpful in severe cases. (See also Raynaud’s phenomenon.)... raynaud’s disease

Separation of the retina from the outer layers at the back of the eye. Detachment may follow an eye injury but usually occurs spontaneously. It is usually preceded by a retinal tear, and is more common in highly myopic (shortsighted) people and in people who have had cataract surgery.

The detachment is painless. The first symptom is either bright flashes of light at the edge of the field of vision, accompanied by floaters, or a black “drape” obscuring vision.

Urgent treatment is required and usually involves surgical repair of the underlying tear. If the macula (site of central vision) has not been detached, the results can be excellent.... retinal detachment

See rheumatoid arthritis, juvenile.... still’s disease

The sudden, unexpected death of an infant that cannot be explained.

Possible risk factors include: laying the baby face-down to sleep; overheating; parental smoking after the birth; prematurity and low birth weight; and poor socioeconomic background.

Preventive measures include: ensuring that the baby sleeps on its back at the foot of the cot; regulating the baby’s temperature (using the same amount of clothing and blankets that an adult would need); and stopping smoking.... sudden infant death syndrome

A common condition affecting some children for a period after the introduction of an adult diet. It occurs because the child is unable to digest food properly, perhaps because of inadequate chewing; the diarrhoea contains recognizable pieces of food. This diarrhoea is no cause for concern, and no treatment is needed.... toddler’s diarrhoea

Another name for neurofibromatosis.... von recklinghausen’s disease

An inherited lifelong bleeding disorder similar to haemophilia. People with the condition have a reduced concentration in their blood of a substance called von Willebrand factor, which helps platelets in the blood to plug injured blood vessel walls and forms part of factor VIII (a substance vital to blood coagulation). Symptoms of deficiency of this factor include excessive bleeding from the gums and from cuts and nosebleeds. Women may have heavy menstrual bleeding. In severe cases, bleeding into joints and muscles may occur.

The disease is diagnosed by bloodclotting tests and measurement of blood levels of von Willebrand factor. Bleeding episodes can be prevented or controlled by desmopressin (a substance resembling ADH). Factor or concentrated von Willebrand factor may also be used to treat bleeding.... von willebrand’s disease

Another name for leptospirosis.... weil’s disease

A rare disorder, also called intestinal lipodystrophy, that can affect many organs. Symptoms include steatorrhoea as a result of malabsorption, abdominal pain, joint pains, progressive weight loss, swollen lymph nodes, anaemia, and fever. The heart, lungs, and brain can also be affected. The condition is most common in middle-aged men.

The cause is thought to be bacterial; affected tissues are found to contain macrophages (a type of scavenging cell) containing rod-shaped bacteria. Treatment is with antibiotic drugs for at least 1 year. Dietary supplements are used to correct nutritional deficiencies occurring as a result of malabsorption.... whipple’s disease

A rare, inherited disorder in which copper accumulates in the liver, resulting in conditions such as hepatitis and cirrhosis. Copper is slowly released into other body parts, damaging the brain, causing mild intellectual impairment, and leading to debilitating rigidity, tremor, and dementia. Symptoms usually appear in adolescence but can occur much earlier or later. Lifelong treatment with penicillamine is needed and, if begun soon enough, can sometimes produce some improvement. If the disease is discovered before the onset of symptoms, the drug may prevent them from developing.... wilson’s disease

originally, a disease transmitted only by direct physical contact: now usually taken to mean any *communicable disease.... contagious disease

(derma-, dermo-, dermat(o)-) combining form denoting the skin.... derm

adj. relating to or affecting the skin, especially the *dermis.... dermal

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

A severe manifestation of infection with the Human immunodeficiency virus (HIV).... acquired immune deficiency syndrome (aids)

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 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

Also known as Dercum’s disease. A condition in which painful masses of fat develop under the skin – more common in women than in men.... adiposis dolorosa

A mechanism by which a competent individual expresses his or her wishes should circumstances arise in which he or she no longer is able to make rational and sound decisions regarding his or her medical treatment. Usually ‘advance directive’ refers to orders for withholding and/or withdrawing life support treatments at the end of life, made by writing living wills and/or granting power of attorney to another individual.... advance directive

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

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

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)

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

Unfair or unequal treatment of people on the grounds of age.... age discrimination

A factor, such as a micro-organism, chemical substance, form of radiation, or excessive cold or heat, which is essential for the occurrence of a disease. A disease may be caused by more than one agent acting together or, in the case of deficiency diseases, by the absence of an agent.... agent (of disease)

When a new drug is introduced, it has usually been studied only in relatively few patients – typically 1,500. If n patients have been studied, and no serious effects observed, there is still a chance of a serious adverse e?ect occurring in the general population as frequently as 3/n (1:500).

Adverse effects can be divided into types. First, those which are closely related to the concentration of the drug and accord with what is known of its PHARMACOLOGY. These so-called type A (augmented pharmacological) effects are distinguished from type B (bizarre) effects which are unpredictable, usually rare, and often severe. ANAPHYLAXIS is the most obvious of these; other examples include bone-marrow suppression with CO-TRIMOXAZOLE; hepatic failure (see HEPATITIS) with SODIUM VALPROATE; and PULMONARY FIBROSIS with AMIODARONE. A more comprehensive classi?cation includes reactions type C (chronic effects), D (delayed effects – such as teratogenesis or carcinogenesis) and E (end-of-dose effects – withdrawal effects). Examples of adverse reactions include nausea, skin eruptions, jaundice, sleepiness and headaches.

While most reported adverse reactions are minor and require no treatment, patients should remind their doctors of any drug allergy or adverse e?ect they have suffered in the past. Medical warning bracelets are easily obtained. Doctors should report adverse effects to the authorities – in the case of Britain, to the Committee on Safety of Medicines (CSM), using the yellow-card reporting machinery.... adverse reactions to drugs

(Roth) K. Schum.

Synonym: A. caryophyllata G. Don

Family: Apocynaceae.

Habitat: Assam, West Bengal, Bihar, Orissa, Andhra Pradesh and Tamil Nadu; often cultivated in Indian gardens.

Ayurvedic: Madhumaalati.

Action: Antiseptic; anodyne (an ingredient in massage oils for paraplegia, neuralgia, sciatica); also anthelmintic and emetic.

The leaves contain quercetin, kaem- pferol and phenolic acids. Shoot tips and flower buds contain tannin.

Aganosma calycina A. DC. is also equated with Madhumaalati.... aganosma dichotoma

Alzheimer’s disease is a progressive degenerating process of neural tissue affecting mainly the frontal and temporal lobes of the BRAIN in middle and late life. There is probably a genetic component to Alzheimer’s disease, but early-onset Alzheimer’s is linked to certain mutations, or changes, in three particular GENES. Examination of affected brains shows ‘senile plaques’ containing an amyloid-like material distributed throughout an atrophied cortex (see AMYLOID PLAQUES). Many remaining neurons, or nerve cells, show changes in their NEUROFIBRILS which thicken and twist into ‘neuro?brillary tangles’. First symptoms are psychological with insidious impairment of recent memory and disorientation in time and space. This becomes increasingly associated with diffculties in judgement, comprehension and abstract reasoning. After very few years, progressive neurological deterioration produces poor gait, immobility and death. When assessment has found no other organic cause for an affected individual’s symptoms, treatment is primarily palliative. The essential part of treatment is the provision of appropriate nursing and social care, with strong support being given to the relatives or other carers for whom looking after sufferers is a prolonged and onerous burden. Proper diet and exercise are helpful, as is keeping the individual occupied. If possible, sufferers should stay in familiar surroundings with day-care and short-stay institutional facilities a useful way of maintaining them at home for as long as possible.

TRANQUILLISERS can help control di?cult behaviour and sleeplessness but should be used with care. Recently drugs such as DONEPEZIL and RIVASTIGMINE, which retard the breakdown of ACETYLCHOLINE, may check

– but not cure – this distressing condition. About 40 per cent of those with DEMENTIA improve.

Research is in progress to transplant healthy nerve cells (developed from stem cells) into the brain tissue of patients with Alzheimer’s disease with the aim of improving brain function.

The rising proportion of elderly people in the population is resulting in a rising incidence of Alzheimer’s, which is rare before the age of 60 but increases steadily thereafter so that 30 per cent of people over the age of 84 are affected.... alzheimer’s disease

See hookworm.... ancyclostoma duodenale

See ANALGESICS; NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS).... anti-inflammatory drugs

See under RECTUM, DISEASES OF.... anus, diseases of

Equipment that enables an individual who requires assistance to perform the daily activities essential to maintain health and autonomy and to live as full a life as possible. Such equipment may include, for example, motorized scooters, walkers, walking sticks, grab rails and tilt-and-lift chairs.... assistive device

See under GENETIC DISORDERS.... autosomal dominant gene

Kuntze

Synonym: Volutarella divaricata Benth. and Hook. F.

Family: Compositae; Asteraceae.

Habitat: Distributed in the Mediterranean region, extending to Central Asia and India.

Ayurvedic: Brahmadandi (Tri- cholepis glaberrima DC. of the same family is also equated with Brahmadandi.)

Unani: Baadaavard.

Action: Deobstruent, aperient, febrifuge, nervine (used in debility), antiseptic (used in leucoderma).... amberboa divaricata

Andrographis Tea is well known for its bitter taste, as well as for its healthy benefits. It has proven to be an adjuvant in treating severe illness such as hepatitis, due to its high content of antioxidants. Andrographis Tea description Andrographis is originating from Asia, being used for centuries in Ayurvedic medicine. The plant is easy to grow: its propagation is by seeds, planted during spring and summer. Andrographis grows both in full sun or shade, developing vigorously in moist conditions. The herb has been proved to treat infectious diseases. This fact was discovered during the global flu epidemic of 1919, known as one of the most destructive infectious to outbreak in history, which killed millions worldwide, in many countries. Andrographis Tea is the resulting beverage from brewing the andrographis plant. It is widely known for its bitter taste as well as for its adjuvant properties against flu, depression, digestion complaints, but not only. Andrographis Tea brewing To brew Andrographis tea:

• place 1 teaspoon of dried andrographis in a tea infuser (10 grams of fresh leaves)
• place the infuser in a tea cup
• cover it with 1 cup of boiling water
• steep the tea for 10 minutes
• drink it slowly

The resulting tea has an extreme bitter taste. Another possibility of enjoying the benefits of Andrographis tea is to intake capsules containing the plant. Andrographis Tea benefits Andrographis Tea has many proven benefits, such as:

• Treating gastrointestinal complains
• Treating throat infections
• Dispelling toxins
• Increasing biliary flow
• Treating coughs, headaches, edema
• Treating pain conditions, inflammation
• Treating arthritis, rheumatism
• Treating constipation
• Treating pneumonia, tuberculosis, leprosy, hepatitis, herpes, diabetes, bronchitis

Andrographis Tea side effects It has been showed that Andrographis Tea should not be used by pregnant and nursing women or by children. It has been also noticed that large doses of Andrographis Tea may lead to infertility. Andrographis Tea is a healthy beverage which has the ability to strengthen the immune system, stop cancer cells from multiplying, and also render a good physical state. It can be consumed as tea or medicinal pills.... andrographis tea: a drop of health

Anise tea is largely used both for culinary and medicinal purposes. It is an important ingredient in the pharmaceutical industry, proving itself useful in enhancing the supply of mother’s milk, but not only. Anise Tea description Anise is a sweet and strong-fragranced plant, known for its star-shaped fruits, harvested just before they ripen. It belongs to the same plant family as carrots, fennel and caraway. Due to its licorice flavor, it is usually added to candies, drinks and food. Anise could be added to mouthwashes and toothpastes, mainly to those found in the natural food stores. Anise tea is the resulting beverage from brewing this plant. Anise Tea brewing To brew Anise tea:

• Boil 1 1/2 cups of water with anise seeds
• Boil 1 1/2 cups of water (in another pot)
• Add the tea bags
• Steep them both (10 minutes)
• Strain anise water into the pot containing tea
• Pour into serving cups

Lemon and honey may be added (depending on the consumer›s taste). Anise Tea benefits Anise tea is a popular beverage, especially in the Middle East, where it is used to sooth a stomachache or to relieve intestinal gas. It can be administrated even to children. Anise tea has proven its efficiency in dealing with:

• the overall treatment of such respiratory ailments as colds, pneumonia, bronchitis and sinusitis
• an upset stomach and flatulence
• the treatment of colic
• loosen phlegm in the throat and lungs
• hiccups

Anise Tea side effects Anise tea is not recommended to pregnant and breast-feeding women. Rarely, Anise tea can cause allergic reactions. Consumers should watch for signs of rash, hives or swelling of the tongue, throat, lips or face. If any of these symptoms occur, stop using anise and ask your health care provider. Anise tea is a healthy choice for a balanced diet.This tea is best known as an adjuvant in the digestive processes and also, as an aid for respiratory problems.... anise tea: for digestion

The average number of hospital beds occupied per day. This measure provides an estimate of the number of inpatients receiving care each day at a hospital.... average daily census

The ratio of the number of new cases of the disease and the amount of population-time of follow-up (e.g. person-year) of the disease-free population.... average incidence density

Fixed dilated pupils of the eyes

Absent CORNEAL REFLEX

Absent VESTIBULO-OCULAR REFLEX

No cranial motor response to somatic (physical) stimulation

Absent gag and cough re?exes

No respiratory e?ort in response to APNOEA despite adequate concentrations of CARBON DIOXIDE in the arterial blood.... b nosed. the test for brain-stem death are:

One of the CORTICOSTEROIDS used as an aerosol inhalant. It must be used regularly for its best e?ect. Unlike systemic corticosteroids, inhaled forms are much less likely to suppress adrenal-gland activity and have fewer side-effects.... beclomethasone dipropionate

An indexed computer or printed source of citations of journal articles and other reports in the literature. Bibliographic citations typically include author, title, source, abstract and/or related information (including full text in some cases).... bibliographic database

Rubus species

Description: These plants have prickly stems (canes) that grow upward, arching back toward the ground. They have alternate, usually compound leaves. Their fruits may be red, black, yellow, or orange.

Habitat and Distribution: These plants grow in open, sunny areas at the margin of woods, lakes, streams, and roads throughout temperate regions. There is also an arctic raspberry.

Edible Parts: The fruits and peeled young shoots are edible. Flavor varies greatly.

Other Uses: Use the leaves to make tea. To treat diarrhea, drink a tea made by brewing the dried root bark of the blackberry bush.... blackberry, raspberry, and dewberry

ARTERIES are the blood vessels that convey blood away from the heart to the tissues. The commonest cause of arterial disease is a degenerative condition known as atherosclerosis. Less commonly, in?ammation of the arteries occurs; this in?ammation is known as arteritis and occurs in a variety of conditions.

Atherosclerosis is due to the deposition of CHOLESTEROL into the walls of arteries. The process starts in childhood with the development of fatty streaks lining the arteries. In adulthood these progress, scarring and calcifying to form irregular narrowings within the arteries and eventually leading to blockage of the vessel. The consequence of the narrowing or blockage depends on which vessels are involved

– diseased cerebral vessels cause strokes; coronary vessels cause angina and heart attacks; renal vessels cause renal failure; and peripheral arteries cause limb ischaemia (localised bloodlessness).

Risk factors predisposing individuals to atherosclerosis include age, male gender, raised plasma cholesterol concentration, high blood pressure, smoking, a family history of atherosclerosis, diabetes and obesity.

Arteritis occurs in a variety of conditions that produce in?ammation in the arteries. Examples include syphilis – now rare in Britain

– which produces in?ammation of the aorta with subsequent dilatation (aneurysm formation) and risk of rupture; giant cell arteritis (temporal arteritis), a condition usually affecting the elderly, which involves the cranial arteries and leads to headache, tenderness over the temporal arteries and the risk of sudden blindness; Takayasu’s syndrome, predominantly affecting young females, which involves the aortic arch and its major branches, leading to the absence of pulse in affected vessels; and polyarteritis nodosa, a condition causing multiple small nodules to form on the smaller arteries. General symptoms such as fever, malaise, weakness, anorexia and weight loss are accompanied by local manifestations of ischaemia (bloodlessness) in di?erent parts of the body.... arteries, diseases of

See URINARY BLADDER, DISEASES OF and GALLBLADDER, DISEASES OF; see also URINE.... bladder, diseases of

See ANAEMIA; LEUKAEMIA; LYMPHOMA; MYELOMATOSIS; THROMBOSIS.... blood, diseases of

An uncommon chronic localised skin disease, presenting as a solitary chronic ?xed irregular plaque mimicking eczema or psoriasis. It is a fairly benign form of CARCINOMA in situ in the EPIDERMIS but can occasionally become invasive. It is curable by CRYOTHERAPY or surgical excision.... bowen’s disease

The presence of reddish brown sediment in the urine, indicating uric acid, hippuric acid and creatinine excess in the blood...an anabolic greaseball who needs more liquids and alkali and who has over-acidic urine. It can be symptomatic of more serious problems as well.... brick dust

Linn.

Family: Gramineae; Poaceae.

Habitat: Native to Mediterranean region; found in Kashmir, Assam and the Nilgiris, also grown in hedges.

English: Great Reed, Spanish- Bamboo-Reed, Giant-Bamboo- Reed.

Ayurvedic: Nala, Potgala, Shuunya- madhya, Dhamana.

Siddha/Tamil: Korukkai.

Action: Rhizome—sudorific, emollient, diuretic, antilactant, antidropsical; uterine stimulant (stimulates menstrual discharge), hypotensive.

The rhizome yields indole-3-alkyl- amine bases, including bufotenidine and dehydro-bufontenine. The leaves yield sterols and triterpenoids.

Bufotenidine possesses antiacetyl- choline properties, histamine release activity and is a uterine stimulant. Alkaloids from the flowers produced cu- rarimetic effect of the non-polarizing type.

Dosage: Root—50-100 ml decoction. (CCRAS.) 4.5%) with methyl eugenol (an important constituent of A. europaeum), and also aristolochic acid. (Aristolochic acid is carcinogenic and nephrotoxic.) Asarum sp. are not used as a substitute for ginger.... arundo donax

A lifelong disorder characterised by overactive behaviour, short attention span and poor concentration. It is thought to be caused by a minor abnormality that affects the part of the brain that allows us to concentrate and focus on tasks. Some scientists have suggested that it may be caused by particular foods, particularly processed foods containing arti?cial additives, and recommend special diets. In some countries, attention de?cit disorder is diagnosed in up to a tenth of all children; this may re?ect di?erences in paediatric practice and diagnosis rather than a real variation in prevalence of the disorder. Behaviour therapy is the main treatment. Those children with very severe symptoms of restlessness, short attention span and disturbed behaviour may respond to additional treatment with methylphenidate (Ritalin®). This is an amphetamine-like drug that is thought to stimulate the part of the brain that is not working properly. Use of this drug has, however, been controversial.... attention deficit disorder (hyperactivity syndrome)

Banaba Tea is a healthy beverage, well known for its ability to fight against diabetes and also kidney ailments. Banaba Tea description Banaba is a medicinal plant used as a natural remedy to treat diabetes. It has dark green leaves that are oblong. During autumn, leaves, acknowledged to be abundant in vitamins and minerals and rich in dietary fibers, turn to an orange-red color. Traditional uses include an infusion from the leaves as a treatment for hyperglycemia. The blood sugar lowering effect of Banaba leaf extract is similar to that of insulin. Banaba tea is normally found in the Philippines and Japan, being an extract from the herb’s plant. Banaba brewing To brew Banaba tea:

• Bring 400 milliliters (1 and 1/2 cups or 12 ounces) water to a strong boil.
• Reduce heat to low and drop in a tea bag.
• Keep at or below a simmer for 15 minutes.
• Evaporation will leave about 250 milliliters (1 cup or 8 ounces) of tea.
• Pour fresh brewed tea into a cup and drink while it is still warm.
• Save the tea bag. You should reuse each tea bag up to four times to achieve effective results.

It is advisable to take the tea before meals: 1 or 2 cups daily. In case of tincture intaking, 2-3 ml is the recommended daily dose (2 - 3 full droppers daily). Banaba Tea benefits Studies have proved that Banaba tea is successfully used to:

• fight against diabetes by helping control blood sugar levels
• control blood cholesterol levels
• lower blood pressure
• help urinary system related ailments
• help in the treatment of diarrhea
• help in the treatment of constipation
• help reducing the absorption of carbohydrates, aiding the weight loss efforts
• help in the treatment of gout
• help in lowering uric acid levels

Banaba Tea side effects Banana tea is not recommended to children, pregnant women and nursing mothers. Patients suffering from diabetes should be cautious when using Banaba tea in combination with other hypoglycemic drugs. Banaba tea could be a healthy alternative to traditional drugs treating diabetes or kidney diseases, but not only.... banaba tea against diabetes

See KIDNEYS, DISEASES OF – Glomerulonephritis.... bright’s disease

See APPENDIX 8: PROFESSIONAL ORGANISATIONS.... british dental association

See THROMBOANGIITIS OBLITERANS.... buerger’s disease

The total significance of disease for society beyond the immediate cost of treatment. It measures years of life lost to ill-health as the difference between total life expectancy and disability-adjusted life expectancy.... burden of disease

Also called beta blockers, these drugs interrupt the transmission of neuronal messages via the body’s adrenergic receptor sites. In the HEART these are called beta1 (cardioselective) receptors. Another type – beta2 (non-cardioselective) receptors – is sited in the airways, blood vessels, and organs such as the eye, liver and pancreas. Cardioselective beta blockers act primarily on beta1 receptors, whereas non-cardioselective drugs act on both varieties, beta1 and beta2. (The neurotransmissions interrupted at the beta-receptor sites through the body by the beta blockers are initiated in the ADRENAL GLANDS: this is why these drugs are sometimes described as beta-adrenergic-blocking agents.)

They work by blocking the stimulation of beta adrenergic receptors by the neurotransmitters adrenaline and noradrenaline, which are produced at the nerve endings of that part of the SYMPATHETIC NERVOUS SYSTEM – the autonomous (involuntary) network

– which facilitates the body’s reaction to anxiety, stress and exercise – the ‘fear and ?ight’ response.

Beta1 blockers reduce the frequency and force of the heartbeat; beta2 blockers prevent vasodilation (increase in the diameter of blood vessels), thus in?uencing the patient’s blood pressure. Beta1 blockers also affect blood pressure, but the mechanism of their action is unclear. They can reduce to normal an abnormally fast heart rate so the power of the heart can be concomitantly controlled: this reduces the oxygen requirements of the heart with an advantageous knock-on e?ect on the respiratory system. These are valuable therapeutic effects in patients with ANGINA or who have had a myocardial infarction (heart attack – see HEART, DISEASES OF), or who suffer from HYPERTENSION. Beta2 blockers reduce tremors in muscles elsewhere in the body which are a feature of anxiety or the result of thyrotoxicosis (an overactive thyroid gland – see under THYROID GLAND, DISEASES OF). Noncardioselective blockers also reduce the abnormal pressure caused by the increase in the ?uid in the eyeball that characterises GLAUCOMA.

Many beta-blocking drugs are now available; minor therapeutic di?erences between them may in?uence the choice of a drug for a particular patient. Among the common drugs are:

Primarily cardioselective	Non-cardioselective
Acebutolol	Labetalol
Atenolol	Nadolol
Betaxolol	Oxprenolol
Celiprolol	Propanolol
Metoprolol	Timolol

These powerful drugs have various side-effects and should be prescribed and monitored with care. In particular, people who suffer from asthma, bronchitis or other respiratory problems may develop breathing diffculties. Long-term treatment with beta blockers should not be suddenly stopped, as this may precipitate a severe recurrence of the patient’s symptoms – including, possibly, a sharp rise in blood pressure. Gradual withdrawal of medication should mitigate untoward effects.... beta-adrenoceptor-blocking drugs

Bitter Melon tea is a bitter beverage, very useful in treating a large array of diseases such as diabetes, but not only. Bitter Melon Tea description Bitter Melon is an herbaceous tendril-bearing vine that grows in parts of East Africa, Asia, the Caribbean islands, and parts of South America. It has dainty yellow flowers, bearing an oblong-shaped fruit that has a pockmarked and warty exterior which turns yellow when ripe. Its flesh is crunchy and watery in texture whereas its skin is tender and edible. The taste of the fruit is very bitter. Bitter Melon tea is the resulting beverage from brewing the abovementioned plant, best known for its efficiency against diabetes. The plant is also added to several types of food, as a culinary ingredient. Bitter Melon Tea brewing To prepare Bitter Melon tea:

• Place a handful of leaves in a pot of boiling water
• Boil the mix until the water turns green
• Let the mix steep for about 5 minutes

The taste is quite bitter. Also, the Bitter Melon fruit can also be made into a tea. The majority of cultures prefer to use the leaves for making tea while the fruit is consumed as an addition to dishes. Bitter Melon Tea benefits Bitter Melon tea has proved its efficiency in treating:

• abdominal gas and colic
• liver problems
• ulcers in different parts of the body
• digestion (It may also help ease symptoms of dyspepsia and constipation)

Bitter Melon tea is said to help in regulating blood sugar levels, being widely used as a herbal remedy by diabetes patients. Bitter Melon tea can be used in the treatment of HIV. Bitter Melon Tea side effects Bitter Melon tea should never be taken in conjuncture with any form of diabetes medication. Pregnant and nursing women should also avoid this tea. Bitter Melon Tea is a natural remedy against type 1 and type 2 of diabetes. It is also consumed for its healing properties when dealing with abdominal gas and colic.... bitter mellon tea against diabetes

The decline in value of capital assets (assets of a permanent or fixed nature, such as goods and plant) with use over time. The rate and amount of depreciation is calculated by a variety of different methods (e.g. straight line, sum of the digits, declining balance), which often give quite different results.... capital depreciation

Black Dragon Pearl tea is a type of black tea that provides a full range of benefits to consumers of all ages, worldwide. It distinguishes itself through its chocolate taste and therapeutical benefits. Black Dragon Pearl Tea description Black Dragon Pearl tea, originating from the Chinese province Yunnan, is a type of unsteady black tea, well-known in the area. Each tea pearl contains thirty hand-picked leaves and buds which are immediately rolled to prevent leaves from drying. A morning or afternoon cup of Black Dragon Pearl tea together served with fruits may be a pleasant way to relax oneself. How to prepare Black Dragon Pearl Tea Black Dragon Pearl Black tea can be infused up to three times and still keeps its malty flavor. In case of steeping too long, like any black tea, it can get bitter. When brewed, it has a reddish-brown color, whose aroma makes it identifiable for the senses and, when drunk it has a very delicate and chocolaty taste. Black Dragon Pearl Black tea can be served with or without sugar (or honey) and milk. It contains a relatively low caffeine level. When preparing Black Dragon Pearl tea:

• Use 1 teaspoon of tea for 8 ounces of water ( 2ounces of tea equals 25-30 teaspoons)
• Heat water until it is almost boiling (195 degrees).
• Pour over the pearls.
• Steep them for 3 or 4 minutes.

Black Dragon Pearl Tea benefits Studies revealed the important qualities of Black Dragon Pearl tea. Like any type of black tea, this luxurious beverage contains antioxidants - proven adjuvants in treating cancer and stopping tumors growth. This type of tea has been associated to lowering the risk of stomach, colon and breast cancer, although the connection is not fully scientifically proven. Researchers claim that a compound in Black Dragon Pearl tea caused colorectal cancer cells to disappear, whereas normal cells were not affected by it. Black Dragon Pearl tea is also recommended in dealing with:

• poor arterial functioning that can cause heart attacks and strokes
• inflammation
• viruses
• cholesterol reduction
• teeth decay
• blood toxins removing
• aging effects

Black Dragon Pearl Tea side effects In case of intaking more than 3 cups of tea per day, headaches and dizziness can sometimes appear. Rarely, symptoms of upset stomach may follow Black Dragon Pearl tea consumption. A diet based on Black Dragon Pearl tea plays an important part in one’s life because it renders the sufficient quantity of antioxidants needed by human body to fight against a large array of diseases.... black dragon pearl tea

DC.

Family: Compositae; Asteraceae.

Habitat: Sub-tropical Himalayas, Nepal, Sikkim, Assam and Khasia hills.

English: Ngai Camphor.

Ayurvedic: Kukundara (var.).

Action: Juice of fresh leaves— insecticidal, mosquito repellant. The plant yields an essential oil which yields camphor.

Aerial part contains sesquiterpene lactones, tagitinin A, tirolundin ethyl ether and iso-alantolactone derivatives.... blumea densiflora

Linn.

Synonym: B. repens Linn. B. procumbens Roxb.

Family: Nyctaginaceae.

Habitat: Throughout India as a weed.

English: Horse-purslane, Hogweed.

Ayurvedic: Rakta-punarnavaa, Punarnavaa, Katthilla, Shophaghni, Shothaghni. Varshaabhu (also equated with Trianthema portu- lacastrum Linn., which exhibits anti-inflammatory, antipyretic and analgesic activity).

Unani: Itsit, Bishkhaparaa.

Siddha/Tamil: Mookkirattai.

Folk: Gadaha-purnaa.

Action: Diuretic, anti-inflammatory, antiarthritic, spasmolytic, antibacterial (used for inflammatory renal diseases, nephrotic syndrome, in cases of ascites resulting from early cirrhosis of liver and chronic peritonitis, dropsy associated with chronic Bright's diseases, for serum uric acid levels). Root—anticon- vulsant, analgesic, expectorant, CNS depressant, laxative, diuretic, abortifacient.

Key application: As diuretic, hepatoprotective. (Indian Herbal Pharmacopoeia.)

B. repanda, synonym B. chinensis Linn., roots exhibited antihepatotox- ic activity against carbon tetrachloride galactosamine-and paracetamol- induced intoxication in rats. Powdered root gave encouraging results in spermatorrhoea and leucorrhoea.

The chloroform and methanolic extracts of the roots and aerial parts of B. diffusa also exhibited antihepatotox- ic activity against carbon tetrachloride- induced intoxication in rats.

Punarnavaa is official in IP as a diuretic. The diuretic action of the drug is attributed to the presence of xanthone, beta-ecdysone. Flavonoid, arbinofura- noside, present in the drug, was found to lower serum uric acid in experimental animals, as also in humans.

Punarnavaa has been reported to increase serum protein level and reduce urinary protein extraction in clinical trials in patients suffering with nephrotic syndrome. The activity is attributed to the presence of rotenoids in various parts of the plant.

An antifibrinolytic agent, punar- navoside, has been found to stop IUCD-induced bleeding in monkeys. The drug contains quinolizidine alkaloids.

Dosage: Whole plant—20-30 g for decoction (API Vol. I); root—1-3 g powder; 10-20 ml fresh juice. (API Vol. III.)... boerhavia diffusa

Formed by the body during metabolism and exhaled by the lungs. Seen in sparkling waters and wines, it is also used in baths as a stimulant to the skin. Combined with oxygen in cylinders, it is used to control breathing in ANAESTHESIA and in the treatment of victims of CARBON MONOXIDE (CO) poisoning.

Measuring the partial pressure of the gas by taking blood for blood gas estimation provides information on the adequacy of breathing. A high partial pressure may indicate impending or actual respiratory failure.... carbon dioxide (co2)

Disorders due to abnormal development, in an embryo, of the branchial arches (paired segmented ridges of tissue in each side of the throat).

They include branchial cyst and branchial fistula.

A branchial cyst is a soft swelling, containing a pus-like or clear fluid, that appears on the side of the neck in early adulthood.

Treatment is by surgical removal.

A branchial fistula occurs between the back of the throat and the external surface of the neck, where it appears as a small hole, usually noted at birth.

A hole in the neck that does not extend to the back of the throat is a branchial cleft sinus.

A branchial fistula or cleft sinus may discharge mucus or pus and may be removed surgically.... branchial disorders

Disorders affecting the breast that are mostly minor and respond readily to treatment. The most important causes of problems are infection, such as mastitis, tumours, and hormonal changes. Breast cysts, fibroadenomas, other noncancerous tumours, or, more rarely, breast cancer may occur. Breast pain and tenderness is common just before menstruation or when a woman is taking hormones. Before menstruation, breasts may become bigger and lumpy. Such lumps shrink when menstruation is over. Hormonal disorders may, rarely, cause galactorrhoea (abnormal milk production). In men, gynaecomastia may result from hormonal disturbance or treatment with certain drugs.... breast, disorders of the

A group of drugs that widen the bronchioles (small airways in the lungs) to increase air flow and improve breathing, especially in the treatment of asthma and chronic obstructive pulmonary disease (see pulmonary disease, chronic obstructive). There are 3 main types of bronchodilator: sympathomimetic drugs (such as salbutamol), anticholinergic drugs, and xanthine drugs (such as aminophylline). Sympathomimetic drugs are used primarily for the rapid relief of breathing difficulty. Anticholinergic and xanthine drugs are more often used for the long-term prevention of attacks of breathing difficulty. Drugs can be given by inhaler, in tablet form, or, in severe cases, by nebulizer or injection.

The main side effects of sympathomimetics are palpitations and trembling.

Anticholinergics may cause dry mouth, blurred vision, and, rarely, difficulty in passing urine.

Xanthines may cause headaches, nausea and palpitations.... bronchodilator drugs

Tooth decay; the gradual erosion of enamel (the covering of the tooth) and dentine (the substance beneath the enamel). Initial decay usually occurs on the grinding surfaces of the back teeth and areas around the gum line. The main cause is plaque, a sticky substance consisting of food deposits, saliva by-products, and bacteria that collects on the teeth. The breakdown of food deposits by bacteria creates an acid that eats into the enamel to form cavities. Unchecked decay spreads to the dentine, and as the cavity enlarges, bacteria may invade and destroy the pulp

at the tooth’s core. Advanced decay causes toothache and bad breath.

Treatment consists of drilling away the area of decay and filling the cavity (see filling, dental). In advanced decay, it may be necessary to remove the infected pulp (see extraction, dental).

Water fluoridation and the use of fluoride toothpaste helps prevent caries.

The risk of caries is also reduced by cutting sugar consumption, practising good oral hygiene, and visiting the dentist regularly.... caries, dental

Various parasites and infectious organisms can spread from cats to humans. The most serious disease is rabies. Cat-scratch fever is an uncommon illness caused by infection with the bacterium ROCHALIMAEA HENDELAE following a cat scratch or bite. Cats commonly carry the protozoan TOXOPLASMA GONDII, which causes toxoplasmosis.

Infection, usually from contact with cat’s faeces, is not generally serious but has serious consequences if a woman is infected during pregnancy.

Cat faeces may also carry eggs of the cat roundworm, a possible cause of toxocariasis.

Rarely, a larva from an ingested roundworm egg migrates to and lodges in an eye, causing deterioration of vision or even blindness.

Children who have been playing in sand or soil contaminated by cat faeces are most commonly affected.

Other cat-related disorders in humans include tinea (ringworm), fungal infections of the skin, bites from cat fleas, and allergic reactions to dander that may cause asthma or urticaria.

Diseases from cats can be avoided by good hygiene, veterinary care for animals that are ill, and regular worming and flea treatment of cats.... cats, diseases from

A hole in a tooth, commonly caused by dental caries (see caries, dental).... cavity, dental

A large group of antibiotic drugs derived from the fungus

CEPHALOSPORIUM ACREMONIUM, which are effective against a wide range of infections.

Cephalosporins are used to treat ear, throat, and respiratory tract infections, and conditions, such as urinary tract infections and gonorrhoea, in which the causative bacteria are resistant to other types of antibiotics.

Occasionally, the drugs cause allergic reactions, such as rash, itching, and fever.

Rarely, anaphylactic shock occurs.

Other side effects include diarrhoea and blood disorders.... cephalosporin drugs

The cervix is susceptible to injuries, infections, tumours, and other conditions. Minor injury to the cervix may occur during childbirth, particularly if labour is prolonged. Persistent damage to muscle fibres as a result of injury may lead to cervical incompetence. Cervical erosion is a condition in which mucus-secreting cells form on the outside of the cervix.

The most common cervical infections are sexually transmitted, such as gonorrhoea, chlamydial infections, and trichomoniasis.

Viral infections of the cervix include those due to the human papilloma virus and the herpes simplex virus (see warts, genital; herpes, genital).

Polyps are noncancerous growths on the cervix.

Cancerous growths (see cervix, cancer of) are preceded by changes in the surface cells (cervical dysplasias), which can be detected by a cervical smear test.... cervix, disorders of

The acquisition of physical, mental, and social skills in children.

Although there is wide variation in individual rates of progress, most children develop certain skills within predictable age ranges.

For example, most infants start to walk at 12–18 months.

Capability for new skills is linked to the maturity of the child’s nervous system.

Individual rates of maturity are determined genetically and modified by environmental factors in the uterus and after birth.

Development is assessed in early childhood by looking at abilities in 4 main areas: locomotion; hearing and speech; vision and fine movement; and social behaviour and play.

(See also developmental delay.)... child development

Any abnormality in colour vision that causes difficulty distinguishing between certain colours. Total absence of colour vision (monochromatism) is rare. The most common types of colour vision deficiency are reduced discrimination of red and green. Most cases of red and green colour vision deficiency are caused by defects in the light-sensitive cells in the retina. These defects are usually inherited, although occasionally defects are caused by retinal or optic nerve diseases or injury. The inherited defects tend to be sex-linked (see genetic disorders), which means that the majority of sufferers are male. A person with a severe green deficiency has difficulty distinguishing oranges, greens, browns, and pale reds. In severe red deficiency, all reds appear dull. A much rarer deficiency in which blue cannot be distinguished may be inherited or may be due to degeneration of the retina or optic nerve.... colour vision deficiency

The use of computer technology in diagnostic tests and procedures.

Probability-based computer systems store information on thousands of cases of different disorders detailing exact type, location, duration, symptoms, medical history, and diagnosis.

A patient’s symptoms and medical history can be entered into a computer, which then compares the details with existing data and produces a list of the most likely diagnoses.

Such technology is not currently in common use in hospitals, but is of value for people isolated from medical services, such as oil-rig crews.

Computers programmed to interpret visual data, such as abnormal cells, have potential use in certain types of blood test and cervical smear tests.

Computers are also used in investigative procedures such as CT scanning and MRI.... computer-aided diagnosis

Procedures to improve the appearance of the teeth or prevent further damage to the teeth and/or gums.

Cosmetic dentistry procedures include: fitting an orthodontic appliance to correct teeth that are out of alignment or where the bite is incorrect (see malocclusion); fitting a crown; bonding to treat chipped or stained teeth; and bleaching of discoloured teeth.... cosmetic dentistry

A group of non-steroidal anti-inflammatory drugs (NSAIDs) that cause less stomach irritation as a side effect than other NSAIDs. Examples of -2 inhibitors include celecoxib and rofecoxib.... cox-2 inhibitor drugs

See overcrowding, dental.... crowding, dental

An artificial replacement for the crown of a tooth that has become decayed, discoloured, or broken. A porcelain crown is usually used on front teeth, but back teeth require the greater strength of a crown made from gold or porcelain fused to metal.

A crown may be fitted by filing the natural tooth to form a peg and cementing the crown over the top. If the tooth is... crown, dental

The scraping of the wall of a cavity or other surface with a dental curette.

Dental curettage is one method used to remove the lining of periodontal pockets and diseased tissue from root surfaces in periodontitis.... curettage, dental

A protrusion on the grinding surface of a tooth.... cusp, dental

Minute scales that are shed from an animal’s skin, hair, or feathers.

Some people are allergic to dander and develop the symptoms of allergic rhinitis or asthma if they inhale the scales.... dander

Brain damage, resulting in the irreversible loss of brain function, renders the individual incapable of life without the aid of a VENTILATOR. Criteria have been developed to recognise that ‘death’ has occurred and to allow ventilation to be stopped: in the UK, these criteria require the patient to be irreversibly unconscious and unable to regain the capacity to breathe spontaneously. (See also GLASGOW COMA SCALE and PERSISTENT VEGETATIVE STATE (PVS).)

All reversible pharmacological, metabolic, endocrine and physiological causes must be excluded, and there should be no doubt that irreversible brain damage has occurred. Two senior doctors carry out diagnostic tests to con?rm that brain-stem re?exes are absent. These tests must be repeated after a suitable interval before death can be declared. Imaging techniques are not required for death to be diag-... brain-stem death

Buchu Tea has a long healing history among the tribes of southern Africa , being effective for urinary tract infections. It also has diuretic, antispasmodic, tonic, antibacterial and stimulant properties. Buchu Tea description Buchu is a small, green, woody plant originating from South Africa. It possesses smooth, thick leaves that have a pungent aroma and fragrance. Buchu is grown for medicinal purposes, owing healing properties especially for the kidney, urinary tract and bladder. Buchu is also mixed with other herbs to alleviate coughs, colds and hangovers. Buchu tea is the resulting beverage from brewing the abovementioned plant. Buchu Tea brewing To prepare Buchu tea:

• Immerse 2 teaspoons of dried buchu leaves into 18 ounces of boiling water.
• Let the mixture soak for about 10 minutes.
• Drink it slowly.

The resulting tea is tasty and may be consumed up to three times a day. Buchu Tea benefits Buchu tea has been successfully used to:

• treat certain prostate disorders
• regulate blood sugar
• lower blood pressure
• help digestion
• eliminate flatulence and bloating
• reduce inflammation, tightness and swelling of the joints

Buchu Tea side effects Studies proved that Buchu tea should not be consumed by pregnant women, because it may cause uterine contraction. Buchu tea is a healthy beverage well known for its medicinal action against flatulence and bloating. Due to its tasty flavor, it is also used as a treat.... buchu tea is good for digestion

Rottl.

Family: Caesalpiniaceae.

Habitat: Bengal, Assam and Andamans up to 1,000 m.

English: Teri Pods.

Ayurvedic: Vaakeri.

Siddha/Tamil: Nunigatcha.

Action: Root—astringent and antipyretic, used in phthisis and scrofulous affections.

The roots gave a phenolic compound vakerin, identical with bergenin. The ethanol-water extract of roots inhibits the growth of Mycobacterium tuberculosis.

The pods contain 28% tannin (without seeds, more than 54%). The bark contains 28% tannin (without seeds, more than 54%). The tannin is pure gallo-tannin and gallic acid.

Dosage: Root—3-5 g powder. (CCRAS.)... caesalpinia digyny

Schult.

Family: Gentianaceae.

Habitat: Throughout India, ascending to 1,500 m.

Ayurvedic: Daakuni (used as a substitute for Shankhapushpi in West Bengal)

Unani: Sankhaahuli.

Folk: Daankuni.

Action: Anticonvulsant, CNS depressant, anti-inflammatory, hepatoprotective.

The plant contains calcium 0.38; magnesium 0.16; potassium 1.66 and iron 0.23 g/100 g; copper 18.97, zinc 70.50; manganese 9.60, cobalt 3.15 and chromium 0.60 mcg/g.

Roots contain beta-amyrin, friede- lin, genianine and 16 xanthones including mangiferin. Mangiferin is protective activity against induced liver injury in albino rats. Xanthones also showed activity against Mycobacterium tuberculosis.

Dried crude powder of the whole plant exhibited anticonvulsant activity in albino rats.

Canscora diffusa (Vahl) R. Br. ex Roem. & Schultes (synonym C. lawii Wt.), found throughout India at 1,100 m, is used as a substitute for C. decussata.... canscora decussata

Slowing the action of the heart... cardiac depressant

Persons with chronic illnesses and/or impairments which lead to long-lasting disabilities in functioning and reliance on care (personal care, domestic life, mobility, self direction).... care-dependent

See INFECTION.... carriers of disease

For the purpose of national mortality statistics, every death is attributed to one underlying condition, based on information reported on the death certificate and using the international rules for selecting the underlying cause of death from the reported conditions. See “International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10)”.... cause of death

These consist either of expanding masses (lumps or tumours), or of areas of shrinkage (atrophy) due to degeneration, or to loss of blood supply, usually from blockage of an artery.

Tumours All masses cause varying combinations of headache and vomiting – symptoms of raised pressure within the inexpansible bony box formed by the skull; general or localised epileptic ?ts; weakness of limbs or disordered speech; and varied mental changes. Tumours may be primary, arising in the brain, or secondary deposits from tumours arising in the lung, breast or other organs. Some brain tumours are benign and curable by surgery: examples include meningiomas and pituitary tumours. The symptoms depend on the size and situation of the mass. Abscesses or blood clots (see HAEMATOMA) on the surface or within the brain may resemble tumours; some are removable. Gliomas ( see GLIOMA) are primary malignant tumours arising in the glial tissue (see GLIA) which despite surgery, chemotherapy and radiotherapy usually have a bad prognosis, though some astrocytomas and oligodendronogliomas are of low-grade malignancy. A promising line of research in the US (in the animal-testing stage in 2000) suggests that the ability of stem cells from normal brain tissue to ‘home in’ on gliomal cells can be turned to advantage. The stem cells were chemically manipulated to carry a poisonous compound (5-?uorouracil) to the gliomal cells and kill them, without damaging normal cells. Around 80 per cent of the cancerous cells in the experiments were destroyed in this way.

Clinical examination and brain scanning (CT, or COMPUTED TOMOGRAPHY; magnetic resonance imaging (MRI) and functional MRI) are safe, accurate methods of demonstrating the tumour, its size, position and treatability.

Strokes When a blood vessel, usually an artery, is blocked by a clot, thrombus or embolism, the local area of the brain fed by that artery is damaged (see STROKE). The resulting infarct (softening) causes a stroke. The cells die and a patch of brain tissue shrinks. The obstruction in the blood vessel may be in a small artery in the brain, or in a larger artery in the neck. Aspirin and other anti-clotting drugs reduce recurrent attacks, and a small number of people bene?t if a narrowed neck artery is cleaned out by an operation – endarterectomy. Similar symptoms develop abruptly if a blood vessel bursts, causing a cerebral haemorrhage. The symptoms of a stroke are sudden weakness or paralysis of the arm and leg of the opposite side to the damaged area of brain (HEMIPARESIS), and sometimes loss of half of the ?eld of vision to one side (HEMIANOPIA). The speech area is in the left side of the brain controlling language in right-handed people. In 60 per cent of lefthanders the speech area is on the left side, and in 40 per cent on the right side. If the speech area is damaged, diffculties both in understanding words, and in saying them, develops (see DYSPHASIA).

Degenerations (atrophy) For reasons often unknown, various groups of nerve cells degenerate prematurely. The illness resulting is determined by which groups of nerve cells are affected. If those in the deep basal ganglia are affected, a movement disorder occurs, such as Parkinson’s disease, hereditary Huntington’s chorea, or, in children with birth defects of the brain, athetosis and dystonias. Modern drugs, such as DOPAMINE drugs in PARKINSONISM, and other treatments can improve the symptoms and reduce the disabilities of some of these diseases.

Drugs and injury Alcohol in excess, the abuse of many sedative drugs and arti?cial brain stimulants – such as cocaine, LSD and heroin (see DEPENDENCE) – can damage the brain; the effects can be reversible in early cases. Severe head injury can cause localised or di?use brain damage (see HEAD INJURY).

Cerebral palsy Damage to the brain in children can occur in the uterus during pregnancy, or can result from rare hereditary and genetic diseases, or can occur during labour and delivery. Severe neurological illness in the early months of life can also cause this condition in which sti? spastic limbs, movement disorders and speech defects are common. Some of these children are learning-disabled.

Dementias In older people a di?use loss of cells, mainly at the front of the brain, causes ALZHEIMER’S DISEASE – the main feature being loss of memory, attention and reasoned judgement (dementia). This affects about 5 per cent of the over-80s, but is not simply due to ageing processes. Most patients require routine tests and brain scanning to indicate other, treatable causes of dementia.

Response to current treatments is poor, but promising lines of treatment are under development. Like Parkinsonism, Alzheimer’s disease progresses slowly over many years. It is uncommon for these diseases to run in families. Multiple strokes can cause dementia, as can some organic disorders such as cirrhosis of the liver.

Infections in the brain are uncommon. Viruses such as measles, mumps, herpes, human immunode?ciency virus and enteroviruses may cause ENCEPHALITIS – a di?use in?ammation (see also AIDS/HIV).

Bacteria or viruses may infect the membrane covering the brain, causing MENINGITIS. Viral meningitis is normally a mild, self-limiting infection lasting only a few days; however, bacterial meningitis – caused by meningococcal groups B and C, pneumococcus, and (now rarely) haemophilus – is a life-threatening condition. Antibiotics have allowed a cure or good control of symptoms in most cases of meningitis, but early diagnosis is essential. Severe headaches, fever, vomiting and increasing sleepiness are the principal symptoms which demand urgent advice from the doctor, and usually admission to hospital. Group B meningococcus is the commonest of the bacterial infections, but Group C causes more deaths. A vaccine against the latter has been developed and has reduced the incidence of cases by 75 per cent.

If infection spreads from an unusually serious sinusitis or from a chronically infected middle ear, or from a penetrating injury of the skull, an abscess may slowly develop. Brain abscesses cause insidious drowsiness, headaches, and at a late stage, weakness of the limbs or loss of speech; a high temperature is seldom present. Early diagnosis, con?rmed by brain scanning, is followed by antibiotics and surgery in hospital, but the outcome is good in only half of affected patients.

Cerebral oedema Swelling of the brain can occur after injury, due to engorgement of blood vessels or an increase in the volume of the extravascular brain tissue due to abnormal uptake of water by the damaged grey (neurons) matter and white (nerve ?bres) matter. This latter phenomenon is called cerebral oedema and can seriously affect the functioning of the brain. It is a particularly dangerous complication following injury because sometimes an unconscious person whose brain is damaged may seem to be recovering after a few hours, only to have a major relapse. This may be the result of a slow haemorrhage from damaged blood vessels raising intracranial pressure, or because of oedema of the brain tissue in the area surrounding the injury. Such a development is potentially lethal and requires urgent specialist treatment to alleviate the rising intracranial pressure: osmotic agents (see OSMOSIS) such as mannitol or frusemide are given intravenously to remove the excess water from the brain and to lower intracranial pressure, buying time for de?nitive investigation of the cranial damage.... brain, diseases of

The female breasts may be expected to undergo hormone-controlled enlargement at puberty, and later in pregnancy, and the glandular part of the breast undergoes evolution (shrinkage) after the menopause. The breast can also be affected by many di?erent diseases, with common symptoms being pain, nipple discharge or retraction, and the formation of a lump within the breast.

Benign disease is much more common than cancer, particularly in young women, and includes acute in?ammation of the breast (mastitis); abscess formation; and benign breast lumps, which may be ?broadenosis – di?use lumpiness also called chronic mastitis or ?brocystic disease – in which one or more ?uid-?lled sacs (cysts) develop.

Women who are breast feeding are particularly prone to mastitis, as infection may enter the breast via the nipple. The process may be arrested before a breast abscess forms by prompt treatment with antibiotics. Non-bacterial in?ammation may result from mammary duct ectasia (dilatation), in which abnormal or

blocked ducts may over?ow. Initial treatments should be with antibiotics, but if an abscess does form it should be surgically drained.

Duct ectasia, with or without local mastitis, is the usual benign cause of various nipple complaints, with common symptoms being nipple retraction, discharge and skin change.

Breast lumps form the chief potential danger and may be either solid or cystic. Simple examination may fail to distinguish the two types, but aspiration of a benign cyst usually results in its disappearance. If the ?uid is bloodstained, or if a lump still remains, malignancy is possible, and all solid lumps need histological (tissue examination) or cytological (cell examination) assessment. As well as having their medical and family history taken, any women with a breast lump should undergo triple assessment: a combination of clinical examination, imaging

– mammography for the over-35s and ultrasonagraphy for the under-35s – and ?ne-needle aspiration. The medical history should include details of any previous lumps, family history (up to 10 per cent of breast cancer in western countries is due to genetic disposition), pain, nipple discharge, change in size related to menstrual cycle and parous state, and any drugs being taken by the patient. Breasts should be inspected with the arms up and down, noting position, size, consistency, mobility, ?xity, and local lymphadenopathy (glandular swelling). Nipples should be examined for the presence of inversion or discharge. Skin involvement (peau d’orange) should be noted, and, in particular, how long changes have been present. Fine-needle aspiration and cytological examination of the ?uid are essential with ULTRASOUND, MAMMOGRAPHY and possible BIOPSY being considered, depending on the patient’s age and the extent of clinical suspicion that cancer may be present.

The commonest solid benign lump is a ?broadenoma, particularly in women of childbearing age, and is a painless, mobile lump. If small, it is usually safe to leave it alone, provided that the patient is warned to seek medical advice if its size or character changes or if the lump becomes painful. Fibroadenosis (di?use lumpiness often in the upper, outer quadrant) is a common (benign) lump. Others include periductal mastitis, fat NECROSIS, GALACTOCELE, ABSCESS, and non-breast-tissue lumps – for example, a LIPOMA (fatty tissue) or SEBACEOUS CYST. A woman with breast discharge should have a mammograph, ductograph, or total duct excision until the cause of any underlying duct ectasia is known. Appropriate treatment should then be given.

Malignant disease most commonly – but not exclusively – occurs in post-menopausal women, classically presenting as a slowly growing, painless, ?rm lump. A bloodstained nipple discharge or eczematous skin change may also be suggestive of cancer.

The most commonly used classi?cation of invasive cancers has split them into two types, ductal and lobular, but this is no longer suitable. There are also weaknesses in the tumour node metastases (TNM) system and the International Union Against Cancer (UICC) classi?cation.

The TNM system – which classi?es the lump by size, ?xity and presence of affected axillary glands and wider metastatic spread – is best combined with a pathological classi?cation, when assessing the seriousness of a possibly cancerous lump. Risk factors for cancer include nulliparity (see NULLIPARA), ?rst pregnancy over the age of 30 years, early MENARCHE, late MENOPAUSE and positive family history. The danger should be considered in women who are not breast feeding or with previous breast cancer, and must be carefully excluded if the woman is taking any contraceptive steroids or is on hormone-replacement therapy (see under MENOPAUSE).

Screening programmes involving mammography are well established, the aim being to detect more tumours at an early and curable stage. Pick-up rate is ?ve per 1,000 healthy women over 50 years. Yearly two-view mammograms could reduce mortality by 40 per cent but may cause alarm because there are ten false positive mammograms for each true positive result. In premenopausal women, breasts are denser, making mammograms harder to interpret, and screening appears not to save lives. About a quarter of women with a palpable breast lump turn out to have cancer.

Treatment This remains controversial, and all options should be carefully discussed with the patient and, where appropriate, with her partner. Locally contained disease may be treated by local excision of the lump, but sampling of the glands of the armpit of the same side should be performed to check for additional spread of the disease, and hence the need for CHEMOTHERAPY or RADIOTHERAPY. Depending on the extent of spread, simple mastectomy or modi?ed radical mastectomy (which removes the lymph nodes draining the breast) may be required. Follow-up chemotherapy, for example, with TAMOXIFEN (an oestrogen antagonist), much improves survival (it saves 12 lives over 100 women treated), though it may occasionally cause endometrial carcinoma. Analysis in the mid-1990s of large-scale international studies of breast-cancer treatments showed wide variations in their e?ectiveness. As a result the NHS has encouraged hospitals to set up breast-treatment teams containing all the relevant health professional experts and to use those treatments shown to be most e?ective.

As well as the physical treatments provided, women with suspected or proven breast cancer should be o?ered psychological support because up to 30 per cent of affected women develop an anxiety state or depressive illness within a year of diagnosis. Problems over body image and sexual diffculties occur in and around one-quarter of patients. Breast conservation and reconstructive surgery can improve the physical effects of mastectomy, and women should be advised on the prostheses and specially designed brassieres that are available. Specialist nurses and self-help groups are invaluable in supporting affected women and their partners with the problems caused by breast cancer and its treatment. Breast Cancer Care, British Association of Cancer United Patients (BACUP), Cancerlink, and Cancer Relief Macmillan Fund are among voluntary organisations providing support.... breasts, diseases of

Cause-of-death ranking for adults is based on the List of 72 Selected Causes of Death, HIV Infection, and Alzheimer’s Disease. The List was adapted from one of the special lists for mortality tabulations recommended for use with the International Classification of Diseases, ninth revision. Two group titles – “Major cardiovascular diseases” and “Symptoms, signs, and ill-defined conditions” – are not ranked based on the list of 72 selected causes. In addition, category titles that begin with the words “other” and “all other” are not ranked. The remaining category titles are ranked according to number of deaths to determine the leading causes of death. When one of the titles that represents a subtotal is ranked (for example, unintentional injuries), its component parts are not ranked (in this case, motor vehicle crashes and all other unintentional injuries).... cause-of-death ranking

(Roxb.) Loud.

Synonym: C. libani Barrel. var. deodara Hook. f.

Family: Pinaceae.

Habitat: North-western Himalayas from Kashmir to Garhwal, from 1,000 to 3,500 m.

English: Himalayan Cedar, Deodar.

Ayurvedic: Devadaaru, Suradru- ma, Suradaaru, Devakaashtha, Devadruma, Saptapatrika, Daaru, Bhadradaaru, Amarataru, Ama- radaaru, Daaruka, Devaahvaa, Surataru, Surabhuruha.

Unani: Deodaar.

Siddha/Tamil: Thevathaaram.

Action: Bark—decoction is used internally as astringent, antidiarrhoeal and febrifuge. Essential oil—antiseptic (used in skin diseases).

The Ayurvedic Pharmacopoeia of India indicated the use of the heart- wood in puerperal diseases.

The wood contains sesquiterpeno- ids; exhibits sapasmolytic activity. Alcoholic extract of the wood showed marked anti-inflammatory activity in mice; alcoholic extract showed antibacterial activity.

The wood possesses diaphoretic, diuretic and carminative properties, and is used in fevers and in pulmonary and urinary disorders.

Himalayan Cedarwood Oil contains two major sesquiterpenoids—alpha- and beta-himchalenes. Presence ofbu- tyric and caproic acids is also reported. The oil shows in vitro antibacterial and antifungal activity. It increases vascular permeability. Needles, on steam distillation, yield a volatile oil, rich in borneol and its esters. An alcoholic extract of the needles shows significant antibacterial activity against diptheria bacteria. The juice shows antiviral activity against tobacco mosaic virus and potato virus.

The bark contains 8-C methyltaxi- foline, dihydroquercetin, 8-C methyl- quercetin, quercetin, sitosterol, and tannins 8.25%, non-tannins 6.95% (varies with the age of the tree). An alcoholic extract of the bark shows significant activity against diptheria bacteria; aqueous extract of the dried bark showed anti-inflammatory activ ity against acute and chronic inflammations. Aqueous extract of the bark is found effective in reducing sugar content of diabetic patient's urine and blood to normal levels.

Dosage: Heartwood—3-6 g powder. (API Vol. IV.)... cedrus deodara

Linn.

Family: Ceratophyllaceae.

Habitat: All over India from temperate to tropics, in ponds and lakes.

English: Coontail, Hornwort.

Ayurvedic: Shaivaala (also equated with Vallisneria spiralis Linn., Hydrocharitaceae), Jalnili, Jalaja.

Unani: Tuhlub, Pashm Vazg.

Siddha/Tamil: Velampasi.

Folk: Sevaar.

Action: Purgative, antibilious, antibacterial.

The herb is rich in protein, calcium and magnesium; contains ferre- doxin and plastocyanin. EtOH (50%) extract—antimicrobial.

Dosage: Whole plant—10- 20 ml juice; 50-100 ml decoction. (CCRAS.)... ceratophyllum demersum

A disease which has one or more of the following characteristics: is permanent; leaves residual disability; is caused by non­reversible pathological alternation; requires special training of the patient for rehabilitation; or may be expected to require a long period of supervision, observation or care.... chronic condition / disease

Refers to diarrhoeal episodes of presumed infectious aetiology that begin acutely but have an unusually long duration, usually more than 14 days (see also WHO Classification).... chronic diarrhoea

UK legislation that provides for the identi?cation and care of individuals who have an incurable chronic or degenerative disorder. The patients are usually distinguished from elderly people with chronic disorders. Local authorities identify relevant individuals and arrange for appropriate services. The legislation does not, however, compel doctors and nurses in the community to inform local authorities of potential bene?ciaries. This may be because the individuals concerned dislike being on a register of disabled, or because questions of con?dentiality prevent health sta? from reporting the person’s condition.... chronic sick and disabled act 1970

Arrangement of diseases into groups having common characteristics. Useful in efforts to achieve standardization in the methods of presenting mortality and morbidity data from different sources and, therefore, in comparability. May include a systematic numerical notation for each disease entry. Examples include the International Statistical Classification of Diseases, Injuries and Causes of Death.... classification of disease

Centaury Tea has been known for centuries as a great medicinal remedy. It is said that Centaury plant is a very powerful diaphoretic, digestive, emetic, febrifuge, hepatic, homeopathic, poultice, stomachic, tonic and liver stimulator. Centaury is a plant from the gentian family which grows mainly in regions like Europe, Northern Africa and Eastern Australia. Also known as centaurium erythraea, this plant can easily be recognized by its triangular pale green leaves, pink flowers and yellowish anthers bloom. The fruit has the shape of a small oval capsule and it can only be harvested in the fall. Centaury Tea Properties Centaury has a bitter taste, which makes it a great ingredient for vermouth. Centaury Tea, however, is used by the alternative medicine for its great curative properties. The active constituents of Centaury Tea are: secoiridoids, alkaloids, phenolic acids, triterpenes, xanthone derivatives and triterpenes, which can only be released in the presence of hot water or other heating sources. Xanthone derivatives are also used by the alcohol producers in order to obtain a variety of liquors (especially the bitter ones). Centaury Tea Benefits Aside from its use as a vermouth ingredient, Centaury Tea has other health benefits, being prescribed by practitioners around the world since ancient times. Centaury Tea may be helpful in case you’re suffering from one of the following conditions: - Blood poisoning, by eliminating the toxins and increasing the blood flow. - A number of digestive ailments, such as constipation and gastritis. - Anemia, by nourishing the nervous system and increasing the coronary system function. - Diabetes and liver failure, by reconstructing the liver cells and lowering your blood sugar. - Kidney failure, by treating nephritis and other ailments of the urinary system. - Centaury Tea may also be used to induce appetite when taken before meals. How to make Centaury Tea Infusion Preparing Centaury Tea infusion is very easy. Use a teaspoon of freshly-picked or dried Centaury herbs for every cup of tea you want to make, add boiling water and wait 10 minutes for the health benefits to be released. Strain the decoction and drink it hot or cold. However, don’t drink more than 2 or 3 cups per day in order to avoid other health complications. Centaury Tea Side Effects When taken properly, Centaury Tea has no effects for adults. However, high dosages may lad to a number of ailments, such as nausea, diarrhea and vomiting. If you’ve been taking Centaury Tea for a while and you’re experiencing some unusual reactions, talk to your doctor as soon as possible! Centaury Tea Contraindications Don’t take Centaury Tea if you’re pregnant or breastfeeding. Also, children and patients suffering from severe diseases that require blood thinners and anti-coagulants ingestion should avoid taking Centaury Tea at all costs! The same advice if you’re preparing for a major surgery (Centaury Tea may interfere with the anesthetic). In order to gather more information, talk to an herbalist or to your doctor. Once he gives you the green light, add Centaury Tea to your shopping cart and enjoy the wonderful benefits of this tea responsibly!... centaury tea - diabetes treatment

The healthy chest is gently rounded all over, its contour being more rounded in women by the breast tissue. In cross-section it is oval-shaped with a longer dimension from side to side than from back to front.

Barrel chest is found in long-standing ASTHMA or chronic BRONCHITIS and EMPHYSEMA, when the lungs are chronically enlarged. The anterio-posterior dimension of the chest is increased and the ribs are near horizontal. In this position they can produce little further expansion of the chest, and breathing often relies on accessory muscles in the neck lifting up the whole thoracic cage on inspiration.

Pigeon chest is one in which the cross-section of the chest becomes triangular with the sternum forming a sort of keel in front. It may be related to breathing problems in early life.

Rickety chest is uncommon now and is caused by RICKETS in early life. There is a hollow down each side caused by the pull of muscles on the softer ribs in childhood. The line of knobs produced on each side where the ribs join their costal cartilages is known as the rickety rosary.

Pectus excavatum, or funnel chest, is quite a common abnormality where the central tendon of the diaphragm seems to be too short so that the lower part of the sternum is displaced inwards and the lower ribs are prominent. When severe, it may displace the heart further to the left side.

Local abnormalities in the shape of the chest occur when there is a deformity in the spine such as scoliosis which alters the angles of the ribs. The chest wall may be locally ?attened when the underlying lung is reduced in size locally over a prolonged period. (See SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.) This may be seen over a scarred area of lung such as that observed in pulmonary TUBERCULOSIS.... chest, deformities of

The use of information technology to assist health care professionals in diagnosis. This usually involves a dialogue between a computer system and a clinician. The systems are generally regarded as support systems for clinicians; the final responsibility for decision-making resides with the clinician.... computer-assisted diagnosis

The term for describing the persistent and involuntary turning of both eyes in any one direction, and is a sign of a lesion in the brain.... conjugate deviation

A group of generalised in?ammatory diseases that affect CONNECTIVE TISSUE in almost any system in the body. The term does not include those disorders of genetic origin. RHEUMATIC FEVER and RHEUMATOID ARTHRITIS were traditionally classi?ed in this group, as were those diseases classed under the outdated heading COLLAGEN DISEASES.... connective tissue disorders

Screening and surveillance uncover problems which then need careful attention. Most NHS districts have a CDT to carry out this task – working from child development centres – usually separate from hospitals. Various therapists, as well as consultant paediatricians in community child health, contribute to the work of the team. They include physiotherapists, occupational therapists, speech therapists, psychologists, health visitors and, in some centres, pre-school teachers or educational advisers and social workers. Their aims are to diagnose the child’s problems, identify his or her therapy needs and make recommendations to the local health and educational authorities on how these should be met. A member of the team will usually be appointed as the family’s ‘key worker’, who liaises with other members of the team and coordinates the child’s management. Regular review meetings are held, generally with parents sharing in the decisions made. Mostly children seen by CDTs are under ?ve years old, the school health service and educational authorities assuming responsibility thereafter.

Special needs The Children Act 1989, Education Acts 1981, 1986 and 1993, and the Chronically Sick and Disabled Persons Legislation 1979 impose various statutory duties to identify and provide assistance for children with special needs. They include the chronically ill as well as those with impaired development or disabilities such as CEREBRAL PALSY, or hearing, vision or intellectual impairment. Many CDTs keep a register of such children so that services can be e?ciently planned and evaluated. Parents of disabled children often feel isolated and neglected by society in general; they are frequently frustrated by the lack of resources available to help them cope with the sheer hard work involved. The CDT, through its key workers, does its best to absorb anger and divert frustration into constructive actions.

There are other groups of children who come to the attention of child health services. Community paediatricians act as advisers to adoption and fostering agencies, vital since many children needing alternative homes have special medical or educational needs or have behavioural or psychiatric problems. Many see a role in acting as advocates, not just for those with impairments but also for socially disadvantaged children, including those ‘looked after’ in children’s homes and those of travellers, asylum seekers, refugees and the homeless.

Child protection Regrettably, some children come to the attention of child health specialists because they have been beaten, neglected, emotionally or nutritionally starved or sexually assaulted by their parents or carers. Responsibility for the investigation of these children is that of local-authority social-services departments. However, child health professionals have a vital role in diagnosis, obtaining forensic evidence, advising courts, supervising the medical aspects of follow-up and teaching doctors, therapists and other professionals in training. (See CHILD ABUSE.)

School health services Once children have reached school age, the emphasis changes. The prime need becomes identifying those with problems that may interfere with learning – including those with special needs as de?ned above, but also those with behavioural problems. Teachers and parents are advised on how to manage these problems, while health promotion and health education are directed at children. Special problems, especially as children reach secondary school (aged 11–18) include accidents, substance abuse, psychosexual adjustment, antisocial behaviour, eating disorders and physical conditions which loom large in the minds of adolescents in particular, such as ACNE, short stature and delayed puberty.

There is no longer, in the UK, a universal school health service as many of its functions have been taken over by general practitioners and hospital and community paediatricians. However, most areas still have school nurses, some have school doctors, while others do not employ speci?c individuals for these tasks but share out aspects of the work between GPs, health visitors, community nurses and consultant paediatricians in child health.

Complementing their work is the community dental service whose role is to monitor the whole child population’s dental health, provide preventive programmes for all, and dental treatment for those who have di?culty using general dental services – for example, children with complex disability. All children in state-funded schools are dentally screened at ages ?ve and 15.

Successes and failures Since the inception of the NHS, hospital services for children have had enormous success: neonatal and infant mortality rates have fallen by two-thirds; deaths from PNEUMONIA have fallen from 600 per million children to a handful; and deaths from MENINGITIS have fallen to one-?fth of the previous level. Much of this has been due to the revolution in the management of pregnancy and labour, the invention of neonatal resuscitation and neonatal intensive care, and the provision of powerful antibiotics.

At the same time, some children acquire HIV infection and AIDS from their affected mothers (see AIDS/HIV); the prevalence of atopic (see ATOPY) diseases (ASTHMA, eczema – see DERMATITIS, HAY FEVER) is rising; more children attend hospital clinics with chronic CONSTIPATION; and little can be done for most viral diseases.

Community child health services can also boast of successes. The routine immunisation programme has wiped out SMALLPOX, DIPHTHERIA and POLIOMYELITIS and almost wiped out haemophilus and meningococcal C meningitis, measles and congenital RUBELLA syndrome. WHOOPING COUGH outbreaks continue but the death and chronic disability rates have been greatly reduced. Despite these huge health gains, continuing public scepticism about the safety of immunisation means that there can be no relaxation in the educational and health-promotion programme.

Services for severely and multiply disabled children have improved beyond all recognition with the closure of long-stay institutions, many of which were distinctly child-unfriendly. Nonetheless, scarce resources mean that families still carry heavy burdens. The incidence of SUDDEN INFANT DEATH SYNDROME (SIDS) has more than halved as a result of an educational programme based on ?rm scienti?c evidence that the risk can be reduced by putting babies to sleep on their backs, avoidance of parental smoking, not overheating, breast feeding and seeking medical attention early for illness.

Children have fewer accidents and better teeth but new problems have arisen: in the 1990s children throughout the developed world became fatter. A UK survey in 2004 found that one in ?ve children are overweight and one in 20 obese. Lack of exercise, the easy availability of food at all times and in all places, together with the rise of ‘snacking’, are likely to provoke signi?cant health problems as these children grow into adult life. Adolescents are at greater risk than ever of ill-health through substance abuse and unplanned pregnancy. Child health services are facing new challenges in the 21st century.... child development teams (cdts)

See “data”.... continuous data (variable)

A persistent or recurring condition or group of symptoms. Chronic disorders are customarily contrasted with acute diseases which start suddenly and last a short time. The symptoms of acute disease often include breathlessness, fever, severe pain and malaise, with the patient’s condition changing from day to day or even hour to hour. Those suffering from chronic conditions – for example, severe arthritis, protracted lung disease, ASTHMA or SILICOSIS – should be distinguished from those with a ‘static disability’ following a stroke or injury. Chronic disorders steadily deteriorate, often despite treatment and the patient is increasingly unable to carry out his or her daily activities.... chronic disorder

The control of disease caused by infectious agents or their toxic products. Successes in the 19th and 20th centuries in the treatment and control of communicable diseases such as SMALLPOX, CHOLERA, TUBERCULOSIS, gastrointestinal infections, POLIOMYELITIS and SEXUALLY TRANSMITTED DISEASES (STDS) resulted in an erroneous conception that they no longer posed a serious threat to public health, and certainly not in developed countries. As a consequence, the maintenance of e?ective public health strategies steadily lost out in the competition for resources to the more ‘glamorous’ developments in medicine, such as improved CANCER treatments, HEART surgery, kidney DIALYSIS and organ TRANSPLANTATION. However, in recent decades the dangers of this approach have become increasingly apparent. Rapidly expanding urban populations, more complex lifestyles, new and resurgent infections (some linked to a spread of antibiotic resistance) such as AIDS/HIV and variant CREUTZFELDT-JAKOB DISEASE (CJD), and the ease with which infection can be spread by the enormous growth of long-distance travel and population migrations are severely straining existing public health measures. The supply of clean water, e?ective waste- and sewage-disposal measures, the hygienic production and delivery of food and early detection and subsequent prevention of infectious diseases can no longer be taken for granted. Governments will need to strengthen the provision of workable, properly resourced public health facilities, and developing countries will need ?nancial support and expert help from developed nations to achieve this objective. Timely recognition of new and resurgent infectious diseases requires national and international early-warning mechanisms to ensure rapid investigation and implementation of e?ective control measures. Otherwise, serious breakdowns in public health will occur, and international co-operation is vital to provide and support control measures. (See also COMMUNICABLE DISEASE; NOTIFIABLE DISEASES.)... communicable diseases control

A dried, unprocessed plant, and referring to one that was or is an official drug plant or the source of a refined drug substance. A—... crude drug

(French) One who is from Aubigny Dabnie, Dabny, Dabni, Dabnee, Dabnea, Dabneah... dabney

This is a term encompassing chronic BRONCHITIS, EMPHYSEMA, and chronic ASTHMA where the air?ow into the lungs is obstructed.

Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.

The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.

Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.

Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:

RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).

marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.

loss of weight.

CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.

bounding pulse with changes in heart rhythm.

OEDEMA of the legs and arms.

decreasing mobility.

Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.

Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.

Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.

Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.

Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)

(Latin) A heavenly messenger; an angel

Dabriah, Dabrea, Dabrya, Dabriya, Dabreah, Dabryah, Dabriyah... dabria

(Irish) Woman from the South Daicey, Dacee, Dacia, Dacie, Dacy, Daicee, Daicy, Daci, Daici, Dacea, Daceah... dacey

Blume.

Synonym: Calamus draco Willd.

Family: Palmae; Aracaceae.

Habitat: Indo-Malayan region. The resin is imported into India mostly from Sumatra and Borneo.

English: East Indian Dragon's Blood.... daemonorops draco

Also known as ‘expert systems’, these are computer software systems intended to help doctors make clinical decisions. Primary care medicine is especially noted for its uncertainty by virtue of being most patients’ ?rst point of contact with health care, confronting the clinician with many ‘undi?erentiated’ health problems. So far, these systems have not been as e?ective as expected because of a failure to ana-lyse the needs of primary care. Simple procedures to prompt the delivery of treatment to patients with chronic conditions have improved care quality, but work needs to be done on their cost-e?ectiveness. The aim of more complex computerised support systems will be to forecast likely future events and the possible e?ectiveness of proposed interventions, based on available information about the patient and an understanding of the risks and e?cacy of interventions by doctors and other experts.

One example, called ISABEL, can be accessed by paediatricians to check on their diagnosis and management of many childhood disorders.... computerised decision-support systems

In the United Kingdom, controlled drugs are those preparations referred to under the Misuse of Drugs Act 1971. The Act prohibits activities related to the manufacture, supply and possession of these drugs, and they are classi?ed into three groups which determine the penalties for o?ences involving their misuse. For example, class A includes COCAINE, DIAMORPHINE, MORPHINE, LSD (see LYSERGIC ACID DIETHYLAMIDE and PETHIDINE HYDROCHLORIDE. Class B includes AMPHETAMINES, BARBITURATES and CODEINE. Class C includes drugs related to amphetamines such as diethylpropion and chlorphentermine, meprobamate and most BENZODIAZEPINES and CANNABIS.

The Misuse of Drugs Regulations 1985 de?ne the classes of person authorised to supply and possess controlled drugs, and lay down the conditions under which these activities may be carried out. In the Regulations, drugs are divided into ?ve schedules specifying the requirements for supply, possession, prescribing and record-keeping. Schedule I contains drugs which are not used as medicines. Schedules II and III contain drugs which are subject to the prescription requirements of the Act (see below). They are distinguished in the British National Formulary (BNF) by the symbol CD and they include morphine, diamorphine (heroin), other opioid analgesics, barbiturates, amphetamines, cocaine and diethylpropion. Schedules IV and V contain drugs such as the benzodiazepines which are subject to minimal control. A full list of the drugs in each schedule can be found in the BNF.

Prescriptions for drugs in schedules II and III must be signed and dated by the prescriber, who must give his or her address. The prescription must be in the prescriber’s own handwriting and provide the name and address of the patient and the total quantity of the preparation in both words and ?gures. The pharmacist is not allowed to dispense a controlled drug unless all the information required by law is given on the prescription.

Until 1997 the Misuse of Drugs (Noti?cation and Supply of Addicts) Regulations 1973 governed the noti?cation of addicts. This was required in respect of the following commonly used drugs: cocaine, dextromoramide, diamorphine, dipipanone, hydrocodeine, hydromorphone, levorphanol, methadone, morphine, opium, oxycodone, pethidine, phenazocine and piritranide.

In 1997 the Misuse of Drugs (Supply to Addicts) Regulations 1997 revoked the 1973 requirement for noti?cation. Doctors are now expected to report (on a standard form) cases of drug misuse to their local Drug Misuse Database (DMD). Noti?cation by the doctor should be made when a patient ?rst presents with a drug problem or when he or she visits again after a gap of six months or more. All types of misuse should be reported: this includes opioids, benzodiazepines and central nervous system stimulants. The data in the DMD are anonymised, which means that doctors cannot check on possible multiple prescribing for drug addicts.

The 1997 Regulations restrict the prescribing of diamorphine (heroin), Diconal® (a morphine-based drug) or cocaine to medical practitioners holding a special licence issued by the Home Secretary.

Fuller details about the prescription of controlled drugs are in the British National Formulary, updated twice a year, and available on the Internet (see www.bnf.org).... controlled drugs

Mart.

Synonym: Calamus jenkinsianus Griff.

Family: Palmae; Aracaceae.

Habitat: Assam, Khasi Hills and Sikkim.

Ayurvedic: Vetra (related species of Calamus tenuis Roxb.)

Action: Used as a vegetable for oedema, also in intrinsic haemorrhage.... daemonorops jenkinsianus

(American) The Lord is gracious

Daeshan, Daeshaun, Daeshauna, Daeshavon, Daeshawn, Daeshawntia, Daeshon, Daeshona, Daiseana, Daiseanah, Daishaughn, Daishaughna, Daishaughnah, Daishaun, Daishauna, Daishaunah, Daishawn, Daishawna, Daishawnah, Daysean, Dayseana, Dayseanah, Dayshaughna, Dayshaughnah, Dayshaun, Dayshauna, Dayshaunah, Dayshawn, Dayshawna... daeshawna

(Hebrew) Feminine form of Dagan; grain of the earth Daganyah, Dagania, Dagana, Daganna, Daganiya, Dagian, Dagonya, Dagonia, Dagoniya, Dagona... daganya

(Scandinavian) Born on a glorious day

Dagmara, Dagmaria, Dagmarie, Dagomar, Dagomara, Dagomar, Dagomaria, Dagmarr, Dagomarr... dagmar

A rapidly progressive, fatal, degenerative disease in humans caused by an abnormal PRION protein. There are three aetiological forms of CJD: sporadic, IATROGENIC, and inherited. Sporadic CJD occurs randomly in all countries and has an annual incidence of one per million. Iatrogenic CJD is caused by accidental exposure to human prions through medical and surgical procedures (and cannibalism in the case of the human prion disease known as kuru that occurs in a tribe in New Guinea, where it is called the trembling disease). Inherited or familial CJD accounts for 15 per cent of human prion disease and is caused by a MUTATION in the prion protein gene. In recent years a new variant of CJD has been identi?ed that is caused by BOVINE SPONGIFORM ENCEPHALOPATHY (BSE), called variant CJD. The incubation period for the acquired varieties ranges from four years to 40 years, with an average of 10–15 years. The symptoms of CJD are dementia, seizures, focal signs in the central nervous system, MYOCLONUS, and visual disturbances.

Abnormal prion proteins accumulate in the brain and the spinal cord, damaging neurones (see NEURON(E)) and producing small cavities. Diagnosis can be made by tonsil (see TONSILS) biopsy, although work is under way to develop a diagnostic blood test. Abnormal prion proteins are unusually resistant to inactivation by chemicals, heat, X-RAYS or ULTRAVIOLET RAYS (UVR). They are resistant to cellular degradation and can convert normal prion proteins into abnormal forms. Human prion diseases, along with scrapie in sheep and BSE in cattle, belong to a group of disorders known as transmissible spongiform encephalopathies. Abnormal prion proteins can transfer from one animal species to another, and variant CJD has occurred as a result of consumption of meat from cattle infected with BSE.

From 1995 to 1999, a scienti?c study of tonsils and appendixes removed at operation suggested that the prevalence of prion carriage may be as high as 120 per million. It is not known what percentage of these might go on to develop disease.

One precaution is that, since 2003, all surgical instruments used in brain biopsies have had to be quarantined and disposable instruments are now used in tonsillectomy.

Measures have also been introduced to reduce the risk of transmission of CJD from transfusion of blood products.

In the past, CJD has also been acquired from intramuscular injections of human cadaveric pituitary-derived growth hormone and corneal transplantation.

The most common form of CJD remains the sporadic variety, although the eventual incidence of variant CJD may not be known for many years.... creutzfeldt-jakob disease (cjd)

Pers.

Family: Gramineae; Poaceae.

Habitat: Throughout India up to 3,000 m.

English: Bermuda Grass, Bahama Grass, Couch Grass.

Ayurvedic: Duurvaa, Bhaargavi, Shatvalli, Shatparvaa, Tiktaparvaa, Shatviryaa, Sahastravirya, Shitaa, Anantaa, Golomi.

Unani: Duub.

Siddha/Tamil: Arugampallu.

Action: The grass is a reputed as a remedy in epitaxis, haematuria, inflammed tumours, whitlows fleshy excrescences, cuts, wounds, bleeding piles, cystitis, nephritis and in scabies and other skin diseases. It is credited with astringent, diuretic, antidiarrhoeal, anticatarrhal, styptic and antiseptic properties. The Ayurvedic Pharmacopoeia ofIn- dia recommended the dried fibrous root in menorrhagia, metrorrhagia and burning micturation.

Phenolic phytotoxins—ferulic, sy- ringic, p-coumaric, vanillic, p-hydro- xybenzoic and O-hydroxyphenyl acetic acids, are reported from the plant. The leaves contain tricin, flavone C- glycosides and a flavonoid sulphate.

Dosage: Whole plant—10-20 ml juice (API Vol. IV.); root—5-10 ml juice (API Vol. III.)... cynodon dactylon

Beauv.

Synonym: Eleusine aegyptiaca Desf.

Family: Gramineae, Poaceae.

Habitat: Common throughout the plains of India (a very variable grass).

Ayurvedic: Takraa, Takraahvaa, Panchaanguli, Nrityakaundaka. (Classical synonyms.) (Takra is the classical name of buttermilk.)

Folk: Makaraa, Makari (Bihar, Orissa), Timidaa (Tamil Nadu)

Action: Astringent, bitter tonic, anthelmintic. Used for polyurea; externally for wounds and ulcers.

The grass growing is New South Wales is reported to contain cyano- genetic glycosides.

In Indian medicine, the grass is used for imparting medicinial properties of Takra (buttermilk) in intestinal, biliary and urinary diseases.

Ayurvedic: Raktaniryaas, Khoon- kharaabaa, Heeraadokhi.

Unani: Damm-ul-Akhwain.

Action: Astringent. Used for diarrhoea, dysentery. Also used against malignant tumours.

The resin contains red tannin derivatives—drocoresinotannols, dracoresen and flavone quinones.

Dosage: Resin—1-3 g. (CCRAS.)... dactyloctenium aegyptium

(Norse) Born on a bright new day Dagney, Dagni, Dagnie, Dagnee, Dagna, Dagnia, Dagne, Dagnea, Dagneah... dagny

(Arabic) The golden child Dhahab, Dahabe, Dahabia, Dahabea, Dahabiah, Dahabeah... dahab

(Swedish) From the valley; resembling the flower

Dahlea, Dahl, Dahiana, Dayha, Daleia ... dahlia

(Greek) One who is well-informed Daeira, Danira, Dayeera... daira

(Sanskrit) The sky dancer Dakinie, Dakyny, Dakyni, Dakynie, Dakiny, Dakiney, Dakin, Dakiny, Dakinee, Dakinea, Dakineah, Dakyney, Dakynee, Dakynea, Dakyneah... dakini

(Native American) A friend to all Dakotah, Dakotta, Dakoda, Dakodah... dakota

(Arabic) A flirtatious woman Dalall, Dalale, Dalalle... dalal

Linn.f.

Synonym: D.frondosa Roxb.

Family: Papilionaceae; Fabaceae.

Habitat: The sub-Himalayan tract, ascending up to 750 m, and throughout India.

Siddha/Tamil: Erigai, Navelangu.

Folk: Gorakh, Takoli, Bithuaa.

Action: A decoction of bark— used in dyspepsia. Oil—applied to rheumatic affections, and cutaneous diseases. Leaf—in leprosy and allied obstinate skin diseases.

Baptigenin from leaves and flowers possesses properties to treat arthritic affections and inflammations. An isoflavone glycoside of biochanin (lanceolarin) has been obtained from the root bark. Ether, EtOH and aqueous extract of leaves exhibited an- tiarthritic activity in rats.

The heartwood of Dalbergia sp. contains quinones. Bark and pods contain tannins.

Root bark gave isoflavone glycosides and lanceolarin.

Dosage: Whole plant—50-100 ml decoction. (CCRAS.)... dalbergia lanceolaria

Roxb.

Synonym: D. emerginata Roxb.

Family: Papilionaceae; Fabaceae.

Habitat: Bengal, Bihar, Madhya Pradesh and Western Peninsula.

English: East Indian Rosewood, Bombay Blackwood.

Ayurvedic: Shimshapaa (related sp.)

Unani: Sheesham.

Siddha/Tamil: Itti, Eravadi, Karun- doroiral.

Folk: Sisu.

Action: Stimulant, appetiser, anthelmintic, spasmogenic. Used in dyspepsia, diarrhoea; also in obesity, cutaneous affections and leprosy.

The bark contains hentriacontane, latifolin, beta-sitosterol and tannins. EtOH (50%) extract of the bark exhibits spasmogenic, and anthelmintic activity against Ascaridia galli.... dalbergia latifolia

Grah.

Family: Papilionaceae; Fabaceae.

Habitat: Throughout India, especially in the South.

English: Malabar Blackwood.

Ayurvedic: Kushimshapaa. (Shimshapaa related species).

Siddha/Tamil: Vel-itti.

Folk: Sisam.

Action: Anti-inflammatory.

The root contains isoflavones. The alcoholic extract of the root exhibited anti-inflammatory activity in carrage- enan-induced hind paw oedema of male albino rats.

A quinone, sissoidenone and dalbergion, latifolin and dalbergin have been isolated from the heartwood; also oleanolic acid, liquiritigenin and isoliquiritigenin. The sapwood and young leaves gave sissotrin. Biochanin A, isolated from young leaves, inhibited both serum and epidermal growth factor (EGF)—stimulated growth of human prostate cancer cell lines.... dalbergia sissoides

Roxb ex DC.

Family: Papilionaceae; Fabaceae.

Habitat: The sub-Himalayan tract, up to 1,200 m from Indus to Assam and in plains throughout India.

English: Sissoo, South Indian Redwood, Sissoo.

Ayurvedic: Shimshapaa, Krishna- shimshapaa, Picchilaa.

Unani: Seesham.

Siddha/Tamil: Irupoolai.

Action: Leaves—bitter, and stimulant. Leaf mucilage, mixed with sweet oil, is applied to excoriations. Wood—anthelmintic, alterative, emetic, stomachic, antileprotic; used in diseases due to vitiated blood. Bark—anticholerin. Root—astringent.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicated the use of the heart- wood in turbity of the urine, calculus and lipuria.

The leaves gave isoflavone sissotrin; flowers 7,4'-di-Me-tectorigenin. Seed oil (4.1%) contained fatty acids composed of palmitic (16.2), stearic (7.0%), oleic (14.6), linolenic (9.80) and linole- ic (52.5) acids and lipids comprising neutral lipids (88.5), glycolipids (7.2) and phospholipids (4.0%). Pods contain 2% tannins.

Dosage: Heartwood—1.5-10 g powder; 10-20 g for decoction. (API Vol. III.)... dalbergia sissoo

Nimmo ex Grah.

Synonym: D. multiflora Heyne ex Prain.

Family: Papilionaceae; Fabaceae.

Habitat: Common in Maharashtra and Karnataka.

Folk: Tibali (Goa), Pentagul (Maharashtra).

Action: Bark—used as a paste for pimples. Leaf—alterative. Aerial part—spasmolytic, CNS active, hypothermic.... dalbergia sympathetica

(English) From the small valley Dayle, Dael, Daelyn, Dail, Daile, Dalena, Dalene, Dalenna, Dalina, Dalla, Dayla, Daele, Dayl... dale

(Arabic / Hebrew) One who is gentle / resembling a slender tree branch Daliah, Dalit, Dalila, Daliya, Daliyah, Dalya, Dalyah, Dalis, Daliyah, Dalea, Daleah... dalia

(Scottish) From the valley meadow Dallis, Dalles, Dallin, Dallon, Dallys... dallas

Roxb.

Family: Papilionaceae; Fabaceae.

Habitat: Central and Eastern Himalayas, Uttar Pradesh and Orissa.

Ayurvedic: Gorakhi.

Siddha/Tamil: Punali.

Folk: Bankharaa, Bhatiaa.

Action: Leaves—used in aphthae. Root—genitourinary tract disinfectant; used in scalding of urine, also in foetid discharges.

The stem bark afforded isoflavo- noids, dalbergio, tectorigenin. The leaves gave flavonoid glycosides. The wood gave friedelin.... dalbergia volubilis

(Latin) Women from Dalmatia, a region of Italy

Dalma, Dalmassa, Dalmatia, Dalmase, Dalmatea... dalmace

(African) A versatile woman Dalmarr, Dalmare, Dalmarre... dalmar

(Arabic) A beautiful vision Damalie, Damaly, Damaley, Damalee, Damaleigh, Damalea, Damaleah... damali

(American) Of a bright tomorrow Damanie, Damany, Damaney, Damanee, Damanea, Damaneah... damani

(Latin) A gentle woman Damara, Damaress, Damariss, Damariz, Dameris, Damerys, Dameryss, Damiris, Damris, Demaras, Demaris, Demarys, Damalas, Damalis, Damalit, Damalla... damaris

(Indian) One who subdues others; in Hinduism, the name of a princess Damayantie, Damayanty, Damayantey, Damayantee, Damayantea, Damayanteah... damayanti

(English) A female knight Daim, Daime, Daym, Dayme, Daem, Daeme... dame

(Irish) Fawn Devent, Downeti, Devnet, Downett... damhnait

(Greek) In mythology, a goddess of nature

Damea, Damiya, Dimaia, Damiah, Dameah, Damiyah... damia

(Greek) One who tames or subdues others

Damiane, Daimen, Daimon, Daman, Damen, Dameon, Damiana, Damianna, Damianus, Damien, Damion, Damon, Damyan, Damyen, Damyon, Dayman, Daymian, Daymon, Demyan, Damina... damian

(African) A cheerful daughter Damysi, Damisie, Damysie, Damisee, Damysee, Damisea, Damysea, Damiseah, Damyseah, Damisy, Damysy, Damisey, Damysey... damisi

(Spanish) The little princess Damitah, Damyta, Dameeta, Damieta, Damitta, Dameita, Dameata, Damytah, Dameetah, Damietah, Damittah, Dameitah, Dameatah... damita

(English) Woman from Denmark Daena, Daina, Danaca, Danah, Dane, Danet, Daney, Dania, Danica, Danna, Danya, Dayna, Dayne... dana

(Greek) In mythology, the mother of Perseus

Danay, Danaye, Danea, Danee, Dee, Denae, Denay, Dene, Dinae, Dinay... danae

(Italian) Form of Angela, meaning “a heavenly messenger; an angel” Dangela, Deangellis, Deangelis, Diangelis... dangelis

(Slavic) Of the morning star Danaca, Danika, Dannica, Dannika, Donika, Donnica, Danyca, Danyka... danica

(Hebrew) Feminine form of Daniel; God is my judge Daanelle, Danee, Danele, Danella, Danelle, Danelley, Danette, Daney, Dani, Dania, Danice, Danie, Daniela, Daniele, Daniella, Danijela, Danila, Danit, Danita, Danitza, Danna, Dannette, Danney, Danni, Danniella, Dannielle, Danny, Dannyce, Dany, Danya, Danyell, Danyella, Danyelle, Dhanielle, Danise, Dannah, Dannalee, Dannaleigh, Dannell, Dannee, Dannelle, Dannia, Dannon, Danuta, Danylynn... danielle

(Latin) An enduring woman; everlasting

Dantae, Dantay, Dantel, Daunte, Dontae, Dontay, Donte, Dontae, Dawnte, Dauntay, Dawntay, Dauntae, Dawntae... dante

Dandelion tea is an excellent source of vitamins and an unbeatable way to maintain healthy body and mind. About Dandelion tea Dandelion is a perennial yellow plant scientifically called Taraxacum officinale. Itcan be used as a herbal plant but also in the kitchen in many recipes, salads etc. It grows everywhere and it appears in early spring. Its flowers last until late fall. For medical purposes, the young flowers are usually used before flowering along with the root. The flowers are an important source of vitamins (A, B, C and D), minerals (is very rich in potassium) proteins, carbohydrates, and tannins, caffeic acid. The leaves are also important. The root contains a bitter compound - taraxacina - but it is also rich in pectins, sterols, vitamins B1, C and D, inulin, tannin, volatile oils and reshines. You can use the leaves to prepare salads, juices, infusions or tinctures. The roots are mostly used for teas, tinctures and decoction. Dandelion tea is considered an overall tonic with multiple benefits. How to brew Dandelion tea For regular use, you can drink 2 cups of dandelion tea per day. Use 2 teaspoons of dried plant for a hot water cup. Let it infuse for a couple of minutes and then let it rinse. Another way of drinking the dandelion tea is by using small cutted leaves and dried roots. Pour into a container approximately 200 ml of water, add the plant and let it boil. After that, cover the container with something and keep it to infuse for 15 minutes. In the end, filter it and enjoy the tea. You may add some honey or sugar. Benefits of Dandelion tea Dandelion tea has lots of benefits as it is considered one of the healthiest teas. - Dandelion tea is depurative, sudorific and diuretic - Dandelion tea helps to diminish high cholesterol - It promotes gastrointestinal health, enhancing digestion, stimulating the appetite and treating digestive problems such as heartburn or upset stomach - Dandelion tea is suitable in diets or in fighting obesity as it helps the body eliminate water, having a detoxifying role -The tea is considered to be aliver, kidney and gallbladder tonic and it normalizes blood circulation - It is used with success in treating several skin ailments like acne, gout, atherosclerosis, varicose veins - Dandelion tea has an antirheumatic effect and some studies underlined that it also boosts the immunity - Dandelion tea also has a cosmetic  use as it improves skin clarity and cleanses complexion Side effects of Dandelion tea Although dandelion tea has many benefits, it also has several warnings that you should take into consideration. It is not advisable to use the plant after flowering. Dandelion tea can reduce the efficiency of some medicines and may interact with some drugs or other herbs. Avoid combining this tea with antibiotics, garlic, gingko biloba, blood thinners or pain relievers, as a risk of bleeding may arise. Some studies pointed out that those suffering of diabetes and low blood sugar, as well as pregnant women or breastfeeding women should consult their physician before drinking dandelion tea. If you are allergic to daisies, chrysanthemum, chamomile or marigold you may also develop same reaction for dandelion. Some people call dandelion tea the elixir of long life as it brings vitality and makes you strong if you consume it on a regular basis. However, it’s best to keep the moderation and to search for information before you decide to drink it on a regular basis.... dandelion tea

(Greek) Of the laurel tree; in mythology, a virtuous woman transformed into a laurel tree to protect her from Apollo Daphna, Daphney, Daphni, Daphnie, Daffi, Daffie, Daffy, Dafna, Dafne, Dafnee, Dafneigh, Dafnie, Danfy, Daphnah, Daph, Daveney, Davne, Daphnea, Daphneah, Dafnea, Dafneah... daphne

(Hebrew / Gaelic) A wise woman / from the oak tree

Darah, Darda, Dareen, Daria, Darian, Darissa, Darra, Darragh, Darrah, Darya, Daracha, Daralis... dara

(English) Of the deer park Darb, Darbee, Darbey, Darbie, Darrbey, Darrbie, Darrby, Derby, Derbie, Derbey, Derbee, Darbea, Darbeah... darby

(English) A dark beauty D’Arcy, Darcee, Darcel, Darcell, Darceigh, Darcelle, Darcey, Darchelle, Darci, Darcia, Darcy, Darice, Darsee, Darseigh, Darsey, Darsie, Darcelle, Daray, Dorcey, Dorcy, Dorci, Dorcie, Dorcee, Dorsey, Dorsy, Dorsi, Dorsie, Dorsee, Darcea, Darceah, Dorcea, Dorceah... darcie

(Greek) Feminine form of Darius; possessing good fortune; wealthy Dari, Darian, Dariane, Darianna, Dariele, Darielle, Darien, Darienne, Darina, Darion, Darrelle, Darrian, Darya, Dhariana, Dorian, Dariana, Darinka, Darena, Dariya... daria

(Greek) Feminine form of Darius; possessing good fortune; wealthy Dareece, Daryce, Dareese, Daryse, Darise... darice

(American) One who takes risks; a bold woman

Daryng, Derring, Dering, Deryng... daring

(English) Our little darling Dareen, Darla, Darleane, Darleen, Darleena, Darlena, Darlenny, Darlina, Darline, Darlinn, Darlyn, Darlyne, Darryleen, Darrylene, Darryline, Darlita, Darelene... darlene

(English) A secretive woman Darnelle, Darnella, Darnae, Darnetta, Darnisha, Darnel, Darnele, Darnela, Darnette, Darnete, Darneta, Darnysha... darnell

Schreb.

Family: Thymelaeaceae.

Habitat: The Western Himalayas and Kashmir at 1,000-3,000 m.

English: Mezereon.

Folk: Kutilal, Kanthan (Punjab).

Action: Active principles are attracting scientific interest. The orthoesters are co-carcinogenic and mezerein antileukaemic in experimental studies. Bark— used as an ointment for inducing discharge from indolent ulcers. Bark, root and root bark—used mainly for obstinate cutaneous diseases, especially for eczema with severe itching and copious exudation (weeping eczema).

As the plant is poisonous, it is used in homoeopathic dilutions internally and topically.

The bark gave diterpenes including mezerein, daphnetoxin (0.02%). Mezerein is anti-inflammatory and anticar- cinogenic. Daphnetoxin is poisonous. Seeds contain daphnane ester (0.1%) and daphnetoxin (0.02%).

EtOH extract showed significant activity against P-388 lymphocytic leukemia and L-1210 leukemia in mice, due to mezerein.... daphne oleoides

Darjeeling tea is a black tea grown in the Darjeeling district in West Bengal, India. Darjeeling tea is also called the “champagne of teas” since it is considered to be the finest tea in the world. At first, Darjeeling tea was available only as black tea but later on, Darjeeling white tea and Darjeeling oolong tea have been produced. Darjeeling tea is made from the small-leaved Chinese plant Camellia Sinensis, unlike most Indian teas that are made from the large-leaved Assam plant. The reason is that, in the early 1840’s, a civil surgeon of the Indian Medical Service named Dr. Campbell was transferred to Darjeeling and used seeds from China to experiment tea planting. How to brew Darjeeling tea Many tea drinkers complain about not getting the right flavor when drinking the Indian Darjeeling tea. The main reason why this happens is because the preparation of Darjeeling tea is a delicate process and ignoring even only one step can cause the loss of an authentic flavor and taste. Here are some important rules in brewing Darjeeling tea:

• Use water that is free of chlorine, iron, salt and other type of impurities, because otherwise it can completely ruin the taste orDarjeeling tea.
• An important detail that most people ignore is using the right teapot. That is why it is recommended the use of China porcelain teapots and cups.
• For proper infusion, the Darjeeling tea leaves should be placed into the pot and then pour hot water on it.
• And last, Darjeeling tea connoisseurs advise not to put any kind of milk, honey or sugar in it since they change the aromatic flavor of Darjeeling tea. Also, milk reduces the benefits of this tea.

Here are the brewing instructions: First of all, you have to boil the water. Once the water is boiled, let it cool for about 5 minutes because if it is too hot, the Darjeeling tea leaves might burn and you will lose the flavor. Then add one teaspoon of Darjeeling leaves per 8 oz cup in the teapot and slowly pour water over the leaves.  Let it steep between 2-5 minutes, but be careful! Steeping it for more than 5 minutes, may lead to a bitter cup of tea!  Try to drink it without any kind of sweetener or milk to really enjoy the flavor. Darjeeling Tea benefits Darjeeling tea has many benefits because of the high antioxidant content that combat free radicals and diseases. Also Darjeeling tea contains vitamins and minerals such as Vitamin C, Vitamin K, calcium, magnesium and potassium, according the University of Arizona.

• Darjeeling tea strengthens your immune system, lowers cholesterol, fights dental plaque and maintains a healthy heart.
• Provides relaxation because of the L-theanine (amino - acid) that reduces mental and physical stress. That is why, people who suffer from depression or have anxiety attacks are advised to drink Darjeeling tea since it offers a feeling of well-being.
• It gives you energy, even though it has a small amount of caffeine. The L-theanine amino- acid softens caffeine’s speedy and uneven effects so that a person who is consuming Darjeeling tea feels relaxed and energized in the same time.
• Darjeeling tea contains antioxidants called flavonoids that protect cells from free radical damage.
• Reduces stroke risks and improves the function of blood vessels.

Darjeeling tea side effects  Since Darjeeling tea is a black tea, it has almost the same side effects as the simple black tea:

• People with anemia and iron deficiency should avoid drinking Darjeeling black tea.
• In cases of diabetes, even though Darjeeling tea’s caffeine content is softened by the the L-theanine amino - acid, still might affect blood sugar.
• People who present calcium deficit shouldn’t drink black tea, including Darjeeling tea, since it could produce dizziness and the sensation of fainting.
• Also, pregnant women are advised not to drink black tea.

Darjeeling tea is perfect for any time of the day and it is worldwide acknowledged as being to teas what champagne is to wine. It has a unique flavor that cannot be replicated anywhere else in the world!... darjeeling tea - the champagne of teas

(Irish / English) The great one / from a small rocky hill Darona, Daronah, Darron... daron

The thin muscle just under the skin of the SCROTUM which enables the scrotum to alter its shape.... dartos

(Slavic) Resembling a honeybee Darvah... darva

(English) One who is greatly loved Darel, Darille, Darolyn, Darrel, Darrell, Darrelle, Darrellyn, Darrill, Darrille, Darryl, Darrylene, Darrylin, Darryline, Darryll, Darrylyn, Darrylynn, Darylene, Darylin, Daryline, Daryll, Darylyn, Darylyne, Derrill, Darelle... daryl

(Greek) Feminine form of Darin; a gift of God

Darynn, Darynne, Darinne, Daren, Darenn, Darene... daryn

Items of information. continuous data: Data with a potentially infinite number of possible values along a continuum (e.g. height, weight). discrete data: Data that can be arranged into naturally occurring or arbitrarily groups or sets of values. individual data: Data that have not been put into a frequency distribution or rank ordered.... data

This legislation puts into e?ect the UK European Directive 95/46/EC on the processing of personal data, whether paper or computer records. The Act is based on eight principles, the ?rst of which stipulates that ‘personal data shall be processed fairly and lawfully’. Unfortunately this phrase is open to di?erent interpretations. Clari?cation is required to determine how the common-law duty of con?dentiality affects the health services in the context of using data obtained from patients for research work, especially epidemiological studies (see EPIDEMIOLOGY). Health authorities, trusts and primary care groups in the NHS have appointed ‘Caldicott guardians’ – named after a review of information that identi?es patients. A prime responsibility of the guardians is to agree and review internal protocols for the protection and use of identi?able information obtained from patients. The uncertainties over the interpretation of the legislation require clari?cation, but some experts have suggested a workable solution: to protect patients’ rights, researchers should ensure that data are fully anonymised whenever possible; they should also agree their project design with those responsible for data protection well in advance of its planned starting date. (See ETHICS.)... data protection act 1998

Any of a wide variety of repositories (often computerized) for observations and related information about a group of individuals, a disease, an intervention or other events or characteristics, typically organized for easy search and retrieval.... database (or register)

See HEALTH DATABASES.... databases

Phoenix dactylifera

Description: The date palm is a tall, unbranched tree with a crown of huge, compound leaves. Its fruit is yellow when ripe.

Habitat and Distribution: This tree grows in arid semitropical regions. It is native to North Africa and the Middle East but has been planted in the arid semitropics in other parts of the world.

Edible Parts: Its fruit is edible fresh but is very bitter if eaten before it is ripe. You can dry the fruits in the sun and preserve them for a long time.

Other Uses: The trunks provide valuable building material in desert regions where few other treelike plants are found. The leaves are durable and you can use them for thatching and as weaving material. The base of the leaves resembles coarse cloth that you can use for scrubbing and cleaning.... date palm

See DRUG ASSISTED RAPE.... date rape

Linn.

Family: Datiscaceae.

Habitat: Temperate and subtropical Himalaya from Kashmir to Nepal at 300-1,800 m.

English: False Hemp.

Folk: Akal-ber. Bhang-jala (Punjab).

Action: Diuretic, purgative, expectorant. Used in fevers, and gastric and scrofulous ailments.

The plant contains flavonoids, datis- cin and datiscanin. EtOH (50%) extract of seeds and flowers exhibited marked sedative, highly anti-inflammatory, mild analgesic, antipyretic and diuretic activity in rats.... datisca cannabina

Nees.

Family: Solanaceae.

Habitat: Throughout India in plains; wastelands, roadsides and gardens.

Ayurvedic: Dhattuura (white var.). (Dhattura consists of dried seeds of Datura sp.)

Unani: Dhaturaa.

Action: See D. Metel Linn.... datura alba

Mill.

Synonym: D. metel auct. non Linn.

Family: Solanaceae.

Habitat: Western Himalayas and hilly regions of the western parts of Peninsular India, abundantly in Maharashtra.

English: Thornapple.

Ayurvedic: Dhattuura.

Unani: Dhaturaa, Joz Maasil.

Action: The plant is the source of alkaloid scopolamine which is used as a pre-anaesthetic in surgery and childbirth, in ophthalmology and for the prevention of motion sickness.

Hyoscyamine and hyoscine and me- teloidine were found in the leaves, flowers, pericarp and seeds of the plant. The root gave tropane, tropine and pseu- dotropine.... datura innoxia

(Hebrew) One who believes in God Datia, Datiah, Datyah, Dateah, Datea... datya

A cyst formed by endogenous or exogenous budding from the germinal layer of a hydatid.... daughter cyst

(Scottish) Feminine form of David; the beloved one

Daveen, Davia, Daviana, Daviane, Davianna, Davida, Davidina, Davine, Davinia, Davita, Davy, Davynn, Davinah, Davite, Davyte, Davyna, Davyta, Davonna, Davi, Daveigh, Davan, Davin, Dava... davina

(English) Born at daybreak; of the day’s first light

Dawna, Dawne, Dawnelle, Dawnetta, Dawnette, Dawnielle, Dawnika, Dawnita, Dawnyelle, Dawnysia, Dowan, Duwan, Dwan... dawn

(Hebrew) Resembling a bird of prey Dayah, Dayana, Dayanara, Dayania, Dayaniah, Dayanea, Dayaneah... daya

Daydreams occur when an individual during waking hours imagines enjoyable or exciting events or images. Most people daydream at some stage during their lives, but it tends to occur when someone is stressed or unhappy. Children and teenagers in particular may sometimes daydream a lot. This should not usually worry their parents or teachers unless their work suffers or it affects the individual’s personal relationships.

In those circumstances professional advice should be sought from a doctor or counsellor.... daydreams

Nutritional Profile Energy value (calories per serving): High Protein: Low Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Very high Sodium: Low (fresh or dried fruit) High (dried fruit treated with sodium sulfur compounds) Major vitamin contribution: B vitamins Major mineral contribution: Iron, potassium

About the Nutrients in This Food Dates are a high-carbohydrate food, rich in fiber and packed with sugar (as much as 70 percent of the total weight of the fruit). Dates are also a good source of nonheme iron, the inorganic iron found in plant foods, plus potassium, niacin, thiamin, and riboflavin, but they are an unusual fruit because they have no vitamin C at all. A serving of 10 whole pitted Medjool dates has 16 g dietary fiber and 2.2 mg iron (12 percent of the R DA for a woman, 27 percent of the R DA for a man).

The Most Nutritious Way to Serve This Food With meat or with a vitamin C- rich food. Both enhance your body’s ability to use the nonheme iron in plants (which is ordinarily much less useful than heme iron, the organic iron in foods of animal origin).

Diets That May Restrict or Exclude This Food Low-carbohydrate diet Low-fiber/low-residue diet Low-potassium diet Low-sodium diet (dried dates, if treated with sodium sulfite)

Buying This Food Look for: Soft, shiny brown dates in tightly sealed packages.

Storing This Food Store opened packages of dates in the refrigerator, tightly wrapped to keep the fruit from drying out. (The dates sold in American markets are partly dried; they retain sufficient mois- ture to keep them soft and tasty.) Properly stored dates will stay fresh for several weeks.

Preparing This Food To slice dates neatly, chill them in the refrigerator or freezer for an hour. The colder they are, the easier it will be to slice them. If you’re adding dates to a cake or bread batter, coat them first with flour to keep them from dropping through the batter.

What Happens When You Cook This Food The dates will absorb moisture from a cake or bread batter and soften.

Medical Uses and/or Benefits Potassium benefits. Because potassium is excreted in urine, potassium-rich foods are often recommended for people taking diuretics. In addition, a diet rich in potassium (from food) is associated with a lower risk of stroke. A 1998 Harvard School of Public Health analysis of data from the long-running Health Professionals Study shows 38 percent fewer strokes among men who ate nine servings of high potassium foods a day vs. those who ate less than four servings. Among men with high blood pressure, taking a daily 1,000 mg potassium supplement—about the amount of potassium in ¾ cup pitted dates—reduced the incidence of stroke 60 percent.

Adverse Effects Associated with This Food Sulfite sensitivity. Dates contain polyphenoloxidase, an enzyme that oxidizes phenols in the fruit to brown compounds that turn its flesh dark in the presence of air. To keep dates from darkening when they are dried, they may be treated with sulfur compounds called sulfites (sulfur dioxide, sodium bisulfite, or sodium metabisulfite). Treated dates may trigger serious allergic reactions, including potentially fatal anaphylactic shock, in people sensitive to sulfites.... dates

Linn.

Synonym: D. fastuosa Linn.

Family: Solanaceae.

Habitat: Throughout India, particularly in waste place.

English: Thornapple, Downy Datura.

Ayurvedic: Dhattuura, Dhuurta, Dhastura, Unmatta, Shivapriya, Harapriya, Hema, Haatta, Dhustuu- ra, Dhustuuraka, Kanaka, Maatula. Also equated with Raaj-dhatuura. (white var.)

Unani: Dhaturaa.

Siddha/Tamil: Oomatthai, Karu- voomatthai.

Action: Various plant parts are used in headache, hemiplegia, epilepsy, delirium, convulsions, cramps, rigid thigh muscles, rheumatism. Leaf— antitumour, antirheumatic. Leaf and corolla—anti-inflammatory. Flower—antiasthmatic. Seed, leaf and root—anticatarrhal, febrifuge, antidiarrhoeal, antidermatosis; also used in cerebral complications. Seeds—used in asthma. Limited use in kinetosis (excessive salivation, nausea and vomiting).

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia ofIndia indicated the use of the whole plant in dysuria and alopecia.

The plant accumulates more hyos- cine than hyoscyamine. Hyoscine content of dried leaves and flowering tops—between 0.02-0.55%. Alkaloid content of leaves—0.55%; stem—0.4%; seeds—0.19%; pericarps—0.8%; root at flowering of the plant—0.77%.

Hyoscine in large doses causes delirium and coma.

Dosage: Seed—30-60 mg. (API Vol. III.)... datura metel

Hemerocallis fulva

Description: This plant has unspotted, tawny blossoms that open for 1 day only. It has long, swordlike, green basal leaves. Its root is a mass of swollen and elongated tubers.

Habitat and Distribution: Daylilies are found worldwide in Tropic and Temperate Zones. They are grown as a vegetable in the Orient and as an ornamental plant elsewhere.

Edible Parts: The young green leaves are edible raw or cooked. Tubers are also edi ble raw or cooked. You can eat its flowers raw, but they taste better cooked. You can also fry the flowers for storage.

CAUTION

Eating excessive amounts of raw flowers may cause diarrhea.... daylily

(African) Our joy has arrived... dayo

(English) From the sunny town Dayten, Daytan... dayton

See RAYNAUD’S DISEASE.... dead fingers

Gas exchange only occurs in the terminal parts of the pulmonary airways (see LUNGS). That portion of each breath that is taken into the lungs but does not take part in gas exchange is known as dead space. Anatomical dead space describes air in the airways up to the terminal BRONCHIOLES. Physiological dead space also includes gas in alveoli (air sacs) which are unable to take part in gas exchange because of structural abnormalities or disease.... dead space

Linn.

Synonym: D. tatula Linn.

Family: Solanaceae.

Habitat: The Himalaya from Kashmir to Sikkim up to 2,700 m, hilly districts of Central and South India.English: Thornapple, Jimsonweed, Stramonium.Ayurvedic: Krishnadhattuura, Dhuurta (black seed var.), Unmatta, Kitav, Tuuri, Maatul, Madan.

Unani: Dhaturaa.

Action: Spasmolytic, antiasthmatic, anticholinergic, cerebral depressant, nerve-sedative. Controls spasms of bronchioles in asthma. Anticholinergic. Effects of overdose are similar to those of atropine. Temporary relief from Parkinsonian tremor recorded. (Contraindicated with depressant drugs.) Applied locally, stramonium palliates the pain of muscular rheumatism, neuralgia, also pain due to haemorrhoids, fistula, abscesses and similar inflammations. Prevents motion sickness.

Key application: In diseases of the autonomic nervous system. (Included among unapproved herbs by German Commission E.) The British Herbal Pharmacopoeia reported antispasmodic action of the leaf; Indian Herbal Pharmacopoeia accepted it as expectorant and antispasmodic. Whole plant contains 0.26% alkaloids (seeds 0.98% and stem 0.08%); also flavonoids, withanolides, cou- marins and tannins; the major alkaloid is hyoscyamine (44-67%), hyoscine (13.2-25.3%) and atropine (0.01-0.1%). The tropane alkaloids are similar to those found in Atropa belladonna. Hyoscine is five times as active as atropine in producing mydriasis, but its main use is as antimotion sickness drug; and in combination as a sedative.Toxic constituents include anti- cholinergic alkaloids.

Dosage: Leaf—60-185 mg powder; seed—60-120 mg powder (CCRAS.)

... datura stramonium

Linn. var. sativa DC.

Family: Umbelliferae; Apiaceae.

Habitat: Native to Europe and the Mediterranean region; extensively cultivated in Punjab, Haryana, Uttar Pradesh and Madhya Pradesh for its fleshy tap roots which are eaten raw or cooked. Wild Carrot: Native to Europe, Africa and Asia. Grows at 3,000-3,600 m in the Himalayas.

English: Carrot, Cultivated Carrot. Wild carrot (D. carota Linn.wild var.: the root, small and white), Queen Anne's Lace, Bird's Nest. Bees' Nest Plant.

Ayurvedic: Gaajara, Garjara, Granjana.

Unani: Gaajar.

Action: Roasted roots—prescribed in palpitation, burning micturation, cough and bronchitis. Carrot increases the quantity of urine and helps the elimination of uric acid; also lowers blood sugar. Juice—a rich source of carotene. Seeds—diuretic, emmenagogue, spasmolytic (prescribed in anuria and sexual debility). Wild carrot— diuretic and antilithic (used for kidney stones, cystitis and in gout). Seeds—emmenagogue. Also used for hot flushes of the menopause.

In cooked (orange) carrots beta- carotene content (1890 mcg) was found much higher than in raw carrots- (1045 mcg/100 g). Heat processing of carrots affected alpha- and beta-carotene contents; their value decreased (3.7; 5.3) in water blanching, whereas increased (5.8; 8.2) in steam blanching compared to that in fresh carrots (5.2; 8.1 mg/100 g) respectively.

An interferon inducer has been isolated from carrot. It stimulates cells to produce the protein that increases human resistance to virus infections.

Aqueous extract of carrots showed hepatoprotective activity against CCl4- induced hepatic damage in mice liver.

The ethanolic extract exhibits direct relaxant action on cardiac and smooth muscle preparation and this action may be responsible for its hypotensive action. (Gently heated peeled roots, mixed with sugar candy, are given as a hypotensive drug.)

The ethanolic extract of seeds exhibited diuretic effect in dogs.

The British Herbal Pharmacopoeia recommends Daucus carota Linn. (wild carrot) for its diuretic activity. Wild carrot contains flavones including apigenin, chypsin, luteolin; flavonols including kaempferol, quer- cetin and various glycosides. The fura- nocoumarins, 8-methoxypsoralen and 5-methoxypsoralen are found in the plant. The seed oil contains terpinen- 4-ol, a renal irritant. It is believed to cause diuretic activity.... daucus carota

The popular name of Atropa belladonna, from which ATROPINE is procured. Its poisonous black berries are sometimes eaten by children.... deadly nightshade

A certi?cate required by law to be signed by a medical practitioner stating the main and any contributary causes of a person’s death.... death certificate

(French) One who is suave; nonchalant

Debonair, Debonaire, Debonnayre, Debonayre, Debonaere, Debonnaere... debonnaire

(Hebrew) Resembling a bee; in the Bible, a prophetess Debbera, Debbey, Debbi, Debbie, Debbra, Debby, Debee, Debera, Deberah, Debi, Debor, Debora, Debra, Debrah, Debralee, Debreanna, Debriana, Debs, Devora, Devorah, Deb, Debb, Debbee, Dobra, Devoria, Debira, Debiria, Devorit, Devra, Devri... deborah

Practically, only three methods have been used from the earliest times: burial, embalming and cremation. Burial is perhaps the earliest and most primitive method. It was customary to bury the bodies of the dead in consecrated ground around churches up until the earlier half of the 19th century, when the utterly insanitary state of churchyards led to legislation for their better control. Burials in Britain take place usually upon production of a certi?cate from a registrar of deaths, to whom notice of the death, accompanied by a medical certi?cate, must be given without delay by the nearest relatives.

When a death occurs at sea, the captain of the ship has authority to permit burial at sea. If, however, there are any doubts about cause of death, the captain may decide to preserve the body and refer the case to the relevant authorities at the next port of call.

Embalming is still used occasionally. The process consists in removing the internal organs through small openings, and ?lling the body cavities with various aromatics of antiseptic power – the skin being swathed in bandages or otherwise protected from the action of the air. Bodies are also preserved by injecting the blood vessels with strong antiseptics such as perchloride of mercury.

Cremation or incineration of the body is now the commonest method of disposal of the dead in the UK, where land for burials is increasingly scarce; today it accounts for around 75 per cent of disposals. The process of incineration takes 1–2 hours. Something in the range of 2·3 to 3·2 kg (5–7 lbs) of ash result from the combustion of the body, and there is no admixture with that from the fuel.

Cremation of a body means that it is almost impossible to conduct any meaningful forensic tests should any subsequent doubts be raised about the cause of death. So, before cremation can take place, two doctors have to sign the cremation forms. The ?rst is usually the doctor who was caring for the patient at the time of death – an important exception being cases of sudden death, when the coroner holds an inquest into the cause and authorises the necessary approval for cremation. In 1999, fewer than 3,500 deaths were certi?ed following a post-mortem, out of a total number of deaths in England and Wales of more than 556,000. When the coroner is not involved, the second doctor must have been quali?ed for ?ve years; he or she must be unconnected with the patient’s care and not linked professionally with the ?rst doctor. (For example, if the ?rst doctor is a general practitioner – as in the majority of cases they are – the second doctor should be from another practice.) Before signing the cremation certi?cate the second doctor must conduct an external examination of the dead person and discuss the circumstances of death with the ?rst doctor.

The two cremation forms are then inspected by crematorium medical referees who must be satis?ed that the cause of death has de?nitely been ascertained. The present death and cremation certi?cation system has been in place in the UK for many years – the legislative framework for cremation was set up in 1902 – and death certi?cation procedures were last reviewed by the government-appointed Brodrick committee in 1971, with no fundamental changes proposed. The case of Harold Shipman, a general practitioner convicted of murdering more than 15 patients, and suspected of murdering many more, has revealed serious weaknesses in the certi?cation system. A comprehensive review of the present procedures was in place at the time of writing (2004).... dead, disposal of the

The ?nal cause of death is usually the failure of the vital centres in the brain that control the beating of the heart and the act of breathing. The important practical question, however, is what disease, injury or other agent has led to this failure. Sometimes the cause may be obvious – for example, pneumonia, coronary thrombosis, or brain damage in a road accident. Often, however, the cause can be uncertain, in which case a POST-MORTEM EXAMINATION is necessary.

The two most common causes of death in the UK are diseases of the circulatory system (including strokes and heart disease) and cancer.

Overall annual death rates among women in the UK at the start of the 21st century were

7.98 per 1,000 population, and among men,

5.58 per 1,000. Comparable ?gures at the start of the 20th century were 16.3 for women and

18.4 for men. The death rates in 1900 among infants up to the age of four were 47.9 per 1,000 females and 57 per 1,000 males. By 2003 these numbers had fallen to 5.0 and 5.8 respectively. All these ?gures give a crude indication of how the health of Britain’s population has improved in the past century.

Death rates and ?gures on the causes of deaths are essential statistics in the study of EPIDEMIOLOGY which, along with information on the incidence of illnesses and injuries, provides a temporal and geographical map of changing health patterns in communities. Such information is valuable in planning preventive health measures (see PUBLIC HEALTH) and in identifying the natural history of diseases – knowledge that often contributes to the development of preventive measures and treatments for those diseases.... death, causes of

(American) Winter’s child; born in December

Decimber, Decymber, Decembar, Decimbar, Decymbar... december

(Celtic) In mythology, a virgin mother

Dechtire, Dechtyre... dechtere

A plant that drops its leaves in the fall or, in some cases, during drought.... deciduous

(Latin) The tenth-born child Decimah, Decema, Decyma, Decia, Decemah, Decymah... decima

An approach to decision-making that involves modelling the sequences or pathways of multiple possible strategies (e.g. of diagnosis and treatment for a particular clinical problem) to determine which is optimal. It is based upon available estimates (drawn from the literature or from experts) of the probabilities that certain events and outcomes will occur and the values of the outcomes that would result from each strategy.... decision analysis

See “decision analysis”.... decision support system

An illness suffered by divers when diving too deep, or too long and characterised bynitrogen bubbles forming in the tissues of the body. This may cause a multitude of symptoms although joint pains are those most-commonly encountered. Confusion may be caused in divers that have suffered an Irukandji sting as the symptoms have some similarities. See also, cerebral gas embolism.... decompression illness (dci)

Drugs which relieve nasal congestion and stu?ness. They may be given orally or by nasal spray, and most are SYMPATHOMIMETIC DRUGS which cause vasoconstriction in the nasal mucosa. Too frequent use reduces their e?ectiveness, and there is a danger of ‘rebound’ worsening if they are used for more than 10–14 days. A safer option for babies is simple sodium chloride drops. Warm moist air is also a traditional e?ective decongestant.... decongestants

There are some minor signs, such as: relaxation of the facial muscles (which produces the staring eye and gaping mouth of the ‘Hippocratic countenance’), as well as a loss of the curves of the back, which becomes ?at by contact with the bed or table; discoloration of the skin, which takes on a wax-yellow hue and loses its pink transparency at the ?nger-webs; absence of blistering and redness if the skin is burned (Christison’s sign); and failure of a ligature tied round the ?nger to produce, after its removal, the usual change of a white ring, which, after a few seconds, becomes redder than the surrounding skin in a living person.

The only certain sign of death, however, is that the heart has stopped beating. To ensure that this is permanent, it is necessary to listen over the heart with a stethoscope, or directly with the ear, for at least ?ve minutes. Permanent stoppage of breathing should also be con?rmed by observing that a mirror held before the mouth shows no haze, or that a feather placed on the upper lip does not ?utter.

In the vast majority of cases there is no dif?culty in ensuring that death has occurred. The introduction of organ transplantation, however, and of more e?ective mechanical means of resuscitation, such as ventilators, whereby an individual’s heart can be kept beating almost inde?nitely, has raised diffculties in a minority of cases. To solve the problem in these cases the concept of ‘brain death’ has been introduced. In this context it has to be borne in mind that there is no legal de?nition of death. Death has traditionally been diagnosed by the irreversible cessation of respiration and heartbeat. In the Code of Practice drawn up in 1983 by a Working Party of the Health Departments of Great Britain and Northern Ireland, however, it is stated that ‘death can also be diagnosed by the irreversible cessation of brain-stem function’. This is described as ‘brain death’. The brain stem consists of the mid-brain, pons and medulla oblongata which contain the centres controlling the vital processes of the body such as consciousness, breathing and the beating of the heart (see BRAIN). This new concept of death, which has been widely accepted in medical and legal circles throughout the world, means that it is now legitimate to equate brain death with death; that the essential component of brain death is death of the brain stem; and that a dead brain stem can be reliably diagnosed at the bedside. (See GLASGOW COMA SCALE.)

Four points are important in determining the time that has elapsed since death. HYPOSTASIS, or congestion, begins to appear as livid spots on the back, often mistaken for bruises, three hours or more after death. This is due to the blood running into the vessels in the lowest parts. Loss of heat begins at once after death, and the body has become as cold as the surrounding air after 12 hours – although this is delayed by hot weather, death from ASPHYXIA, and some other causes. Rigidity, or rigor mortis, begins in six hours, takes another six to become fully established, remains for 12 hours and passes o? during the succeeding 12 hours. It comes on quickly when extreme exertion has been indulged in immediately before death; conversely it is slow in onset and slight in death from wasting diseases, and slight or absent in children. It begins in the small muscles of the eyelid and jaw and then spreads over the body. PUTREFACTION is variable in time of onset, but usually begins in 2–3 days, as a greenish tint over the abdomen.... death, signs of

Wight & Arn.

Family: Asclepiadaceae.

Habitat: Deccan Peninsula; common in the forest areas of Western Ghats.

Unani: Desi Ushbaa.

Siddha/Tamil: Mahali kizhangu.

Action: Root—appetizer, blood purifier, bacteriostatic. Used as a substitute for Shveta Saarivaa (Hemidesmus indicus). Sold as Saarivaa in Kerala, Tamil Nadu and Karnataka. The root powder is given to diabetics.

The root contains quercetin, kaempferol, coumarin and rutin. It has a sweet sarsaparilla-like taste; contains 92% fleshy matter and 8% woody core.

The root can be stored for longer periods and remains unaffected by microorganisms and insects, apparently due to the presence of the volatile principle which possesses bacteriostat- ic and toxic properties.

The root, on steam distillation, gave 4-O-methyl-resorcylaldehyde in a concentration of 0.8%. (The growth of E. coli was arrested by the aldehyde in 0.041% concentration; fish died within 4 min in 0.02% solution.) The sterols consists mainly of stagma and brassica sterols. Alpha-amyrin and lupeol, both free and as esters are also present in the root.

The plant contains lupeol, beta- amyrin 2-hydroxy, 4-methoxy benzaldehyde, and ferulic acid.... decalepis hamiltonii

The amount of loss or expense that must be incurred by an insured individual before an insurer will assume any liability for all or part of the remaining cost of covered services. Deductibles may be either fixed monetary amounts or the value of specified services (such as two days of hospital care or one medical practitioner visit). Deductibles are usually tied to some reference period over which they must be incurred.... deductible

See THROMBOSIS; VEINS, DISEASES OF.... deep vein thrombosis (dvt)

Lust, Psychic Powers... deerstongue

Diethyltoluamide. An effective insect repellant used on the skin.... deet

This is the main cause of anaemia in infections. The micro-organism responsible for the infection has a deleterious e?ect upon the blood-forming organs, just as it does upon other parts of the body.

Toxins. In conditions such as chronic glomerulonephritis (see KIDNEYS, DISEASES OF) and URAEMIA there is a severe anaemia due to the e?ect of the disease upon blood formation.

Drugs. Certain drugs, such as aspirin and the non-steroidal anti-in?ammatory drugs, may cause occult gastrointestinal bleeding.... defective blood formation

If a heart is ?brillating (see VENTRICULAR FIBRILLATION), the application of a large electric shock via paddles applied to the chest wall causes simultaneous electrical depolarisation of all the cardiac cells, and may allow the heart’s natural pacemaker to re-establish sinus rhythm. One paddle is placed below the right clavicle and the other over the cardiac apex. Care must be taken that no one is in contact with the patient or the bed when the shock is given, to avoid electrocution.... defibrillation

Apparatus that delivers a controlled electric shock to restore normal heart rhythm in patients whose hearts have developed VENTRICULAR FIBRILLATION or have stopped beating. The shock is delivered by electrodes placed on the chest wall or directly to the heart after the chest has been surgically opened. De?brillators are a standard item of equipment for paramedical sta? in ambulances, and aeroplanes of some airlines now routinely carry the apparatus. (See also HEART, DISEASES OF.)... defibrillator

Any disease resulting from the absence from the diet of any substance essential to good health: for example, one of the vitamins.... deficiency disease

An animal wherein the adult stage of the parasite resides.... definitive or final host

Malformations or distortions of part of the body. They may be present at birth, or they may be the result of injuries, or disease, or simply produced by bad posture, like the curved spine occasionally found in children. (See BURNS AND

SCALDS; CHEST, DEFORMITIES OF; TALIPES; FLAT-FOOT; JOINTS, DISEASES OF; KNOCK-KNEE; LEPROSY; PALATE, MALFORMATIONS OF; PARALYSIS; RICKETS; SCAR; SKULL; SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.)... deformities

(Greek) In mythology, the wife of Heracles

Deianeira, Deianiera, Deianyra, Deianeera, Deianeara... deianira

(Greek) In mythology, the mother of Achilles’ only son Deidameia, Deidamia, Deidameah, Deidameiah, Deidamiah... deidamea

(Gaelic) A brokenhearted or raging woman

Deadra, Dede, Dedra, Deedra, Deedre, Deidra, Deirdre, Deidrie, Deirdra, Derdre, Didi, Diedra, Diedre, Diedrey, Dierdre, Deardriu, Dierdra... deidre

(Spanish) Born on a religious holiday

Deiena, Deine, Deina, Deikun... deiene

(Latin) Daughter of God Deifiliah, Deiflea, Deifileah... deifilia

A policy which calls for the provision of supportive care and treatment for medically and socially dependent individuals in the community rather than in an institutional setting.... deinstitutionalization

(American) From the lush valley Deiondra, Deiondria, Deiondrea, Deiondriya... deiondre

(French) One of remembrance Daejah, Daejia, Daija, Daijah, Daijaah, Daijea, Daijha, Daijhah, Dayja, Dajah, Deija, Deijah, Dejah, Dejanae, Dejanee, Dejanique, Dejanira, Deyanira... deja

(African) A pleasing woman Decca, Decka, Dekah, Deccah, Deckah... deka

(Latvian) In mythology, a trinity goddess

Decla, Deckla, Deklah, Decklah, Declah... dekla

(German) One who is a noble protector

Dalaina, Dalainah, Dalaine, Dalanah, Dalanna, Dalannah, Dalayna, Dalaynah, Delanah, Dalinah, Dalinda, Dalinna, Delania, Delanna, Delannah, Delanya, Deleina, Deleinah, Delena, Delenya, Deleyna, Deleynah, Dellaina... delana

(French) Named for a street in New York City

Delancie, Delancy, Delanci, Delancea, Delanceah, Delancee... delancey

(Irish / French) The dark challenger / from the elder-tree grove Delaina, Delaine, Delainey, Delainy, Delane, Delanie, Delany, Delayna, Delayne, Delani, Delainie, Delanea, Delainea, Delaeny, Delaeni, Delaenie, Delaenee, Delaenea... delaney

(English) From the state of Delaware

Delawair, Delaweir, Delwayr, Delawayre, Delawaire, Delawaer, Delawaere... delaware

A prolonged hospital stay due to non-medical conditions, such as a lack of, or delayed start of, community care arrangements.... delayed discharge

(Greek) Resembling a flower Delbina, Delbin, Delbyne, Delbyn, Delbyna, Delbeene, Delbeena, Delbeina, Delbeine, Delbiena, Delbiene, Delbeana, Delbeane... delbine

(Latin) Woman from Delos; form of Cordelia, meaning “a good-hearted woman; a woman of honesty” Delya, Deliya, Delea, Deelia, Deelea, Deelya, Deliah, Deleah, Deliyah, Delyah... delia

(Latin) One who gives pleasure Delice, Delisa, Delisha, Delissa, Deliza, Delyssa, Delicea, Deliciae, Delight, Delite, Delit, Deliz, Deliciah, Deliceah... delicia

(Hebrew) A seductive woman; in the Bible, the woman who discovered the source of Samson’s strength Dalila, Delila, Delyla, Dalyla, Dalilah, Delylah, Dalylah... delilah

Burkill.

Tetracera scandens

Family: Dilleniaceae.

Habitat: Forests of Bengal, Assam and the Andamans.

Ayurvedic: Paaniya Valli.

Action: A decoction of the plant is given in dysentery and coughs. Leaves—used for the treatment of boils. Root—astringent, used as external application for burns.... delima scandens

See “meals on wheels”.... delivered meals

(German) Born of the nobility Delle, Dell, Dellene, Delline, Dellah, Dela, Delah

... della

(Scandinavian) One who is sparkling and witty Dellyng, Delleng... delling

(German) A noble protector Delmi, Delmy, Delmira, Delmah... delma

(English) Feminine form of Delmar; woman of the sea Delmaria, Delmare, Delma, Delmia, Delmarra, Dellmara, Dellmarra... delmara

Rafin.

Synonym: Poinciana regai Bojer ex Hook.

Family: Caesalpiniaceae.

Habitat: Native to Madagascar; grown in gardens and avenues for ornamental purposes and for shade.

English: Flamboyant Flame tree, Gold Mohur.

Ayurvedic: Gulmohar (var.) White Gold Mohur is equated with Delonix elata Gamble, synonym Poinciana elata Linn.

Siddha: Vadanarayana, Pe- rungondrai, Mayarum. White Gulmohar. (Tamil)

Action: Bark—antiperiodic, febrifuge. Plant—antirheumatic, spasmogenic. Flowers (aqueous and alcoholic extract)—active against roundworm.

White Gulmohar trunk-bark yielded asparagine and aspartic acid. Flowers gave iso-quercetin.

Delonix regia bark gave leucocyani- din; bark and leaves contain tannin, lu- peol and beta-sitosterol, and free OH- proline as major amino acid. Flower anthers are a rich source of zeaxanthin.... delonix regia

An iterative group judgment technique in which a central source forwards surveys or questionnaires to isolated, anonymous (to each other) participants whose responses are collated/summarized and recirculated to the participants in multiple rounds for further modification/critique, producing a final group response (sometimes statistical).... delphi technique

(Greek) Woman from Delphi; resembling a dolphin

Delphine, Delphinea, Delphinia, Delfa, Delfin, Delfine, Delfyne, Delpha, Delfina, Delphia... delphina

Royle.

Family: Ranunculaceae.

Habitat: Native to China; distributed in West Himalayas.

English: Musk Larkspur.

Ayurvedic: Sprikkaa. (Melilotus officinalis, known as Aspurka or Naakhunaa, is also equated with Sprikkaa.) Used as a substitute for Tagara (valerian).

Action: Himalayan species act as cardiac and respiratory depressant. All the species of Delphinium are poisonous; find use in indigenous medicine for destroying maggots in wounds, particularly in sheep. The flowers are considered acrid, bitter and astringent; seeds are cathartic, anthelmintic, emetic and insecticidal.... delphinium brunonianum

Royle.

Family: Ranunculaceae.

Habitat: Kashmir (Himalayan species).

English: Kashmir Larkspur.

Ayurvedic: Used as a substitute for Tagara (valerian).

Action: See D. brunonianum.... delphinium cashmirianum

(Greek) From the mouth of the river; the fourth letter of the Greek alphabet Dellta, Deltah, Delltah... delta

Abnormal electrical waves observed in the electroencephalogram (see ELECTROENCEPHALOGRAPHY (EEG)). The frequency of the normal alpha waves is 10 per second; that of the delta waves is 7 or fewer per second. They occur in the region of tumours of the brain, and in the brains of patients with EPILEPSY.... delta waves

(African) The sole daughter Delue, Deloo... delu

An irrational and usually unshakeable belief (idée ?xe) peculiar to some individuals. They fail to respond to reasonable argument and the delusion is often paranoid in character with a belief that a person or persons is/are persecuting them. The existence of a delusion, of such a nature as to in?uence conduct seriously, is one of the most important signs in reaching a decision to arrange for the compulsory admission of the patient to hospital for observation. (See MENTAL ILLNESS.)... delusions

Linn.

Synonym: D. ajacis Linn.

Family: Ranunculaceae.

Habitat: Cultivated in gardens.

English: Forking Larkspur, Larkspur, Lark's Claw, Knight's Spur.

Action: Parasiticide. A tincture is used to destroy lice in hair.

The toxicity of the seeds is due to diterpene alkaloids (delcosine, delso- line, consolidine). Delsonine and an- thranoyllycoctonine are amorphous alkaloids.

The alkaloids lead to bradycardia, lowering of blood pressure, and cardiac arrest. Also, they have a central paralyzing and curare-like effect on the respiratory system. (German Commission E.)

Entire plant, including roots and seeds, is used topically. Not to be used on abraded skin.

Seeds contain 1.01-1.06% alkaloids and 28.7% of a fixed oil. A digly- coside pigment, delphonin and kaem- pferol have been isolated from the flowers.... delphinium consolida

Wall.

Synonym: D. pauciflorum Royle.

Family: Ranunculaceae.

Habitat: The temperate Himalayas from Kashmir to Kumaon at altitudes of 2,400-3,600 m.

English: Larkspur. Ayurvedic: Nirvishaa, Nirvishi. (Kyllinga triceps Rottb. is used as a substitute for Nirvishaa.)

Unani: Jadwaar Khataai, Maatiryaaq.

Folk: Root—astringent, vulnerary, deobstruent, alterative. Used for painful piles, muscular atrophy, gout and as a nervine tonic. Also used as an adulterant for aconite.

Oral administration of the aqueous extract of the plant to rats with CCl4- induced hepatotoxicity revealed hepa- toprotective property of the plant.

The roots contain campesterol, stig- masterol, sitosterol, cholesterol, delta- avenasterol and alkaloids including de- nudatine, denudatidine, condelphine, talatizidine and iso-talatizidine.... delphinium denudatum

Linn.

Habitat: Native to Mediterranean region.

English: Stavesacre.

Unani: Muvizaj.

Action: Parasiticide. Used for destroying lice. Contains poisonous alkaloids. Seeds are violently emetic and cathartic; used as an external application in obstinate skin diseases and eruptions under medical supervision.

Seeds contain diterpene alkaloids; delphidine, delphinine, delphirine, del- phisine and neoline.

Stavesacre has a similar effect to aco- nitine. Extract from the seeds is used in homoeopathic dilutions.... delphinium staphisagria

Wall. ex Royle.

Synonym: Delphinium elatum auct. non Linn.

D. speciosum Janka ex Nym.

Family: Ranunculaceae.

Habitat: The temperate Himalaya from Kashmir to Nepal to 2,7004,700 m.

English: Candle Larkspur, Bee Larkspur.

Ayurvedic: Nirvisha.

Action: Whole plant—cardiac and respiratory depressant, emetic, diuretic, anthelmintic. Seed— insecticidal. Used in skin eruptions. Powdered flowers, mixed with mustard oil, are used for destroying lica.

The plant contains beta-sitosterol and alkaloid delpheline; aerial parts contain an alkaloid, elatine.

Seeds are very poisonous; contain several aconitine-like alkaloids. Del- phinidine, isolated from seeds, causes drastic gastro-enteric irritation.... delphinium vestitium

Aitch. & Hemsl.

D. semibarbatum Blenert

Family: Ranunculaceae.

Habitat: Persia and Afghanistan.

English: Zalil Larkspur.

Ayurvedic: Sprikkaa. (Melilotus officinalis, known as Aspurka or Naakhunaa, is also equated with Sprikkaa.)

Unani: Zarir, Zalil, Asbarg, Gul-Zalil (flower).

Action: Diuretic, anodyne, anti- inflammatory, detergent. Used in jaundice, dropsy and diseases of the spleen. Ash—used externally on wounds and skin diseases.

The seeds contain norditerpenoid alkaloid, zaliline, besides anhweidel- phinine, browniine, desacetylnudi- cauline, lycoctonine, methyllycaconi- tine and nudicauline. The medicinal properties of the plant are attributed to desacetylnudicauline, methyllycaconi- tine and nudicauline.... delphinium zalil

(Welsh) A pretty young woman Delythe, Delith, Delithe... delyth

Willingness and/or ability to seek, use and, in some settings, pay for services. Sometimes further subdivided into expressed demand (equated with use) and potential demand or need.... demand (for health services)

(English) From the hill’s fortress Demelzah, Demelzia, Demelziah, Demelzea, Demelzeah... demelza

(Greek) In mythology, the goddess of the harvest

Demetra, Demitra, Demitras, Dimetria, Demetre, Demetria, Dimitra, Dimitre, Dimitria, Dimiter, Detria, Deetra, Deitra... demeter

(Greek) Of the common people... demos

(Indian) A superior woman Denalie, Denaly, Denally, Denalli, Denaley, Denalee, Denallee, Denallie, Denalley, Denalea, Denallea... denali

(Egyptian) From the town on the river

Dendera, Dendaria, Denderia, Dendarra... dendara

(Willd.) Kranzl.

Habitat: The Western Ghats.

Ayurvedic: Jivanti (substitute.)

Folk: Nagli (Maharashtra)

Action: Juice of fresh plant—stomachic, carminative, antispasmodic, laxative, liver tonic. (excites the bile). A related species, Dendrobium crumenatum Sw., occurs in Andaman Islands. Pounded leaves are used in Malaya for poulticing boils and pimples. Traces of alkaloids have been reported to be present in the pseudobulbs and leaves.

D. macraei Lindl. and D. normale Face. are also known as Jivanti.... dendrobium ovatum

(Linn. f.) Etting.

Family: Loranthaceae.

Habitat: Throughout India.

Ayurvedic: Bandaaka, Vrkshaadani, Vrkshruuhaa.

Siddha: Pulluri, Plavithil (Tamil).

Folk: Baandaa.

Action: Bark—astringent and narcotic; used in menstrual disorders, consumption, asthma, also for treating wounds.

The plant contains several flavo- noids. Being parasitic, different flavo- noids have been recorded in plants growing on different host plants. Quer- citrin has been found to be the major common constituent. The plant also contains gallic, ellagic and chebulinic acids.

Aqueous and alcoholic extracts of the plant were tested in rats for their diuretic and anti-lithiatic activities. Alcoholic extract was found to be more effective than aqueous extract.

Dosage: Leaf, flower—10-20 ml juice. (CCRAS.)

Essential oil from leaves—antibacterial, antifungal.

Dosage: Bark—50-100 ml decoction; leaf—10-20 ml juice. (CCRAS.)... dendrophthoe falcata

(Syn. “Breakbone fever”) A flavivirus, dengue virus types 1-4, transmitted by infected specific Aedes spp mosquitoes. Sudden abrupt onset of high fever, headache, retrobulbar pain and lumbosacral pain. Fever lasts 6-7 days and may be ‘saddleback’. Initial symptoms followed by generalised myalgia, bone pain, anorexia, nausea, vomiting and weakness. A transient mottled rash may appear on 1st/2nd day and a second rash appears with resolution of fever - at first on trunk, spreading outward. WCC and platelet count depressed. Mild haemorrhagic phenomena in a few.... dengue fever

Usually a second infection with a different serotype of the dengue virus (see dengue fever). A primary infection at a young age is common finding. Age of patient with DHF is often less than 5 years, but young adults may be affected. Severe illness with abnormal vascular permeability, hypovolaemia and abnormal clotting mechanisms. Bleeding into skin or internally. Dengue shock syndrome may also be a complication.... dengue haemorrhagic fever

(American) Made of a strong cloth Denym, Denem, Denam... denim

(French) Feminine form of Denis; follower of Dionysus Deneigh, Denese, Dennet, Dennette, Deney, Deni, Denice, Deniece, Denisa, Denissa, Denisse, Denize, Denni, Dennie, Denisse, Dennise, Denny, Denyce, Denys, Denyse, Dinnie, Dinni, Dinny, Denisha... denise

A person quali?ed to carry out the scaling (removal of calculus [deposits]) from the teeth and to advise patients on how to keep their teeth and gums healthy. Hygienists usually work in a quali?ed dentist’s surgery.... dental hygienist

A dental surgeon, or dentist, is an individual trained to diagnose and treat disorders of the teeth and gums, as well as to advise on preventive measures to ensure that these areas remain healthy. Dentists qualify after a four-year course at dental school and then register with the GENERAL DENTAL COUNCIL, which is responsible for maintaining educational and professional standards. Around 25,000 dentists practise in the NHS and private sector.

Over the past four decades the ?nancial outlay on NHS dental services has been around 5 per cent of total NHS funding. This contrasts with 10 per cent during the service’s early years, when the NHS was coping with decades of ‘dental neglect’. The population’s dental health has, however, been steadily improving: in 1968 more than one-third of people had no natural teeth; by the late 1990s the proportion had fallen to 13 per cent.

Dentistry is divided into several groupings.

General dental practitioners Concerned with primary dental care, the prevention, diagnosis and treatment of diseases of the gums and teeth – for example, caries (see TEETH, DISORDERS OF). They also deal with diffculties in biting and the effects of trauma, and are aware that oral disorders may re?ect disease elsewhere in the body. They will refer to the hospital dental services, patients who require treatment that cannot be satisfactorily carried out in a primary-care setting.

Most routine dental prevention and treatment is carried out in general dental practitioners’ surgeries, where the dentists also supervise the work of hygienists and dental auxiliaries. Appliances, such as dentures, crowns, bridges and orthodontic appliances are constructed by dental technicians working in dental laboratories.

There are around 18,800 dentists providing general dental services in the UK. These practitioners are free to accept or reject any potential patient and to practise where they wish. Those dentists treating patients under an NHS contract (a mixture of capitation fees and items of service payments) can also treat patients privately (for an appropriate fee). Some dentists opt for full-time private practice, and their numbers are increasing in the wake of changes in 1990 in the contracts of NHS general dental practitioners.

Community dental practitioner Part of the public-health team and largely concerned with monitoring dental health and treating the young and the handicapped.

In the hospitals and dental schools are those who are involved in only one of the specialities.

Around 2,800 dentists work in NHS hospitals and 1,900 in the NHS’s community services. In some parts of the UK, people wanting NHS treatment are having diffculties ?nding dentists willing to provide such care.

Restorative dentist Concerned with the repair of teeth damaged by trauma and caries, and the replacement of missing teeth.

Orthodontist Correction of jaws and teeth which are misaligned or irregular. This is done with appliances which may be removable or ?xed to the teeth which are then moved with springs or elastics.... dental surgeon

Toothache... dentalgia

(English) From the green valley... denver

Relieving or removing obstruction... deobstruent

(Celtic) In mythology, a princess of Munster... deoch

(Portuguese) God is beautiful Deolynda, Deolenda... deolinda

(American) From a small town in Colorado... deora

Reliance on others to provide physical, mental and/or social support.... dependency

An indicator used in population studies to measure the portion of the population which is economically dependent on active age groups. It is calculated as the sum of the 0-14 year-olds and the over 60 or 65 year-olds, depending on the working age limit considered, divided by the number of people aged between 15 and 59 or 64, respectively.... dependency ratio

In a statistical analysis, the outcome variable(s) or the variable(s) whose values are a function of, or dependent on the effect of other variable(s) (called independent variables) in the relationship under study.... dependent variable

Also called hypo-pigmentation, this congenital or acquired disorder is one in which the skin loses its pigmentation because of reduced MELANIN production. It can be classi?ed into three groups: VITILIGO, ALBINISM and post-in?ammatory hypopigmentation.... depigmentation

The process of destroying hair – substances and processes used for this purpose being known as depilatories. The purpose may be e?ected in three ways: by removing the hairs at the level of the skin surface; by pulling the hairs out (epilation); and by destroying the roots and so preventing the growth of new hairs.

Shaving is the most e?ective way of removing super?uous hairs. Rubbing morning and night with a smooth pumice-stone is said to be helpful. Electrolysis and diathermy are also used.... depilation

(English) Ruler of the people Darinda, Derynda, Darynda, Derenda, Darenda... derinda

(German) Feminine form of Derek; a gifted ruler

Deryne, Derina, Deryna, Deriena, Deriene, Dereina, Dereine, Dereena, Dereene, Dereana, Dereane... derine

Also known as histiocytoma. A ?rm, painless nodule in the skin, typically on a leg, due to excessive formation of COLLAGEN. A common disorder, it is often a slow response to an insect bite and persists inde?nitely.... dermatofibroma

A medically quali?ed specialist who diagnoses and treats disorders of the skin (see SKIN, DISEASES OF).... dermatologist

Any skin disorder... dermatopathy

Fungi which can infect skin, hair and nails. About 30 species in three genera are PATHOGENIC to humans (see RINGWORM).... dermatophytes

A superficial infection of the skin caused by a fungus... dermatophytosis

A disorder present at birth in which the head of the femur (thigh-bone) fails to fit properly into the cup-like socket in the pelvis to form a joint. One or both of the hips may be affected.

The cause of developmental hip dysplasia is not known, although it is more common in girls, especially babies born by breech delivery or following pregnancies in which the amount of amniotic fluid was abnormally small.

If dislocation is detected in early infancy, splints are applied to the thigh to manoeuvre the ball of the joint into the socket and keep it in position. These are worn for about 3 months and usually correct the problem. Progress may be monitored by ultrasound scanning and X-rays. Corrective surgery may also be required.

If treatment is delayed, there may be lifelong problems with walking. Without treatment, the dislocation often leads to shortening of the leg, limping, and early osteoarthritis in the joint.... developmental hip dysplasia

Pregnancy in a woman with pre-existing diabetes mellitus or in a woman who develops diabetes during pregnancy. The latter is known as gestational diabetes. Women with established diabetes mellitus can have a normal pregnancy provided that the diabetes is controlled well. Poor control of blood glucose during the pregnancy may affect the baby’s growth or increase the risk of complications during pregnancy.

Gestational diabetes is usually detected in the second half of pregnancy.

The mother does not produce enough insulin to keep blood glucose levels normal.

True gestational diabetes disappears with the delivery of the baby but is associated with an increased risk of developing type 2 diabetes in later life.... diabetic pregnancy

Several diseases are linked with diet. Diseases due to a deficiency are rare in developed countries, but many disorders are due partly to overconsumption of certain foods. A diet high in fats may contribute to atherosclerosis and heart disease. A high-fat diet has also been linked with cancer of the bowel (see colon, cancer of) and breast cancer. Obesity increases the risk of many other disorders, including diabetes mellitus and stroke.

Overconsumption of alcohol can lead to various alcohol-related disorders. A high salt intake predisposes a person towards hypertension. Some components of the diet protect against disease. For example, fibre protects against diverticular disease, chronic constipation, and haemorrhoids.

Many people’s diets contain too few natural vitamins. Pregnant women need high intakes of folic acid to reduce the risk of neural tube defects.

Although many illnesses are commonly ascribed to food allergy, it is only rarely that a definite link is proved. (See also nutritional disorders).... diet and disease

The spread of a substance in a fluid from an area of high concentration to one of lower concentration.... diffusion

A nonsteroidal anti-inflammatory drug (NSAID) used to relieve joint pain and stiffness in types of arthritis. The drug is also given for back pain, sprains, and strains. Side effects include nausea, diarrhoea, and a rash.... diflunisal

A group of drugs that are extracted from plants belonging to the foxglove family.

They are used to treat heart conditions, most commonly atrial fibrillation.

Those most frequently used are digitoxin and digoxin.... digitalis drugs

A measure of an individual’s or group’s lack of normal social amenities such as proper housing, diet and warmth. It was devised in the 1980s to help assess the medical services needed by a socially deprived population.... deprivation score

(American) Feminine form of Derek; a gifted ruler

Dereka, Dericka, Derrica, Derika, Derecka, Derecca, Deryca, Deryka, Derycca, Derycka... derica