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


Salpingitis

Inflammation of the fallopian tubes. (See PELVIC INFLAMMATORY DISEASE.)... salpingitis

Sassafras

Sassafras albidum

Description: This shrub or small tree bears different leaves on the same plant. Some leaves will have one lobe, some two lobes, and some no lobes. The flowers, which appear in early spring, are small and yellow. The fruits are dark blue. The plant parts have a characteristics root beer smell.

Habitat and Distribution: Sassafras grows at the margins of roads and forests, usually in open, sunny areas. It is a common tree throughout eastern North America.

Edible Parts: The young twigs and leaves are edible fresh or dried. You can add dried young twigs and leaves to soups. Dig the underground portion, peel off the bark, and let it dry. Then boil it in water to prepare sassafras tea.

Other Uses: Shred the tender twigs for use as a toothbrush.... sassafras

Scabies

Sarcoptic infestation of the human skin particularly a contagious skin disease caused by invasion of the epidermis... scabies

Sciatica

This is neuralgia of the sciatic nerve. These are the two largest nerves in the body, composed of the tibial and common perineal nerves, bound together and containing elements of the lowest two lumbar and upper three sacral spinal cord nerves. Sciatica is felt as severe pain from the buttocks, down the back of the thighs, often radiating to the inside of the leg, even to the point of parasthesia or prickly numbness. Although tumors can cause the problem, far and away the most common causes are a lower back subluxation (responding to adjustment) or pelvic congestion and edema (responding to laxatives, exercise, and decreasing portal vein and lymphatic congestion).... sciatica

Scrofula

Tuberculous cervical adenitis with or without ulceration... scrofula

Senna

Cassia acutifolia. N.O. Leguminosae.

Synonym: Alexandrian Senna, Cassia, East Indian Senna, Tinnevelly Senna.

Habitat: Imported from Alexandria, East Indies, and the Near East.

Features ? Leaves, grey-green, lanceolate, unequal and varying at the base, between half an inch and one and a half inches long, and about a third of an inch across. Tinnevelly Senna leaves are broader near the middle and proportionately longer than the Alexandrian leaves. The commercial "Mecca Senna" is usually badly picked, and of poor quality generally. Pods (Alexandrian) green, about two inches by a quarter-inch ; East Indian narrower and darker coloured. Taste, sickly sweet.

Part used ? Leaves, pods.

Action: Laxative, cathartic.

For occasional and chronic constipation, dyspepsia, and disordered stomach. Two ounces of the leaves may be infused in 1 pint of boiling water and allowed to stand for an hour before use in wineglass doses. Any possibility of griping will be avoided if 1 drachm of Ginger is added to the Senna leaves before infusing.

The Alexandrian leaves and pods are considered superior to the East Indian kind as, with most people, they act more mildly, but with equal certainty.... senna

Sinusitis

Inflammation affecting the mucal epithelium of a sinus... sinusitis

Stasis

Static, atonic, unable to resolve or initiate change, resulting in lympatic and venous stasis, congestion or stagnation...such as an intestinal blockage.... stasis

Stomatitis

Generalised inflammation of the oral mucosa... stomatitis

Symptom

A sign or indication of disorder or disease, especially when experienced by an individual as a change in normal function, sensation or appearance.... symptom

Syphilis

A contagious venereal disease... syphilis

Ankylosing Spondylitis

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

Aortic Stenosis

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

Altitude Sickness

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

Carcinoma In Situ

The ?rst stage of CARCINOMA in which the malignant tumour is present only in the EPITHELIUM, and when surgical excision of the local growth, with its pathological status con?rmed in the laboratory, should ensure a cure.... carcinoma in situ

Case Control Study

A study that starts with the identification of persons with the disease (or other outcome variable) of interest, and a suitable control (comparison, reference) group of persons without the disease. The relationship of an attribute to the disease is examined by comparing the diseased and non-diseased with regard to how frequently the attribute is present or, if quantitative, the level of the attribute, in each of the groups.... case control study

Central Nervous System

A collective term for the brain, spinal cord, their nerves, and the sensory end organs. More broadly, this can even include the neurotransmitting hormones instigated by the CNS that control the chemical nervous system, the endocrine glands.... central nervous system

Chronic Fatigue Syndrome

(CFS) is a recently designated semi-disease, often attributed to EBV (the Epstein-Barr virus) or CMV (Cytomegalovirus) infections, characterized by FUOs (Fevers of Unknown Origin) and resulting in the patient suffering FLS (Feels Like Shit). In most of us, the microorganisms involved in CFS usually provoke nothing more than a head cold; in some individuals, however, they induce a long, grinding, and debilitating disorder, characterized by exhaustion, depression, periodic fevers...a crazy-quilt of symptoms that frustrates both the sufferer and the sometimes skeptical physician. MCS (Multiple Chemical Sensitivities) are another syndrome that is often lumped with CFS, and they may often be two faces of the same condition. I am not using all these acronyms to mock the conditions, but as an irony. There is too much (Acronym Safety Syndrome) in medicine, reducing complex and frustrating conditions to insider’s techno-babble, somehow therein trivializing otherwise complex, painful and crazy-making problems. The widest use of acronyms (AIDS, HIV, CFS, MCS, MS etc.) seems to be for diseases hardest to treat, least responsive to procedural medicine, and most depressing to discuss with patients or survivors.... chronic fatigue syndrome

Dumping Syndrome

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

Frozen Shoulder

A painful condition of the shoulder accompanied by sti?ness and considerable limitation of movement. The usual age-incidence is between 50 and 70. The cause is in?ammation and contracture of the ligaments and muscles of the shoulder joint, probably due to overuse. Treatment is physiotherapy and local steroid infections. There is practically always complete recovery, even though this may take 12–18 months.... frozen shoulder

Immune System

See IMMUNITY.

Age Disease and mode of administration

3 days BCG (Bacille Calmette-Guerin) by injection if tuberculosis in family in past 6 months.

2 months Poliomyelitis (oral); adsorbed diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

3 months Poliomyelitis (oral); diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

4 months Poliomyelitis (oral); diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

12–18 months Measles, mumps, and rubella (German measles)4 (given together live by injection).

(SCHOOL ENTRY)

4–5 years Poliomyelitis (oral); adsorbed diphtheria and tetanus (given together by injection); give MMR vaccine if not already given at 12–18 months.

10–14 females Rubella (by injection) if they have missed MMR.

10–14 BCG (Bacille Calmette-Guerin) by injection to tuberculin-negative children to prevent tuberculosis.

15–18 Poliomyelitis single booster dose (oral); tetanus (by injection).

1 Pertussis may be excluded in certain susceptible individuals.

2 Known as DPT or triple vaccine.

3 Haemophilus in?uenzae immunisation (type B) is being introduced to be given at same time, but di?erent limb.

4 Known as MMR vaccine. (Some parents are asking to have their infants immunised with single-constituent vaccines because of controversy over possible side-effects – yet to be con?rmed scienti?cally – of the combined MMR vaccine.)

Recommended immunisation schedules in the United Kingdom... immune system

Limbic System

A functional, not physical, system in the brain, generally considered to mediate emotions with metabolism.... limbic system

Multiple Sclerosis

A chronic, usually progressive disease of the central nervous system, with the gradual patchy disorganization of the protective myelin cells. It is almost certainly an auto-immune disorder, although viral infections sometimes seem to initiate the condition, and physical trauma is often seen to anomalously precede the first symptoms.... multiple sclerosis

Nervous System

This extensive, complex and ?nely tuned network of billions of specialised cells called neurones (see NEURON(E)) is responsible for maintaining the body’s contacts with and responses to the outside world. The network also provides internal communication links – in concert with HORMONES, the body’s chemical messengers – between the body’s diverse organs and tissues, and, importantly, the BRAIN stores relevant information as memory. Each neurone has a ?lamentous process of varying length called an AXON along which passes messages in the form of electrochemically generated impulses. Axons are bundled together to form nerves (see NERVE).

The nervous system can be likened to a computer. The central processing unit – which receives, processes and stores information and initiates instructions for bodily activities – is called the central nervous system: this is made up of the brain and SPINAL CORD. The peripheral nervous system – synonymous with the cables that transmit information to and from a computer’s processing unit – has two parts: sensory and motor. The former collects information from the body’s many sense organs. These respond to touch, temperature, pain, position, smells, sounds and visual images and the information is signalled to the brain via the sensory nerves. When information has been processed centrally, the brain and spinal cord send instructions for action via motor nerves to the ‘voluntary’ muscles controlling movements and speech, to the ‘involuntary’ muscles that operate the internal organs such as the heart and intestines, and to the various glands, including the sweat glands in the skin. (Details of the 12 pairs of cranial nerves and the 31 pairs of nerves emanating from the spinal cord are given in respective texts on brain and spinal cord.)

Functional divisions of nervous system As well as the nervous system’s anatomical divisions, the system is divided functionally, into autonomic and somatic parts. The autonomic nervous system, which is split into sympathetic and parasympathetic divisions, deals with the automatic or unconscious control of internal bodily activities such as heartbeat, muscular status of blood vessels, digestion and glandular functions. The somatic system is responsible for the skeletal (voluntary) muscles (see MUSCLE) which carry out intended movements initiated by the brain – for example, the activation of limbs, tongue, vocal cords (speech), anal muscles (defaecation), urethral sphincters (urination) or vaginal muscles (childbirth). In addition, many survival responses – the most powerfully instinctive animal drives, which range from avoiding danger and pain to shivering when cold or sweating when hot – are initiated unconsciously and automatically by the nervous system using the appropriate neural pathways to achieve the particular survival reaction required.

The complex functions of the nervous system include the ability to experience emotions, such as excitement and pleasure, anxiety and frustration, and to undertake intellectual activities. For these experiences an individual can utilise many built-in neurological programmes and he or she can enhance performance through learning – a vital human function that depends on MEMORY, a three stage-process in the brain of registration, storage and recall. The various anatomical and functional divisions of the nervous system that have been unravelled as science has strived to explain how it works may seem confusing. In practical terms, the nervous system works mainly by using automatic or relex reactions (see REFLEX ACTION) to various stimuli (described above), supplemented by voluntary actions triggered by the activity of the conscious (higher) areas of the brain. Some higher functions crucial to human activity – for example, visual perception, thought, memory and speech – are complex and subtle, and the mechanisms are not yet fully understood. But all these complex activities rest on the foundation of relatively simple electrochemical transmissions of impulses through the massive network of billions of specialised cells, the neurones.... nervous system

Respiratory System

All the organs and tissues associated with the act of RESPIRATION or breathing. The term includes the nasal cavity (see NOSE) and PHARYNX, along with the LARYNX, TRACHEA, bronchi (see BRONCHUS), BRONCHIOLES and LUNGS. The DIAPHRAGM and other muscles, such as those between the RIBS, are also part of the respiratory system which is responsible for oxygenating the blood and removing carbon dioxide from it.... respiratory system

Sarcoma

A cancer of connective tissue, bone, cartilage, fat, muscle, nerve sheath, blood vessels or lymph system.... sarcoma

Schistosomiasis

A disease caused by parasites o f the genus Schistosoma , also known as bilharzia, which has an aquatic snail intermediate host.... schistosomiasis

Scleritis

Inflammation of the sclera... scleritis

Sclerosis

This term means literally hardening, and is applied to conditions in which portions of organs harden and lose their function as the result of an excessive production of CONNECTIVE TISSUE. The term is especially applied to a change of this type taking place in the nervous system. (See MULTIPLE SCLEROSIS (MS)).... sclerosis

Scurvy

A deficiency disease due to lack of Vitamin C... scurvy

Seborrhoea

Excessive production of SEBUM; it occurs in ACNE vulgaris.... seborrhoea

Secondary Prevention

Measures that identify and treat asymptomatic persons who have already developed risk factors or preclinical disease, but in whom the condition is not clinically apparent. These activities are focused on early case-finding of asymptomatic disease that occurs commonly and has significant risk for negative outcome without treatment.... secondary prevention

Seminal Vesicle

The dilated lower part of the vas deferens of cestodes which opens into cirrus.... seminal vesicle

Sensitivity

A high rate of detection of “true positives”, for example, the fraction of subjects who actually received good care who are classified as recipients of good care. For medical screening tests, sensitivity is the proportion of truly diseased persons in the screened population who are identified as diseased by the screening test. Sensitivity is a measure of the probability of correctly diagnosing a case, or the probability that any given case will be identified by the test (synonymous with ‘true positive rate’).... sensitivity

Sepsis

Like septicemia, an infection that has moved deeply into the body, involving the subcutaneous or submucosal layers, connective tissue, lymph system...or blood... sepsis

Septicaemia

The presence of multiplying bacteria in the bllod associated with severe clinical symptoms.... septicaemia

Septum

A membrane wall separating two or more cavities, such as the one between the nasal fossae and those separating the air sacs (alveoli) of the lungs.... septum

Serum Sickness

A complex systemic reaction that may become evident any time up to 14 days after antivenom or antitoxin use. Symptoms are fever, generalised lymphadenopathy and an urticarial rash. Severe cases of serum sickness may have to be treated with oral steroids. The incidence of serum sickness is often related to the amount of antivenom used.... serum sickness

Shingles

Also called Herpes zoster. It is caused by the chickenpox virus, and usually occurs in middle-age, beginning as inflammation, sharp pain and finally vesicles, erupting at the edges of posterior ganglia of the trunk or face. Usually lasting two or three weeks, it is often triggered by stress or a concurrent viral infection, and can return again in some individuals.... shingles

Shock

Collapse of the circulation resulting in inadequate tissue perfusion to the body cells.... shock

Sleeping Sickness

A disease caused by haemoflagellate protozoa and transmitted by blood-feeding tsetse flies of the genus Glossina. East African (Rhodesian) Sleeping Sickness is the more severe zoonotic form caused byTrypanosoma brucei rhodesiense found on the game-rich savannahs of East Central Africa while West African (Gambian) Sleeping Sickness is the more chronic form found in riverine areas of West Central Africa and which has a significant human reservoir although animals such as pigs may also be involved as reservoirs.... sleeping sickness

Smallpox

Variola. A human viral disease characterised by vesicular skin lesions covering the whole body but being particularly heavy at the extremeties including the face. Caused by a pox virus. The disease can be prevented through regular smallpox vaccinations. Variola has now been officially declared eradicated by the WHO.... smallpox

Somatic

Of the body.... somatic

Sperm

See SPERMATOZOON.... sperm

Sphincter

A circular muscle which surrounds the opening from an organ, and, by maintaining a constant state of moderate contraction, prevents the escape of the contents of the organ. Sphincters close the outlet from the URINARY BLADDER and RECTUM, and in certain nervous diseases their action is interfered with, so that the power to relax or to keep moderately contracted is lost, and retention or INCONTINENCE of the evacuation results.... sphincter

Splenitis

Inflammation of the spleen... splenitis

Splenomegaly

Enlargement of the spleen... splenomegaly

Spleen

The large organ lying to the left of, below, and behind the stomach. This organ is partially responsible for white blood cell formation (red blood cells in childhood), and it is lined with resident macrophages that help it filter the blood, remove and recycle old and dead red blood cells, and send this all up to the liver in the portal blood. The liver, in fact, does most of the recycling of splenic hemoglobin derivatives. The spleen initiates much resistance and immunologic response, being made mostly of lymph pulp, and it stores and concentrates a large number of red blood cells. These can be injected into the bloodstream for immediate use under flight or fight stress, since the spleen is covered with capsule and vascular muscles that constrict in the presence of adrenalin or sympathetic adrenergic nerve stimulus.... spleen

Stimulant

Making a body organ active... stimulant

Strangury

Painful, sporadic and drop-by-drop urination, caused by the presence of kidney stones, chronic inflammation such as interstitial cystitis, or urethral scar tissue. This is not a specific disease, but a symptom, like nausea or a sore joint.... strangury

Subacute

Having characteristics of both acute and chronic. This is the state in a disease when most of the aches and pains have subsided and you are likely to overdo things and not completely recover. The chest cold that lingers for weeks as a stubborn cough is a subacute condition, as is the tendonitis that lingers because you won’t stop playing tennis long enough to completely heal.... subacute

Subcutaneous

Below the surface of the skin, but probably above the following term...well anyway, definitely lower than the TOP of the skin... subcutaneous

Subclinical

This is our turf, the period of time when a potential disease is still potential, and a functional imbalance or tendency has not caused any organic disruption. Years of poor digestion, heartburn, and systematic suppression of upper GI function by adrenalin stress have not become overt gastritis, ulcers, or IBS. You have symptoms of distress (subclinical) but no real, ripened clinical disease. Some medical authorities (usually administrative docs from the “spokesman” and “quack-patrol” ranks of industry, academia or agency) actually insist that there is no such thing as a subclinical condition...you are either SICK or NOT SICK and presumably well. Sort of like the mechanic saying that the car works or doesn’t work...four quarts low on oil, but it WORKS. Only when it is five quarts low and has a siezed-up engine is there a need for a mechanic.... subclinical

Syndrome

A pattern of symptoms and signs, appearing one by one or simultaneously, that together characterise a particular disease or disorder.... syndrome

Systemic

Involving the whole body or organism, and not just individual parts.... systemic

Adrenogenital Syndrome

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

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

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

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

Apgar Score

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

Atrial Septal Defect

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

Autonomic Nervous System

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

Blind Loop Syndrome

A disorder in which abnormal FAECES occur as a result of a redundant loop in the small INTESTINE. The loop obstructs the normal ?ow of the contents of the bowel, causing stagnation. The syndrome is characterised by light-yellow, smelly, fatty, bulky faeces. The patient suffers from tiredness, malaise and loss of weight. Previous abdominal surgery is sometimes the cause, but the condition can be inherited. Blockage of intestinal contents upsets the bowel’s normal bacterial balance and hinders the normal absorption of nutrients. Treatment is either with antibiotics or, if that fails, surgery.... blind loop syndrome

Cat-scratch Fever

An infection in humans caused by a small gram-negative BACILLUS (Bartonella henselae). The domestic cat is a reservoir for the bacteria, and up to 50 per cent of the cat population may be affected. The disorder manifests itself as a skin lesion 3–10 days after a minor scratch; within two weeks the victim’s lymph glands enlarge and may produce pus. Fever, headache and malaise occur in some patients. Antibiotics do not seem to be e?ective. The skin lesion and lymph-gland enlargement subside spontaneously within 2–5 months.... cat-scratch fever

Caesarean Section

The operation used to deliver a baby through its mother’s abdominal wall. It is performed when the risks to mother or child of vaginal delivery are thought to outweigh the problems associated with operative delivery. One of the most common reasons for Caesarean section is ‘disproportion’ between the size of the fetal head and the maternal pelvis. The need for a Caesarean should be assessed anew in each pregnancy; a woman who has had a Caesarean section in the past will not automatically need to have one for subsequent deliveries. Caesarean-section rates vary dramatically from hospital to hospital, and especially between countries, emphasising that the criteria for operative delivery are not universally agreed. The current rate in the UK is about 23 per cent, and in the USA, about 28 per cent. The rate has shown a steady rise in all countries over the last decade. Fear of litigation by patients is one reason for this rise, as is the uncertainty that can arise from abnormalities seen on fetal monitoring during labour. Recent research suggesting that vaginal delivery is becoming more hazardous as the age of motherhood rises may increase the pressure from women to have a Caesarean section – as well as pressure from obstetricians.

The operation is usually performed through a low, horizontal ‘bikini line’ incision. A general anaesthetic in a heavily pregnant woman carries increased risks, so the operation is often performed under regional – epidural or spinal – ANAESTHESIA. This also allows the mother to see her baby as soon as it is born, and the baby is not exposed to agents used for general anaesthesia. If a general anaesthetic is needed (usually in an emergency), exposure to these agents may make the baby drowsy for some time afterwards.

Another problem with delivery by Caesarean section is, of course, that the mother must recover from the operation whilst coping with the demands of a small baby. (See PREGNANCY AND LABOUR.)... caesarean section

Cascara Sagrada

Rhamnus purshiana. N.O. Rhamnaceae.

Synonym: Sacred Bark, Chittem Bark.

Habitat: California and British Columbia. Features ? Bark in quills about three-quarter inch wide by one-sixteenth inch thick,

furrowed-longitudinally, purplish-brown in colour. Inner surface longitudinally

striated, transversely wrinkled. Fracture pale brown, or dark brown when older.

Persistently bitter taste, leather-like odour.

Older bark is preferred, younger sometimes griping. Part used ? Bark.

Action: Tonic laxative.

In habitual constipation due to sluggishness and atony of the lower bowel, and for digestive disorders generally. Doses for chronic constipation, firstly 1/2 to 1 teaspoonful at bedtime, afterwards 5-10 drops before each meal, of the fluid extract.... cascara sagrada

Cohort Study

An observational study in which outcomes in a group of participants that received an intervention are compared with outcomes in a similar group (i.e. the cohort) of participants, either contemporary or historical, that did not receive the intervention. In an adjusted (or matched) cohort study, investigators identify (or make statistical adjustments to provide) a cohort group that has characteristics (e.g. age, gender, disease severity) that are as similar as possible to the group that experienced the intervention.... cohort study

Crush Syndrome

A condition in which kidney failure occurs in patients who have been the victims of severe crushing accidents (see also KIDNEYS). The fundamental injury is damage to muscle. The limb swells. The blood volume falls. Blood UREA rises; there is also a rise in the POTASSIUM content of the blood. Urgent treatment in an intensive therapy unit is required and renal dialysis may well be necessary. The patient may survive; or die with renal failure. Post-mortem examination shows degeneration of the tubules of the kidney, and the presence in them of pigment casts.... crush syndrome

Extrapyramidal System

This is a complex part of the nervous system, extending from the cortex to the medulla in the BRAIN, from which emerge descending spinal pathways which in?uence voluntary motor activity throughout the body. Although the normal functions of the system are poorly understood, there are characteristic signs of an extrapyramidal LESION. These include disturbance of voluntary movements, notably slowness and ‘poverty’ of movement; disturbance of muscular tone, which may be increased or decreased; and involuntary movements, such as a tremor, irregular jerking movements, or slow writhing movements.

Diseases There are several diseases that result from lesions to the extrapyramidal system, of which the most common is PARKINSONISM. Others include WILSON’S DISEASE, KERNICTERUS, CHOREA and ATHETOSIS.... extrapyramidal system

Follicle-stimulating Hormone

A hormone produced by the anterior PITUITARY GLAND which stimulates the formation of follicles in the ovary each menstrual cycle (see OVARIES; MENSTRUATION) and of spermatocytes in the testis (see TESTICLE). It is under hypothalamic control (see HYPOTHALAMUS) and in the female there is feedback inhibition by oestrogens from the developing follicle.... follicle-stimulating hormone

Gram Stain

Stain developed in 1884 by Hans Christian Gram, whereby Gram positive bacteria stain purple while Gram negative bacteria stain red.... gram stain

Guillain-barré Syndrome

A disease of the peripheral nerves causing weakness and numbness in the limbs. It customarily occurs up to three weeks after an infection – for example, CAMPYLOBACTER infection of the gastrointestinal tract provoking an allergic response in the nerves. It may begin with weakness of the legs and gradually spread up the body. In the worst cases the patient may become totally paralysed and require to be arti?cially ventilated. Despite this, recovery is the rule.... guillain-barré syndrome

Gulf War Syndrome

A collection of varying symptoms, such as persistent tiredness, headaches, muscle pain and poor concentration, reported by members of the Coalition Armed Forces who served in the 1991 Gulf War. Whilst there is strong evidence for a health e?ect related to service, there is no evidence of a particular set of signs and symptoms (the de?nition of a ‘syndrome’) unique to those who served in the Gulf War. Symptoms have been blamed on multiple possible hazards, such as exposure to depleted uranium munitions, smoke from oil-well ?res and use of pesticides. However, the only clearly demonstrated association is with the particular pattern of vaccinations used to protect against biological weapons. Many con?icts in the past have generated their own ‘syndromes’, given names such as e?ort syndrome and shell-shock, suggesting a link to the psychological stress of being in the midst of warfare.... gulf war syndrome

Herpes Simplex

An acute infectious disease, characterised by the development of groups of super?cial vesicles, or blebs, in the skin and mucous membrane. It is due to either simplex type 1 or 2 virus, and infection can occur at any time from birth onwards; however the usual time for primary infection with type 1 is between the second and 15th year. Once an individual is infected, the virus persists in the body for the rest of their life. It is one of the causes of scrum-pox. Type 2 causes HERPES GENITALIS.

Symptoms Symptoms vary with the age of infection. In young infants, herpes simplex may cause a generalised infection which is sometimes fatal. In young children the infection is usually in the mouth, and this may be associated with enlargement of the glands in the neck, general irritability and fever. The condition usually settles in 7–10 days. In adults the vesicles may occur anywhere in the skin or mucous membranes: the more common sites are the lips, mouth and face, where they are known as cold sores. The vesicles may also appear on the genitalia (herpes genitalis) or in the conjunctiva or cornea of the EYE, and the brain may be infected, causing ENCEPHALITIS or MENINGITIS. The ?rst sign is the appearance of small painful swellings; these quickly develop into vesicles which contain clear ?uid and are surrounded by a reddened area of skin. Some people are particularly liable to recurrent attacks, and these often tend to be associated with some debilitating condition or infection, such as pneumonia.

Except in the case of herpes of the cornea, the eruption clears completely unless it becomes contaminated with some other organism. In the case of the cornea, there may be residual scarring, which may impair vision.

Treatment Aciclovir is e?ective both topically as cream or eye drops or orally. In severe systemic infections it can be given intravenously.... herpes simplex

Irritable Bowel Syndrome

(IBS) This is a common and generally benign condition of the colon, taking different forms but usually characterized by alternating constipation and diarrhea. There is often some pain accompanying the diarrhea phase. The bowel equivalent of spasmodic asthma, its main cause is stress, often accompanied by a history of GI infections. Adrenalin stress slows the colon and causes constipation, followed by a cholinergic rebound overstimulation of the colon. It is also called spastic colon, colon syndrome, mucous colitis, even chronic colitis. True colitis is a potentially or actually serious pathology.... irritable bowel syndrome

Infantile Spasms

Also known as salaam attacks, these are a rare but serious type of EPILEPSY, usually starting in the ?rst eight months of life. The spasms are short and occur as involuntary ?exing of the neck, arms, trunk and legs. They may occur several times a day. If the baby is sitting, it may collapse into a ‘salaam’ position; more usually there is a simple body jerk, sometimes accompanied by a sudden cry. An electroencephalogram (see ELECTROENCEPHALOGRAPHY (EEG)) shows a picture of totally disorganised electrical activity called hypsarrhythmia. The condition results from any one of many brain injuries, infections or metabolic insults that may have occurred before, during, or in the ?rst few months after birth. Its importance is that in most cases, the baby’s development is seriously affected such that they are likely to be left with a profound learning disability. Consequently, prompt diagnosis is important. Treatment is with CORTICOSTEROIDS or with certain anti-convulsants – the hope being that prompt and aggressive treatment might prevent further brain damage leading to learning disability.... infantile spasms

Keyhole Surgery

See MINIMALLY INVASIVE SURGERY (MIS).... keyhole surgery

Mountain Sickness

See ALTITUDE SICKNESS.... mountain sickness

Nephrotic Syndrome

Nephrotic syndrome is one of PROTEINURIA, hypo-albuminaemia and gross OEDEMA. The primary cause is the leak of albumin (see ALBUMINS) through the GLOMERULUS. When this exceeds the liver’s ability to synthesise albumin, the plasma level falls and oedema results. The nephrotic syndrome is commonly the result of primary renal glomerular disease (see KIDNEYS, DISEASES OF – Glomerulonephritis). It may also be a result of metabolic diseases such as diabetic glomerular sclerosis and AMYLOIDOSIS. It may be the result of systemic autoimmune diseases such as SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and POLYARTERITIS NODOSA. It may complicate malignant diseases such as MYELOMATOSIS and Hodgkin’s disease (see LYMPHOMA). It is sometimes caused by nephrotoxins such as gold or mercury and certain drugs, and it may be the result of certain infections such as MALARIA and CROHN’S DISEASE.... nephrotic syndrome

Peripheral Nervous System

See NERVOUS SYSTEM.... peripheral nervous system

Plastic Surgery

See RECONSTRUCTIVE (PLASTIC) SURGERY.... plastic surgery

Port Wine Stain

See NAEVUS.... port wine stain

Premenstrual Syndrome

This has been de?ned as ‘any combination of emotional or physical features which occur cyclically in a woman before MENSTRUATION, and which regress or disappear during menstruation’. It is characterised by mood-changes, discomfort, swelling and tenderness in the breasts, swelling of the legs, a bloated feeling in the abdomen, headache, fatigue and constipation. The mood-changes range from irritability and mild depression to outbursts of violence. It may last for 3–14 days. How common it is is not known, as only the more severe cases are seen by doctors, but it has been estimated that one in ten of all menstruating women suffer from it severely enough to require treatment. The cause is not known, but it is probably due to some upset of the hormonal balance of the body. In view of the multiplicity of causes that have been put forward, it is not surprising that there is an equal multiplicity of treatments. Among these, one of the most widely used is PROGESTERONE. Others include pyridoxine, danazol, and gamma linolenic acid available in the form of oil of evening primrose. Whatever drug may be prescribed, counselling is equally essential and, in many cases, is all that is required.... premenstrual syndrome

Prospective Study

See “cohort study”.... prospective study

Pulmonary Stenosis

A disorder of the HEART in which obstruction of the out?ow of blood from the right ventricle occurs. Narrowing of the pulmonary valve at the exit of the right ventricle and narrowing of the pulmonary artery may cause obstruction. The condition is usually congenital, although it may be caused by RHEUMATIC FEVER. In the congenital condition, pulmonary stenosis may occur with other heart defects and is then known as Fallot’s tetralogy. Breathlessness and enlargement of the heart and eventual heart failure may be the consequence of pulmonary stenosis. Surgery is usually necessary to remove the obstruction.... pulmonary stenosis

Pyloric Stenosis

Narrowing of the PYLORUS, the muscular exit from the STOMACH. It is usually the result of a pyloric ulcer or cancer near the exit of the stomach. Food is delayed when passing from the stomach to the duodenum and vomiting occurs. The stomach may become distended and peristalsis (muscular movement) may be seen through the abdominal wall. Unless surgically treated the patient will steadily deteriorate, losing weight, becoming dehydrated and developing ALKALOSIS.

A related condition, congenital hypertrophic pyloric stenosis, occurs in babies (commonly boys) about 3–5 weeks old, and surgery produces a complete cure.... pyloric stenosis

Radiation Sickness

The term applied to the nausea, vomiting and loss of appetite which may follow exposure to RADIATION – for example, at work – or the use of RADIOTHERAPY in the treatment of cancer and other diseases. People exposed to radiation at work should have that exposure carefully monitored so it does not exceed safety limits. Doses of radiation given during radiotherapy treatment are carefully measured: even so, patients may suffer side-effects. The phenothiazine group of tranquillisers, such as CHLORPROMAZINE, as well as the ANTIHISTAMINE DRUGS, are of value in the prevention and treatment of radiation sickness.... radiation sickness

Retrospective Study

A research design used to test hypotheses in which inferences about exposure to the putative causal factor(s) are derived from data relating to characteristics of the persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or other outcome condition of interest, and their characteristics and past experiences are compared with those of other, unaffected persons.... retrospective study

Rocky Mountain Spotted Fever

A fever of the typhus group (see TYPHUS FEVER). It received its name from the fact that it was ?rst reported in the Rocky Mountain States of the United States; these are still the most heavily infected areas, but the fever is now found in all parts of the US. The causative organism is Rickettsia rickettsi, which is transmitted to humans by tics.... rocky mountain spotted fever

Sacral Nerves

These are five pairs of CNS nerves that exit through the sacral foramen and sacral hiatus, and bring information in and out of the spinal cord. Much of their function relates to the sciatic nerve, and they bring information in from the skin sensory zones (dermatomes) of the heel, back of the legs, buttocks, and the pelvic floor.... sacral nerves

Sacrum

The portion of the SPINAL COLUMN near its lower end. The sacrum consists of ?ve vertebrae fused together to form a broad triangular bone which lies between the two haunch-bones and forms the back wall of the pelvis.... sacrum

Safe Period

That period during the menstrual cycle (see MENSTRUATION) when fertilisation of the OVUM is unlikely to occur. OVULATION usually occurs about 15 days before the onset of the menstrual period. A woman is commonly believed to be fertile for about 11 days in each menstrual cycle – in other words, on the day of ovulation and for ?ve days before and ?ve days after this; this would be the eighth to the 18th day of the usual 28-day menstrual cycle. Outside this fertile period is the SAFE PERIOD: the ?rst week and the last ten days of the menstrual cycle. On the other hand, there is increasing evidence that the safest period is the last few days before menstruation. In the case of irregular menstruation it is not possible to calculate the safe period. In any event, the safety is not absolute. (See also CONTRACEPTION.)... safe period

Salbutamol

A short-acting selective beta2-adrenoceptor stimulant delivered via a metered-dose aerosol inhaler, a powder inhaler or through a nebuliser to control symptoms of ASTHMA. If stimulant inhalation is needed more than twice a day to control asthma attacks, prophylactic treatment should be considered including, in severe cases, oral CORTICOSTEROIDS. Salbutamol relaxes the muscles which cause bronchial spasms in the lungs – the prime symptom of asthma. There are other similar preparations such as terbutaline.... salbutamol

Salicylic Acid

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

Saline

Normal saline is a solution containing 0·9 per cent of sodium chloride (common salt). Saline is used clinically to dilute drugs given by injection; it is also given as an intravenous infusion to restore blood volume if blood loss from accident or operation is not too serious, or to tide a patient over until PLASMA or blood for TRANSFUSION becomes available.

Saline is also given orally to severely dehydrated children or adults suffering from diarrhoea and, in particular, CHOLERA.... saline

Saliva

The ?uid secreted by the SALIVARY GLANDS into the mouth. The ingestion of food stimulates saliva production. Saliva contains mucus and an ENZYME known as PTYALIN, which changes starch into dextrose and maltose (see DIGESTION); also many cells of di?erent types. About 750 millilitres are produced daily.

The principal function of saliva is to aid in the initial processes of digestion, and it is essential for the process of mastication (chewing), whereby food is reduced to an homogeneous mass before being swallowed. In addition, the ptyalin in the saliva initiates the digestion of starch in the food.

An excessive ?ow of saliva known as salivation occurs as the result of taking certain drugs. Salivation also occurs as the result of irritation in the mouth – as for instance, in the teething child – and from DYSPEPSIA. De?ciency of saliva is known as XEROSTOMIA.... saliva

Salivary Glands

The glands that produce the saliva injected when a mosquito or other ectoparasite bites, which prevent blood from clotting while the mosquito feeds.... salivary glands

Salpingo-oöphorectomy

Surgical removal of a Fallopian tube (see FALLOPIAN TUBES) and its accompanying ovary (see OVARIES).... salpingo-oöphorectomy

Sarcoidosis

An uncommon chronic in?ammatory disease of unknown origin which can affect many organs, particularly the SKIN, eyes (see EYE) and LUNGS. Commonly, it presents as ERYTHEMA nodosum in association with lymph-gland enlargement within the chest. In the eyes it causes UVEITIS. BIOPSY of affected tissue allows diagnosis, which is con?rmed by a KVEIM TEST. Often sarcoidosis is self-limiting, but in severe cases oral CORTICOSTEROIDS may be needed.... sarcoidosis

Scab

The crust which forms on super?cial injured areas. It is composed of FIBRIN, which is exuded from the raw surface, together with blood corpuscles and epithelial cells entangled in its meshes. Healing takes place naturally under this protection, and the scab dries up and falls o? when healing is complete. Scabs appearing on the face without any previous abrasion are usually caused by an infection (see IMPETIGO).... scab

Scald

The lesion caused by contact with a hot liquid or vapour... scald

Scalpel

A small, straight, surgical knife.... scalpel

Scapula

The scienti?c name for the shoulder-blade. (See SHOULDER.)... scapula

Scar

The name applied to a healed wound, ulcer or breach of tissue. A scar consists essentially of ?brous tissue, covered by an imperfect formation of epidermis in the case of scars on the surface of the skin. The ?brous tissue is produced by the connective tissue that migrates to the wound in the course of its repair (see WOUNDS). Gradually this ?brous tissue contracts, becomes more dense, and loses its blood vessels, leaving a hard white scar. (See also KELOID.)... scar

Scarlet Fever

This disorder is caused by the erythrogenic toxin of the STREPTOCOCCUS. The symptoms of PYREXIA, headache, vomiting and a punctate erythematous rash (see ERYTHEMA) follow a streptococcal infection of the throat or even a wound. The rash is symmetrical and does not itch. The skin subsequently peels.

Symptoms The period of incubation (i.e. the time elapsing between the reception of infection and the development of symptoms) varies somewhat. In most cases it lasts only two to three days, but in occasional cases the patient may take a week to develop his or her ?rst symptoms. The occurrence of fever is usually short and sharp, with rapid rise of temperature to 40 °C (104 °F), shivering, vomiting, headache, sore throat and marked increase in the rate of the pulse. In young children, CONVULSIONS or DELIRIUM may precede the fever. The rash usually appears within 24 hours of the onset of fever and lasts about a week.

Complications The most common and serious of these is glomerulonephritis (see under KIDNEYS, DISEASES OF), which may arise during any period in the course of the fever, but particularly when DESQUAMATION occurs. Occasionally the patient develops chronic glomerulonephritis. Another complication is infection of the middle ear (otitis media – see under EAR, DISEASES OF). Other disorders affecting the heart and lungs occasionally arise in connection with scarlet fever, the chief of these being ENDOCARDITIS, which may lay the foundation of valvular disease of the heart later in life. ARTHRITIS may produce swelling and pain in the smaller rather than in the larger joints; this complication usually occurs in the second week of illness. Scarlet fever, which is now a mild disease in most patients, should be treated with PENICILLIN.... scarlet fever

Schizophrenia

An overall title for a group of psychiatric disorders typ?ed by disturbances in thinking, behaviour and emotional response. Despite its inaccurate colloquial description as ‘split personality’, schizophrenia should not be confused with MULTIPLE PERSONALITY DISORDER. The illness is disabling, running a protracted course that usually results in ill-health and, often, personality change. Schizophrenia is really a collection of symptoms and signs, but there is no speci?c diagnostic test for it. Similarity in the early stages to other mental disorders, such as MANIC DEPRESSION, means that the diagnosis may not be con?rmed until its response to treatment and its outcome can be assessed and other diseases excluded.

Causes There is an inherited element: parents, children or siblings of schizophrenic sufferers have a one in ten chance of developing the disorder; a twin has a 50 per cent chance if the other twin has schizophrenia. Some BRAIN disorders such as temporal lobe EPILEPSY, tumours and ENCEPHALITIS seem to be linked with schizophrenia. Certain drugs – for example, AMPHETAMINES – can precipitate schizophrenia and DOPAMINE-blocking drugs often relieve schizophrenic symptoms. Stress may worsen schizophrenia and recreational drugs may trigger an attack.

Symptoms These usually develop gradually until the individual’s behaviour becomes so distrubing or debilitating that work, relationships and basic activities such as eating and sleeping are interrupted. The patient may have disturbed perception with auditory HALLUCINATIONS, illogical thought-processes and DELUSIONS; low-key emotions (‘?at affect’); a sense of being invaded or controlled by outside forces; a lack of INSIGHT and inability to acknowledge reality; lethargy and/or agitation; a disrespect for personal appearance and hygiene; and a tendency to act strangely. Violence is rare although some sufferers commit violent acts which they believe their ‘inner voices’ have commanded.

Relatives and friends may try to cope with the affected person at home, but as severe episodes may last several months and require regular administration of powerful drugs – patients are not always good at taking their medication

– hospital admission may be necessary.

Treatment So far there is no cure for schizophrenia. Since the 1950s, however, a group of drugs called antipsychotics – also described as NEUROLEPTICS or major tranquillisers – have relieved ?orid symptoms such as thought disorder, hallucinations and delusions as well as preventing relapses, thus allowing many people to leave psychiatric hospitals and live more independently outside. Only some of these drugs have a tranquillising e?ect, but their sedative properties can calm patients with an acute attack. CHLORPROMAZINE is one such drug and is commonly used when treatment starts or to deal with an emergency. Halperidol, tri?uoperazine and pimozide are other drugs in the group; these have less sedative effects so are useful in treating those whose prominent symptoms are apathy and lethargy.

The antipsychotics’ mode of action is by blocking the activity of DOPAMINE, the chemical messenger in the brain that is faulty in schizophrenia. The drugs quicken the onset and prolong the remission of the disorder, and it is very important that patients take them inde?nitely. This is easier to ensure when a patient is in hospital or in a stable domestic environment.

CLOZAPINE – a newer, atypical antipsychotic drug – is used for treating schizophrenic patients unresponsive to, or intolerant of, conventional antipsychotics. It may cause AGRANULOCYTOSIS and use is con?ned to patients registered with the Clorazil (the drug’s registered name) Patient Monitoring Service. Amisulpride, olanzapine, quetiapine, risperidone, sertindole and zotepine are other antipsychotic drugs described as ‘atypical’ by the British National Formulary; they may be better tolerated than other antipsychotics, and their varying properties mean that they can be targeted at patients with a particular grouping of symptoms. They should, however, be used with caution.

The welcome long-term shift of mentally ill patients from large hospitals to community care (often in small units) has, because of a lack of resources, led to some schizophrenic patients not being properly supervised with the result that they fail to take their medication regularly. This leads to a recurrence of symptoms and there have been occasional episodes of such patients in community care becoming a danger to themselves and to the public.

The antipsychotic drugs are powerful agents and have a range of potentially troubling side-effects. These include blurred vision, constipation, dizziness, dry mouth, limb restlessness, shaking, sti?ness, weight gain, and in the long term, TARDIVE DYSKINESIA (abnormal movements and walking) which affects about 20 per cent of those under treatment. Some drugs can be given by long-term depot injection: these include compounds of ?upenthixol, zuclopenthixol and haloperidol.

Prognosis About 25 per cent of sufferers recover fully from their ?rst attack. Another 25 per cent are disabled by chronic schizophrenia, never recover and are unable to live independently. The remainder are between these extremes. There is a high risk of suicide.... schizophrenia

Sclera

See EYE.... sclera

Scleroderma

A rare autoimmune disease. Scleroderma circumscriptum (morphoea) affects the skin, usually of the trunk, producing indurated plaques which resolve over many years. The more serious systemic form of scleroderma usually begins with RAYNAUD’S DISEASE, eventually producing a deforming hardening and clawing of the hands. Later the face and sometimes the internal organs, particularly the gastrointestinal tract and kidneys, may be affected.... scleroderma

Sclerotherapy

A treatment that involves injecting varicose veins (see VEINS, DISEASES OF) with a sclerosing ?uid. This causes ?brosis of the lining of the vein and its eventual obliteration. Sclerotherapy is also used to treat varicose veins in the legs, anus (HAEMORRHOIDS) and at the junction of the OESOPHAGUS with the stomach.... sclerotherapy

Scoliosis

The name applied to curvature of the spine. (See SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.)... scoliosis

Scotoma

An area of blindness in the ?eld of vision.... scotoma

Scrotum

The pouch of skin and ?brous tissue, positioned outside the abdomen behind the root of the PENIS, within which the testicles (see TESTICLE) are suspended. It consists of a purse-like fold of skin, within which each testicle has a separate investment of muscle ?bres, several layers of ?brous tissue, and a serous membrane known as the tunica vaginalis. The extra-abdominal site means that the production and storage of sperm (see SPERMATOZOON) in the testicles is at a lower temperature than internal body heat. Temperature control is facilitated by contraction and relaxation of the scrotal muscles.... scrotum

Scullcap

Scutellaria lateriflora. N.O. Labiateae.

Synonym: Sometimes named Skullcap, and locally known as Madweed.

Habitat: Indigenous to the United States, the plant is also found in England on the banks of streams and in wet ditches.

First introduced by the Spaniards in 1563 as a specific for syphilis, this claim has long been disproved, although the root undoubtedly possesses active alterative principles. It is consequently now held in high regard as a blood purifier, and is usually administered with other alteratives, notably Burdock.

Compound decoctions of Sarsaparilla are very popular as a springtime medicine, and Coffin's prescription will be found in the Herbal Formulae section of this volume.... scullcap

Sebaceous Cyst

A misnomer applied to epidermoid cysts of the skin whose contents are kerateous not sebaceous. The common ‘wen’ of the scalp arises from follicular epithelium and is similar.... sebaceous cyst

Sebum

The secretion of the SEBACEOUS GLANDS. It acts as a natural lubricant of the hair and skin and protects the skin from the effects of moisture or excessive dryness. It may also have antibacterial action.... sebum

Secondary Care

Specialist care provided on an ambulatory or inpatient basis, usually following a referral from primary care.... secondary care

Secretin

A hormone (see HORMONES) secreted by the mucous membrane of the duodenum, the ?rst part of the small INTESTINE, when food comes in contact with it. On being carried by the blood to the PANCREAS, it stimulates the secretion of pancreatic juice.... secretin

Secretion

The term applied to the material formed by a GLAND as the result of its activity. For example, saliva is the secretion of the salivary glands; gastric juice that of the glands in the stomach wall; bile that of the liver. Some secretions consist apparently of waste material which is of no further use in the chemistry of the body. These secretions are often spoken of as excretions: for example, the URINE and the sweat – see PERSPIRATION. (For further details, see ENDOCRINE GLANDS, and also under the headings of the various organs.)... secretion

Sedation

The production of a calm and peaceful state of mind, especially by the use of SEDATIVES. The aim is to reduce abnormal anxiety and bring aggressive behaviour under control. Sedation is also a part of the preparation of a patient for surgery or for any procedure that may be frightening or uncomfortable.... sedation

Sedative

Acting on the central nervous system to produce sleep... sedative

Selegiline

A monoamine-oxidase-B-inhibiting drug used in conjunction with LEVODOPA to treat severe PARKINSONISM. Early treatment with selegiline may delay the need to give the patient levo-dopa, but at present there is no ?rm evidence that it slows down the progression of the disease.... selegiline

Semen

Fluid produced by the male on ejaculation from the penis at sexual orgasm. Each ejaculate contains up to 500 million spermatozoa (male germ cells) suspended in a ?uid that is secreted by the PROSTATE GLAND, seminal vesicles (see TESTICLE), and Cowper’s glands – a pair of small glands (also called the bulbo-urethral glands) that open into the URETHRA at the base of the penis. Semen, or seminal ?uid, contains a form of sugar (fructose) essential for the motility of sperm. The hormone TESTOSTERONE is a key element in the production of sperm and of seminal ?uid.... semen

Seminoma

A malignant tumour of the testis (see TESTICLE) that appears as an often painless swelling. This tumour usually occurs in an older age-group of men than does TERATOMA. The treatment is surgical removal. (See also TESTICLE, DISEASES OF.)... seminoma

Senility

The generalized characterization of progressive decline in mental or physical functioning as a condition of the ageing process. Within geriatric medicine, this term has limited meaning and has generally been replaced by more specific terminology.... senility

Senile Dementia

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

Sensation

See PAIN; TOUCH.... sensation

Sensory Cortex

See BRAIN.... sensory cortex

Sensory Deprivation

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

Septic Arthritis

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

Septal Defect

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

Septic Shock

A dangerous disorder characterised by a severe fall in blood pressure and damage to the body tissues as a result of SEPTICAEMIA. The toxins from the septicaemia cause widespread damage to tissue, provoke clotting in small blood vessels, and seriously disturb the circulation. The kidneys, lungs and heart are particularly affected. The condition occurs most commonly in people who already have a chronic disease such as cancer, CIRRHOSIS of the liver or DIABETES MELLITUS. Septic shock may also develop in patients with immunode?ciency illnesses such as AIDS (see AIDS/HIV). The symptoms are those of septicaemia, coupled with those of SHOCK: cold, cyanotic limbs; fast, thready pulse; and a lowered blood pressure. Septic shock requires urgent treatment with ANTIBIOTICS, intravenous ?uids and oxygen, and may require the use of drugs to maintain blood pressure and cardiac function, arti?cial ventilation and/or renal DIALYSIS.... septic shock

Serotonin

Also known as 5-hydroxytryptamine, this is a substance widely distributed in the body tissue, but especially in the PLATELETS in the blood, the lining of the gastrointestinal tract, and the BRAIN. Serotonin is believed to have a similar function to that of HISTAMINE in INFLAMMATION. In the gut it inhibits gastric secretion and stimulates smooth (involuntary) muscle in the walls of the INTESTINE. Serotonin participates in the transmission of nerve impulses and may have a function in controlling mood and states of consciousness. (See also SELECTIVE SEROTONIN-REUPTAKE INHIBITORS (SSRIS).)... serotonin

Serum

The ?uid which separates from blood, LYMPH, and other body ?uids when clotting occurs (see COAGULATION; HAEMORRHAGE). PLASMA is the ?uid of the blood, including FIBRIN, which carries the circulating blood cells and PLATELETS.

Serum is a clear, yellowish ?uid containing around 7 per cent proteins and globulins, small quantities of salts, fat, sugar, urea, and uric acid, and even smaller quantities of immunoglobulins, essential in the prevention of disease (see IMMUNITY; IMMUNOLOGY). The serum given in the commonly used vaccines is generally derived from horses’ blood, after they have been subjected to a long course of treatment.... serum

Sesame

See Ajonjolí.... sesame

Sessile

A growth or tumour that has no stalk.... sessile

Sexual Abuse

See CHILD ABUSE.... sexual abuse

Sexual Deviation

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

Sheltered Housing

Purpose-built or adapted accommodation for older people with a warden and an emergency alarm system. Different kinds of sheltered housing provide different levels of care. See “extra care sheltered housing”.... sheltered housing

Shigellosis

An acute, self-limiting intestinal infection, with diarrhea, fever, and abdominal pain, caused by one of the Shigella genus of gram-negative bacteria. The infection is contracted through food prepared by infected individuals or by direct contact with them. Raw sewage contamination can also be a source.... shigellosis

Shoulder

The joint formed by the upper end of the HUMERUS and the shoulder-blade or SCAPULA. The acromion process of the scapula and the outer end of the collar-bone (see CLAVICLE) form a protective bony arch above the joint, and from this arch the wide and thick deltoid muscle passes downwards, protecting the outer surface of the joint and giving to the shoulder its rounded character. The joint itself is of the ball-and-socket variety, the rounded head of the humerus being received into the hollow glenoid cavity of the scapula, which is further deepened by a rim of cartilage. One tendon of the biceps muscle passes through the joint, grooving the humerus deeply, and being attached to the upper edge of the glenoid cavity. The joint is surrounded by a loose ?brous capsule, strengthened at certain places by ligamentous bands. The main strength of the joint comes from the powerful muscles that unite the upper arm with the scapula, clavicle and ribs.

Shoulder-blade or scapula. A ?at bone, about as large as the ?at hand and ?ngers, placed on the upper and back part of the With the arm hanging by the side, the scapula extends from the second to the seventh rib, but, as the arm is raised and lowered, it slides freely over the back of the chest. On the rear surface of the bone is a strong process, the spine of the scapula. This arches upwards and forwards into the acromion process. The latter forms the bony prominence on the top of the shoulder, where it unites in a joint with the outer end of the clavicle.... shoulder

Shunt

Passage of blood through a channel that is not its normal one. This may occur as a result of a congenital deformity (see SEPTAL DEFECT) or of surgery – for example, a porto-caval shunt in which the main portal vein is joined up to the inferior vena cava.... shunt

Siamese Twins

See CONJOINED TWINS; MULTIPLE BIRTHS.... siamese twins

Side-effect

An effect, other than the intended one, produced by a preventive, diagnostic or therapeutic procedure or regimen.... side-effect

Siderosis

Chronic FIBROSIS of the LUNGS occurring in iron-workers and due to the inhalation of ?ne iron particles. The term is also applied to the condition in which there is an excessive deposit of iron in the tissues of the body.... siderosis

Sids

See SUDDEN INFANT DEATH SYNDROME (SIDS).... sids

Sigmoidoscopy

Examination of the RECTUM and sigmoid COLON (see also INTESTINE) with an endoscopic viewing device called a sigmoidoscope (see also ENDOSCOPE). The procedure is done to investigate rectal bleeding or persistent diarrhoea, with the aim of detecting or excluding cancer of the rectum and COLITIS. Sigmoidoscopy, which nowadays is performed with a ?exible instrument, can usually be performed on an outpatient basis.... sigmoidoscopy

Sign

An indication of the existence of something; any objective evidence of a disease.... sign

Silicosis

The most important industrial hazard in those industries in which SILICA is encountered: in other words, the pottery industry, the sandstone industry, sandblasting, metal-grinding, the tin-mining industry, and anthracite coal-mines. It is a speci?c form of PNEUMOCONIOSIS caused by the inhalation of free silica. Among pottery workers the condition has for long been known as potter’s asthma, whilst in the cutlery industry it was known as grinder’s rot. For the production of silicosis, the particles of silica must measure 0·5–5 micrometres in diameter, and they must be inhaled into the alveoli (air sacs) of the lungs, where they produce FIBROSIS. This diminishes the e?ciency of the lungs, resulting in slowly progressive shortness of breath. The main danger of silicosis, however, is that it is liable to be complicated by TUBERCULOSIS.

The incidence of silicosis is steadily being reduced by various measures which diminish the risk of inhaling silica dust. These include adequate ventilation to draw o? the dust; the suppression of dust by the use of water; the wearing of respirators where the risk is particularly great and it is not possible to reduce the amount of dust – for example, in sand-blasting; and periodic medical examination of work-people exposed to risk. Fewer than 100 new cases a year are diagnosed now in the United Kingdom. (See also OCCUPATIONAL HEALTH, MEDICINE AND DISEASES.)... silicosis

Simvastatin

One of the STATINS – a group of LIPID-lowering drugs which are e?ective – in combination with a low CHOLESTEROL diet – in reducing the incidence of heart attacks (see HEART, DISEASES OF – Coronary thrombosis).... simvastatin

Sinoatrial Node

This is the natural pacemaker of the HEART, and comprises a collection of specialised muscle cells in the wall of the upper chamber (atrium) of the heart. The cells initiate electrical impulses at a rate of up to 100 a minute. These impulses stimulate the muscles of the heart to contract. The rate is altered by the effects of certain hormones and various impulses from the nervous system. Damage or disease of the node affects the regular beating of the heart. (See also CARDIAC PACEMAKER.)... sinoatrial node

Sinus

A term applied to narrow cavities of various kinds, occurring naturally in the body, or resulting from disease. Thus it is applied to the air-containing cavities which are found in the frontal, ethmoidal, sphenoidal and maxillary bones of the SKULL, and which communicate with the NOSE. The function of these paranasal sinuses, as they are known, is doubtful, but they do lighten the skull and add resonance to the voice. They enlarge considerably around puberty and in this way are a factor in the alteration of the size and shape of the face. The term is also used in connection with the wide spaces through which the blood circulates in the membranes (MENINGES) of the BRAIN. Cavities which are produced when an ABSCESS has burst, but remain unhealed, are also known as sinuses (see also FISTULA).... sinus

Skeleton

The comprehensive term applied to the hard structures that support or protect the softer tissues of the body. Many animals are possessed of an exoskeleton, consisting of super?cial plates of bone, horn, or the like; but in humans the skeleton is entirely an endoskeleton, covered everywhere by soft parts and consisting mainly of bones, but in places also of cartilage. The chief positions in which cartilage is found in place of bone are the larynx and the front of the chest. (For details of the skeleton, see BONE.)... skeleton

Slapped Cheek Syndrome

See ERYTHEMA – Erythema infectiosum.... slapped cheek syndrome

Sling

A hanging bandage for the support of injured or diseased parts. Slings are generally applied for support of the upper limb, in which case the limb is suspended from the neck. The lower limb may also be supported in a sling from an iron cage placed upon the bed on which the patient lies, the object usually being to aid the circulation, and so quicken the healing of ulcers on the leg.... sling

Skull

This is the collection of 22 ?at and irregularly shaped bones which protect the brain and form the face (see BONE).

Arrangement of the bones In childhood, the bones are independent, gradually fusing together by sutures, and in old age fusing completely so that the cranium forms a solid bony case. At the time of birth the growth of several bones of the infant’s head has not been quite completed, so that six soft spots, or fontanellas, present; here the brain is covered only by skin and membranes, and the pulsations of its blood vessels may be seen. One of these spots, the anterior fontanelle, does not close completely until the child is 18 months to 2••• years old.

Parts of the skull The cranium, enclosing the brain, consists of eight bones, while the face, which forms a bony framework for the eyes, nose and mouth, consists of 14 bones. These two parts can be detached.

Shape of the skull The development of large central hemispheres of the brain in humans has in?uenced the skull shape. Unlike in other mammals, the cranium extends above as well as behind the face which therefore looks forwards. The skull’s proportions change with age: the cranium in children is larger in comparison with the face – one-eighth of the whole head – than is the case in adults, where sizes are about the same. Old age reduces the size of the face because of the loss of teeth and absorption of their bony sockets. Women’s skulls tend to be lighter and smoother with less obvious protuberances than those in men.... skull

Sleep

Sleep is a state which alternates with wakefulness, and in which awareness and responsiveness to the environment are reduced. It is not, however, uniform and can be divided into two main states di?erentiated according to electrical recordings of brain activity (EEG), of the muscles (EMG), and of the eye movements (EOG).

Non-rapid-eye-movement (NREM) sleep This is subdivided into four stages, of which stage 1 is the lightest and stage 4 the deepest. The activity of the cerebral cortex (see BRAIN) is diminished and the body’s functions are mainly regulated by brain-stem activity. The metabolic rate is reduced; in keeping with this the temperature falls, respiration is reduced, cardiac output, heart rate, and blood pressure fall, and activity of the sympathetic nervous system is reduced. NREM sleep normally occurs at the onset of sleep except in neonates. During adult life, the duration – particularly of stages 3 and 4 – of NREM sleep becomes less, and very little of this deep sleep occurs after the age of 60 years.

NREM sleep has been thought to have several functions, such as energy conservation and growth. Growth hormone is produced in bursts during stages 3 and 4, and more cell division occurs during this type of sleep than during wakefulness. A controversial proposal has been that processing of information acquired during wakefulness occurs during NREM sleep.... sleep

Slough

Slough (pronounced ‘slu?’) is dead tissue separated by natural processes from the living body. The term is applied to hard external parts which the lower animals cast o? naturally in the course of growth, like the skin of snakes or the shell of crabs. In humans, however, the process is generally associated with disease, and is then known as GANGRENE. Sloughs may be of very small size, as in the case of the core of a boil, or they may include a whole limb; but in general a slough involves a limited area of skin or of the underlying tissues. The process of separation of a slough is described under gangrene.... slough

Smegma

A thick, cheesy secretion formed by the SEBACEOUS GLANDS of the glans penis (see PENIS). A bacillus, closely resembling the tubercle bacillus morphologically, develops readily in this secretion.... smegma

Snellen Chart

The most commonly used chart for testing the acuity of distant VISION. The chart comprises rows of capital letters, with the letters in each row being smaller than those in the one above. The top line of large letters can be seen by a normally sighted person standing 60 metres away. The subject under test sits 6 metres from the screen and, if he or she can read the 6-metre line of letters, his or her visual acuity is normal at 6/6.... snellen chart

Snow Blindness

Damage caused to the cornea of an unprotected EYE by the re?ection of the sun’s rays from snow. ULTRAVIOLET RAYS (UVR) are the damaging agent and people going out in snow and sunlight should wear protective goggles. The condition is painful but resolves if the eyes are covered with pads for a day or two. Prolonged exposure may seriously damage the cornea and impair vision.... snow blindness

Snoring

This is usually attributed to vibrations of the soft PALATE, but there is evidence that the main fault lies in the edge of the posterior pillars of the FAUCES which vibrate noisily. Mouth-breathing is necessary for snoring, but not all mouth-breathers snore. The principal cause is blockage of the nose, such as occurs during the course of the common cold or chronic nasal CATARRH; such blockage also occurs in some cases of deviation of the nasal SEPTUM or nasal polypi (see NOSE, DISORDERS OF). In children, mouth-breathing, with resulting snoring, is often due to enlarged TONSILS and adenoids. A further cause of snoring is loss of tone in the soft palate and surrounding tissues due to smoking, overwork, fatigue, obesity, and general poor health. One in eight people are said to snore regularly. The intensity, or loudness, of snoring is in the range of 40–69 decibels. (Pneumatic drills register between 70 and 90 decibels.) Bouts of snoring sometimes alternate with SLEEP APNOEAS.

Treatment therefore consists of the removal of any of these causes of mouth-breathing that may be present. Should this not succeed in preventing snoring, then measures should be taken to prevent the sufferer from sleeping lying on his or her back, as this is a habit strongly conducive to snoring. Simple measures include sleeping with several pillows, so that the head is raised quite considerably when asleep; alternatively, a small pillow may be put under the nape of the neck. If all these measures fail it may be worth trying the traditional method of sewing a hairbrush, or some other hard object such as a stone, into the back of the snorer’s pyjamas. Thus, if they turn on their back, they are quickly awakened. (See also STERTOR.)... snoring

Sodium

A metal, the salts of which are white, crystalline, and very soluble. The ?uids of the body contain naturally a considerable quantity of sodium chloride.

Sodium carbonate, commonly known as soda or washing soda, has a powerful softening action upon the tissues.

Sodium bicarbonate, or baking soda, is used as an antacid (see ANTACIDS) in relieving indigestion associated with increased acidity of the gastric secretion.

The citrate and the acetate of sodium are used as DIURETICS.... sodium

Sodium Valproate

A drug of ?rst choice for the treatment of several forms of EPILEPSY, including primary generalised epilepsy, generalised absences and myoclonic seizures; it may also be tried in atypical absence, atonic and tonic seizures. Usually taken orally, the drug has shown promising initial results from controlled trials in partial epilepsy. It probably has similar e?cacy to CARBAMAZEPINE and PHENYTOIN SODIUM.

Sodium valproate has widespread metabolic effects and may have dose-related side-effects. There has been concern over severe hepatic or pancreatic toxicity, but such adverse effects are rare. Other adverse effects include digestive upsets, drowsiness, muscle incoordination and skin rashes. Rare reports have been given of behavioural disturbances, with occasional aggression. Initiation and withdrawal of treatment should always be slow. Patients should reduce their alcohol intake; any other drugs they are taking that are metabolised by the liver should be carefully monitored.... sodium valproate

Solar Plexus

A large network of sympathetic nerves and ganglia situated in the abdomen behind the stomach, where it surrounds the coeliac artery. Branches of the VAGUS nerve – the most important part of the PARASYMPATHETIC NERVOUS SYSTEM – lead into the solar plexus, which in turn distributes branches to the stomach, intestines and several other abdominal organs. A severe blow in the solar plexus may cause temporary unconsciousness.... solar plexus

Somatotype

The physical build of a person. Attempts have been made to link body build with personality type, but with no great success. One approach is to classify people as endomorphs (heavy physique and sociable personality); mesomorphs (strong, muscular build with well-developed bones linked with a physically adventurous temperament); and ectomorphs (thin and lightly built with an introspective nature).... somatotype

Somnambulism

Sleep-walking. (See SLEEP.)... somnambulism

Soporific

Inducing sleep... soporific

Sore

Sore is a popular term for ULCER.... sore

Sore Throat

A raw sensation at the back of the throat. A common symptom, the cause is usually PHARYNGITIS, sometimes TONSILLITIS. It is often the presenting symptom of colds, INFLUENZA, LARYNGITIS and infectious MONONUCLEOSIS. Sore throats caused by streptococcal infection (see STREPTOCOCCUS) should be treated with antibiotics, as should other bacteria-initiated sore throats; otherwise, symptomatic treatment with analgesics and antiseptic gargles is suf?cient for this usually self-limiting condition.... sore throat

Spasmolytic

Helping to relieve cramps and other muscle contractions... spasmolytic

Specificity

A high rate of detection of “true negatives”, for example, the fraction of subjects who actually received bad care who are classified as recipients of bad care. For medical screening tests, the proportion of truly non-diseased persons who are so identified by the screening test. It is a measure of the probability of correctly identifying a non-diseased person with a screening test (synonymous with ‘true negative rate’).... specificity

Spasm

An involuntary, and, in severe cases, painful contraction of a muscle or of a hollow organ with a muscular wall. Spasm may be due to affections in the muscle where the spasm takes place, or it may originate in some disturbance of that part of the nervous system which controls the spasmodically acting muscles. Spasms of a general nature are usually spoken of as CONVULSIONS; spasms of a painful nature are known as cramp (see under MUSCLES, DISORDERS OF) when they affect the muscles of the limbs, and as COLIC when they are situated in the stomach, intestines, ureters or bile duct, or other organs of the abdomen. Spasm of the heart is called ANGINA PECTORIS, and is both a serious and an agonising condition. When the spasm is a prolonged ?rm contraction, it is spoken of as tonic spasm; when it consists of a series of twitches or quick alternate contractions and relaxations, it is known as clonic spasm. Spasm is a symptom of many diseases.... spasm

Speculum

An instrument designed to aid the examination of the various openings on the surface of the body. Many specula are provided with small electric lamps so placed as to light up the cavity of the mouth, ear, nose, rectum or vagina.... speculum

Speech Therapy

The treatment of speech and communication disorders.... speech therapy

Spermatic Cord

This comprises the VAS DEFERENS, nerves and blood vessels, and it runs from the cavity of the ABDOMEN to the TESTICLE in the SCROTUM.... spermatic cord

Sphygmomanometer

The traditional device for measuring blood pressure in clinical practice, devised by Riva-Rocci and Korotko? about a century ago. Measurement depends on accurate transmission and interpretation of the pulse wave to an artery. The sphygmomanometer is of two types, mercury and aneroid. The former is more accurate. Both have some features in common – an in?ation-de?ation system, an occluding bladder encased in a cu?, and the use of AUSCULTATION with a STETHOSCOPE. The mercury sphygmomanometer consists of a pneumatic armlet which is connected via a rubber tube with an air-pressure pump and a measuring gauge comprising a glass column containing mercury. The armlet is bound around the upper arm and pumped up su?ciently to obliterate the pulse felt at the wrist or heard by auscultation of the artery at the bend of the elbow. The pressure, measured in millimetres of mercury (mm Hg), registered at this point on the gauge is regarded as the pressure of the blood at each heartbeat (ventricular contraction). This is called the systolic pressure. The cu? is then slowly de?ated by releasing the valve on the air pump and the pressure at which the sound heard in the artery suddenly changes its character marks the diastolic pressure. Aneroid sphygmomanometers register pressure through an intricate bellows and lever system which is more susceptible than the mercury type to the bumps and jolts of everyday use which reduce its inaccuracy.

While mercury sphygmomanometers are simple, accurate and easily serviced, there is concern about possible mercury toxicity for users, those servicing the devices and the environment. Use of them has already been banned in some European hospitals. Although it may be a few years before they are widely replaced, automated blood-pressure-measuring devices will increasingly be in routine use. A wide variety of ambulatory blood-pressuremeasuring devices are already available and may be ?tted in general practice or hospital settings, where the patient is advised on the technique. Blood-pressure readings can be taken half-hourly – or more often, if required – with little disturbance of the patient’s daily activities or sleep. (See also BLOOD PRESSURE; HYPERTENSION.)... sphygmomanometer

Spikenard

Aralia racemosa. N.O. Araliaceae.

Synonym: Indian Spikenard, Pettymorrel, Spignet.

Habitat: U.s.a

Features ? Rhizome is about one inch in diameter, oblique, with concave stem scars. Root is a similar thickness at the base, wrinkled, light brown. Fracture short and whitish. Taste and odour aromatic.

Part used ? Root, rhizome.

Action: Alterative, diaphoretic.

The strong alterative properties are made considerable use of in rheumatic and general uric acid disorders, as well as various skin diseases. Decoction of 1/2 ounce to 1 1/2 pints (reduced to 1 pint) is taken in tablespoonful doses four times daily.... spikenard

Spirochaete

An order of bacteria which has a spiral form. (See MICROBIOLOGY.)... spirochaete

Spironolactone

One of the group of substances known as spirolactones. These are steroids similar to ALDOSTERONE in structure which competitively act as inhibitors of it; they can thus antagonise the action of aldosterone in the renal tubules. As there is evidence that there is an increased output of aldosterone in oedematous conditions (see OEDEMA) – such as congestive heart failure, which accentuates the oedema – spironolactone is used, along with other DIURETICS.... spironolactone

Splenectomy

Removal of the SPLEEN. This operation may be necessary if the spleen has been severely injured, or in the treatment of the severe form of acholuric JAUNDICE or autoimmune thrombocytopenic PURPURA.... splenectomy

Spondylitis

Another name for ARTHRITIS of the spine (see SPINE AND SPINAL CORD, DISEASES AND INJURIES OF).... spondylitis

Spondylolisthesis

See SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.... spondylolisthesis

Spinal Cord

This is the lower portion of the CENTRAL NERVOUS SYSTEM which is situated within the SPINAL COLUMN. Above, it forms the direct continuation of the medulla oblongata, this part of the BRAIN changing its name to spinal cord at the foramen magnum, the large opening in the base of the skull through which it passes into the spinal canal. Below, the spinal cord extends to about the upper border of the second lumbar vertebra, where it tapers o? into a ?ne thread, known as the ?lum terminale, that is attached to the coccyx at the lower end of the spine. The spinal cord is thus considerably shorter than the spinal column, being only 37– 45 cm (15–18 inches) in length, and weighing around 30 grams.

In its course from the base of the skull to the lumbar region, the cord gives o? 31 nerves on each side, each of which arises by an anterior and a posterior root that join before the nerve emerges from the spinal canal. The openings for the nerves formed by notches on the ring of each vertebra have been mentioned under the entry for spinal column. To reach these openings, the upper nerves pass almost directly outwards, whilst lower down their obliquity increases, until below the point where the cord ends there is a sheaf of nerves, known as the cauda equina, running downwards to leave the spinal canal at their appropriate openings.

The cord is a cylinder, about the thickness of the little ?nger. It has two slightly enlarged portions, one in the lower part of the neck, the other at the last dorsal vertebra; and from these thickenings arise the nerves that pass to the upper and lower limbs. The upper four cervical nerves unite to produce the cervical plexus. From this the muscles and skin of the neck are mainly supplied, and the phrenic nerve, which runs down through the lower part of the neck and the chest to innervate the diaphragm, is given o?. The brachial plexus is formed by the union of the lower four cervical and ?rst dorsal nerves. In addition to nerves to some of the muscles in the shoulder region, and others to the skin about the shoulder and inner side of the arm, the plexus gives o? large nerves that proceed down the arm.

The thoracic or dorsal nerves, with the exception of the ?rst, do not form a plexus, but each runs around the chest along the lower margin of the rib to which it corresponds, whilst the lower six extend on to the abdomen.

The lumbar plexus is formed by the upper four lumbar nerves, and its branches are distributed to the lower part of the abdomen, and front and inner side of the thigh.

The sacral plexus is formed by parts of the fourth and ?fth lumbar nerves, and the upper three and part of the fourth sacral nerves. Much of the plexus is collected into the sciatic nerves, the largest in the body, which go to the legs.

The sympathetic system is joined by a pair of small branches given o? from each spinal nerve, close to the spine. This system consists of two parts, ?rst, a pair of cords running down on the side and front of the spine, and containing on each side three ganglia in the neck, and beneath this a ganglion opposite each vertebra. From these two ganglionated cords numerous branches are given o?, and these unite to form the second part – namely, plexuses connected with various internal organs, and provided with numerous large and irregularly placed ganglia. The chief of these plexuses are the cardiac plexus, the solar or epigastric plexus, the diaphragmatic, suprarenal, renal, spermatic, or ovarian, aortic, hypogastric and pelvic plexuses.

The spinal cord, like the brain, is surrounded by three membranes: the dura mater, arachnoid mater, and pia mater, from without inwards. The arrangement of the dura and arachnoid is much looser in the case of the cord than their application to the brain. The dura especially forms a wide tube which is separated from the cord by ?uid and from the vertebral canal by blood vessels and fat, this arrangement protecting the cord from pressure in any ordinary movements of the spine.

In section the spinal cord consists partly of grey, but mainly of white, matter. It di?ers from the upper parts of the brain in that the white matter (largely) in the cord is arranged on the surface, surrounding a mass of grey matter (largely neurons – see NEURON(E)), while in the brain the grey matter is super?cial. The arrangement of grey matter, as seen in a section across the cord, resembles the letter H. Each half of the cord possesses an anterior and a posterior horn, the masses of the two sides being joined by a wide posterior grey commissure. In the middle of this commissure lies the central canal of the cord, a small tube which is the continuation of the ventricles in the brain. The horns of grey matter reach almost to the surface of the cord, and from their ends arise the roots of the nerves that leave the cord. The white matter is divided almost completely into two halves by a posterior septum and anterior ?ssure and is further split into anterior, lateral and posterior columns.

Functions The cord is, in part, a receiver and originator of nerve impulses, and in part a conductor of such impulses along ?bres which pass through it to and from the brain. The cord contains centres able to receive sensory impressions and initiate motor instructions. These control blood-vessel diameters, eye-pupil size, sweating and breathing. The brain exerts an overall controlling in?uence and, before any incoming sensation can affect consciousness, it is usually ‘?ltered’ through the brain.

Many of these centres act autonomously. Other cells of the cord are capable of originating movements in response to impulses brought direct to them through sensory nerves, such activity being known as REFLEX ACTION. (For a fuller description of the activities of the spinal cord, see NEURON(E) – Re?ex action.)

The posterior column of the cord consists of the fasciculus gracilis and the fasciculus cuneatus, both conveying sensory impressions upwards. The lateral column contains the ventral and the dorsal spino-cerebellar tracts passing to the cerebellum, the crossed pyramidal tract of motor ?bres carrying outgoing impulses downwards together with the rubro-spinal, the spino-thalamic, the spino-tectal, and the postero-lateral tracts. And, ?nally, the anterior column contains the direct pyramidal tract of motor ?bres and an anterior mixed zone. The pyramidal tracts have the best-known course. Starting from cells near the central sulcus on the brain, the motor nerve-?bres run down through the internal capsule, pons, and medulla, in the lower part of which many of those coming from the right side of the brain cross to the left side of the spinal cord, and vice versa. Thence the ?bres run down in the crossed pyramidal tract to end beside nerve-cells in the anterior horn of the cord. From these nerve-cells other ?bres pass outwards to form the nerves that go direct to the muscles. Thus the motor nerve path from brain to muscle is divided into two sections of neurons, of which the upper exerts a controlling in?uence upon the lower, while the lower is concerned in maintaining the muscle in a state of health and good nutrition, and in directly calling it into action. (See also NERVE; NERVOUS SYSTEM.)... spinal cord

Sprue

A disease occurring most commonly in patients in or from the tropics, and characterised by diarrhoea with large, fatty stools; ANAEMIA; sore tongue; and weight loss. Its manifestations resemble those of non-tropical sprue, or gluten enteropathy, and COELIAC DISEASE.

Causes Tropical sprue is thought to be due to an inborn error of metabolism, characterised primarily by an inability to absorb fats from the intestines. Its epidemiological pattern suggests that an infection such as DYSENTERY may be the precipitating factor. Subsequently there is interference with the absorption of carbohydrates, vitamins, and minerals, leading to anaemia and HYPOCALCAEMIA.

Symptoms Of gradual or rapid onset, there is initial weakness, soreness of the tongue, dif?culty swallowing, indigestion, diarrhoea and poor appetite. Anaemia is typically macrocytic, and mild HYPOGLYCAEMIA may occur. Untreated, the patient steadily loses weight and, unless appropriate treatment is started early, death may be expected because of exhaustion and some intercurrent infection.

Treatment This consists of bed rest, a high-protein diet (initially skimmed milk), and treatment of the anaemia and any other de?ciencies present. Minimum fat should be given to sufferers, who should also take folic acid and cyanocobalamin for the anaemia; large vitamin-B-complex supplements (such as Marmite®) are helpful. Vitamins A and D, together with calcium supplements, help to raise the concentration of calcium in the blood. A long convalescence is often required, which may lead to marked depression, and patients should be sent home to a temperate climate.

Non-tropical sprue is the result of GLUTEN hypersensitivty and is treated with a gluten-free diet.... sprue

Squamous Cell Carcinoma

Malignant tumour of squamous epithelium of skin, which generally spreads and metastasises.... squamous cell carcinoma

Stage

Estimate of the extent of spread of a cancer; usually expressed in as a number, often with subdivisions. The prognosis of a particular cancer varies with the staging.... stage

Sports Medicine

The ?eld of medicine concerned with physical ?tness and the diagnosis and treatment of both acute and chronic sports injuries sustained during training and competition. Acute injuries are extremely common in contact sports, and their initial treatment is similar to that of those sustained in other ways, such as falls and road traf?c incidents. Tears of the muscles (see MUSCLES, DISORDERS OF), CONNECTIVE TISSUE and LIGAMENTS which are partial (sprains) are initially treated with rest, ice, compression, and elevation (RICE) of the affected part. Complete tears (rupture) of ligaments (see diagrams) or muscles, or fractures (see BONE, DISORDERS OF – Bone fractures) require more prolonged immobilisation, often in plaster, or surgical intervention may be considered. The rehabilitation of injured athletes requires special expertise

– an early graded return to activity gives the best long-term results, but doing too much too soon runs the risk of exacerbating the original injury.

Chronic (overuse) injuries affecting the bones (see BONE), tendons (see TENDON) or BURSAE of the JOINTS are common in many sports. Examples include chronic INFLAMMATION of the common extensor tendon where it

attaches to the later EPICONDYLE of the humerus – common in throwers and racquet sportspeople – and stress fractures of the TIBIA or METATARSAL BONES of the foot in runners. After an initial period of rest, management often involves coaching that enables the athlete to perform the repetitive movement in a less injury-susceptible manner.

Exercise physiology is the science of measuring athletic performance and physical ?tness for exercise. This knowledge is applied to devising and supervising training regimens based on scienti?c principles. Physical ?tness depends upon the rate at which the body can deliver oxygen to the muscles, known as the VO2max, which is technically di?cult to measure. The PULSE rate during and after a bout of exercise serves as a good proxy of this measurement.

Regulation of sport Sports medicine’s role is to minimise hazards for participants by, for example, framing rule-changes which forbid collapsing the scrum, which has reduced the risk of neck injury in rugby; and in the detection of the use of drugs taken to enhance athletic performance. Such attempts to gain an edge in competition undermine the sporting ideal and are banned by leading sports regulatory bodies. The Olympic Movement Anti-Doping Code lists prohibited substances and methods that could be used to enhance performance. These include some prohibited in certain circumstances as well as those completely banned. The latter include:

stimulants such as AMPHETAMINES, bromantan, ca?eine, carphedon, COCAINE, EPHEDRINE and certain beta-2 agonists.

NARCOTICS such as DIAMORPHINE (heroin), MORPHINE, METHADONE HYDROCHLORIDE and PETHIDINE HYDROCHLORIDE.

ANABOLIC STEROIDS such as methandione, NANDROLONE, stanazol, TESTOSTERONE, clenbuterol, androstenedone and certain beta-2 agonists.

peptide HORMONES, mimetics and analogues such as GROWTH HORMONE, CORTICOTROPHIN, CHORIONIC GONADOTROPHIC HORMONE, pituitary and synthetic GONADOTROPHINS, ERYTHROPOIETIN and INSULIN. (The list produced above is not comprehen

sive: full details are available from the governing bodies of relevant sports.) Among banned methods are blood doping (pre-competition administration of an athlete’s own previously provided and stored blood), administration of arti?cial oxygen carriers or plasma expanders. Also forbidden is any pharmacological, chemical or physical manipulation to affect the results of authorised testing.

Drug use can be detected by analysis of the URINE, but testing only at the time of competition is unlikely to detect drug use designed to enhance early-season training; hence random testing of competitive athletes is also used.

The increasing professionalism and competitiveness (among amateurs and juveniles as well as professionals) in sports sometimes results in pressures on participants to get ?t quickly after injury or illness. This can lead to

players returning to their activity before they are properly ?t – sometimes by using physical or pharmaceutical aids. This practice can adversely affect their long-term physical capabilities and perhaps their general health.... sports medicine

Squill

Urginea scilla. N.O. Liliaceae.

Synonym: Scilla.

Habitat: Grown near the sea coast in Sicily and Malta.

Features ? A large bulbous plant, Scilla is imported in the form of dried, curved segments of the white, bulbous root, which are tough, dirty white in colour, and approximate two inches long by a quarter-inch wide. The fracture is short, taste acrid. The powdered bulb is very hydroscopic, and should consequently be kept airtight. An Indian variety is used throughout the East, and has similar properties to the above.

Part used ? Bulb.

Action: Expectorant, emetic.

As an expectorant for coughs and all bronchial affections. Is used generally to allay irritation of mucous surfaces. Dose, 2 to 10 grains of the powdered bulb. Large doses produce emesis.... squill

Standard 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

Squint

Squint, or strabismus, is a condition in which the visual axes of each EYE are not directed simultaneously at the same ?xation point (i.e. each eye is not pointing at the same object at the same time). Squints may be: (a) Paralytic, where one or more of the muscles, or their nerve supply, is damaged; this type usually results in double vision. (b) Non-paralytic, where the muscles and nerves are normal. It is usually found in children. This type of squint can either result in poor vision, or occasionally may result from poor vision.

Squints may be convergent (where one eye ‘turns in’) or divergent (one eye ‘turns out’). Vertical squints can also occur but are less common. All squints should be seen by an eye specialist as soon as possible. Some squints can be corrected by exercises or spectacles; others require surgery.... squint

Stammering

A disruption of the forward ?ow of speech. The individual knows what he or she wants to say, but temporarily loses the ability to execute linguistically formulated speech. Stammering is characterised by a silent or audible involuntary repetition/prolongation of an utterance, be it a sound, syllable or word. Sometimes it is accompanied by accessory behaviours, or speech-related struggle. Usually there are indications or the report of an accompanying emotional state, involving excitement, tension, fear or embarrassment.

Idiopathic stammering begins at some time between the onset of speech and puberty, mostly between 2–5 years of age. Acquired stammering at a later age due to brain damage is rare. The prevalence of stammering (the percentage of the population actually stammering at any point in time) is approximately 0·9 per cent. Three times as many boys as girls stammer. About 70 per cent of stammering children recover with little or no therapy. Stammerers have not been shown to demonstrate di?erences in personality from non-stammerers; there are, however, indications that at least some stammerers show minimal di?erences from ?uent speakers in cerebral processing of verbal material.

There is a genetic predisposition towards stammering. The risk of stammering among ?rst-degree relatives of stammerers is more than three times the population risk. In 77 per cent of identical twins, either both stammer or both are ?uent. Only 33 per cent of non-identical twins agree in this way. As there are identical twins who di?er for stammering, environmental factors must be important for some stammerers. There are relatively large numbers of stammerers in highly competitive societies, where status and prestige are important and high standards of speech competence are valued.

Di?erent treatments have been demonstrated to produce considerable bene?t, their basic outline being similar. A long period of time is spent in training stammerers to speak in a di?erent way (?uency-shaping techniques). This may include slowing down the rate of speech, gentle onset of utterance, continuous ?ow with correct juncturing, etc. When the targets have been achieved within the clinic, a series of planned speech assignments outside the clinic is undertaken. In these assignments, and initially in everyday situations, the ?uency-enchancing techniques have to be used conscientiously. Gradually speech is shaped towards normality requiring less and less e?ort. Therapy may also include some work on attitude change (i.e. helping the client to see him or herself as a ?uent speaker) and possibly general communicative skills training.

For information about organisations concerned with stammering, see Appendix 2.... stammering

Stapedectomy

An operation on the middle EAR to remove the STAPES and replace it with an arti?cial alternative. The procedure is aimed at treating DEAFNESS caused by otosclerosis in which the stapes becomes ?xed by an overgrowth of bone, preventing it from transmitting sound. Stapedectomy improves hearing in around 90 per cent of those people who have the operation. (See EAR, DISEASES OF.)... stapedectomy

Stapes

The innermost of the small trio of bones in the middle EAR. It is stirrup-shaped, articulates with the incus, and is linked to the oval window of the inner ear.... stapes

Starch

A substance belonging to that group of carbohydrate known as the amyloses. It is the form in which utilisable CARBOHYDRATE is stored in granules within the seeds and roots of many plants.

Starch is converted into sugar when treated with heat in presence of a dilute acid. It is changed largely into dextrin when exposed to a considerable degree of dry heat, as in toasting bread; and a similar change into dextrin and malt-sugar takes place under the action of various enzymes (see ENZYME) such as the PTYALIN of the SALIVA. Starch forms a chief constituent of the carbohydrate foods (see DIET); and in the process of digestion, the above-mentioned change takes place to prepare it for absorption. It is also slowly broken down in the process of cooking.

Starch is used as a constituent of dusting powders for application to chafed or irritable areas of the skin.... starch

Starvation

A condition that results from a lack of food for a long time. The person suffers weight loss and changes in the body’s METABOLISM, with production of potentially harmful chemicals called ketones (see KETONE) and ACETONE. Sometimes starvation may occur as a result of an eating disorder (see EATING DISORDERS – Anorexia nervosa). In cases of slow starvation, the vitality of the tissues is reduced and they become more liable to tuberculosis and other diseases. (See also FASTING.)... starvation

Status Asthmaticus

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

Status Epilepticus

Repeated epileptic ?ts (see EPILEPSY) with no return to consciousness between them. Breathing stops between each ?t and the body is deprived of oxygen which causes damage to the brain. Urgent medical attention is required to control the condition, or the patient may suffer permanent brain damage.... status epilepticus

Steatorrhoea

Any condition characterised by the passing of stools (FAECES) containing an excess of FAT. (See MALABSORPTION SYNDROME.)... steatorrhoea

Stenosis

An unnatural narrowing in any passage or ori?ce of the body. The word is especially used in connection with the four openings of the HEART at which the valves are situated. (See HEART, DISEASES OF.)... stenosis

Stent

A surgical device used to assist the healing of an operative anastamosis – a joining-up of two structures. A splint is left inside the lumen of a duct and this drains the contents.... stent

Stem Cell

Stem CELLS develop a few days after an egg (ovum) is fertilised by a spermatozoon and starts developing to form an EMBRYO. These master cells are crucial to the development of a normal embryo. They contain a specialised ENZYME that gives them the facility to divide inde?nitely, developing into the many di?erent specialised cells that comprise the various tissues in the body – for example, skin, blood, muscle, glands or nerves.

In a highly signi?cant advance in research, a scienti?c team in the United States obtained stem cells from newly formed human embryos

– donated by women who had become pregnant after successful in vitro fertilisation – and successfully cultivated these cells in the laboratory. This achievement opened the way to replicating in the laboratory, the various specialised cells that develop naturally in the body. UK government legislation constrains the use of human embryos in research (see ETHICS) and the ethical aspects of taking this stem-cell culture technique forwards will have to be resolved. Nevertheless, this discovery points the biological way to the use of genetic engineering in selecting di?erentiated specialised cells from which replacement tissues could be grown for use as transplants to rectify absent or damaged tissues in the human body.

Research into potential use of stem cells has raised expectations that in the long term they may prove to be an e?ective regenerative treatment for a wide range of disorders including PARKINSONISM, ALZHEIMER’S DISEASE, type-2 diabetes (see under DIABETES MELLITUS), myocardial infarction (see HEART, DISEASES OF), severe burns, osteoporosis (see under BONE, DISORDERS OF) and the regeneration of blood to replace the need for BONE MARROW TRANSPLANT. Recent research has shown that adult stem cells may also be stimulated to produce new cell lines. If successful, this would eliminate the need to use embryos and thus resolve existing ethical dilemmas over the use of stem cells.... stem cell

Sterility

The state of (1) being free of infectious agents or (2) permanent INFERTILITY.... sterility

Sternum

The scienti?c name for the breastbone. This is a long, ?at, bony plate that comprises the central part of the chest. Made up of three parts: an upper triangular piece (manubrium); a middle part (the body); and at the bottom end the small, ?exible xiphoid process. The two clavicles articulate to the manubrium. Seven pairs of costal cartilages link the sternum to the ribs. The sternum is very strong and a powerful blow is needed to fracture it: such an injury may damage the underlying heart and lungs.... sternum

Stillbirth

A stillborn child is ‘any child which has issued forth from its mother after the 24th week of pregnancy and which did not at any time after being completely expelled from its mother, breathe or show any other sign of life’. In the United Kingdom in 2002 the number of stillbirths and deaths at under one week of age (PERINATAL MORTALITY) was 5.6 per 1,000 live births.... stillbirth

Stitch

A popular name for a sharp pain in the side. It is generally due to cramp (see MUSCLES, DISORDERS OF) following unusually hard exertion, but care must be taken that this trivial condition is not taken for PLEURISY or for a fractured rib. The word is also used to mean the repair of skin following surgery or any other trauma.... stitch

Stoma

A stoma refers to an opening constructed when the bowel has to be brought to the skin surface to convey gastrointestinal contents to the exterior. It is derived from the Greek word meaning mouth. In the United Kingdom there are about 100,000 patients with a COLOSTOMY, 10,000 with an ILEOSTOMY and some 2,000 with a urostomy, in which the ureters (see URETER) are brought to the skin surface. They may be undertaken because of malignancy of the colon or rectum (see INTESTINE) or as a result of in?ammatory bowel diseases such as CROHN’S DISEASE. Urostomies usually take the form of an isolated loop of ilium into which the ureters have been implanted and which in its turn is either brought to the skin’s surface or converted into an arti?cial bladder. This is undertaken because of bladder cancer or because of neurological diseases of the bladder. The stomas drain into appliances such as disposable plastic bags. Most of the modern appliances collect the e?uent of the stoma without any leak or odour.

Patients with stomas often ?nd explanatory booklets helpful: Living with your Colostomy and Understanding Colostomy are examples. They are published by the British Colostomy Association.... stoma

Stomach

This is a distensible, sac-like organ with an average adult capacity of 1·5 litres situated in the upper abdomen. It is positioned between the OESOPHAGUS and DUODENUM, lying just beneath the DIAPHRAGM to the right of the SPLEEN and partly under the LIVER. The stomach is a part of the gastrointestinal tract with its walls formed of layers of longitudinal and circular muscles and lined by glandular cells that secrete gastric juice. It is well supplied with blood vessels as well as nerves from the autonomic system which enter via the phrenic nerve. The exit of the stomach is guarded by a ring of muscle called the pyloric sphincter which controls the passage of food into the duodenum.

Function As well as the stomach’s prime role in physically and physiologically breaking down the food delivered via the oesophagus, it also acts as a storage organ – a function that enables people to eat three or four times a day instead of every 30 minutes or so as their metabolic needs would otherwise demand. Gastric secretion is stimulated by the sight and smell of food and its subsequent arrival in the stomach. The secretions, which contain mucus and hydrochloric acid (the latter produced by parietal cells), sterilise the food; pepsin, a digestive ENZYME in the gastric juices, breaks down the protein in food. The juices also contain intrinsic factor, vital for the absorption of vitamin B12 when the chyle – as the stomach contents are called – reaches the intestine. This chyle is of creamy consistency and is the end product of enzymic action and rhythmic contractions of the stomach’s muscles every 30 seconds or so. Food remains in the stomach for varying lengths of time depending upon its quantity and nature. At regular intervals a bolus of chyle is forced into the duodenum by contractions of the stomach muscles coordinated with relaxation of the pyloric sphincter.... stomach

Strabismus

See SQUINT.... strabismus

Strain

Stretching or tearing of muscle ?bres caused by subjecting them to sudden pulling. Bleeding into the muscle causes pain and swelling and sometimes muscle spasm. Application of ice packs and strapping, coupled with a day or two’s rest and analgesics, are usually su?cient to remedy most strains. Sometimes antiin?ammatory drugs or physiotherapy may be required.... strain

Strangulation

The constriction of a passage or tube in the body that blocks the blood ?ow and disturbs the working of the affected organ. It is usually caused by compression or twisting. Strangulation customarily occurs when part of the INTESTINE herniates either inside the abdomen or outside as in an inguinal HERNIA. If a section of the intestine twists, this may strangulate and is known as a VOLVULUS.

Strangulation of a person’s neck, either with a ligature or with the hands, obstructs the jugular veins in the neck, preventing the normal out?ow of blood from the brain and head. The TRACHEA is also compressed, cutting o? the supply of air to the lungs. The combination of these effects leads to HYPOXIA and damage to the brain. If not quickly relieved, unconsciousness and death follow. Strangulation may be deliberate or accidental – the latter being a particular hazard for children, for example, when playing with a rope. Removal of the constriction, arti?cial respiration, and medical attention are urgently necessary.... strangulation

Streptokinase

An ENZYME produced by certain streptococci (see STREPTOCOCCUS). It acts as a PLASMINOGEN activator, and hence enhances FIBRINOLYSIS. The most important use of streptokinase is in the treatment of myocardial infarction (see HEART, DISEASES OF) in the ?rst 12 hours after the initial diagnosis. Subsequently, use of this thrombolytic drug should be under hospital supervision. It is given intravenously, in hospital by infusion. It may be given as an infusion to treat severe THROMBOSIS or EMBOLISM, particularly when they occur in a limb, and in deep venous thrombosis. Being antigenic and very expensive it is rarely used for more than two days, and is followed by anticoagulation therapy. The chief risk is haemorrhage, so an anti?brinolytic such as aminocaproic acid should always be available.... streptokinase

Streptomycin

Streptomycin is an antibacterial substance obtained from the soil mould, Streptomyces griseus, ?rst isolated in 1944 and the ?rst antibiotic to be e?ective against the tubercle bacillus. It was once routinely used to treat TUBERCULOSIS; because of side-effects and the development of other drugs, it is now rarely used except for in cases of resistant tuberculosis.

One of the AMINOGLYCOSIDES, streptomycin has two disadvantages. The most important of these is the tendency of organisms to become resistant to it. This means that the administration of this antibiotic must be carefully supervised to ensure that correct dosage is being used. The other disadvantage is that streptomycin produces toxic effects, especially disturbance of the vestibular and hearing apparatus. This may result in DEAFNESS, VERTIGO, and TINNITUS. Whilst in many cases these toxic manifestations disappear when the antibiotic is withdrawn, they may be permanent. For this reason therefore streptomycin must always be used with special care.... streptomycin

Stress

Any factor or event that threatens a person’s health or adversely affects his or her normal functioning. Injury, disease or worry are common examples; others include internal con?icts, emotive life events – such as the death of a close relative or friend, the birth of a baby, separation or divorce – pressures at work or a hostile environment such as war or famine. Some individuals seem to be more prone than others to develop medical problems related to stress.

Stress prompts the body to raise its output of HORMONES such as ADRENALINE and CORTISOL, causing changes in blood pressure, heart rate and metabolism. These are physiological responses intended to improve a person’s physical and mental performance – the ‘?ght or ?ight’ reaction to fear. Stress may, however, disrupt the ability to cope. Constant or recurrent exposure to stress may produce symptoms such as anxiety, depression, headaches, indigestion, diarrhoea, palpitations and general malaise (see POST-TRAUMATIC STRESS DISORDER (PTSD)). Treatment can be di?cult and prolonged; counselling can help as can ANXIOLYTICS or ANTIDEPRESSANT DRUGS – but a change in job or lifestyle may be necessary in some circumstances.... stress

Stricture

A narrowing in any of the natural passages of the body, such as the GULLET, the bowel, or the URETHRA. It may be due to the development of some growth in the wall of the passage affected, or to pressure upon it by such a growth in some neighbouring organ, but in the majority of cases a stricture is the result of previous ulceration on the inner surface of the passage, followed by contraction of the scar. (See INTESTINE, DISEASES OF; URETHRA, DISEASES OF.)... stricture

Stridor

A noise associated with inspiration due to narrowing of the upper airway, in particular the LARYNX.... stridor

Stroma

The name applied to the tissue which forms the framework and covering of an organ.... stroma

Stupor

See UNCONSCIOUSNESS.... stupor

Stuttering

See STAMMERING.... stuttering

Stye

See under EYE, DISORDERS OF.... stye

Styptic

Having the power to arrest bleeding... styptic

Stroke

Stroke, or cerebrovascular accident (CVA), is sudden damage to BRAIN tissue caused either by a lack of blood supply or rupture of a blood vessel (see ISCHAEMIC STROKE). The affected brain cells die and the parts of the body they control or receive sensory messages from cease to function.

Causes Blood supply to the brain may be interrupted by arteries furring up with ATHEROSCLEROSIS (which is accelerated by HYPERTENSION and DIABETES MELLITUS, both of which are associated with a higher incidence of strokes) or being occluded by blood clots arising from distant organs such as infected heart valves or larger clots in the heart (see BLOOD CLOT; THROMBOSIS). Hearts with an irregular rhythm are especially prone to develop clots. Patients with thick or viscous blood, clotting disorders or those with in?amed arteries – for example, in SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) – are particularly in danger of having strokes. Bleeding into the brain arises from areas of weakened blood vessels, many of which may be congenital.

Symptoms Minor episodes due to temporary lack of blood supply and oxygen (called TRANSIENT ISCHAEMIC ATTACKS OR EPISODES (TIA, TIE)) are manifested by short-lived weakness or numbness in an arm or leg and may precede a major stroke. Strokes cause sudden weakness or complete paralysis of the muscles controlled by the part of the brain affected, as well as sensory changes (e.g. numbness or tingling). In the worst cases these symptoms and signs may be accompanied by loss of consciousness. If the stroke affects the area of the brain controlling the larynx and throat, the patient may suffer slurring or loss of speech with di?culty in initiating swallowing. When the face is involved, the mouth may droop and the patient dribble. Strokes caused by haemorrhage may be preceded by headaches. Rarely, CVAs are complicated by epileptic ?ts (see EPILEPSY). If, on the other hand, numerous small clots develop in the brain rather than one major event, this may manifest itself as a gradual deterioration in the patient’s mental function, leading to DEMENTIA.

Investigations Tests on the heart or COMPUTED TOMOGRAPHY or ultrasonic scans (see ULTRASOUND) on arteries in the neck may indicate the original sites of distantly arising clots. Blood tests may show increased thickness or tendency to clotting, and the diagnosis of general medical conditions can explain the presence of in?amed arteries which are prone to block. Special brain X-rays show the position and size of the damaged brain tissue and can usually distinguish between a clot or infarct and a rupture of and haemorrhage from a blood vessel in the brain.

Management It is better to prevent a stroke than try to cure it. The control of a person’s diabetes or high blood pressure will reduce the risk of a stroke. Treatment with ANTICOAGULANTS prevents the formation of clots; regular small doses of aspirin stop platelets clumping together to form plugs in blood vessels. Both treatments reduce the likelihood of minor transient ischaemic episodes proceeding to a major stroke.

Once the latter has occurred, there is no e?ective treatment to reduce the damage to brain tissue. Function will return to the affected part of the body only if and when the brain recovers and messages are again sent down the appropriate nerves. Simple movements are more likely to recover than delicate ones, and sophisticated functions have the worst outlook. Thus, movement of the thigh may improve more easily than ?ne movements of ?ngers, and any speech impairment is more likely to be permanent. A rehabilitation team can help to compensate for any disabilities the subject may have. Physiotherapists maintain muscle tone and joint ?exibility, whilst waiting for power to return; occupational therapists advise about functional problems and supply equipment to help patients overcome their disabilities; and speech therapists help with diffculties in swallowing, improve the clarity of remaining speech or o?er alternative methods of communication. District nurses or home helps can provide support to those caring for victims of stroke at home. Advice about strokes may be obtained from the Stroke Association.... stroke

Strongyloidiasis

This infection is caused by nematode worms of the genus Strongyloides spp. – the great majority being from S. stercoralis. This helminth is present throughout most tropical and subtropical countries; a single case report has been made in England – about an individual who had not been exposed to such an environment. Larvae usually penetrate intact skin, especially the feet (as with hookworm infection). Unlike hookworm infection, eggs mature and hatch in the lower gastrointestinal tract; thus larvae can immediately re-enter the circulation in the colo-rectum or perianal region, setting up an auto-infection cycle. Therefore, infection can continue for the remaining lifespan of the individual. Severe malnutrition may be a predisposing factor to infection, as was the case in prisoners of war in south-east Asia during World War II.

Whilst an infected patient is frequently asymptomatic, heavy infection can cause jejunal mucosal abnormalities, and an absorptive defect, with weight loss. During the migratory phase an itchy linear rash (larva currens) may be present on the lower abdomen, buttocks, and groins; this gives rise to recurrent transient itching. In an immunosuppressed individual, the ‘hyperinfection syndrome’ may ensue; migratory larvae invade all organs and tissues, including the lungs and brain. Associated with this widespread infection, the patient may develop an Enterobacteriacae spp. SEPTICAEMIA; this, together with S. stercoralis larvae, produces a MENINGOENCEPHALITIS. There is no evidence that this syndrome is more common in patients with HIV infection.

Diagnosis consists of visualisation of S. stercoralis (larvae or adults) in a jejunal biopsy-section or aspirate. Larvae may also be demonstrable in a faecal sample, especially following culture. Eosinophilia may be present in peripheral blood, during the invasive stage of infection. Chemotherapy consists of albendazole. The formerly used benzimidazole compound, thiabendazole, is now rarely prescribed in an uncomplicated infection due to unpleasant side-effects; even so, in the ‘hyperinfection syndrome’ it probably remains the more e?ective of the two compounds.... strongyloidiasis

Subarachnoid Haemorrhage

A haemorrhage into the subarachnoid space in the BRAIN. It is usually the result of rupture of an ANEURYSM on the CIRCLE OF WILLIS. Head injury or intense physical exercise occasionally cause subarachnoid haemorrhage; the diagnosis is con?rmed by CT scan or by identifying blood in the CEREBROSPINAL FLUID at LUMBAR PUNCTURE. Cerebral ANGIOGRAPHY will usually pinpoint the site of bleeding. Treatment is bed rest, life-support measures and procedures to reduce blood pressure; sometimes surgery is carried out but not usually until several weeks after the acute episode. About 30 per cent of patients recover fully, whilst some have residual disabilities such as EPILEPSY, mental deterioration or paralysis. About 50 per cent of those affected die.... subarachnoid haemorrhage

Sublimation

The conversion of a solid substance into a vapour and its recondensation. The term is also used in a mental sense for the process of converting instinctive sexual desires to new aims and objects devoid of sexual signi?cance.... sublimation

Subluxation

A partial dislocation of a joint; the term is sometimes applied to a sprain.... subluxation

Subphrenic Abscess

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

Substrate

A compound on which an ENZYME acts: for instance, ribonucleic acid (RNA) is the substrate for ribonuclease (an enzyme that catalyses the breakdown of ribonucleic acid, a cellular compound involved in the synthesis of PROTEIN).... substrate

Subconscious

A state of being partially conscious, or the condition in which mental processes occur and outside objects and events are perceived with the mind nearly or quite unconscious of them. Such subconscious impressions or events may be forgotten at the time but may nevertheless exert a continued in?uence over the conscious mind, or may at a subsequent time come fully into consciousness. Much importance is attached to the in?uence of painful or unpleasant experiences which, although forgotten, continue to in?uence the mind; these may be a factor in the development of anxiety states. This injurious in?uence may be reduced when the subconscious impressions come fully into consciousness and are then remembered and clearly seen in their relative importance.... subconscious

Suction

The use of a reduction in pressure to clear away ?uids or other material through a tube. Suction is used to remove blood from the site of a surgical operation; it is commonly necessary to remove secretions from the airways of newly born babies to help them breathe.... suction

Sudorific

Acting to increase perspiration... sudorific

Suffocation

See ASPHYXIA; CHOKING.... suffocation

Sugar

(American) A sweetheart... sugar

Suicide

Self-destruction as an intentional act. Attempted suicide is when death does not take place, despite an attempt by the person concerned to kill him or herself; parasuicide is the term describing an attempt at suicide that is really an act to draw attention to the perceived problems of the individual involved.

Societies vary in the degree to which they tolerate individuals acting intentionally to cause their own death. Apart from among some native peoples, particularly the Innuit, suicide is generally viewed pejoratively in modern societies. Major religious movements, including Catholicism, Judaism and Islam, have traditionally regarded suicide as a sin. Nevertheless, it is a growing phenomenon, particularly among the young, and so has become a serious public health problem. It is estimated that suicide among young people has tripled – at least – during the past 45 years. Worldwide, suicide is the second major cause of death (after tuberculosis) for women between the ages of 15 and 44, and the fourth major killer of men in the same age-group (after tra?c accidents, tuberculosis and violence). The risk of suicide rises sharply in old age. Globally, there are estimated to be between ten and 25 suicide attempts for each completed suicide.

In the United Kingdom, suicide accounts for 20 per cent of all deaths of young people. Around 6,000 suicides are reported annually in the UK, of which approximately 75 per cent are by men. In the late 1990s the suicide rate in England, Wales and Northern Ireland fell, but increased in Scotland and the Republic of Ireland. Attempted suicide became signi?cantly more common, particularly among people under the age of 25: among adolescents in the UK, for example, it is estimated that there are about 19,000 suicide attempts annually. Follow-up studies of teenagers who attempt suicide by an overdose show that up to 11 per cent will succeed in killing themselves over the following few years. In young people, factors linked to suicide and attempted suicide include alcohol or drug abuse, unemployment, physical or sexual abuse, and the fact of being in custody. (In the mid-1990s, 20 per cent of all prison suicides were by people under 21.)

Apart from the young, those at highest risk of dying by suicide include health professionals, pharmacists, vets and farmers. Self-poisoning (see POISONS) is the common method used by health professionals for whom high stress levels, together with relatively easy access to means, are important factors. The World Health Organisation has outlined six basic steps for the prevention of suicide, focusing particularly on reducing the availability of common methods. Although suicide is not a criminal o?ence in the UK, assisting suicide is a crime carrying a potential sentence of 14 years’ imprisonment. There are several dilemmas faced by health professionals if they believe that a patient is considering suicide: one is that the provision of information to the patient may make them an accessory (see below). A dilemma after suicide is the common demand from insurers for medical information, although, ethically, the duty of con?dentiality extends beyond the patient’s death (see ETHICS). (Legally, some disclosure is permitted to those with a claim arising from the patient’s death.) Life-insurance contracts generally render invalid any claim by the heirs on the policy of an individual who commits suicide, so that disclosure by a doctor often creates tensions with the relatives. Non-disclosure of relevant medical information, however, may result in a fraudulent insurance claim being made.

Physician-assisted suicide Although controversial, a special legal exemption applies to doctors in a few countries who assist terminally ill patients to kill themselves. Oregon in the United States legalised physician-assisted suicide in 1997, where it still occurs; assisted suicide was brie?y legal in the Australian Northern Territory in 1996 but the legislation was repealed. (It is also practised, but not legally authorised, in the Netherlands and Switzerland.)

In the UK there have been unsuccessful parliamentary attempts to legalise assisted suicide, such as the 1997 Doctor Assisted Dying Bill. In law, a distinction is made between killing people with their consent (classi?ed as murder) and assisting them to commit suicide (a statutory o?ence under the Suicide Act 1961). The distinction is between acting as a perpetrator and as an accessory. Doctors may be judged to have aided and abetted a suicide if they knowingly provide the means – or even if they simply provide advice about the toxicity of medication and tell patients the lethal dosage. Some argue that the distinction between EUTHANASIA and physician-assisted suicide has no moral or practical relevance, particularly if patients are too disabled to act themselves. In theory, patients retain ultimate control in cases of assisted suicide, whereas control rests with the doctor in euthanasia. Surveys of health professionals appear to indicate a feeling by some that less responsibility or culpability attaches to assisting suicide than to euthanasia. In a recent UK court case (2002), a judge declared that a mentally alert woman on a permanent life-support regime in hospital had a right to ask for the support system to be switched o?. (See also MENTAL ILLNESS.)... suicide

Sulfasalazine

A chemical combination of sulphapyridine and 5-aminosalycilic acid. It is used to treat ULCERATIVE COLITIS (valuable as oral therapy for mild symptomatic disease; also available as suppositories for rectal disease) and RHEUMATOID ARTHRITIS. The salicylate part is now available alone in drugs such as mesalazine and olsalazine. Several reports of blood dyscrasias from patients taking these drugs have prompted the COMMITTEE ON SAFETY OF MEDICINES (CSM) to recommend that patients with unexplained blood disorders should stop treatment and be given an immediate blood count.... sulfasalazine

Sulphur

Chemical combinations of this substance were once applied topically because of their antimicrobial activity; they are no longer used.... sulphur

Sumatriptan

A drug used in the treatment of MIGRAINE attacks. Given by subcutaneous injection, it provides quick relief of pain, acting on the same receptors as 5-hydroxytryptamine – a neurotransmitter and vasoconstrictor agent. It may also be taken orally, but sumatriptan should not be used within 24 hours of treatment with ERGOTAMINE, the standard antimigraine treatment.... sumatriptan

Sunburn

See PHOTODERMATOSES.... sunburn

Supination

Supination means the turning of the forearm and hand so that the palm faces upwards.... supination

Suppository

A drug preparation in solid, bullet-like form, which is inserted into the RECTUM (or the VAGINA, when it is called a pessary). This method of using drugs may be chosen for various reasons. For example, the suppository, as in the case of glycerin suppositories, may be used to produce an aperient action. Other suppositories, such as those of MORPHINE, are used to reduce pain and check the action of the bowels. Suppositories are useful when the patient is unable to take oral medication and when no suitable preparation is available for injection.... suppository

Suppuration

The process of PUS formation. When pus forms on a raw surface the process is called ulceration, whilst a deep-seated collection of pus is known as an ABSCESS. (See also INFLAMMATION; PHAGOCYTOSIS; ULCER; WOUNDS.)... suppuration

Suprarenal Glands

See ADRENAL GLANDS.... suprarenal glands

Supraventricular Tachycardia

An unusually fast but regular beating of the HEART occurring for periods that may last several hours or days. In most people with this abnormality the heart rate is between 140 and 180 beats a minute; rarely, the rate may rise as high as 250–300 beats. The condition occurs when abnormal electrical impulses that arise in the upper chambers (atria) of the heart override the normal control centre – the sinoatrial node – for the heartbeat. Symptoms usually include breathlessness, palpitations, pain in the chest and fainting. An ELECTROCARDIOGRAM (ECG) is taken to help make the diagnosis. An acute episode can sometimes be stopped by VALSAVA’S MANOEUVRE or by drinking cold water. Anti-arrhythmic drugs (see ARRHYTHMIA) such as adenosine and digoxin are used to treat recurrent attacks. Occasionally, a severe attack may need to be treated with an electric shock to the heart: this is known as DEFIBRILLATION.... supraventricular tachycardia

Surfactant

A surface-active agent lining the alveoli (see ALVEOLUS) of the LUNGS, which plays an essential part in RESPIRATION by preventing the alveoli from collapsing at the end of expiration. Absence, or lack, of surfactant is one of the factors responsible for HYALINE MEMBRANE DISEASE, and it is now being used in the treatment of this condition by means of instillation into the trachea.... surfactant

Surgery

That branch of medicine involved in the treatment of injuries, deformities or individual diseases by operation or manipulation. It incorporates: general surgery; specialised techniques such as CRYOSURGERY, MICROSURGERY, MINIMALLY INVASIVE SURGERY (MIS), or minimal access (keyhole) surgery, and stereotactic sugery (see STEREOTAXIS); and surgery associated with the main specialties, especially cardiothoracic surgery, gastroenterology, GYNAECOLOGY, NEUROLOGY, OBSTETRICS, ONCOLOGY, OPHTHALMOLOGY, ORTHOPAEDICS, TRANSPLANTATION surgery, RECONSTRUCTIVE (PLASTIC) SURGERY, and UROLOGY. Remotely controlled surgery using televisual and robotic techniques is also being developed.

It takes up to 15 years to train a surgeon from the time at which he or she enters medical school; after graduating as a doctor a surgeon has to pass a comprehensive two-stage examination to become a fellow of one of the ?ve recognised colleges of surgeons in the UK and Ireland.

Surgery is carried out in specially designed operating theatres. Whereas it used to necessitate days and sometimes weeks of inpatient hospital care, many patients are now treated as day patients, often under local anaesthesia, being admitted in the morning and discharged later in the day.

More complex surgery, such as transplantation and neurosurgery, usually necessitates patients being nursed post-operatively in high-dependency units (see INTENSIVE THERAPY UNIT (ITU)) before being transferred to ordinary recovery wards. Successful surgery requires close co-operation between surgeons, physicians and radiologists as well as anaesthetists (see ANAESTHESIA), whose sophisticated techniques enable surgeons to undertake long and complex operations that were unthinkable 30 or more years ago. Surgical treatment of cancers is usually done in collaboration with oncologists. Successful surgery is also dependent on the skills of supporting sta? comprising nurses and operating-theatre technicians and the availability of up-to-date facilities.... surgery

Susceptibility

A reduced ability to combat an illness, usually an infection. The patient may be in poor general health, or immunisation or disease may have affected his or her defence mechanisms. For example, a person with AIDS is particularly susceptible to infection.... susceptibility

Swab

A term applied to a small piece of gauze, lint or similar material used for wiping out the mouth of a patient or for drying out a wound. The term is also applied to a tuft of sterilised cotton-wool wrapped round a wire and enclosed in a sterile glass tube used for obtaining a sample – for example, from the throat or from wounds – for bacteriological examination.... swab

Suture

A word used in both an anatomical and a surgical sense. (1) Anatomically, suture is a type of immovable joint, found particularly in the SKULL, including the coronal suture (between the frontal and parietal bones); the lamboidal suture (between the parietal and occipital bones); and the sagittal suture (between the two parietal bones). (2) Surgically the word refers either to the technique of closing a wound, or to the material used. Stitching methods have been developed for gastrointestinal, neurological, dermatological and other forms of surgery, and include laser surgery and removable clips or staples. The material used is generally divided into mono?lament, twisted or braided. Absorbable sutures – used for internal stitching

– include catgut, Vicryl® and Dexon®. Nonabsorbable sutures include silk, nylon and prolene. The type used and time of suture-removal depend upon the site and general state of the patient. Those patients on steroids who have a malignant or infective disorder heal slowly, and their sutures may need to stay in for 14 days or more instead of the usual 5–8 days.... suture

Sympathetic Nervous System

Part of the AUTONOMIC NERVOUS SYSTEM. It consists of scattered collections of grey matter known as ganglia, united by an irregular network of nerve-?bres; those portions where the ganglia are placed most closely and where the network of ?bres is especially dense being known as plexuses. The chief part of the sympathetic system consists of two ganglionated cords that run through the neck, chest, and abdomen, lying close in front of the spine. In conjunction with the other part of the autonomic nervous system – the parasympathetic – this part controls many of the body’s involuntary activities involving glands, organs and other tissues. (For further details, see NERVOUS SYSTEM.)... sympathetic nervous system

Symphysis

An anatomical description of a joint in which two bones are connected by strong ?brous cartilage. One example is the joint between the two pubic bones in the front of the pelvis; another, the joint between the upper and middle parts of the breastbone.... symphysis

Syndactyly

A congenital condition in which two or more ?ngers or toes are fused together to a varying extent. The condition is popularly known as WEBBED FINGERS (or toes).... syndactyly

Synapse

The term applied to the anatomical relation of one NEURON(E) (nerve cell) with another which is e?ected at various points by contact of their branching processes. The two neurons do not come directly into contact, but the release of a chemical NEUROTRANSMITTER by one neuronal AXON is followed by this chemical travelling across the synapse and ?ring o? the signal along another nerve. A signal can be sent across a synapse in one direction only, from presynaptic or postsynaptic membranes. Synapses are divided into excitatory and inhibitory types. When a neurotransmitter travels across an excitatory synapse it usually provokes the receptor neuron into initiating an electrical impulse. Inhibitory synapses cool down the excitation of the adjacent neurons. Drugs that in?uence the NERVOUS SYSTEM usually do so by affecting the release or modi?cation of the neurotransmitters passing across the synapse.... synapse

Syncope

Another word for fainting – a loss of consciousness due to a fall in BLOOD PRESSURE. This may result because the cardiac output has become reduced, or because the peripheral resistance provided by the arterioles has decreased. The simple faint or vaso-vagal attack is a result of a failure to maintain an adequate venous return of blood to the heart. This is likely to occur after prolonged periods of standing, particularly if one is standing still or if the climatic conditions are hot. It can also result from an unpleasant or painful experience. Pallor, sweating and a slow pulse are characteristic. Recovery is immediate when the venous return is restored by lying ?at.

Syncope can also result when the venous return to the heart is impaired as a result of a rise in intrathoracic pressure. This may happen after prolonged vigorous coughing – the so-called COUGH SYNCOPE – or when elderly men with prostatic hypertrophy strain to empty their bladder. This is known as micturition syncope. Syncope is particularly likely to occur when the arterial blood pressure is unusually low. This may result from overtreatment of HYPERTENSION with drugs or it may be the result of diseases, such as ADDISON’S DISEASE, which are associated with low blood pressures. It is important that syncope be distinguished from EPILEPSY.... syncope

Synovectomy

Surgical removal of the synovium (see SYNOVIAL MEMBRANE) to treat troublesome SYNOVITIS. The operation is not normally done until other treatments have failed.... synovectomy

Synovitis

In?ammation of the membrane lining a joint (see JOINTS). It is usually painful and accompanied by e?usion of ?uid within the synovial sac of the joint. It is found in RHEUMATOID ARTHRITIS, various injuries and in?ammations of joints, and in the chronic form in TUBERCULOSIS. Treatment of synovitis is with rest, splinting, ANALGESICS and NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS). Infection should be treated with ANTIBIOTICS. If the joint fails to respond, surgery (SYNOVECTOMY) may be needed. (See also JOINTS, DISEASES OF.)... synovitis

Synovium

See SYNOVIAL MEMBRANE.... synovium

Syringe

An instrument for injecting ?uid into, or withdrawing ?uid from, a body cavity, tissue or blood. Syringes come in di?erent sizes and some are specially designed for use in a particular site – for example, for withdrawing CEREBROSPINAL FLUID. The basic design is the same: a calibrated barrel with a plunger at one end, while the other end has a nozzle to which a hollow needle can be attached. Most syringes are disposable, plastic, presterilised and packed in sealed containers. Injections can be given under the skin, into muscle, into a vein or into the cerebrospinal ?uid. The term hypodermic, though literally meaning under the skin, is now used to describe most syringes.... syringe

System

A network of interdependent components that work together to attain the goals of the complex whole.... system

Syringomyelia

A rare disease affecting the SPINAL CORD, in which irregular cavities form, surrounded by an excessive amount of the connective tissue of the central nervous system. These cavities encroach upon the nerve-tracts in the cord, producing especially loss of the sense of pain or of that for heat and cold in parts of the limbs, although the sensation of touch is retained. Another occasional symptom is wasting of certain muscles in the limbs. Changes affecting outlying parts like the ?ngers are also found. Because of their insensitiveness to pain, these are often burnt or injured; troublesome ulcers, or loss of parts of the ?ngers, may result. The condition of the spinal cord is probably present at birth, although the symptoms do not usually appear until adulthood. The disease is slowly progressive, although sudden exacerbations may occur after a cough, a sneeze, or sudden straining. Treatment is supportive for this progressive disorder.... syringomyelia

Systole

The contraction of the HEART. It alternates with the resting phase, known as DIASTOLE. The two occupy, respectively, about one-third and two-thirds of the cycle of heart action.... systole

Ventricular Septal Defect

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

Toxic Shock Syndrome

First described in 1978, this disorder is characterised by high fever, diarrhoea, SHOCK and a rash. It is frequently associated with the use of tampons (see TAMPON), but has occasionally been reported in men. The syndrome may also be linked to the use of contraceptives such as the diaphragm, cap and sponge (see under CONTRACEPTION), and skin wounds or infections may also be a cause. The disease is due to a staphylococcal toxin (see STAPHYLOCOCCUS; TOXINS). Treatment consists of supportive measures to combat shock and eradication of the staphylococcus by ANTIBIOTICS. The design of tampons has been improved. Recurrence of the disorder has been reported and women who have had an episode should stop using tampons and vaginal contraceptives.... toxic shock syndrome

Travel Sickness

Sickness induced by any form of transport, whether by sea, air, motor-car or train. (See also MOTION (TRAVEL) SICKNESS.)

Traveller’s diarrhoea is an all-toocommon a?iction of the traveller, which basks in a multiplicity of names: for example, Aden gut, Aztec two-step, Basra belly, Delhi belly, Gippy tummy, Hong Kong dog, Montezuma’s revenge, Tokyo trots, turista. It is caused by a variety of micro-organisms, usually E. coli. Some people seem to be more prone to it than others, although for no good cause. Obvious preventive measures include the avoidance of salads, unpeeled fruit and ice cream, and never drinking unboiled or unbottled water. If diarrhoea occurs, co-phenotrope and loperamide are often used to reduce the frequency of bowel movements in adults. Prophylactic antibacterial drugs are not advisable.... travel sickness

Tuberous Sclerosis

Also called epiloia: a rare inherited disease transmitted as an autosomal dominant trait. EPILEPSY in childhood is often the ?rst manifestation (see INFANTILE SPASMS), although ovoid hypopigmented macules (‘ash leaf patches’) in the skin may be detected in infancy. Later an ACNE-like eruption of the face (adenoma sebaceum), ?brous outgrowths around the nails and ?brous plaques on the lower back (shagreen patch) can all occur. Half of those affected have learning diffculties and behaviour problems, and autistic symptoms may occur (see AUTISM).

Characteristic white streaks appear on the optic fundi (see EYE). Molecular genetic testing can identify up to 90 per cent of individuals with a tuberin gene. Genetic counselling of families is helpful. Relatives of those with this condition can obtain help and guidance from the Tuberous Sclerosis Association of Great Britain.... tuberous sclerosis

Morning Sickness

See: PREGNANCY.

MOTH REPELLENT. Sew into small linen bags any of the following: Cinnamon, Sandalwood chips, Camphor, Cloves. Add: sprinkle of Cedarwood for greater potency. MOTHER SEIGEL’S SYRUP. See: SHAKERS, The. ... morning sickness

Bovine Spongiform Encephalopathy

BOVINE SPONGIFORM ENCEPHALOPATHY (BSE)

Scrapie. Notifiable disease. Fatal disease in the nervous system of cattle, unknown before 1985. Microscopic holes appear in the brain giving a spongiform appearance, but with little inflammation. Can spread from one animal to another: sheep, goats, deer, mules, mink, hamsters, mice, pigs and monkeys. Cause: not a virus. Animals itch and scrape themselves against trees or posts for relief. May spread from animals to humans, with brain infection after the character of polio.

Symptoms. (Human). Speech impairment, short-term-memory-loss, difficulty in controlling body movements. Zinc deficiency.

Treatment. Hospitalisation.

Suggested treatment for human infection, unproven.

Tinctures. Echinacea 5; Black Cohosh 3; Yarrow 2; Senna leaf 1.2-3 teaspoons in water (or cup hot Yarrow tea) 3-4 times daily. For headache: Gelsemium.

Supplement: Zinc.

To be treated by a general medical practitioner or hospital specialist. ... bovine spongiform encephalopathy

Cold Sore

See: HERPES SIMPLEX.

COLI BACILLUS. Infections. Freshly-grated Horseradish root steeped in cup cold water for 2 hours.

Remove root. 1 cupful freely, as tolerated. Papaya fruit.

COLIC. Spasm of the bowels, particularly the colon. Severe pain under the navel with nausea, vomiting.

Patient writhes from side to side. Cause may be wind, acid bile, worms, constipation, food; aluminium, lead or other metal poisoning, strangulated hernia, appendicitis, adhesions.

Differential diagnosis: gallstones, menstrual difficulties, kidney stone.

Alternatives. Teas, any one. Roman Chamomile, Catmint, Fennel, Lovage, Caraway, Betony, Avens, Wormwood, Holy Thistle, Peppermint leaves, Aniseed, Tormentil.

Decoction, any one. Angelica root, Boldo, Calamus, Cardamom, Condurango, Coriander, Cramp bark, Ginger root, Liquorice, Wild Yam.

Tablets/capsules. Dandelion, Capsicum, Valerian, Wild Yam, Cramp bark, Blue Flag root.

Powders. Alternatives. (1) Calamus 2; Marshmallow root 1. Add pinch Cayenne. (2) Turkey Rhubarb plus pinch of Cayenne. (3) Wild Yam plus pinch of Cayenne. Dose: 500mg (one-third teaspoon or two 00 capsules) every 2 hours.

Tinctures. Formulae. Alternatives: (1) Angelica root 1; Wild Yam 1; Ginger half. Mix. (2) Dandelion 2; Wild Yam 1; few drops Tincture Capsicum. Mix. (3) Wild Yam 1; Galangal root half; Ginger half. Mix. Dose: 1 teaspoon in hot water every 2 hours.

Traditional German combination. Ginger, Gentian, Turkey Rhubarb.

Topical. Apply hot bran, oats, hops or Slippery Elm poultice, or Castor oil packs to abdomen. Aromatherapy. Any one oil: Aniseed, Fennel, Mint, Garlic, Bergamot. Adult: 6 drops to 2 teaspoons Almond oil: child, 2 drops in 1 teaspoon Almond oil, for abdominal massage.

Enema. 1oz Catmint, Boneset or Chamomile in 2 pints boiling water. Strain, inject warm.

Diet. 3-day fast, with fruit juices and herb teas.

See: RENAL COLIC, COLIC OF PREGNANCY, CHILDREN. Gripe water. ... cold sore

Cushing’s Syndrome

A glandular disorder occurring mostly in females, aged 30 to 50.

Causes: a tumour on the adrenal glands or excessive medication with large doses of corticosteroid drugs to make up for adrenal insufficiency. There is diminished resistance to infection. (Echinacea)

Symptoms. Fat plethoric ‘moon’ face. Limbs thin, trunk obese. Skin easily bruises (Arnica). Fatigue, weakness, pink streaks on skin. Cessation of menstruation. Loss of sex drive in men. High blood pressure and sugar in the urine are common. Bone softening leads to pain. Acne (Agnus Castus). Excess body hair. Personality change.

Treatment. Adrenal stimulants may obviate surgery or irradiation to the adrenal glands: they include Ginseng, Liquorice, Sarsaparilla, Holy Thistle (Hyde), Samphire (Hyde).

Men. Tinctures. Formula. Ginseng 3; Sarsaparilla 2; Liquorice 1. One to two teaspoons in water thrice daily.

Women. Tinctures. Formula. Agnus Castus 2; Helonias 2; Pulsatilla 1. One to two teaspoons in water thrice daily.

Good responses have been observed from Pulsatilla and Black Cohosh. ... cushing’s syndrome

Down’s Syndrome

Mongolism. Trisomy 21. Not a disease but a defect in mental and physical development. In the normal human being there are 46 chromosomes; in Down’s there are 47 – one extra No 21 chromosome. The syndrome increases with the age of the mother after the age of 35. Over the age of 40 the chances of a mother having such a child are 1-2 per cent. Children with the defect have low levels of zinc.

Cases of Down’s have followed use of nonoxynol-9 (vaginal contraceptive device) such as the polyurethane sponge. The sponge. when left in situ for a long time, may cause Down’s to follow.

Certain physical characteristics are present. The most important feature is impaired mental development. Almost all are coeliacs.

Symptoms. Low IQ, short fingers, small flat head, flattened nose, low-set ears. May be subject to umbilical hernia, and heart disease. No treatment can cure, but certain herb teas rich in minerals (Alfalfa, Red Clover) together with Kelp (either in tablet or powder form) may help children, with possible improvements in IQ. Vitamin supplements – A, D, Thiamine, Riboflavin, B6, B12, C and E improve a child’s physical and mental health – as do also the minerals: Magnesium, Calcium, Zinc, Manganese, Copper, Iron and Iodine.

Children with Down’s syndrome run an increased risk of coeliac disease, due to disturbed immunity. A substantial evidence is held in America that links a low level of Selenium in the mother. Unnecessary X- rays should be avoided. Ensure fitness before conception by gentle exercise and nutrients: Folic Acid, Selenium and Zinc.

Children with the condition are noted for their happy disposition and warmth of feeling towards others. ... down’s syndrome

Kaposi’s Sarcoma

Vascular tumour. Begins with small reddish-purple plaques and skin nodules on the legs and feet. May remain benign for many years. Usually associated with AIDS, but the classical form may also be seen in renal transplant and elderly male patients receiving cortisone preparations. The tumours may appear anywhere in the body, especially around eyes and nose, giving a bruised appearance.

Diagnosis is difficult to the inexperienced practitioner. Referral to a dermatologist for skin biopsy. Homosexuals are at risk from semen ejaculated into a foreign environment. The blood abnormality extends to the lymph system for which Lymphatics such as Echinacea, Saw Palmetto and Poke root are indicated. See: AIDS.

Treatment by a general medical practitioner or hospital specialist. ... kaposi’s sarcoma

Lymphatic System

Lymph is the same fluid which oozes from a cut when bleeding stops. It surrounds every living cell. Lymph conveys to the blood the final products of digestion of food. It also receives from the blood waste products of metabolism. This is a two-way traffic.

Lymph fluid, loaded with waste, excess protein, etc, is sucked into the lymph tubes to be filtered by the spleen and the lymph nodes. The tubes are filled with countless one-way valves referred to collectively as the lymphatic pump, which propels the flow of lymph forwards. Lymph ultimately is collected in the main thoracic duct rising upwards in front of the spine to enter the bloodstream at the base of the neck.

A number of disorders may arise when the fluid becomes over-burdened by toxaemia, poor drainage and enlarged nodes (glands). Such un-eliminated wastes form cellulite – unwanted tissue formation and swelling. Thus, the soil may be prepared for various chronic illnesses from glandular disorders to arthritis. If the lymph is circulating freely it is almost impossible to become sick.

This system is capable of ingesting foreign particles and building up an immunity against future infection. Some herbal Lymphatics are also antimicrobials, natural alternatives to conventional antibiotics.

Treatment. Clivers is particularly relative to glandular swellings of neck and axillae.

For active inflammation: Echinacea, Goldenseal, Ginseng (Panax).

Alternatives. Teas: Clivers, Red Clover, Agnus Castus herb, Bladderwrack, Violet leaves, Marigold petals.

Decoctions: Blue Flag, Echinacea, Fenugreek seeds, Saw Palmetto.

Tablets/capsules. Agnus Castus, Echinacea, Bladderwrack, Red Clover, Thuja, Poke root, Fenugreek. Formula No 1. Echinacea 2; Clivers 1; Burdock 1; Poke root half. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Formula No 2. Equal parts: Blue Flag root, Poke root, Senna. Dose: as above.

Topical. Poultices: Slippery Elm, Fenugreek seeds, Marshmallow. Horsechestnut (Aesculus) ointment. ... lymphatic system

Marfan’s Syndrome

A collagen disease in infants (hereditary) with lax joints permitting easy dislocation and strain.

Features: long fingers and arm span, high palate, kyphosis, etc.

Symptoms. Backache, pain in joints, dislocations.

Alternatives. Alfalfa, Fenugreek, Irish Moss, Kelp, Horsetail, Marshmallow, Bamboo gum.

Teas. Alfalfa, Comfrey leaves, Horsetail, Plantain, Silverweed. Any one: 1 heaped teaspoon to each cup boiling water; infuse 10-15 minutes. 1 cup thrice daily.

Decoction. Fenugreek seeds 2; Horsetail 1; Bladderwrack 1; Liquorice half. Prepare: 3 heaped teaspoons to 1 pint (500ml) water gently simmered 10 to 20 minutes. 1 wineglass thrice daily. Fenugreek seeds decoction.

Diet. High protein, oily fish.

Supplements. Calcium, Dolomite, Zinc. ... marfan’s syndrome

Motion Sickness

Nausea and vomiting caused by lack of air and restricted vision upsetting the balance of the inner ear.

Cup of Chamomile, Balm, or Meadowsweet tea. Liquorice helpful, but most popular is Ginger taken in the form of Ginger wine, or powdered root (quarter to half a teaspoon). Chrystalised Ginger from sweetshop is one of the safest and cheapest: 2-3 pieces sucked or chewed half hour before journey and at intervals thereafter.

Avoid tobacco which reduces oxygen count. Potter’s Ginger root capsules.

Peppermint. Before travelling, glass water with 2 drops.

Aromatherapy. Inhalant. 2-3 drops Peppermint oil on tissue.

Diet. No alcohol or fatty foods. Accept Papaya fruit, Lemons or Lemon juice, Honey, Acidophilus. Supplements. Alternatives to the above. Seven days before journey: B-complex, magnesium 200mg, calcium 400mg. ... motion sickness

Air-sickness

This condition is very similar to sea-sickness. (See MOTION (TRAVEL) SICKNESS.)... air-sickness

Anabolic Steroids

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

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

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

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

Arcus Senilis

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

Assisted Suicide

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

Barium Sulphate

A radio-opaque white powder used in X-ray examinations of the stomach and gastrointestinal tract. The barium sulphate may be swallowed to enable the oesophagus, stomach and small and large intestines to be assessed for disorders such as ulceration, tumours, DIVERTICULAR DISEASE and polyps. It may also be inserted into the RECTUM or descending COLON to investigate for possible disease. These procedures are usually done after endoscopy examinations have been carried out.... barium sulphate

Bee Stings

See BITES AND STINGS.... bee stings

Bicarbonate Of Soda

Also known as baking soda. Bicarbonate of soda is an alkali, sometimes used as a home remedy for indigestion or for soothing insect bites.... bicarbonate of soda

Breath Sounds

The transmitted sounds of breathing, heard when a stethoscope is applied to the chest. Normal breath sounds are described as vesicular. Abnormal sounds may be heard when there is increased ?uid in the lungs or ?brosis (crepitation or crackles), when there is bronchospasm (rhonchi or wheezes), or when the lung is airless (consolidated – bronchial breathing). Breath sounds are absent in people with pleural e?usion, pneumothorax, or after pneumonectomy.... breath sounds

Caput Succedaneum

Usually shortened by obstetricians to ‘caput’, this is the temporary swelling which is sometimes found on the head of the newborn infant. It is due to OEDEMA in and around the scalp, caused by pressure on the head as the child is born. It is of no signi?cance and quickly disappears spontaneously.... caput succedaneum

Cardiovascular System

This refers to the whole circulatory system: the heart, the systemic circulation (the arteries and veins of the body) and the pulmonary circulation (the arteries and veins of the lungs). Blood circulates throughout the cardiovascular system bringing oxygen and nutrients to the tissues and removing carbon dioxide and other waste products.... cardiovascular system

Carpal Tunnel Syndrome

A condition characterised by attacks of pain and tingling in the ?rst three or four ?ngers of one or both hands. The attacks usually occur at night. Carpal tunnel syndrome is caused by pressure on the median nerve as it passes under the strong ligament that lies across the front of the wrist. The condition may respond to use of a night splint on the hand; otherwise a corticosteroid injection under the ligament may help. If not, pressure is relieved by surgical division of the compressing ligament.... carpal tunnel syndrome

Cavernous Sinus

A channel for venous blood placed either side of the sphenoid bone at the base of the SKULL behind the eye sockets. Blood drains into it from the eye, the nose, the brain and part of the cheek, and leaves via the internal jugular and facial veins. Sometimes the sinus becomes blocked by a blood clot (thrombus), usually a complication of a nearby bacterial infection. A potentially serious condition, it should be treated with thrombolysis and antibiotics.... cavernous sinus

Cervical Smear

This screening test detects abnormal changes in the cells of the cervix (see CERVIX UTERI), enabling an affected woman to have early treatment. The National Health Service has arrangements to check women regularly. A woman’s ?rst test should be within six months of her ?rst experience of intercourse and thereafter at three-yearly intervals for the rest of her life. The test is simple, with some cells being scraped o? the cervix with a spatula and the tissue then being examined microscopically.... cervical smear

Compression Syndrome

See MUSCLES, DISORDERS OF.... compression syndrome

Cross-sectional Study

A study that measures the prevalence of health outcomes or determinants of health, or both and other variables of interest in a population at a point in time or over a short period.... cross-sectional study

Day Surgery

Surgery done in a clinic or a hospital without an overnight stay either before or after the operation. Improvements in surgery – especially the introduction of MINIMALLY INVASIVE SURGERY (MIS) – as well as more e?ective methods of ANAESTHESIA have simpli?ed many procedures and reduced the physical and mental stress on patients. Patients undergoing day surgery should be accompanied home by a friend or relative. Occasionally a patient may develop complications that require a post-operative stay in hospital.... day surgery

Death, Sudden

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

Dioctyl Sodium Sulphosuccinate

See DOCUSATE SODIUM.... dioctyl sodium sulphosuccinate

Disseminated Sclerosis

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

Docusate Sodium

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

Dreams

See SLEEP.... dreams

Erythrocyte Sedimentation Rate

See ESR.... erythrocyte sedimentation rate

Fetal Blood Sampling

A procedure performed during a mother’s labour in which a blood sample is taken from a vein in the scalp of the FETUS. This enables tests to be performed that indicate whether the fetus is, for example, suffering from a shortage of oxygen (HYPOXIA). If so, the obstetrician will usually accelerate the baby’s birth.... fetal blood sampling

Frontal Sinus

One of the airspaces that form the paranasal sinuses (see SINUS) within some of the frontal bones of the skull. These sinuses are lined with mucous membrane and open into the nasal cavity.... frontal sinus

Gall-stones

See under GALL-BLADDER, DISEASES OF.... gall-stones

General Dental Services

See DENTAL SURGEON.... general dental services

Glasgow Coma Scale

A method developed by two doctors in Glasgow that is used to assess the depth of COMA or unconsciousness suffered by an individual. The scale is split into three groups – eye opening, motor response, and verbal response – with the level of activity within each group given a score. A person’s total score is the sum of the numbers scored in each group, and this provides a reasonably objective assessment of the patient’s coma state – particularly useful when monitoring people who have suffered a head injury. (See also PERSISTENT VEGETATIVE STATE (PVS).)... glasgow coma scale

Genetic Screening

A screening procedure that tests whether a person has a genetic make-up that is linked with a particular disease. If so, the person may either develop the disease or pass it on to his or her o?spring. When an individual has been found to carry a genetically linked disease, he or she should receive genetic counselling from an expert in inherited diseases.

Genetic screening is proving to be a controversial subject. Arguments are developing over whether the results of such screenings should be made available to employers and insurance companies – a move that could have adverse consequences for some individuals with potentially harmful genetic make-ups. (See GENES; GENETIC DISORDERS.)... genetic screening

Golden Seal

Hydrastis canadensis. N.O. Ranunculaceae.

Synonym: Orange Root, Yellow Root.

Habitat: This valuable plant appears, according to Coffin, to have been first discovered and used by the aborigines of North America. It is indigenous to that part of the world.

Features ? Golden Seal is found growing to a height of one to two feet in rich, moist and shady soils. The leaves are alternate, the lower one stalked, the upper one sessile. Both are unequally toothed, and have from three to seven acute lobes. White and red single terminal flowers bloom in April. The root is short, knotty with the bases of stems, and covered with many rootlets. The taste is very bitter, and the scent strong and unpleasant.

Part used ? Golden Seal was so named by the followers of Thomson, who first used the root about 1845, since when it has figured prominently in herbal practice.

Action: Tonic, alterative, and laxative.

Golden Seal has proved itself to be a very valuable remedy in digestive disorders and in debilitated conditions of mucous membranes. Its use is indicated in various gastric complaints, and it may be taken with advantage by most dyspeptics in doses of 10 grains of the powdered root.

Hydrastis is also given in conjunction with Lime flowers and Valerian to reduce blood pressure.... golden seal

Haemolytic Uraemic Syndrome

A disease of children resulting in acute RENAL failure. A febrile illness of the gastrointestinal or respiratory tracts is followed by intravascular COAGULATION of blood which results in HAEMOLYSIS, ANAEMIA, THROMBOCYTOPAENIA and renal failure (resulting from ?brin deposition in renal arterioles and glomerular capillaries).

The death rate is 2–10 per cent and the majority of patients survive without renal failure. The longer the period of OLIGURIA, the greater the risk of chronic renal failure.

Treatment is supportive, with replacement of blood and clotting factors, control of HYPERTENSION, and careful observation of ?uid balance.... haemolytic uraemic syndrome

Haemopoietic Stem Cell

This is the basic cell from which all types of blood cells originate. Its appearance is believed to be similar to that of a LYMPHOCYTE.... haemopoietic stem cell

Heart Surgery

Open-heart surgery permits the treatment of many previously inoperable conditions that were potentially fatal, or which made the patient chronically disabled. CORONARY ARTERY VEIN BYPASS GRAFTING (CAVBG), used to remedy obstruction of the arteries supplying the heart muscle, was ?rst carried out in the mid1960s and is now widely practised. Constricted heart valves today are routinely dilated by techniques of MINIMALLY INVASIVE SURGERY (MIS), such as ANGIOPLASTY and laser treatment, and faulty valves can be replaced with mechanical alternatives (see VALVULOPLASTY).

Heart transplant Replacement of a person’s unhealthy heart with a normal heart from a healthy donor. The donor’s heart needs to be removed immediately after death and kept chilled in saline before rapid transport to the recipient. Heart transplants are technically demanding operations used to treat patients with progressive untreatable heart disease but whose other body systems are in good shape. They usually have advanced coronary artery disease and damaged heart muscle (CARDIOMYOPATHY). Apart from the technical diffculties of the operation, preventing rejection of the transplanted heart by the recipient’s immune system requires complex drug treatment. But once the patient has passed the immediate postoperative phase, the chances of ?ve-year survival is as high as 80 per cent in some cardiac centres. A key di?culty in doing heart transplants is a serious shortage of donor organs.... heart surgery

Hellp Syndrome

A type of severe PRE-ECLAMPSIA (a disorder affecting some pregnant women) that affects various systems in the body. HAEMOLYSIS, raised concentration of the enzymes in the LIVER, and a low blood platelet count are among the characteristics (and explain the name HELLP); patients are acutely ill and immediate termination of pregnancy is necessary. (See also PREGNANCY AND LABOUR.)... hellp syndrome

Hla System

The major histocompatibility complex, or human leucocyte antigen (HLA) region, consists of genetically determined antigens, situated on chromosome 6. Found in most tissues, though to a di?ering extent, the four gene loci are known as A, B, C, D, while the individual alleles at each locus are numbered 1, 2, 3, etc. The number of possible combinations is thus enormous, and the chance of two unrelated people being identical for HLA is very low.

HLA incompatibility causes the immune response, or rejection reaction, that occurs with unmatched tissue grafts. Strong associations between HLA and susceptibility to certain diseases – notably the AUTOIMMUNE DISORDERS such as rheumatoid arthritis, insulin-dependent diabetes, and thyrotoxicosis – have been described. Certain HLA antigens occur together more frequently than would be expected by chance (linkage disequilibrium), and may have a protective e?ect, conferring resistance to a disease. (See IMMUNITY.)... hla system

Insulin Shock

A disorder in which the body produces excess INSULIN, which then reduces the amount of glucose in the blood (HYPOGLYCAEMIA). Treatment is with glucose or GLUCAGON. Untreated, the patient goes into a COMA and dies.... insulin shock

Intervention Study

Comparison of outcomes between two or more groups of patients who have been intentionally given di?erent treatments or preventative measures, for example, diets. The subjects in the trial should be randomly allocated to the groups, with patients in one group – called controls – receiving no active treatment. If possible, neither patients nor doctors participating in a study should know which patients are receiving what treatment (double blind study/trial). Furthermore, groups should exchange treatments after a prearranged time (crossover study/trial). (See CLINICAL TRIALS; RANDOMISED CONTROLLED TRIAL.)... intervention study

Indian Senna

Cassia senna

Caesalpiniaceae

San: Svarnapatri;

Hin: Sanay, Sana Ka Patt;

Ben: Sonamukhi;

Mal: Sunnamukki, Chonnamukki, Nilavaka;

Tam: Nilavirai, Nilavakai;

Tel: Netatangedu

Importance: Indian Senna or Tinnevelly senna is a shrub very highly esteemed in India for its medicinal value. The leaves are useful in constipation, abdominal disorders, leprosy, skin diseases, leucoderma, splenomegaly, hepatopathy, jaundice, helminthiasis, dyspepsia, cough, bronchitis, typhoid fever, anaemia, tumours and vitiated conditions of pitta and vata (Warrier et al,1994). It is used in Ayurvedic preparations; “Pancha Sakara Churna”, “Shat Sakara Churna” and “Madhu Yastyadi Churna” used for constipation. Its use is widespread in Unani system and some of the important products of this system containing senna are “Itrifal Mulayyin”, “Jawarish Ood Mulayyin”, “Hab Shabyar”, “Sufuf Mulliyin”, “Sharbat Ahmad Shahi”, etc. used as a mild laxative (Thakur et al, 1989).

Distribution: The plant is of Mediterranean origin. It is found in Somalia, Saudi Arabia, parts of Pakistan and Kutch area of Gujarat. It is largely cultivated in Tirunelveli, Ramanathapuram, Madurai and Salem districts of Tamil Nadu.

Botany: The genus Cassia, belonging to the family Caesalpiniaceae, comprises of a number of species, namely,

C. senna Linn. syn. C. angustifolia Vahl.

C. absus Linn.

C. alata Linn.

C. auriculata Linn.

C. burmanni Wight. syn. C. obovata (Linn.) Collad.

C. glauca Lam.

C. javanica Linn.

C. mimosoides Linn.

C. obtusifolia Linn. syn. C. tora Linn.

C. occidentalis Linn.

C. pumila Lam.

C. slamea Lam.

C. acutifolia Delile.

C. sophera Linn.

C. senna is a shrub or undershrub, 60-75cm in height with pale subterete or obtusely angled erect or spreading branches. Leaves are paripinnate. Leaflets are 5-8 in number, ovate-lanceolate and glabrous. Flowers are yellowish, many and arranged in axillary racemes. Fruits are flat legumes, greenish brown to dark brown and nearly smooth (Chopra et al,1980, Warrier et al,1994).

In commerce, the leaves and pods obtained from C. senna are known as “ Tinnevelly Senna” and those from C. acutifolia Delile. as “Alexandrian Senna”. The leaves of C. acutifolia are narrower than C. senna, otherwise both resemble to a large extent (Thakur et al, 1989). All the true Sennas have the portions of their leaves unequally divided. In some kinds the lower part of one side is reduced to little more than a line in breadth, while the other is from a quarter to half an inch in breadth. The drug known under the name of East Indian Senna is nearly free from adulteration; and as its properties appear identical with those of the Alexandrian and the price being less, it probably will supersede it in general practice. Its size and shape readily identify it (Graves, 1996).

Agrotechnology: The plant requires a mild subtropical climate with warm winters which are free from frost for its growth. Semiarid areas with adequate irrigation facilities are ideal for cultivation. Areas having high rainfall, humidity and poor drainage are not suitable. Light or medium loamy soils with adequate drainage and pH varying from 7.0-8.2 are preferable. In South India both summer and winter crops are possible. The plant is propagated by seeds. The seed rate required is 15-20kg/ha. Seeds are sown in October-November (winter rainfed crop) or in February-March (irrigated crop). Higher seed rate is required for unirrigated crop. Seeds are sown in lines 30cm apart. Application of 5-10t of FYM/ha before planting or raising a green manure crop is beneficial. About 40kg N and 25-50kg P2O5/ha applied as basal dressing and 40kg N/ha applied in 2 split dozes as top dressing gave better yield. While the rainfed crop is grown without irrigation, the irrigated crop requires 5-8 light irrigations during the entire growing season. The crop requires 2-3 weedings and hoeings in order to keep it free from weeds. Alternaria alternata causes leaf spot and dieback but the disease is not serious. In North India, the plant is attacked by the larvae of butterfly Catopsilia pyranthe which can be controlled by planting the crop in March-April instead of June-July. Under irrigated conditions, the first crop is obtained after 90 days of planting. The leaves are stripped by hand when they are fully green, thick and bluish-green in colour. The second crop is taken 4 weeks after the first harvest and the third 4-6 weeks after the second one. The last harvest of leaves is done when the entire crop is harvested along with the pods. Yield under irrigated conditions is nearly1.4t of leaves and 150kg pods/ha and under unirrigated conditions is 500-600kg leaves and 80-100kg pods/ha. The leaves are dried in thin layers under shade so as to retain the green colour and the pods are hung for 10-12 days to get dried. The leaves and pods are cleaned, graded and marketed (Husain et al, 1993).

Properties and Activity: Leaves contain glucose, fructose, sucrose and pinnitol. Mucilage consists of galactose, arabinose, rhamnose and galacturonic acid. Leaves also contain sennoside-C(8,8’- diglucoside of rhein-aloe-emodin-dianthrone). Pods contain sennosides A and B, glycoside of anthraquinones rhein and chrysophanic acid. Seeds contain -sitosterol (Husain et al, 1992). Leaves and pods also contain 0.33% -sterol and flavonols-kaempferol, kaempferin, and iso-rhamnetin. Sennoside content of C. acutifolia is higher ranging from 2.5% to 4.5% as compared to C. angustifolia ranging from 1.5 % to 2.5%.

The purgative activity of Senna is attributed to its sennosides. The pods cause lesser griping than the leaves. Leaf and pod is laxative. The leaves are astringent, bitter, sweet, acrid, thermogenic, cathartic, depurative, liver tonic, anthelmintic, cholagogue, expectorant and febrifuge.... indian senna

Intracytoplasmic Sperm Injection

Intracytoplasmic sperm injection (ICSI) is the most signi?cant therapeutic advance in male INFERTILITY treatment in the past 30 years. The technique is used when in vitro fertilisation (IVF – see under ASSISTED CONCEPTION) is not possible because the man has very few, motile, normal sperm (see SPERMATOZOON), or when previous attempts at IVF have not produced a fertilised EMBRYO. ICSI requires a single sperm which is injected directly into the cytoplasm of an egg previously retrieved from the woman. Once fertilised, the embryo is transferred to her UTERUS. For men with no sperm in the semen, it may be possible to retrieve sperm by needle aspiration of the EPIDIDYMIS under local anaesthetic (see ANAESTHESIA). Other techniques involve microsurgical retrieval from the epididymis or TESTICLE under a general anaesthetic. Potential complications include scrotal pain, bruising, HAEMATOMA formation and infection. ICSI and surgical sperm-retrieval require extensive training and expertise and is currently available in only a few selected

infertility units. Safety concerns relate to a higher-than-expected rate of abnormalities in the SEX CHROMOSOMES after ICSI, and also the potential risk of transmitting paternal genetic defects in the Y chromosome to sons born after ICSI.... intracytoplasmic sperm injection

Irritable Bowel Syndrome (ibs)

A disorder of the intestinal tract that affects its motility and causes abdominal distension and irregular defaecation. Traditional, but now discarded, names have been spastic or irritable colon. The disease affects around 20 per cent of the general population but in most it is no more than a minor nuisance. The causes are not fully understood, but it is generally believed that symptoms develop in response to psychological factors, changed gastrointestinal motility, or altered visceral sensation. About 50 per cent of patients meet criteria for a psychiatric diagnosis. Anxiety, depression, neurosis, panic attacks, acute disease are among possible triggering factors. Some patients have diarrhoea, others are constipated, and some alternate between the two. Many have increased sensitivity to distension of the intestine. Dietary factors such as intolerance to dairy products and wheat are apparent in certain patients.

Common features of IBS include:

abdominal distension.

altered bowel habit.

colicky lower abdominal pain, eased by defaecation.

mucous discharge from rectum.

feelings of incomplete defaecation.

Investigations usually produce normal results. Positive diagnosis in people under 40 is usually straightforward. In older patients, however, barium ENEMA, X-rays and COLONOSCOPY should be done to exclude colorectal cancer.

Reassurance is the initial and often e?ective treatment. If this fails, treatment should be directed at the major symptoms. Several months of the antidepressant amitriptyline (see ANTIDEPRESSANT DRUGS) may bene?t patients with intractable symptoms, given at a dose lower than that used to treat depression. The majority of patients follow a relapsing/remitting course, with episodes provoked by stressful events in their daily lives. (See also INTESTINE, DISEASES OF.)... irritable bowel syndrome (ibs)

Kaposi’s Sarcoma

A cancer or tumour of the blood and/or lymphatic vessel walls. It usually appears as blue-violet to brownish skin blotches or lumps. Before the appearance of AIDS, it was rare in the developed world. AIDSassociated Kaposi’s sarcoma is much more aggressive than the earlier form of the disease and is associated with Human Herpes Virus 8.... kaposi’s sarcoma

Kidney Stone

Small, hard stone that may form in the kidneys and cause intense pain... kidney stone

Liver Spots

A misnomer applied to the brown MACULES often seen on the backs of the hands of those chronically exposed to sunlight (see LENTIGO). They have no connection with any liver disorder.... liver spots

Locked-in Syndrome

This describes a condition in which a patient is awake and retains the power of sense perception, but is unable to communicate except by limited eye movements because the motor nervous system is paralysed. Several diseases can cause this syndrome, which results from interruption of some of the nerve tracts between the mid brain and the pons (see BRAIN). Sometimes the syndrome is caused by severe damage to muscles or the nerves enervating them. Locked-in syndrome may sometimes be confused with a PERSISTENT VEGETATIVE STATE (PVS).... locked-in syndrome

Malabsorption Syndrome

This term includes a multiplicity of diseases, all of which are characterised by faulty absorption from the INTESTINE of essential foodstu?s such as fat, vitamins and mineral salts. Among the conditions in this syndrome are COELIAC DISEASE, SPRUE, CYSTIC FIBROSIS and pancreatitis (see PANCREAS, DISORDERS OF). Surgical removal of the small intestine also causes the syndrome. Symptoms include ANAEMIA, diarrhoea, OEDEMA, vitamin de?ciencies, weight loss and, in severe cases, MALNUTRITION.... malabsorption syndrome

Mendelson Syndrome

Inhalation of regurgitated stomach contents, usually as a complication of general ANAESTHESIA. It may cause death from ANOXIA or result in extensive lung damage.... mendelson syndrome

Methyl Salicylate

Also called oil of Wintergreen, the liquid has analgesic (see ANALGESICS) and counter-irritant properties. Rubbed into the skin, the oil helps to relieve pain in LUMBAGO, SCIATICA and ‘rheumatic conditions’.... methyl salicylate

Minimum Standard

A level of quality that all health plans and providers are required to meet in order to offer services to clients/consumers.... minimum standard

Mitral Stenosis

Narrowing of the opening between the left ATRIUM and left VENTRICLE of the HEART as a result of rigidity of, and adhesion between, the cusps of the MITRAL VALVE. It is due, almost invariably, to the infection RHEUMATIC FEVER. The atrium has to work harder to force blood through the narrowed channel. The effects are similar to those of MITRAL INCOMPETENCE. Shortness of breath and palpitations and irregular beating (?brillation) of the atrium are common consequences in adults. Drug treatment with DIGOXIN and DIURETICS helps, but surgery to dilate or replace the faulty valve may be necessary.... mitral stenosis

Mongolian Blue Spots

Irregularly shaped areas of bluish-black pigmentation found occasionally on the buttocks, lower back or upper arms in newborn infants of African, Chinese and Japanese parentage, and sometimes in the babies of black-haired Europeans. They measure from one to several centimetres in diameter, and usually disappear in a few months. They are commonly mistaken for bruises.... mongolian blue spots

Needle-stick Injury

Accidental perforation of the skin by an injection needle, commonly of the hand or ?nger and usually by a nurse or doctor administering a therapeutic injection. The term also refers to accidental injuries from injection needles discarded by drug abusers. Dangerous infections such as viral HEPATITIS or HIV may be acquired from needle-stick injuries, and there are strict procedures about the disposal of used syringes and needles in medical settings.... needle-stick injury

Oral Surgery

A branch of surgery that treats deformities, injuries or diseases of the TEETH and JAW, as well as other areas of the face and mouth. Surgeons doing this work are usually quali?ed dentists who have done further training in oral and maxillofacial surgery.... oral surgery

Oriental Sore

This term is a synonym for cutaneous LEISHMANIASIS; others include: Cochin, Delhi, Kandahar, Lahore, Madagascar, Natal, Old World tropical, tropical sore, etc. As with many of the local names for this infection, it is now rarely used.... oriental sore

Osteogenic Sarcoma

See OSTEOSARCOMA.... osteogenic sarcoma

Pet Scanning

Positron-emission tomography is a NUCLEAR MEDICINE diagnostic technique that works by identifying positrons – positively charged electrons – given o? by substances labelled with radioactive varieties of elements. The result is three-dimensional images that identify metabolic and chemical activities of tissues, especially brain tissues. The images provide information about tissue and organ functions, and can be collated with structural images using COMPUTED TOMOGRAPHY or magnetic resonance imaging (MRI). The equipment is very expensive and available only in selected hospitals in the United Kingdom. The technique is especially valuable in the assessment of neurological disorders.... pet scanning

Parasympathetic Nervous System

That part of the AUTONOMIC NERVOUS SYSTEM which is connected with the BRAIN and SPINAL CORD through certain nerve centres in the midbrain, medulla, and lower end of the cord. The nerves from these centres are carried in the third, seventh, ninth and tenth cranial nerves and the second, third and fourth sacral nerves. The action of the parasympathetic system is usually antagonistic to that of the sympathetic system. Thus it inhibits the action of the HEART and augments the action of the INTESTINE; whereas the sympathetic augments the action of the heart and inhibits that of the intestine. (See diagram of sympathetic and parasympathetic nervous systems under NERVOUS SYSTEM.)... parasympathetic nervous system

Plummer-vinson Syndrome

Hypochromic ANAEMIA and di?culty in swallowing due to an oesophageal web.... plummer-vinson syndrome

Portal System

A vein or collection of veins which ?nish at both ends in a bed of capillary blood vessels. An important example is the hepatic portal system, comprising the portal vein and its tributaries. Blood from the stomach, pancreas, spleen and intestines drains into the veins that join up to comprise the portal vein into the liver, where it branches into sinusoids.... portal system

Polycystic Ovary Syndrome

Characterised by scanty (or absent) MENSTRUATION, INFERTILITY, hirsutism (excessive hairiness) and OBESITY and the sufferers often have multiple cysts in their OVARIES.

The condition is caused by an imbalance between LUTEINISING HORMONE (LH) and FOLLICLE-STIMULATING HORMONE (FSH); this imbalance stops OVULATION and varies the TESTOSTERONE output of the ovaries. The treatment may be with CLOMIPHENE; with a PROGESTOGEN drug; with LUTEINISING HORMONE-RELEASING HORMONE (LHRH); or with oral contraceptives (see under CONTRACEPTION – Non-barrier methods). The treatment chosen depends on the severity of the disease and whether the woman wants to conceive. Rarely a section of ovarian tissue is surgically removed.... polycystic ovary syndrome

Post-viral Fatigue Syndrome

See MYALGIC ENCEPHALOMYELITIS (ME).... post-viral fatigue syndrome

Pressure Sores

See ULCER – Decubitus ulcer.... pressure sores

Puerperal Sepsis

An infection, once called puerperal fever, that starts in the genital tract within ten days after childbirth, miscarriage or abortion (see PREGNANCY AND LABOUR). Once a scourge of childbirth, with many women dying from the infection, the past 50 years have seen a dramatic decline in its incidence in developed countries, with only 1–3 per cent of women having babies now being affected. This decline is due to much better maternity care and the advent of ANTIBIOTICS. Infection usually starts in the VAGINA and is caused by the bacteria that normally live in it: they can cause harm because of the mother’s lowered resistance, or when part of the PLACENTA has been retained in the genital tract. The infection usually spreads to the UTERUS and sometimes to the FALLOPIAN TUBES. Sometimes bacteria may enter the vagina from other parts of the body.

Fever, an o?ensive-smelling post-partum vaginal discharge (lochia) and pain in the lower abdomen are the main features. Untreated, the women may develop SALPINGITIS, PERITONITIS and septicaemia. Antibiotics are used to treat the infection and any retained placental tissue must be removed.... puerperal sepsis

Radical Surgery

An operation to remove a cancer, plus adjacent tissue and lymph nodes.... radical surgery

Representative Sample

The term “representative”, as it is commonly used, is undefined in the statistical or mathematical sense; it means simply that the sample resembles the population in some way. The use of probability sampling will not ensure that any single sample will be “representative” of the population in all possible aspects. A common fallacy lies in the unwarranted assumption that, if the sample resembles the population closely on those factors that have been checked, it is “totally representative” and no differences exist between the sample and the universal or reference population.... representative sample

Reproductive System

A collective term for all the organs involved in sexual reproduction. In the female these are the OVARIES, FALLOPIAN TUBES, UTERUS, VAGINA and VULVA. In the male these are the testes (see TESTICLE), VAS DEFERENS, SEMINAL VESICLES, URETHRA and PENIS.... reproductive system

Respiratory Distress Syndrome

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

Restless Legs Syndrome

A condition in which the patient experiences unpleasant sensations, and occasionally involuntary movements, in the legs when at rest, especially at night. No pathological changes have been identi?ed. It is sometimes indicative of iron-de?ciency ANAEMIA, but in many cases the cause remains a mystery and the variety of cures o?ered are a testimony to this. Some anti-epileptic drugs are said to help (see EPILEPSY).... restless legs syndrome

Risus Sardonicus

The term used for describing the facial appearance when the muscles of the forehead and the face go into spasm in TETANUS, giving the e?ect of a sardonic grin.... risus sardonicus

Saccharine

A sweetening agent that is 400 times as sweet as cane sugar, but with no energy content. Apart from its rather bitter aftertaste, it has practically no e?ect on the tissues, and escapes from the body unchanged. Destroyed by heat, saccharine is not used in cooking, but is an important component of all diabetic and low-calorie diets.... saccharine

Saccharomyces

Another name for YEAST.... saccharomyces

Sacral Vertebrae

The ?ve fused vertebrae that link the thoracic spine and the coccyx and form the sacrum (see SPINAL COLUMN).... sacral vertebrae

Sacroiliac Joint

One of a pair of joints between each side of the SACRUM and each ILIUM. Strong ligaments between the ilium and the sacrum stabilise the joint, permitting little movement. Childbirth or strenuous sporting activities may strain the joint, causing pain in the lower part of the back and buttocks. Such strains may take a long time to mend; PHYSIOTHERAPY is the treatment. The joint(s) may become in?amed (see SACROILEITIS).... sacroiliac joint

Sadism

The term applied to a form of sexual perversion, in which satisfaction is derived from the in?iction of cruelty upon another person. The condition is commoner in men than in women and is sometimes linked with MASOCHISM (a wish to be hurt or abused).... sadism

Safety

A judgment of the acceptability of risk (a measure of the probability of an adverse outcome and its severity) associated with a given situation or setting.... safety

Saffron

(English) Resembling the yellow flower

Saffrone, Saffronn, Saffronne, Safron, Safronn, Safronne, Saffronah, Safrona, Safronah, Safrone, Safronna, Safronnah, Saffrona... saffron

Sage

(English) Wise one; type of spice Saige, Sayge, Saege, Sagia, Saig, Sayg, Saeg... sage

Sagittal

The term applied to a structure or section running from front to back in the body.... sagittal

Salaam Attacks

See INFANTILE SPASMS.... salaam attacks

Salk Vaccine

A vaccine obtained by treating the POLIOMYELITIS virus with formalin. This prevents the virus from causing the disease but allows it to stimulate the production of ANTIBODIES. Salk vaccine is given by injection and protects the recipient against the disease. (See also IMMUNISATION.)... salk vaccine

Salmonella

A widespread genus of gram-negative motile-rod bacteria, some of them can cause moderate GI infections, while several can produce metabolites in food that cause serious toxic reaction when the food is eaten... salmonella

Salmonella Infections

See FOOD POISONING; ENTERIC FEVER; DYSENTERY.... salmonella infections

Salpingography

Radiography (see X-RAYS) of one or both FALLOPIAN TUBES after radio-opaque material has been injected into them via the UTERUS.... salpingography

Salt

The substance produced by the replacement of the acidic hydrogen of an acid by a metal or basic radical. It is also a synonym for common salt or sodium chloride. Sodium chloride is a vital constituent of cells, and a proper balance between it and other salts in the cells and body tissues is important for their viability.... salt

Sandalwood

Protection, Healing, Exorcism, Spirituality... sandalwood

Sandfly Fever

This is a short, sharp fever occurring in many parts of the tropics and subtropics, including most of the Mediterranean littoral. It is due to a virus, called phlebovirus, conveyed by the bite of a small hairy midge or sandfly (Phlebotomus papatasi). The incubation period is 3–7 days.

Symptoms There are headache, feverishness, general sensations like those of INFLUENZA, flushed face and bloodshot eyes, but no signs of CATARRH. The fever passes off in three days, but the patient may take some time to convalesce.

Treatment As there is no specific remedy, PROPHYLAXIS is important. This consists of the spraying of rooms with an insecticide such as GAMMEXANE; the application of insect repellents such as dimethyl phthalate to the exposed parts of the body (e.g. ankles, wrists and face), particularly at sunset; and the use of sandfly nets at night. Once the infection is acquired, treatment consists of rest in bed, light diet and aspirin and codeine.... sandfly fever

Sanguineous

This term means containing blood. ... sanguineous

Sanitary Protection

Disposable sanitary towels or tampons (see TAMPON) used to protect clothing from bloodstains during MENSTRUATION. They are available in different absorbencies to meet women’s individual needs.... sanitary protection

Saprophyte

An organism which lives usually upon decaying and dead matter and produces its decomposition.... saprophyte

Sarcoptes

Mites which infest humans and animals. Sarcoptes scabei hominis causes human SCABIES. Other species infest dogs (sarcoptic mange), cats and birds.... sarcoptes

Sarsaparilla

Love, Money... sarsaparilla

Savory, Summer

Mental Powers ... savory, summer

Scabicide

A drug that eliminates the mites which cause SCABIES.... scabicide

Scale

A set of numbers or other symbols used to designate characteristics of a variable that is used in measurement. A system for measuring equal portions.... scale

Scalp

The soft covering of the SKULL on the top of the head. It consists of ?ve layers, which from the surface inwards are as follows: the skin, from which grows hair; next a subcutaneous layer of fat; thirdly, a tough ?brous membrane known as the epicranium; fourthly, a loose layer of connective tissue attaching the epicranium to the deepest layer, and permitting the free movement of the scalp; and, ?nally, another ?brous layer clinging closely to the skull, and known as the pericranium.... scalp

Scanning Speech

A speech disorder in which articulated syllables are wrongly spaced and each is given the same vocal emphasis. The condition occurs as a result of disease in the cerebellum (see BRAIN) or its connecting nerves. (See also VOICE AND SPEECH.)... scanning speech

Scanning Techniques

Ways of producing images of body organs that record, process and analyse sound waves, radio waves or X-RAYS passing through or generated by the body’s tissues. ULTRASOUND scanning using high-frequency, inaudible sound waves directed at the area of the body being studied is the most generally used scanning procedure. Sound waves are re?ected more powerfully by some structures than others, and a pattern of those re?ections is detected and shown on a screen. Other screening methods include COMPUTED TOMOGRAPHY, magnetic resonance imaging (MRI), positron emission tomography (PET SCANNING) and RADIONUCLIDE scanning, which measures the di?erential uptake of radioactive materials in the body’s tissues.... scanning techniques

Scaphoid Bone

The outside bone on the thumb side of the HAND in the row of carpal (wrist) bones nearest to the forearm. Fracture of the scaphoid is a common wrist injury that usually occurs when someone falls on to their outstretched hand. The fracture may not be diagnosed at ?rst (even an X-ray may not be abnormal). Pain in and permanent damage to the wrist can occur.... scaphoid bone

Scatter Diagram

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

Schizogony

An asexual phase in the life-cycle of a sporozoan (see SPOROZOA) that occurs in red blood cells or liver cells.... schizogony

Scolex

The anterior organ of a tapeworm used for attachment to host tissues. Also known as the holdfast.... scolex

Scorbutic

This is an adjective characterising SCURVY; typically swollen, spongy gums that bleed easily, and spontaneous haemorrhages and bruising anywhere in the body.... scorbutic

Screening

The use of procedures and measures to identify and differentiate apparently well persons who have a disease or condition or a high risk thereof from those who probably do not have the disease or condition.... screening

Screening Test

The screening of apparently healthy people to identify those who may have treatable diseases. Cervical smears are done when screening women to detect if they have cancer or precancer of the neck of the womb (cervix). Newborn babies are screened for hip dislocation. Screening tests are not designed to diagnose individual persons, but rather to divide a population into a large number at low risk and a small number at high risk of a condition. This allows clinicians to concentrate on a sub-section of the population. All screening tests produce false negative and false positive results, a problem often misunderstood by those at the receiving end. Factors to be assessed when planning screening procedures include the severity, frequency and distribution of the disease, and the availability and e?ectiveness of treatment. Convenience, safety, sensitivity and cost should also be assessed. In the United Kingdom the government has supported the extension of screening procedures for breast cancer, cervical cancer, hypertension and diabetes. (See PREVENTIVE MEDICINE.)... screening test

Scrub Typhus

A febrile illness caused by Orientia tsutsugamushi, transmitted through the larval stage of several species of infected trombiculid mites, often called chiggers. The endemic region is a roughly triangular area bounded by Japan in the north, Pakistan in the west and with Queensland, Vanuatu and the Solomon Islands in the South.... scrub typhus

Scrum-pox

A popular name for a contagious condition of the face affecting rugby football players. It is most likely to occur in forwards as a result of face-to-face contact with individuals with the infection in the opposing side of the scrum. Other possible sources of infection are changing rooms and communal baths. The condition may take the form of IMPETIGO or HERPES SIMPLEX.... scrum-pox

Seasonal Affective Disorder Syndrome

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

Sebaceous Gland

Oil secreting glands, mostly clustered around hair follicles. The oil, sebum, is released into the oil glands from the disintegrated cytoplasm of shedding holocrine cells that line the alveolar surfaces. The nature of the secretion is a direct reflection of the state of the body’s lipid metabolism.... sebaceous gland

Sebaceous Glands

The minute glands situated alongside hairs and opening into the follicles of the latter a short distance below the point at which the hairs emerge on the surface. These glands secrete an oily material, and are especially large upon the nose, where their openings form pits that are easily visible. In the mouth the glands open directly on the mucosal surface. (See also SKIN.)... sebaceous glands

Secondary Sexual Characteristics

The physical characteristics that develop during PUBERTY as the body matures sexually. Girls’ breasts and genitals increase in size, and, like boys, they grow pubic hair. Boys also grow facial hair, their voice breaks and their genitals grow to adult size.... secondary sexual characteristics

Section

(1) A thin slice of a tissue specimen taken for examination under a microscope.

(2) The act of cutting in surgery; for example, an abdominal section is done to explore the abdomen.

(3) The issuing of an order under the United Kingdom’s Mental Health Act to admit someone compulsorily to a psychiatric hospital.... section

Sedimentation Rate

See ESR.... sedimentation rate

Seizure

Also called a FIT, this is a sudden burst of uncontrolled electrical activity in the BRAIN. A seizure may be generalised or partial: in the former, abnormal electrical activity may affect the whole brain, resulting in unconsciousness and characteristic of EPILEPSY; in partial seizures, abnormal electrical activity occurs in one part of the brain. HALLUCINATIONS may occur and localised symptoms include muscular twitching or a tingling sensation in a small area of the face, arm, leg or trunk. Di?erent neurological or medical disorders may cause seizures: for example, STROKE, brain tumour, head injury, infection or metabolic disturbance (see METABOLISM; METABOLIC DISORDERS). People dependent on alcohol may suffer seizures if they stop drinking. Treatment is of the underlying condition coupled with antiepileptic drgus such as CARBAMAZEPINE, lamotrigine, SODIUM VALPROATE or PHENYTOIN SODIUM.... seizure

Selenium Sulphide

This is used as a shampoo in the treatment of dandru? and seborrhoeic DERMATITIS of the scalp. In view of its potential toxicity it should only be used under medical supervision. It must never be applied to in?amed areas of the scalp, and it must not be allowed to get into the eyes as it may cause conjunctivitis or keratitis. It is also used in the treatment of tinea versicolor (see RINGWORM).... selenium sulphide

Sella Turcica

The deep hollow on the upper surface of the sphenoid bone in which the PITUITARY GLAND is enclosed.... sella turcica

Sensory

Description applied to the part of the nervous system dedicated to bringing information on sensations affecting the body to the brain. The opposite of sensory nerves is motor nerves; these carry instructions for action to the voluntary muscles in the body.... sensory

Sequestrum

A fragment of dead bone cast o? from the living bone in the process of NECROSIS. (See also BONE, DISORDERS OF.) A sequestrum often remains in contact with, and partly enveloped by, newly formed bone, so that a SINUS is produced; a constant discharge goes on until the dead bone is removed.... sequestrum

Serotype

A classi?cation of a substance according to its serological activity. This is done in the context of the antigens (see ANTIGEN) that it contains, or the ANTIBODIES it may provoke. Microorganisms of the same species may be classi?ed according to the di?erent antigens that they produce.... serotype

Serous

... serous

Serous Membranes

Membranes that line many internal organs and cavities, secreting a thin, lymph-like fluid, that lubricates and slowly circulates.... serous membranes

Serpiginous

A term describing a creeping or extending skin lesion such as an ULCER.... serpiginous

Sexual Dysfunction

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

Shigella

The name given to a group of rod-shaped, gram-negative bacteria (see GRAM’S STAIN) that are the cause of bacillary DYSENTERY.... shigella

Shin Splints

See MEDIAL TIBIAL SYNDROME.... shin splints

Shock Therapy

See ELECTROCONVULSIVE THERAPY (ECT).... shock therapy

Short Stature

See DWARFISM.... short stature

Sialogogue

An agent that increases the flow of saliva... sialogogue

Sialorrhoea

Also called ptyalism, this is the excessive production of SALIVA. It occurs in various nervous disorders, such as PARKINSONISM; poisoning by MERCURY or mushrooms; or RABIES infection.... sialorrhoea

Sibling

A brother or sister. Sibling rivalry is the term... sibling

Side

(Anatolian) Resembling a pomegranate, symbolizing abundance... side

Side Effects

Unwanted effects of a drug or treatment.... side effects

Sida Rhombifolia

Linn.

Family: Malvaceae.

Habitat: Throughout India, in moist places.

English: Common Bala.

Ayurvedic: Mahaabalaa, Mahaa- samangaa, Sahadevaa, Kshetrabalaa.

Unani: Bariyaara (red-flowered var.).

Siddha/Tamil: Athi Bala-chedi, Chitrmutti, Tennacham.

Action: Plant—used as a supporting drug in pulmonary tuberculosis, nervous diseases and rheumatism. Leaves—applied to swelling as paste. Stem-mucilage—demulcent and emollient. Used internally in skin diseases and as a diuretic and febrifuge.

The Ayurvedic Pharmacopoeia of India recommends the root in deficient spermatogensis and oedema.

Alkaloids, ephedrine, si-ephedrine and cryptolepine, are reported from aerial parts. The root contains 0.054% alkaloids, beta-phenethylamine, N- methyl-beta-phenethylamine, vasici- nol, vasicinone, vasicine, choline and betaine. These alkaloids are also present in the aerial parts.

Alcoholic extract of the root exhibited antibacterial and antipyretic activities.

Proteins, linoleic, malvlic and ster- culic acids have been reported from seeds.

Dosage: Root—3-6 g powder. (API, Vol. III.)... sida rhombifolia

Sidero

(Greek) In mythology, stepmother of Pelias and Neleus Siderro, Sydero, Sideriyo... sidero

Sight

See VISION.... sight

Simmonds’ 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

Sinus Tachycardia

A regular heart rate of 100 or more beats a minute, caused by increased electrical activity in the SINOATRIAL NODE (see also HEART). This level of tachycardia is normal during and just after exercise, and may also be caused by stress or anxiety. If tachycardia persists when the person is resting, it may be due to underlying disease such as thyrotoxicosis (see under THYROID GLAND, DISEASES OF) and investigation is advisable.... sinus tachycardia

Sinusoid

A small blood vessel like an enlarged capillary (see CAPILLARIES) occurring, for example, in the LIVER, which contains a large number of them. The sinusoids in the liver are drained by the hepatic veins.... sinusoid

Skeletal Muscle

Muscle under a person’s voluntary control (see MUSCLE; VOLUNTARY MUSCLE).... skeletal muscle

Skin

The membrane which envelops the outer surface of the body, meeting at the body’s various ori?ces, with the mucous membrane lining the internal cavities.

Structure

CORIUM The foundation layer. It overlies the subcutaneous fat and varies in thickness from 0·5–3.0 mm. Many nerves run through the corium: these have key roles in the sensations of touch, pain and temperature (see NEURON(E)). Blood vessels nourish the skin and are primarily responsible for regulating the body temperature. Hairs are bedded in the corium, piercing the epidermis (see below) to cover the skin in varying amounts in di?erent parts of the body. The sweat glands are also in the corium and their ducts lead to the surface. The ?brous tissue of the corium comprises interlocking white ?brous elastic bundles. The corium contains many folds, especially over joints and on the palms of hands and soles of feet with the epidermis following the contours. These are permanent throughout life and provide unique ?ngerprinting identi?cation. HAIR Each one has a root and shaft, and its varying tone originates from pigment scattered throughout it. Bundles of smooth muscle (arrectores pilorum) are attached to the root and on contraction cause the hair to stand vertical. GLANDS These occur in great numbers in the skin. SEBACEOUS GLANDS secrete a fatty substance and sweat glands a clear watery ?uid (see PERSPIRATION). The former are made up of a bunch of small sacs producing fatty material that reaches the surface via the hair follicle. Around three million sweat or sudoriparous glands occur all over the body surface; sited below the sebaceous glands they are unconnected to the hairs. EPIDERMIS This forms the outer layer of skin and is the cellular layer covering the body surface: it has no blood vessels and its thickness varies from 1 mm on the palms and soles to 0·1 mm on the face. Its outer, impervious, horny layer comprises several thicknesses of ?at cells (pierced only by hairs and sweat-gland openings) that are constantly rubbed o? as small white scales; they are replaced by growing cells from below. The next, clear layer forms a type of membrane below which the granular stratum cells are changing from their origins as keratinocytes in the germinative zone, where ?ne sensory nerves also terminate. The basal layer of the germinative zone contains melanocytes which produce the pigment MELANIN, the cause of skin tanning.

Nail A modi?cation of skin, being analagous to the horny layer, but its cells are harder and more adherent. Under the horny nail is the nail bed, comprising the well-vascularised corium (see above) and the germinative zone. Growth occurs at the nail root at a rate of around 0·5 mm a week – a rate that increases in later years of life.

Skin functions By its ability to control sweating and open or close dermal blood vessels, the skin plays a crucial role in maintaining a constant body temperature. Its toughness protects the body from mechanical injury. The epidermis is a two-way barrier: it prevents the entry of noxious chemicals and microbes, and prevents the loss of body contents, especially water, electrolytes and proteins. It restricts electrical conductivity and to a limited extent protects against ultraviolet radiation.

The Langerhans’ cells in the epidermis are the outposts of the immune system (see IMMUNITY), just as the sensory nerves in the skin are the outposts of the nervous system. Skin has a social function in its ability to signal emotions such as fear or anger. Lastly it has a role in the synthesis of vitamin D.... skin

Slipped Disc

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

Slow Virus

See prion.... slow virus

Slippery Elm

Ulmus fulva. N.O. Urticaceae.

Synonym: Moose Elm, Red Elm.

Habitat; North America, particularly Canada.

Features ? The dried inner bark of Ulmus fulva is one of the most valued articles in herbal medicine. It is tough and fibrous, becoming soft and mucilaginous when moistened. It is this mucilaginous quality which originated the popular name of Slippery Elm. The inner bark has a slight pinkish or rusty tint, is faintly striated longitudinally, has a strong characteristic odour, and the distinctive "slimy" taste.

Action: Emollient, demulcent, pectoral.

The finely powdered bark, prepared as an ordinary gruel, has shown remarkable results as a demulcent in catarrhal affections of the whole digestive and urinary tracts, and in all diseases involving inflammation of the mucous membranes. Both bronchitis and gastritis yield to its soothing

and healing properties, and as a nutrient in general debility it is probably unrivalled.

A teaspoonful of the powder to 1 pint of boiling water makes the food or gruel. The powder should be first thoroughly mixed with an equal quantity of brown sugar and the boiling water added in small quantities, say four to the pint, mixing each time until a smooth result is obtained.

Slippery Elm bark coarsely powdered makes one of the best possible poultices for boils, carbuncles, chilblains, and skin eruptions generally. It soothes the part, disperses inflammation, draws out impurities, and heals rapidly.... slippery elm

Small-cell Carcinoma

See OAT CELL.... small-cell carcinoma

Smell

The sense of smell is picked up in what is known as the olfactory areas of the NOSE. Each of these is about 3 square centimetres in area and contains 50 million olfactory, or smelling, cells. They lie, one on either side, at the highest part of each nasal cavity. This is why we have to sni? if we want to smell anything carefully, as in ordinary quiet breathing only a few eddies of the air we breathe in reaches an olfactory area. From these olfactory cells the olfactory nerves (one on each side) run up to the olfactory bulbs underneath the frontal lobe of the BRAIN, and here the impulse is translated into what we describe as smell.... smell

Smoking

See TOBACCO.... smoking

Smooth Muscle

Muscle under the ‘involuntary’ control of the autonomic nervous system (see MUSCLE; NERVOUS SYSTEM).... smooth muscle

Snakeroot

Luck Money... snakeroot

Sneezing

A sudden expulsion of air through the NOSE, designed to expel irritating materials from the upper air passages. In sneezing, a powerful expiratory e?ort is made; the vocal cords (see VOICE AND SPEECH; LARYNX) are kept shut until the pressure in the chest has risen high; and air is then suddenly allowed to escape upwards, being directed into the back of the nose by the soft PALATE. One sneeze projects 10,000 to 100,000 droplets a distance of up to 10 metres at a rate of over 60 kilometres an hour. As such droplets may contain micro-organisms, it is clear what an important part sneezing plays in transmitting infections such as the COMMON COLD. Alhough usually transitory, sneezing may persist for days on end – up to 204 days have been recorded.

Sneezing may be caused by the presence of irritating particles in the nose, such as snu?, or the pollen of grasses and ?owers. It is also an early symptom of colds, INFLUENZA, MEASLES, and HAY FEVER, being then accompanied or followed by running at the nose (RHINITIS).... sneezing

Social Medicine

See PUBLIC HEALTH.... social medicine

Social Services

Services provided by government to improve the social welfare of those who need them.... social services

Sodium Aurothiomalate

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

Sodium Chloride

The chemical name for common salt (see SODIUM).... sodium chloride

Sodium Hypochlorite

A disinfectant by virtue of the fact that it gives o? chlorine. For domestic use – as, for example, for sterilising baby feeding bottles – it is available in a variety of proprietary preparations.... sodium hypochlorite

Soma

(Indian) An exalted woman; one who gives praise... soma

Somatostatin

Also known as the growth-hormone-releaseinhibiting factor, this is a hormone secreted by the HYPOTHALAMUS and some non-nervous tissues (including the gastrointestinal tract and pancreas). It stops the pituitary-releasing somatotrophin – GROWTH HORMONE. Somatostatin and growth-hormone-releasing hormone are controlled by complicated neural mechanisms linked to exercise, sleep patterns, stress, NEUROTRANSMITTERS and blood GLUCOSE.... somatostatin

Solomon's Seal

Polygonatum officinalis. N.O. Liliaceae.

Habitat: Rocky woods in high situations.

Features ? Stem from twelve to eighteen inches high, with alternate sessile leaves. White flowers in May and June, usually solitary, stalks axillary ; black berries. Rhizome cylindrical, about half an inch diameter, transverse ridges, slightly flattened above, circular stem scars at intervals. Fracture short, yellowish, waxy. Taste mucilaginous, sweet then acrid.

Part used ? Rhizome.

Action: Astringent, demulcent.

Lung complaints, when combined with other remedies. Also in leucorrhea. Powdered root used as poultice for inflammations.

Infusion of 1 ounce to 1 pint boiling water—wineglass doses.... solomon's seal

Sotalol

See BETA-ADRENOCEPTOR-BLOCKING DRUGS.... sotalol

Sound

A rod with a curve at one end used to explore body cavities such as the bladder, or to dilate strictures in the urethra or other channels in the body. (See URINARY BLADDER, DISEASES OF.)... sound

Space Medicine

A medical specialty dealing with the physiological, PSYCHOLOGICAL and pathological consequences of space ?ight in which the body has to cope with unusual variations in gravitational forces, including weightlessness, a constricted environment, prolonged close contact with work colleagues in very demanding technical circumstances, and sustained periods of emotional pressure including fear. Enormous progress has been made in providing astronauts with as normal an environment as possible, and they have to undergo prolonged physical and mental training before embarking on space travel.... space medicine

Spanish Fly

A popular term for cantharides, which is used as a blistering agent.... spanish fly

Spatula

A ?at, knife-like instrument used for spreading plasters and ointments, and also for depressing the tongue when the throat is being examined.... spatula

Specialist

A health professional who is specially trained in a certain branch of his/her profession related to specific services or procedures.... specialist

Species

A fairly well-defined, interbreeding group of plants or animals. The lowest taxonomic grouping of closelyrelated varieties - below a Genus. See Taxonomy .... species

Speech Disorders

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

Spermatogenesis

The production of mature sperm (see SPERMATOZOON) in the testis (see TESTICLE). The sperm cells originate from the outermost layer of the seminiferous tubules in the testis: these multiply throughout reproductive life and are transformed into mature spermatozoa, a process that takes up to 80 days.... spermatogenesis

Spermatorrhoea

The passage of SEMEN without erection of the PENIS or ORGASM.... spermatorrhoea

Spermatozoa

See SPERMATOZOON.... spermatozoa

Spermicide

Contraceptive preparations that kill sperm. They may be in the form of gels, pessaries, cream or foam and should be used with a barrier contraceptive such as a diaphragm or a condom. (See CONTRACEPTION.)... spermicide

Sphygmograph

An instrument for recording the PULSE.... sphygmograph

Spica

(Latin) One of the brightest stars Spicah, Spicka, Spika, Spicca, Spyca, Spycka, Spyka... spica

Spicule

A male accessory reproductive organ in nematodes helping to attach the male to the female during copulation. There may be one or two or it may be absent in some nematodes.... spicule

Spinal Anaesthesia

See under ANAESTHESIA.... spinal anaesthesia

Spermatozoon

(Plural: spermatozoa.) This is the male sex or germ cell which unites with the OVUM to form the EMBRYO or fetus. It is a highly mobile cell approximately 4 micrometres in length – much smaller than an ovum, which is about 35 micrometres in diameter. Each millilitre of SEMEN contains on average about 100 million spermatozoa, and the average volume of semen discharged during ejaculation in sexual intercourse is 2–4 ml. (Some recent research suggests that male fertility is falling because of a reduction in the production of viable spermatozoa – possibly due to environmental factors, including the discharge of hormones used for agricultural purposes and for human hormonal contraception.)

Once ejaculated during intercourse the spermatozoon travels at a rate of 1·5–3 millimetres a minute and remains mobile for several days after insemination, but quickly loses its potency for fertilisation. As it takes only about 70 minutes to reach the ovarian end of the uterine tube, it is assumed that there must be factors other than its own mobility, such as contraction of the muscle of the womb and uterine tube, that speed it on its way.... spermatozoon

Spirillum

A form of micro-organism of wavy or spiral shape. (See MICROBIOLOGY.)... spirillum

Spirometer

A device to test how the lung is working (see also PULMONARY FUNCTION TESTS) to assess the effects of lung disease or the progress of treatment – a procedure called spirometry. The spirometer records the total volume of air breathed out – the forced vital capacity. The machine also records the volume of air breathed out in one second – the forced expiratory volume. In diseases such as ASTHMA, in which the airways are obstructed, the ratio of the forced expiratory volume to the forced vital capacity is reduced. (See RESPIRATION.)... spirometer

Splanchnic

Anything belonging to the internal organs of the body, as distinguished from its framework.... splanchnic

Spinal Column

Also known as the spine, this forms an important part of the skeleton, acting both as the rigid pillar which supports the upper parts of the body and as a protection to the SPINAL CORD and nerves arising from it. The spinal column is built up of a number of bones placed one upon another, which, in consequence of having a slight degree of turning-movement, are known as the vertebrae. The possession of a spinal cord supported by a vertebral column distinguishes the higher animals from the lower types, and is why they are called vertebrates. Of the vertebrates, humans alone stand absolutely erect, and this erect carriage of the body gives to the skull and vertebral column certain distinctive characters.

The human backbone is about 70 cm (28

inches) in length, and varies little in full-grown people; di?erences in height depend mainly upon the length of the lower limbs. The number of vertebrae is 33 in children, although in adult life ?ve of these fuse together to form the sacrum, and the lowest four unite in the coccyx, so that the number of separate bones is reduced to 26. Of these there are seven in the neck, known as cervical vertebrae; 12 with ribs attached, in the region of the thorax known as thoracic or dorsal vertebrae; ?ve in the loins, called lumbar vertebrae; ?ve fused to form the sacrum; and four joined in the coccyx. These numbers are expressed in a formula thus: C7, D12, L5, S5, Coc4=33.

Although the vertebrae in each of these regions have distinguishing features, all the vertebrae are constructed on the same general plan. Each has a thick, rounded, bony part in front, known as the body, and these bodies form the main thickness of the column. Behind the body of each is a ring of bone, the neural ring, these rings placed one above another forming the bony canal which lodges the spinal cord. From each side of the ring a short process of bone known as the transverse process stands out, and from the back of the ring a larger process, the spinous process, projects. These processes give attachment to the strong ligaments and muscles which unite, support, and bend the column. The spines can be seen or felt beneath the skin of the back lying in the centre of a groove between the muscular masses of the two sides, and they give to the column its name of the spinal column. One of these spines, that of the seventh cervical vertebra, is especially large and forms a distinct bony prominence, where the neck joins the back. Between the bodies of the vertebrae lies a series of thick discs of ?brocartilage known as intervertebral discs. Each disc consists of an outer portion, known as the annulus ?brosus, and an inner core, known as the nucleus pulposus. These 23 discs provide the upper part of the spine with pliability and resilience.

The ?rst and second cervical vertebrae are specially modi?ed. The ?rst vertebra, known as the atlas, is devoid of a body, but has a specially large and strong ring with two hollows upon which the skull rests, thus allowing forward and backward movements (nodding). The second vertebra, known as the axis, has a pivot on its body which ?ts into the ?rst vertebra and thus allows free rotation of the head from side to side. The spinal column has four natural curves (see diagram) which help to cushion the shocks of walking and running.

The neural rings of the vertebrae form a canal, which is wide in the neck, smaller and almost round in the dorsal region, and wide again in the lumbar vertebrae. Down the canal runs the spinal cord, and the nerves leaving the cord do so through openings between the vertebrae which are produced by notches on the upper and lower margins of each ring. The intervertebral foramina formed by these notches are so large in comparison with the nerves passing through them that there is no chance of pressure upon the latter, except in very serious injuries which dislocate and fracture the spine.... spinal column

Spondylosis

See SPINE AND SPINAL CORD, DISEASES AND INJURIES OF.... spondylosis

Spongiform Encephalopathy

A disease of the neurological system caused by a PRION. Spongy degeneration of the BRAIN occurs with progressive DEMENTIA. Known examples of the disorder in humans are CREUTZFELDT-JAKOB DISEASE (CJD) and KURU. Among animals, scrapie in sheep and BOVINE SPONGIFORM ENCEPHALOPATHY (BSE) are caused by slow viruses. The latter has occurred as an outbreak in cattle over the past decade or so, probably as a result of cattle being fed processed o?al from infected animals. Some people have developed a form of CJD from eating infected beef.... spongiform encephalopathy

Sporadic

The term applied to cases of disease occurring here and there, as opposed to EPIDEMIC outbreaks.... sporadic

Spore

Part of the lifecycle of certain BACTERIA when the vegetative cell is encapsulated and metabolism falls to a low level. The spore is resistant to changes in the environment and, when these are unfavourable, the spore remains dormant; when they improve, it starts to grow. Certain dangerous bacteria, such as CLOSTRIDIUM, produce resistant ubiquitous spores, so sterilisation procedures need to be very e?ective.... spore

Sporozoa

The name of a group of parasitic PROTOZOA which includes the parasitic Plasmodium that causes MALARIA. The life-cycles of sporozoa are complex, often with sexual and asexual stages.... sporozoa

Sporozoites

The final stage of development of Plasmodium in the mosquito; this is the infective form of the malarial parasite; occurring either in a mature oocyst before its rupture or in the salivary gland of a mosquito.... sporozoites

Spotted Fever

See MENINGITIS; EPIDEMIC; TYPHUS FEVER.... spotted fever

Sputum

The mucous secretions from the mouth, throat or back of the nose. Sputum is also expectorated by coughing from the lower air passages. Its production may be increased by respiratory-tract allergy (ASTHMA) or by breathing-in irritants such as tobacco smoke, smoke from a ?re, or fumes from chemical materials. Sputum is normally white, but infection will turn it to yellow or green, and blood from the lungs may produce pink frothy sputum. Treatment is to deal with the underlying disorder. Production of large quantities of sputum – for instance, in BRONCHIECTASIS – may require physiotherapy and postural drainage. (See also EXPECTORATION.)... sputum

Ssris

See SELECTIVE SEROTONIN-REUPTAKE INHIBITORS (SSRIS).... ssris

Staghorn Calculus

A branched renal stone formed in the image of the collecting system of the kidney (see KIDNEYS). It ?lls the calyces and pelvis and is commonly associated with an infection of the urine, particularly Proteus vulgaris. The calculus may lead to pyonephrosis and an ABSCESS of the kidney.... staghorn calculus

Standard Population

A population in which the age and sex composition is known precisely, as a result of a census. A standard population is used as a comparison group in the procedure for standardizing mortality rates.... standard population

Stanozolol

See ANABOLIC STEROIDS.... stanozolol

Staphylococcus

Staphylococcus is a genus of gram-positive bacterium (see GRAM’S STAIN; BACTERIA) which under the microscope appears in small masses like bunches of grapes. It is one of the most common infectious micro-organisms and is found, for example, in the PUS discharged from BOILS (FURUNCULOSIS). (See also MICROBIOLOGY.)... staphylococcus

Star Anise

See Anís de estrella.... star anise

Statins

A group of LIPID-lowering drugs used to treat primary hypercholesterolaemia – a condition in which the concentrations of LIPOPROTEINS in the blood plasma are raised, increasing the likelihood of affected individuals developing coronary heart disease. Statins act by competitively inhibiting an ENZYME called 3-hydroxy-3methylglutaryl coenzyme A (HMG CoA) reductase. This enzyme plays a part in the synthesis of CHOLESTEROL, particularly in the LIVER. Statins are more e?ective than other classes of drugs in lowering body concentrations of LDL-cholesterol but less e?ective than ?brates in reducing triglyceride concentration. Their use results in signi?cant reductions in heart attacks (myocardial infarctions) and other adverse cardiovascular events, such as STROKE. Recent research shows that drugs which reduce lipid concentrations may prevent as many as one-third of myocardial infarctions and deaths from coronary disease. Statins are valuable in preventing coronary events in patients at increased risk of those conditions. They should be used in conjunction with other preventive measures such as low-fat diets, reduction in alcohol consumption, taking exercise and stopping smoking. Among statin drugs available are atorvastatin, cerivastatin sodium, ?uvastatin, pracastatin sodium and simvasatin. (See HEART, DISEASES OF; HYPERLIPIDAEMIA.)... statins

Steatoma

A fatty, cystic tumour.... steatoma

Stereognosis

The faculty of recognising the solidity of objects, and thus their nature, by handling them.... stereognosis

Sterculia

Sterculia foetida

Description: Sterculias are tall trees, rising in some instances to 30 meters. Their leaves are either undivided or palmately lobed. Their flowers are red or purple. The fruit of all sterculias is similar in aspect, with a red, segmented seedpod containing many edible black seeds.

Habitat and Distribution: There are over 100 species of sterculias distributed through all warm or tropical climates. They are mainly forest trees.

Edible Parts: The large, red pods produce a number of edible seeds. The seeds of all sterculias are edible and have a pleasant taste similar to cocoa. You can eat them like nuts, either raw or roasted.

CAUTION

Avoid eating large quantities. The seeds may have a laxative effect.... sterculia

Steroid

The group name for compounds that resemble CHOLESTEROL chemically. The group includes the sex hormones, the hormones of the adrenal cortex, and bile acids. They have a powerful in?uence on the normal functioning of the body, and natural and synthetic steroids are used in the treatment of many disorders. (See CORTICOSTEROIDS; ENDOCRINE GLANDS.)... steroid

Stertor

Stertor is a form of noisy breathing, similar to SNORING, and usually due to ?apping of the soft PALATE. Whereas ordinary snoring results from sleeping with the mouth open, stertor is the result of paralysis of the soft palate: this may be the result of a stroke, su?ocation, concussion, drunkenness, or poisoning by OPIUM or chloroform. In severe cases of paralysis, the tongue may loll back against the back of the throat, resulting in a very loud sound. In such cases breathing may be rapidly relieved by pulling the lower jaw forwards, pulling the tongue out of the mouth, or turning the person on to one side.... stertor

Stethoscope

An instrument used for listening to the sounds produced by the action of the lungs, heart, and other internal organs. (See AUSCULTATION.)... stethoscope

Stigma

Any spot or impression upon the SKIN. The term, stigmas of degeneration, is applied to physical defects that are found in people with learning disabilities (see LEARNING DISABILITY).... stigma

Stilboestrol

A synthetic oestrogen (see OESTROGENS). Its physiological actions are closely similar to those of the natural ovarian hormone, and it has the great merit of being active when taken by mouth. The drug may help patients suffering from cancer of the PROSTATE GLAND, inducing in some cases regression of the primary tumour and of secondary deposits in bone.... stilboestrol

Stilet

A stilet, or stilette, is the delicate probe or the wire used to clear a catheter (see CATHETERS) or hollow needle.... stilet

Stiffness

A condition which may be due to a change in the joints, ligaments, tendons, or muscles, or to the in?uence of the nervous system over the muscles of the part affected. Sti?ness is associated with various forms of arthritis or muscular disorders and with the effects of injuries to joints, tendons and muscles. Sti?ness of the neck muscles resulting in bending the head backwards, and of the hamstring muscles, causing di?culty in straightening the lower limbs, is a sign of MENINGITIS. Sti?ness or spasticity also occurs in certain diseases of the central nervous system.

Treatment is of the underlying disease or injury. Mild sti?ness can be treated symptomatically with local warmth and ANALGESICS. PHYSIOTHERAPY is helpful in relieving sti?ness as a result of muscle or joint injuries.... stiffness

Stings

See BITES AND STINGS.... stings

Stokes-adams Syndrome

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

Stomachic

Aiding the stomach and digestion... stomachic

Stone

See URINARY BLADDER, DISEASES OF; GALLBLADDER, DISEASES OF.... stone

Strapping

The application of strips of adhesive plaster, one overlapping the other, so as to cover and exert pressure on an area of the body. This treatment is used in cases of injury or disease when it is desired to keep a part at rest: for example, strapping may be applied to the chest in cases of pleurisy and fracture of the ribs. Also, it is often used to prevent the movement of joints which are sprained or otherwise injured.... strapping

Strawberry

Fragaria species

Description: Strawberry is a small plant with a three-leaved growth pattern. It has small, white flowers usually produced during the spring. Its fruit is red and fleshy.

Habitat and Distribution: Strawberries are found in the North Temperate Zone and also in the high mountains of the southern Western Hemisphere. Strawberries prefer open, sunny areas. They are commonly planted.

Edible Parts: The fruit is edible fresh, cooked, or dried. Strawberries are a good source of vitamin C. You can also eat the plant’s leaves or dry them and make a tea with them.... strawberry

Strep Throat

An infection of the throat with STREPTOCOCCUS bacteria: it is most common in children and symptoms range from minor discomfort to sore throat, fever, general malaise and enlarged LYMPH nodes in the neck. If symptoms are severe the infection may lead to SCARLET FEVER. PENICILLIN is the treatment of choice.... strep throat

Streptococcus

Streptococcus is a variety of gram-positive bacterium (see GRAM’S STAIN; BACTERIA) which under the microscope has much the appearance of a string of beads. Most species are saprophytic (see SAPROPHYTE); a few are PATHOGENIC and these include haemolytic types which can destroy red blood cells in a culture of blood agar. This o?ers a method of classifying the varying streptococcal strains. Alphahaeomolytic streptococci are usually associated with bacterial ENDOCARDITIS. SCARLET FEVER is caused by a ?-haeomolytic streptococcus called S. pyogenes. S. pneumoniae, also called PNEUMOCOCCUS, causes respiratory-tract infections, including PNEUMONIA. S. pyogenes may on its own, or with other bacteria, cause severe NECROTISING FASCIITIS or CELLULITIS in which oedema and death of subcutaneous tissues occur. The infection can spread very rapidly and, unless urgently treated with ANTIBIOTICS and sometimes surgery, death may quickly result. This spread is related to the ability of S. pyogenes to produce toxic substances called exotoxins. Although drug-resistant forms are occurring, streptococcal infections usually respond to treatment with antibiotics.... streptococcus

Strobila

The body of a tapeworm.... strobila

Strongyloides

A genus of intestinal nematodes which includes Strongyloides stercoralis in humans and S. fu?lleborni in monkeys and humans.... strongyloides

Subacute Combined Degeneration Of The Cord

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

Subacute Sclerosing Panencephalitis

A rare complication of MEASLES due to infection of the brain with the measles virus. It develops 2–18 years after the onset of the measles, and is characterised by mental deterioration leading on to CONVULSIONS, COMA and death. The annual incidence in Britain is about one per million of the childhood population. The risk of its developing is 5–25 times greater after measles than after measles vaccination (see MMR VACCINE; IMMUNISATION).... subacute sclerosing panencephalitis

Subarachnoid Space

The space between the arachnoid and the pia mater – two of the membranes covering the BRAIN. (See also MENINGES.)... subarachnoid space

Subdural

Relating to the space between the strong outer layer of the MENINGES, the membranes which cover the BRAIN, and the arachnoid, which is the middle layer of the meninges. A subdural haemorrhage occurs when bleeding takes place into this space. The trapped blood forms a large blood clot or haematoma within the skull and this causes pressure on the underlying brain. Bleeding may occur slowly as the result of disease or suddenly as the result of injury. Headaches, confusion and drowsiness result, sometimes with paralysis. Medical attention is required urgently if a serious haematoma occurs soon after injury.... subdural

Strychnine

An alkaloid (see ALKALOIDS) derived from Strychnos nux-vomica, the seeds of an East Indian tree, as well as from the seeds of several other closely allied trees and shrubs. It is a white crystalline body possessed of an intensely bitter taste, more bitter perhaps than that of any other substance, and it is not very soluble in water. It stimulates all parts of the nervous system, and was at one time widely used for this purpose. Strychnine poisoning is fortunately rare. It shows itself in CONVULSIONS, which come on very speedily after the person has taken the poison. The mental faculties remain unaffected, and the symptoms end in death or recovery within a few hours.

Treatment The patient should be kept quiet. Arti?cial respiration may be necessary and intravenous BENZODIAZEPINES to prevent convulsions may also be needed. (See POISONS; also APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)... strychnine

Subinvolution

A term used to indicate that the womb (see UTERUS) has failed to undergo the usual involution, or decrease in size, which naturally takes place within one month after a child is born.... subinvolution

Submucosa

The layer of CONNECTIVE TISSUE that occurs under a MUCOUS MEMBRANE – for example, in the intestinal wall.... submucosa

Succus Entericus

Intestinal Juice. These are enzyme-rich secretions produced by the lining of the upper small intestines. Apparently the enzymes produced compensate for any pancreatic enzymes that are deficient for that particular meal.... succus entericus

Succussion

See THRILL. A clinical technique in which a patient suspected of having excessive ?uid in a body cavity – usually the stomach or pleural cavity – is gently shaken in order to elicit splashing sounds.... succussion

Sucrose

Cane sugar.... sucrose

Sulcus

The term applied to any groove or furrow, but especially to a ?ssure of the BRAIN.... sulcus

Sulfadiazine

A highly active drug which in moderate dosage produces a high and persistent blood concentration. It is relatively non-toxic and is sometimes used to prevent the recurrence of RHEUMATIC FEVER.... sulfadiazine

Sulfamethoxazole

has been used in combination with TRIMETHOPRIM (as co-trimoxazole) to treat infections of the URINARY TRACT. Increasing bacterial resistance to sulphonamides and the incidence of side-effects means that caution is needed in prescribing co-trimoxazole.... sulfamethoxazole

Super

A pre?x signifying above, or implying excess.... super

Supine

Lying on the back, face upwards; or the position of the forearm where the hand lies face upwards.... supine

Suppression

(1) The stopping of any physiological activity.

(2) A psychological defence mechanism by which an individual intentionally refuses to acknowledge an idea or memory that he or she ?nds distasteful or unpleasant.

(3) A treatment that stops the visible signs of an illness or holds back its usual progress.... suppression

Supra

A pre?x signifying above or upon.... supra

Swan-ganz Catheter

(See also CATHETERS.) A ?exible tube with a double lumen and a small balloon at its distal end. It is introduced into a vein in the arm and advanced until the end of the catheter is in the right atrium (see HEART). The balloon is then in?ated with air through one lumen and this enables the bloodstream to propel the catheter through the right ventricle to the pulmonary artery. The balloon is de?ated and the catheter can then record the pulmonary artery pressure. When the balloon is in?ated, the tip is isolated from the pulmonary artery and measures the left atrial pressure. These measurements are important in the management of patients with circulatory failure, as under these circumstances the central venous pressure or the right atrial pressure is an unreliable guide to ?uid-replacement.... swan-ganz catheter

Sweat

See PERSPIRATION.... sweat

Sweat Glands

See SKIN.... sweat glands

Sycosis Barbae

(Barber’s itch.) A chronic staphylococcal folliculitis (infection of the hair follicles with staphylococci bacteria – see STAPHYLOCOCCUS) of the beard area in males, causing a papulopustular in?ammation clearly centred on hair follicles. It must be distinguished from RINGWORM infection of the face and hair follicles (tinea barbae) and from pseudo-folliculitis due to ingrowing hairs. Topical and oral antistaphyloccoccal antibiotics are e?ective.... sycosis barbae

Sympathetic

A division of the autonomic or involuntary nervous system that works in general opposition to the parasympathetic division (q.v.). Many of the sympathetic functions are local, specific, and involve secretion of acetylcholine, like any other of your normal nerves...stimulating or suppressing a specific muscle, gland, or whatever. A certain number of these nerves, however, unlike any others in the body, secrete epinephrine (adrenalin) and norepinephrine (noradrenalin). These are called adrenergic. Since the adrenal medulla also secretes the same substances into the bloodstream as hormones, all the muscles or glands that are affected by the adrenergic sympathetic nerves also react in toto to the epinephrine secreted into the blood. This forms the basis for a potentially lifesaving emergency fight or flight response and is meant for short, drastic activities. A chronic excess of the adrenergic response, however, is a major cause of stress-and a major contributor to many types of chronic disease. The more you use a particular nerve pathway or induce a particular group of functions, the more blood, fuel storage, and mitochondria are produced to strengthen that group of actions. Using adrenergic energy excessively gives literal dominance to those things that are stimulated or suppressed, and the effects of adrenalin stress linger in the body after the adrenalin is long gone. Since one of the first subjective symptoms of subclinical malnutrition, metabolic imbalances, and environmental pollution is irritability of the central nervous system, hypersympathetic function acts as an intermediate between poor diet, pollution, and disease.... sympathetic

Sympathomimetic

A substance that mimics at least part of adrenalin or catecholamine responses. The term is a little biased towards the minority of sympathetic functions that are adrenergic. A better name might be adrenalomimetic, epinephromimetic, catecholamimetic...or speedomimetic. Examples: coffee, ephedrine, amphetamines.... sympathomimetic

Synergist

(1) A muscle that works in concert with an AGONIST muscle to perform a certain movement.

(2) An agent, for example a drug, that acts with another to produce a result that is greater than adding together the separate effects of the two agents. Synergism in drug treatment may be bene?cial, as in the case of combined LEVODOPA and SELEGILINE, a selective monoamine oxidase inhibitor (see MONOAMINE OXIDASE INHIBITORS (MAOIS), in the treatment of PARKINSONISM. It may be potentially dangerous, however, as when MAOIs boost the effects of BARBITURATES.... synergist

Synostosis

The term applied to a union by bony material of adjacent bones which are normally separate.... synostosis

Synovial Membrane

This forms the lining of the soft parts that enclose the cavity of a joint. (See JOINTS.)... synovial membrane

Systemic Lupus Erythematosus (sle)

See separate dictionary entry.... systemic lupus erythematosus (sle)

Systolic Pressure

See BLOOD PRESSURE.... systolic pressure

Tay Sachs Disease

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

Thumb-sucking

Also called ?nger-sucking, this is a universal and harmless habit in infancy. It is usually given up gradually during the pre-school period, but quite often persists after school age – especially if the child is tired, lonely or unhappy. In these cases the remedy is to deal with the cause. It is cruel to use threats or punishment to try to stop the habit.... thumb-sucking

Tricuspid Stenosis

The normal working of the TRICUSPID VALVE in the HEART is impeded by a narrowing of the opening, often as a sequel of RHEUMATIC FEVER. As with TRICUSPID INCOMPETENCE, heart failure may result and treatment is similar, with surgery to repair or replace the faulty valve an option.... tricuspid stenosis

Vital Sign

An indication that an individual is still alive. Chest movements (resulting from respiration), the existence of a pulse (showing that the heart is still beating) and constriction of the pupil of the eye in response to bright light are all vital signs. Other tests such as assessment of brain activity may also be needed in some circumstances: for example, when a patient is on a life-support machine. (See also GLASGOW COMA SCALE.)... vital sign

Vital Signs

The pulse, respiration, temperature and blood pressure.... vital signs

Vital Statistics

Systematically tabulated information concerning births, marriages, divorces, separations and deaths, based on registrations of those vital events.... vital statistics

Withdrawal Symptoms

Unpleasant physical and mental symptoms that occur when a person stops using a drug or substance on which he or she is dependent (see DEPENDENCE). The symptoms include tremors, sweating, and vomiting which are reversed if further doses are given. Alcohol and hard drugs, such as morphine, heroin, and cocaine, are among the substances that induce dependence, and therefore withdrawal symptoms, when stopped. Amphetamines and nicotine are other examples.... withdrawal symptoms

Wood Sorrel

Oxalis species

Description: Wood sorrel resembles shamrock or four-leaf clover, with a bell-shaped pink, yellow, or white flower.

Habitat and Distribution: Wood sorrel is found in Temperate Zones worldwide, in lawns, open areas, and sunny woods.

Edible Parts: Cook the entire plant.

CAUTION

Eat only small amounts of this plant as it contains a fairly high concentration of oxalic acid that can be harmful.... wood sorrel

Yerba Santa

Eriodictyon glutinosum. (Eriodictyon californicum). Synonym: Bearsweed, Mountain Balm.

Habitat: Grown in, and imported from, California. Features ? Leaves elliptic-lanceolate, serrate, about three inches by one inch, shiny above, white down underneath. Taste and odour, aromatic. Part used ? Leaves.

Action: Expectorant, tonic. In catarrhal affections of the respiratory organs. Often a constituent of asthma prescriptions.... yerba santa

Zollinger-ellison Syndrome

A rare disorder in which severe peptic ulcers recur in the stomach and duodenum (see DUODENAL ULCER; STOMACH, DISEASES OF). It is caused by a tumour in the PANCREAS that produces a hormone, GASTRIN, which stimulates the stomach and duodenum to produce excess acid: this causes ulceration. Treatment is by surgery.... zollinger-ellison syndrome

Age Spots

Liver spots. Pigment defects.

External: Aloe Vera juice or gel. Comfrey paste: Mix a little powder and water. ... age spots

Air Swallowing

Aerophagia. Swallowing mouthfuls of air. Usually associated with indigestion. Treatment. Carminatives, antacids.

Teas: any one: Aniseed, Balm, Caraway seeds, Cardamom seeds, Cinnamon bark, Fennel seeds, Dill seeds, Parsley. 1 teaspoon to each cup boiling water; infuse 5-15 minutes; dose half-1 cup freely.

Ginger: powder, crystallised or tincture. Horseradish sauce. Few grains Cayenne pepper. Oil Peppermint: 1-2 drops in honey. ... air swallowing

Anaphylactic Shock

See: SERUM SICKNESS. ... anaphylactic shock

Bamboo Spine

See: ANKYLOSING SPONDYLITIS. ... bamboo spine

Cardiogenic Shock

The result of myocardial infarction. Reduction in contractility and output of the heart.

Symptoms: low blood pressure, reduced urinary output, water in the lungs, etc. See: MYOCARDITIS. ... cardiogenic shock

Osgood Schlatter Disease

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

Asperger’s Syndrome

A rare developmental disorder that is usually first recognized in childhood because of difficulties with social interactions, stilted speech, and very specialized interests.

Intelligence is normal or high.

Asperger’s syndrome is considered to be an autistic spectrum disorder and is also known as pervasive developmental disorder.

Special educational support may be needed, often within mainstream education.

The condition is lifelong.... asperger’s syndrome

Behçet’s Syndrome

A rare, multisystem disorder with recurrent mouth ulcers and genital ulcers and inflammation of the eyes, skin joints, blood vessels, brain, and intestines. The cause of Behçet’s syndrome is unknown, but it is strongly associated with a genetically determined histocompatability antigen, -B51. Treatment is difficult and may require corticosteroid and immunosuppressant drugs. The condition often becomes long-term.... behçet’s syndrome

Blind Spot

The small, oval-shaped area on the retina of the eye where the optic nerve leaves the eyeball.

The area is not sensitive to light because it has no light receptors (nerve endings responsive to light).

The blind spot can also be used to describe the part of the visual field in which objects cannot be detected.... blind spot

Carcinoid Syndrome

Flushing of the face and neck caused by an active malignant tumour in the stomach or intestines with secondary growths in the liver. Often accompanied by an explosive diarrhoea. The lesion is usually found in the ileum yet it may also appear in the bile duct, ovaries or bronchi. Other symptoms include low blood pressure, drastic reduction in weight due to loss of body fluids.

Symptoms: flushing of face and neck, diarrhoea, low blood pressure, weight loss.

Treatment: relief of symptoms only. Diarrhoea – Fenugreek seed tea. Flushing: Chamomile tea.

Vitamin and Mineral Supplementation: Because of severe drain on these food elements Multivitamins should be taken daily together with additional 1000ius Vitamin E for the disturbed circulatory system. The heart should be sustained with a preparation of the Hawthorn berry.

To be treated by or in liaison with a qualified medical practitioner. ... carcinoid syndrome

Blood Sugar

See blood glucose.... blood sugar

Cavernous Sinus Thrombosis

Thrombosis arising in the cavernous sinus of the sphenoid bone in the head.

Cause: Septicaemia or infected embolism conveyed from elsewhere – veins of the face, sinuses, head. May be a complication of meningitis.

Symptoms: headache, nausea, swelling of eyelids and forehead, pupils distended, veins of temples prominent, fever with severe constitutional disturbance.

Prognosis: usually fatal in the absence of orthodox antibiotics, but anti-staphylococcal herbs are helpful. Tinctures. Formula. Echinacea 3; Goldenseal 2; Myrrh (Tincture) 1. 1 teaspoon in water every 2 hours (acute). Thrice daily (chronic).

Treatment by or in liaison with general medical practitioner. ... cavernous sinus thrombosis

Celery Seed

Apium graveolens, L. French: Ache. German: Sellerie. Spanish: Apio. Italian: Sedano. Indian: Chanoo Rhadodni. Chinese: Han-ch’in. Dried seeds.

Contains apiol, coumarins. Minerals: iron, phosphorus, potassium, sodium.

Action: alkaline reaction on the blood. Antirheumatic, urinary antiseptic, diuretic, antispasmodic, carminative, tonic digestive, galactagogue, assists elimination of uric acid. Anti-gout, anti-inflammatory, hypotensor, aphrodisiac.

Uses: Rheumatic disorders, stiffness and muscular pain, rheumatoid arthritis. Inflammation of the urinary tract, cystitis. To increase milk flow in nursing mothers. Bad breath.

Preparations: Thrice daily.

Green Drink: fresh raw celery juice prepared in a liquidiser. Blends well with carrot or apple juice. Cooling drink for a sickroom.

Decoction. Quarter to half a teaspoon bruised dry seeds to each cup water, gently simmer 10 minutes in covered vessel. Half-1 cup.

Liquid extract, BHC Vol 1. 1:1, 90 per cent ethanol. Dose: 0.5 to 2ml.

Tincture, BHC Vol 1. 1:5, 90 per cent ethanol. Dose: 2 to 8ml.

Tablets/capsules. Powdered plant 120mg; seed BHP (1983) 5mg.

Home acid tincture. 1 part bruised celery seed to 20 parts Cider vinegar. Macerate 1 month. Filter. Dose: 2-3 teaspoons in water (rheumatic aches and pains).

Essential oil: 1-2 drops in water or honey.

Diet: The vegetable is low in calories: for weight-conscious. Non-fattening.

Not taken in pregnancy.

CELL PROLIFERANTS. Comfrey, Fenugreek, Calendula. ... celery seed

Café Au Lait Spots

Patches of coffeecoloured skin that may occur anywhere on the body.

Café au lait spots are usually oval in shape and may measure several centimetres across.

Generally, a few spots are not significant; larger numbers may be a sign of neurofibromatosis.... café au lait spots

Compartment Syndrome

A painful cramp due to compression of a group of muscles within a confined space. It may occur when muscles are enlarged due to intensive training or injury such as shin splints. Cramps induced by exercise usually disappear when exercise is stopped. Severe cases may require fasciotomy to improve blood flow and prevent development of a permanent contracture.... compartment syndrome

Glands – Swollen

Lymphadenitis. Non-infectious. Can be localised, e.g. armpit only, due to lymphatic drainage of a local inflammation or generalised due to systemic infection (AIDS) or some malignant conditions.

Symptoms. Swelling of glands of armpit, neck and groin.

Alternatives. Tea: combine equal parts: Clivers, Red Clover, Gotu Kola. 2 teaspoons to each cup boiling water; infuse 15 minutes. Dose: half-1 cup thrice daily.

Decoction. Formula. Equal parts, Yellow Dock, Plantain, Clivers, Liquorice root, 1oz to 1 pint water gently simmered 20 minutes. Half a cup thrice daily.

Powders. Formula. Bayberry 1; Echinacea 2; Poke root half; a trace of Cayenne. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Combine equal parts: Poke root and Echinacea. One 5ml teaspoon in water thrice daily.

Poke root. A leading remedy for the condition.

Agnus Castus. Swollen glands in young girls.

Dr Finlay Ellingwood: Liquid Extracts: equal parts, Blue Flag root and Poke root. 30-60 drops in water thrice daily.

Diet. See: DIET – GENERAL. See: LYMPHATICS. ... glands – swollen

Conn’s Syndrome

A disorder caused by the secretion of excessive amounts of the hormone aldosterone by a noncancerous tumour of one of the adrenal glands. (See also aldosteronism.)... conn’s syndrome

Cri Du Chat Syndrome

A rare, congenital condition of severe mental handicap, abnormal facial appearance, low birth weight, and short stature, which is characterized by a cat-like cry in infancy. The syndrome is caused by a chromosomal abnormality. There is no treatment. (See also genetic counselling.)... cri du chat syndrome

Oesophageal Spasm

Constriction of the gullet and throat. Sense of rising pressure from chest to jaw that can simulate early heart attack.

Causes: emotional tension, hiatus hernia, food allergy and the damaging potential of hot drinks. Alternatives. Acute case: Cramp bark. German Chamomile tea, freely. Phytomedicines for chronic condition or as preventatives: Passion flower, Skullcap, Wild Yam, Lobelia, Mistletoe, Valerian. Formula. Cramp bark 2; Chamomile 1; Peppermint 1. Dose – Liquid extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon) 3 or more times daily.

Milk. Drink whole glass cold milk, with or without 1 drop oil Peppermint, immediately on onset of pain. May relieve spasms in seconds. ... oesophageal spasm

Dry Socket

Infection at the site of a recent tooth extraction, causing pain, bad breath, and an unpleasant taste. Dry socket occurs when a blood clot fails to form in the tooth socket after a difficult extraction, such as removal of a wisdom tooth (see impaction, dental). Sometimes, the clot itself becomes infected, or infection may already have been present before extraction. The inflamed socket appears dry, and exposed bone is often visible. The socket is irrigated to remove debris and may then be coated with an antiinflammatory paste. The infection usually begins to clear up within a few days.... dry socket

Oesophageal Stricture

An abnormal narrowing of the (lower) gullet.

Causes: injury, scarring by chemical medicines, drugs swallowed with insufficient water, antacids for heartburn, piping-hot tea. It is important to exclude oesophageal cancer.

Those with ‘gullet-reflex’ such as the elderly, are at risk. A relationship exists between toothlessness and this condition. Eating of soft fibreless foods does not expand the tube down which food passes. Alternatives. Horsetail, Irish Moss. Echinacea. Marshmallow. Goldenseal. Sarsaparilla. Calendula (Marigold), Chamomile.

Tea. Formula – equal parts, Horsetail, Chamomile, Marshmallow. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 1 cup thrice daily.

Tablets/capsules. Echinacea, Goldenseal, Sarsaparilla, Chamomile.

Formula. Irish Moss 1; Comfrey 1; Calendula half; Goldenseal quarter. Dose – Liquid extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon) in water before meals.

Diet. High fibre. Raw carrots with prolonged mastication. Hot drinks are potentially damaging. ... oesophageal stricture

Chorionic Villus Sampling

A method of diagnosing genetic abnormalities in a fetus using a small sample of tissue taken from the chorionic villi at edge of the placenta. Because the cells have the same chromosome makeup as those in the fetus, they can be used to detect genetic abnormalities. Chorionic villus sampling (CVS) is usually performed in the first 3 months of pregnancy in women who are at a higher-than-normal risk of having a child with a chromosomal disorder, such as Down’s syndrome, or a genetic disease, such as thalassaemia. Chromosome analysis of the villi cells takes place in the laboratory. CVS slightly increases the risk of miscarriage. choroid A layer of tissue at the back of the eye, behind the retina. The choroid contains many blood vessels that supply nutrients and oxygen to the retinal cells and to surrounding tissues in the eye. choroiditis Inflammation of the choroid. It is often caused by infections such as toxocariasis or toxoplasmosis, more rarely by sarcoidosis, syphilis, and histoplasmosis. It sometimes has no obvious cause. Treatment includes corticosteroid drugs for the inflammation, and antibiotic drugs for any causative infection.... chorionic villus sampling

Circulatory System

The heart and blood vessels, which together maintain a continuous flow of blood throughout the body. The system provides tissues with oxygen and nutrients, and carries away waste products. The circulatory system consists of 2 main parts: the systemic circulation, which supplies blood to the whole body apart from the lungs; and the pulmonary circulation to the lungs. Within the systemic circulation, there is a bypass (the portal circulation), which carries nutrient-rich blood from the stomach, intestine, and other digestive organs to the liver for processing, storage, or re-entry into general circulation.

In the systemic circulation, oxygen-rich blood from the pulmonary circulation is pumped under high pressure from the left ventricle of the heart into the aorta, from where it travels through arteries and smaller arterioles to all parts of the body. Within body tissues, the arterioles branch into networks of fine blood vessels called capillaries. Oxygen and other nutrients pass from the blood through the capillaries’ thin walls into body tissues; carbon dioxide and other wastes pass in the opposite direction. Deoxygenated blood is returned to the heart via venules, veins, and the venae cavae.

Venous blood returns to the right atrium of the heart to enter the pulmonary circulation. It is pumped from the right ventricle through the pulmonary artery

to the lungs, where carbon dioxide is exchanged for oxygen. The reoxygenated blood then returns through the pulmonary veins to the heart and re-enters the systemic circulation.... circulatory system

Decompression Sickness

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

Fanconi’s Syndrome

A rare kidney disorder that occurs most commonly in childhood. Various important chemicals, such as amino acids, phosphate, calcium, and potassium, are lost in the urine, leading to failure to thrive, stunting of growth, and bone disorders such as rickets. Possible causes of the syndrome include several rare inherited abnormalities of body chemistry and an adverse reaction to certain drugs.

The child may resume normal growth if an underlying chemical abnormality can be corrected. Alternatively, a kidney transplant may be possible.... fanconi’s syndrome

Ferrous Sulphate

Another name for iron sulphate (see iron).... ferrous sulphate

Ewing’s Sarcoma

A rare malignant form of bone cancer. It arises in a large bone, usually the femur, tibia, humerus, or a pelvic bone, and spreads to other areas at an early stage. The condition is most common in children aged 10–15. An affected bone is painful and tender. It may also become weakened and fracture easily. Other symptoms include weight loss, fever, and anaemia.

The sarcoma is diagnosed by X-rays and a biopsy.

If cancer is found, the whole skeleton is examined by X-rays and radionuclide scanning, and the lungs viewed by CT scanning, to determine if, and how far, the cancer has spread.

Treatment is with radiotherapy and anticancer drugs.

If the cancer has not spread, the outlook is good.... ewing’s sarcoma

Fragile X Syndrome

An inherited defect of the X chromosome that causes learning difficulties.

The disorder occurs within families according to an X-linked recessive pattern of inheritance (see genetic disorders).

Although mainly males are affected, women can become carriers of the genetic defect.

In addition to having learning difficulties, affected males tend to be tall and physically strong, with large testes, a prominent nose and jaw, increased ear length, and are prone to epileptic seizures.

About a third of female carriers show some intellectual impairment.

The condition cannot be treated.... fragile x syndrome

Ganser’s Syndrome

A rare factitious disorder in which a person seeks, consciously or unconsciously, to mislead others about his or her mental state and may simulate symptoms of psychosis.... ganser’s syndrome

Gilles De La Tourette’s Syndrome

A rare, inherited neurological disorder.

It starts in childhood with repetitive grimaces and tics.

Involuntary barks, grunts, or other noises may appear as the disease progresses.

In some cases, the sufferer has episodes of issuing foul language.

The syndrome is more common in males.

It is usually of lifelong duration, but antipsychotic drugs can help in some cases.... gilles de la tourette’s syndrome

Goodpasture’s Syndrome

A rare autoimmune disorder causing inflammation of the glomeruli in the kidney (see glomerulus) and the alveoli in the lungs, and anaemia. It is a serious disease; unless treated early it may lead to lifethreatening bleeding into the lungs and progressive kidney failure. The disease is most common in young men, but can develop at any age and in women. Sometimes, it responds to treatment with immunosuppressant drugs and plasmapheresis. People who have severe or repeated attacks require dialysis and, eventually, a kidney transplant.... goodpasture’s syndrome

Hidradenitis Suppurativa

Inflammation of the sweat glands in the armpits and groin due to a bacterial infection.

Abscesses develop beneath the skin, which becomes reddened and painful and may ooze pus.

The condition tends to be recurrent and can eventually cause scarring in the affected areas.

Antibiotic drugs may help to reduce the severity of an outbreak.... hidradenitis suppurativa

Horner’s Syndrome

A group of physical signs (narrowing of the eye pupil, drooping of the eyelid, and absence of sweating) affecting 1 side of the face that indicates damage to part of the sympathetic nervous system (see autonomic nervous system).... horner’s syndrome

Hurler’s Syndrome

A rare, inherited condition caused by an enzyme defect. The syndrome is a type of inborn error of metabolism (see metabolism, inborn errors of) in which there is an abnormal accumulation of substances known as mucopolysaccharides in the tissues.

Affected children may appear normal at birth but, at 6–12 months of age, they develop cardiac abnormalities, umbilical hernia, skeletal deformities, and enlargement of the tongue, liver, and spleen.

Growth is limited and mental development slows.

If the condition is diagnosed in early infancy, a bone marrow transplant may be curative.... hurler’s syndrome

Klinefelter’s Syndrome

A chromosomal abnormality in which a male has 1, or occasionally more, extra X chromosomes in his cells, giving a complement of instead of. The risk of a baby having the condition increases with maternal age. Features of the syndrome vary in severity and may not become apparent until puberty, when gynaecomastia (breast enlargement) occurs and the testes remain small. Affected males are usually infertile (see infertility). They tend to be tall and thin with a female body shape and absence of body hair. Incidence of learning difficulties is higher in people with Klinefelter’s syndrome than in the general population. There is no cure for the disorder, but hormonal treatment can induce secondary sexual characteristics, and mastectomy may be used to treat gynaecomastia.... klinefelter’s syndrome

Koplik’s Spots

Tiny, grey-white spots that appear in the mouth during the incubation period of measles.... koplik’s spots

Magnesium Sulphate

A magnesium compound used as a laxative drug and an anticonvulsant drug.... magnesium sulphate

Minimally Invasive Surgery

Surgery using a rigid endoscope passed into the body through a small incision. Further small openings are made for surgical instruments so that the operation can be performed without a long surgical incision. Minimally invasive surgery may be used for many operations in the abdomen (see laparoscopy), including appendicectomy, cholecystectomy, hernia repair, and many gynaecological procedures. Knee operations (see arthroscopy) are also often performed by minimally invasive surgery.... minimally invasive surgery

Munchausen’s Syndrome

A chronic factitious disorder in which the sufferer complains of physical symptoms that are pretended or self-induced in order to play the role of patient. Most afflicted people are repeatedly hospitalized.

The usual complaints are abdominal pain, bleeding, neurological symptoms, rashes, and fever. Sufferers typically invent dramatic histories and behave disruptively in hospital. Many have detailed medical knowledge and scars from self-injury or previous treatment. In Munchausen’s syndrome by proxy, parents cause factitious disorders in their children.

Treatment consists of protecting sufferers from unnecessary operations and drug treatments.... munchausen’s syndrome

Nelson’s Syndrome

A rare disorder of the endocrine system that causes increased skin pigmentation. Nelson’s syndrome results from enlargement of the pituitary gland, which can follow removal of the adrenal glands (a treatment for Cushing’s syndrome).

Nelson’s syndrome is treated by hypophysectomy (removal or destruction of the pituitary gland).... nelson’s syndrome

Orthognathic Surgery

An operation to correct deformity of the jaw and the severe malocclusion that is invariably associated with it. The bones of the jaw are repositioned under general anaesthesia, and often require splinting (see splinting, dental) until they heal.... orthognathic surgery

Persistent Vegetative State

Long-term unconsciousness caused by damage to areas of the brain that control higher mental functions. The eyes may open and close, and there may be random movements of the limbs, but there is no response to stimuli such as pain. Basic functions such as breathing and heartbeat are not affected. There is no treatment to reverse the situation, but, with good nursing care, survival for months or years is possible.... persistent vegetative state

Post-traumatic Stress Disorder

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

Reiter’s Syndrome

A condition in which there is a combination of urethritis, reactive arthritis, and conjunctivitis. There may also be uveitis. Reiter’s syndrome is more common in men.

The syndrome is caused by an immune response and usually develops only in people with a genetic predisposition. Most patients have the -B27 tissue type (see histocompatability antigens). The syndrome’s development is induced by infection: usually nongonococcal urethritis, but sometimes bacillary dysentery. Reiter’s syndrome usually starts with a urethral discharge, which is followed by conjunctivitis and then arthritis. The arthritis usually affects 1 or 2 joints (usually the knee and/or ankle) and is often associated with fever and malaise. Attacks can last for several months. Tendons, ligaments, and tissue in the soles of the feet may also become inflamed. Skin rashes are common.

Diagnosis is made from the symptoms.

Analgesic drugs and nonsteroidal antiinflammatory drugs relieve symptoms but may have to be taken for a long period.

Relapses occur in about 1 in 3 cases.... reiter’s syndrome

Repetitive Strain Injury

(RSI) An overuse injury that affects keyboard workers and musicians, causing weakness and pain in the wrists and fingers.... repetitive strain injury

Rett’s Syndrome

A brain disorder, thought to be a genetic disorder, that only affects girls. Symptoms usually occur when the child is 12–18 months old. Acquired skills, such as walking and communication skills, disappear and the girl becomes progressively handicapped, perhaps with signs of autism. There are repetitive writhing movements of the hands and limbs, and inappropriate outbursts of crying or laughter. There is no cure for Rett’s syndrome and sufferers need constant care and attention. Parents of an affected child should receive genetic counselling.... rett’s syndrome

Sacralization

Fusion of the 5th (lowest) lumbar vertebra with the upper sacrum.

It may be present at birth, in which there are usually no symptoms.

Surgery may be performed to treat a disc prolapse or spondylolisthesis.

(See also spinal fusion.)... sacralization

Sacroiliitis

Inflammation of a sacroiliac joint. Causes include ankylosing spondylitis, rheumatoid arthritis, Reiter’s syndrome or arthritis associated with psoriasis. The main symptom is pain in the lower back, buttocks, groin, and back of the thigh. Treatment is with nonsteroidal antiinflammatory drugs.... sacroiliitis

Reye’s Syndrome

A rare disorder in which brain and liver damage follow a viral infection. Children over 15 are rarely affected. The cause is unknown, but aspirin seems to be a predisposing factor to developing the condition and is therefore not recommended for children.

The disorder starts as the child recovers from the infection. Symptoms include uncontrollable vomiting, lethargy, memory loss, and disorientation. Swelling of the brain may cause seizures, disturbances in heart rhythm, coma, and cessation of breathing.

Brain swelling may be controlled by corticosteroid drugs and by intravenous infusions of mannitol. Dialysis or blood transfusions may be needed. If breathing stops, a ventilator is used.

The death rate is around 10 per cent, and higher for those who have seizures, lapse into deep coma, and stop breathing.

Permanent brain damage may occur.... reye’s syndrome

Salmeterol

A bronchodilator drug used in the treatment of asthma. The drug is usually inhaled twice a day to prevent asthma attacks. Side effects may include slight tremor, agitation, insomnia, and, rarely, a rapid heartbeat.... salmeterol

Salmon Patch

See stork mark.... salmon patch

Salpingectomy

Surgical removal of one or both fallopian tubes.

Salpingectomy may be performed if the tube is infected (see salpingitis) or to treat ectopic pregnancy.

(See also salpingo-oophorectomy.)... salpingectomy

Saphenous Vein

A major vein that runs the length of the leg just under the skin.

It is sometimes removed and used to bypass a blockage in blood vessels of the heart (see coronary artery bypass).... saphenous vein

Scan

An image produced by one of several scanning techniques.... scan

Scarlatina

Another name for scarlet fever.... scarlatina

Sciatic Nerve

The main nerve in each leg and the largest nerve in the body.The sciatic nerves are formed from nerve roots in the spinal cord.... sciatic nerve

Scirrhous

A term that means hard and fibrous and is usually applied to malignant tumours containing dense, fibrous tissue.... scirrhous

Scleromalacia

Softening of the sclera, commonly a complication of scleritis, especially scleritis of rheumatoid arthritis.... scleromalacia

Seasickness

A type of motion sickness.... seasickness

Selenium

A trace element that may help to preserve the elasticity of body tissues.

The richest sources are meat, fish, whole grains, and dairy products.... selenium

Sensitization

The initial exposure of a person to an allergen or other substance recognized as foreign by the immune system, which leads to an immune response. On subsequent exposures to the same substance, there is a much stronger and faster immune reaction. This forms the basis of allergy and other types of hypersensitivity reaction.... sensitization

Separation Anxiety

The feelings of distress a young child experiences when parted from his or her parents or home. This is a normal aspect of infant behaviour and usually diminishes by age 3 or 4.

In separation anxiety disorder, the reaction to separation is greater than that expected for the child’s level of development.

The anxiety may manifest as physical symptoms.

Separation anxiety disorder may be a feature of depression.... separation anxiety

Sequela

A condition that results from or follows a disease, disorder, or injury.

The term is usually used in plural (sequelae) to refer to the complications of a disease.... sequela

Sequestration

A portion of diseased or dead tissue separated from, or joined abnormally to, surrounding healthy tissue.... sequestration

Serology

A branch of laboratory medicine concerned with analysis of blood serum.

Applications of serological techniques include the diagnosis of infectious diseases by the identification of antibodies, the development of antiserum preparations for passive immunization, and the determination of blood groups in paternity testing and forensic investigations.... serology

Sertraline

A selective serotonin reuptake inhibitor drug used in the treatment of depression (see antidepressants).... sertraline

Sézary Syndrome

A rare condition in which there is an abnormal overgrowth of lymphocytes in the skin, liver, spleen, and lymph nodes. It mainly affects middleaged and elderly people. The first symptom is the appearance of red, scaly patches on the skin that spread to form an itchy, flaking rash. There may also be accumulation of fluid under the skin, baldness, and distorted nail growth. Sézary syndrome is sometimes associated with leukaemia. Treatment includes anticancer drugs and radiotherapy.... sézary syndrome

Siadh

The abbreviation for syndrome of inappropriate antidiuretic hormone (secretion), associated with certain lung or brain disorders and some types of cancer.... siadh

Sievert

A unit for measuring doses of ionizing radiation.

(See radiation units).... sievert

Sigmoid Colon

The S-shaped part of the colon, in the lower abdomen, extending from the brim of the pelvis, usually down to the 3rd segment of the sacrum. It is connected to the descending colon above, and the rectum below.... sigmoid colon

Sildenafil

Commonly known by its brand name Viagra, a drug used in the treatment of impotence. Because of the risk of potentially serious side effects in certain people, the drug must only be used on medical advice.... sildenafil

Sinew

A nonmedical term for a tendon.... sinew

Sjögren’s Syndrome

A condition in which the eyes and mouth are excessively dry.

The nasal cavity, throat, and vagina may also be affected.

The syndrome tends to occur with certain autoimmune disorders, such as rheumatoid arthritis and systemic lupus erythematosus.

Most sufferers are middle-aged women.... sjögren’s syndrome

Skin Graft

A technique used to repair areas of lost or damaged skin that are too large to heal naturally, that are slow

to heal, or that would leave tethering or unsightly scars. A skin graft is often used in the treatment of burns or sometimes for nonhealing ulcers. A piece of healthy skin is detached from one part of the body and transferred to the affected area. New skin cells grow from the graft and cover the damaged area. In a meshed graft, donor skin is removed and made into a mesh by cutting. The mesh is stretched to fit the recipient site; new skin cells grow to fill the spaces in the mesh. In a pinch graft, multiple small areas of skin are pinched up and removed from the donor site. Placed on the recipient site, they gradually expand to form a new sheet of healthy skin. (See also skin flap.)... skin graft

Sleep Apnoea

A disorder in which there are episodes of temporary cessation of breathing (lasting 10 seconds or longer) during sleep.

People with sleep apnoea may not be aware of any problem during the night, but they may be sleepy during the day, with poor memory and concentration. Severe sleep apnoea is potentially serious and may lead to hypertension, heart failure, myocardial infarction, or stroke.

Obstructive sleep apnoea is the most common type and may affect anyone, but more often middle-aged men, especially those who are overweight. The most common cause is over-relaxation of the muscles of the soft palate in the pharynx, which obstructs the passage of air. Obstruction may also be caused by enlarged tonsils or adenoids. The obstruction causes snoring. If complete blockage occurs, breathing stops. This triggers the brain to restart breathing, and the person may gasp and wake briefly.

In central sleep apnoea, breathing stops because the chest and diaphragm muscles temporarily cease to work, probably due to a disturbance in the brain’s control of breathing. Causes include paralysis of the diaphragm and disorders of the brainstem. Snoring is not a main feature.People who are overweight may find losing weight helps.

Alcohol and sleeping drugs aggravate sleep apnoea.

In one treatment, air from a compressor is forced into the airway via a mask worn over the nose.

Night-time artificial ventilation may be needed.

Tonsillectomy, adenoidectomy, or surgery to shorten or stiffen the soft palate may be performed.... sleep apnoea

Sleep Paralysis

The sensation of being unable to move at the moment of going to sleep or when waking up, usually lasting only a few seconds. It may be accompanied by hallucinations. Sleep paralysis most often occurs in people with narcolepsy. (See also cataplexy.)... sleep paralysis

Slit-lamp

An illuminated type of microscope that is used to examine the internal structures of the front

part of the eye and of the retina at the back. (See also eye, examination of.)... slit-lamp

Smear

A specimen for microscopic examination prepared by spreading a thin film of cells on to a glass slide.... smear

Snuffles

A general term for nasal obstruction, especially in infants suffering from an upper respiratory tract infection.... snuffles

Sodium Bicarbonate

An over-thecounter antacid drug used to relieve indigestion, heartburn, and pain caused by a peptic ulcer.

It often causes belching and abdominal discomfort.

Long-term use may cause swollen ankles, muscle cramps, tiredness, and nausea.... sodium bicarbonate

Sodium Cromoglicate

A drug given by inhaler to control mild asthma in children and allergic or exercise-induced asthma in adults; as a nasal spray to treat allergic rhinitis; in eye-drops for allergic conjunctivitis; and orally for food allergy.

Side effects include coughing and throat irritation on inhalation.... sodium cromoglicate

Spasticity

Increased rigidity in a group of muscles, causing stiffness and restriction of movement. Spasticity occurs in Parkinson’s disease, multiple sclerosis, cerebral palsy, and tetanus.... spasticity

Spastic Paralysis

Inability to move a part of the body, accompanied by rigidity of the muscles. Causes of spastic paralysis include stroke, cerebral palsy, and multiple sclerosis. (See also paralysis.)... spastic paralysis

Specific Gravity

The ratio of the density of a substance to that of water.... specific gravity

Spermatocele

A harmless cyst of the epididymis containing fluid and sperm.... spermatocele

Sphincterotomy

A surgical procedure that involves cutting the muscle that closes a body opening or that constricts the opening between body passages.... sphincterotomy

Spider Naevus

A red, raised pinheadsized dot, from which small blood vessels radiate, due to a dilated minor artery and its connecting capillaries. Small numbers of spider naevi are common in children and pregnant women, but in larger numbers, they may indicate liver disease. (See also telangiectasia.)... spider naevus

Spina Bifida

A congenital defect that is a type of neural tube defect in which part of 1 or more vertebrae fails to develop completely. As a result, a portion of the spinal cord is left exposed.

spinal anaesthesia Injection of an anaesthetic into the cerebrospinal fluid in the spinal canal to block pain sensations before they reach the central nervous system. It is used mainly during surgery on the lower abdomen and legs.

(See also epidural anaesthesia.)... spina bifida

Spinal Nerves

A set of 31 pairs of nerves that connect to the spinal cord. Spinal nerves emerge in 2 rows from either side of the spinal cord and leave the spine through gaps between adjacent vertebrae. The nerves then branch out to supply all parts of the trunk, arms, and legs with sensory and motor nerve fibres.

Disc prolapse may lead to pressure on a spinal nerve, causing pain. Injury to a nerve may lead to loss of sensation or movement in the area supplied by the nerve. (See also nerve injury; neuropathy.)... spinal nerves

Splint

A device used to immobilize a part of the body.... splint

Splinter Haemorrhage

Bleeding under the fingernails visible as tiny splinterlike marks.

Usually due to trauma, it can also be a sign of infective endocarditis.... splinter haemorrhage

Spine

The column of bones and cartilage that extends from the base of the skull to the pelvis, enclosing the spinal cord and supporting the trunk and head. The spine is made up of 33 roughly cylindrical vertebrae. Each pair of adjacent vertebrae is connected by a facet joint, which stabilizes the vertebral column. Between each pair of vertebrae lies a disc-shaped pad of cartilage called an intervertebral disc (see disc, intervertebral). These discs cushion the vertebrae during movement. The vertebrae are bound together by 2 ligaments running the length of the spine and by smaller ligaments between each vertebra. Attached to the vertebrae are several groups of muscles, which control movement of, and help to support, the spine. spine, disorders of Many disorders of the spine cause back pain. Spina bifida is a congenital disorder in which part of the spinal cord is exposed. Sometimes, the spine is abnormally curved (see lordosis, kyphosis, scoliosis). In ankylosing spondylitis, and in some cases of rheumatoid arthritis, spinal joints are affected; osteoarthritis affects the spinal joints of most people over 60. Other disorders affecting the spine are spinal injuries; disc prolapse, and spondylolisthesis.... spine

Spondylolysis

A disorder of the spine in which the arch of the 5th (or, rarely, the 4th) lumbar vertebra consists of soft fibrous tissue instead of normal bone.

As a result, the arch is weak and prone to damage under stress, which may produce spondylolisthesis.

Otherwise, spondylolysis is usually symptomless.

See cervical spondylosis; cervical osteoarthritis.... spondylolysis

Sporotrichosis

A chronic infection caused by the fungus SPOROTHRIX SCHENCKII, which grows on plants.

The infection is most often contracted through a skin wound; gardeners are particularly vulnerable.

An ulcer develops at the site of the wound, followed by the formation of nodules in lymph channels around the site.

Potassium iodide solution taken orally usually clears up the infection.

Rarely, in people with reduced immunity, sporotrichosis spreads to other parts of the body and requires treatment with amphotericin, an antifungal drug.... sporotrichosis

Sprain

Tearing or stretching of the ligaments that hold together the bone ends in a joint, caused by a sudden pull. The ankle is the most commonly sprained joint. A sprain causes painful swelling of the joint, which cannot be moved without increasing the pain. There may also be spasm of surrounding muscles.

Treatment consists of applying an icepack, wrapping the joint in a bandage, resting it in a raised position, and taking analgesic drugs.

In severe cases, surgical repair may be necessary.... sprain

Stein-leventhal Syndrome

See ovary, polycystic.... stein-leventhal syndrome

Sterilization

The complete destruction or removal of living organisms, usually to prevent spread of infection; any procedure that renders a person infertile (see sterilization, female; vasectomy).... sterilization

Stimulus

Anything that directly results in a change in the activities of the body as a whole or of any individual part.... stimulus

Stool

Another word for faeces.... stool

Stress Fracture

A fracture that occurs as a result of repetitive jarring of a bone. Common sites include the metatarsal bones in the foot (see March fracture), the tibia or fibula, the neck of the femur, and the lumbar spine. The main symptoms are pain and tenderness at the fracture site. Diagnosis is by bone imaging. Treatment consists of resting the affected area for 4–6 weeks. The fracture may be immobilized in a cast.... stress fracture

Stria

Also called a stretch-mark, a line on the skin caused by thinning and loss of elasticity in the dermis. Striae first appear as red, raised lines. Later they become purple, eventually fading to shiny streaks.

Striae often develop on the hips and thighs during the adolescent growth spurt, especially in athletic girls. They are a common feature of pregnancy, occurring on the breasts, thighs, and lower abdomen. Purple striae are a characteristic feature of Cushing’s syndrome.

Striae are thought to be caused by an excess of corticosteroid hormones.

There is no means of prevention, but in some cases laser treatment may be used.... stria

Strontium

A metallic element occurring in various compounds in certain minerals, seawater, and marine plants.

A radioactive variety, strontium 90, is produced during nuclear reactions and may be present in nuclear fallout.

Strontium 90 accumulates in bone, where the radiation it emits may cause leukaemia and/or bone tumours.

Other forms of radioactive strontium have been used to diagnose and treat bone tumours.... strontium

Subclavian Steal Syndrome

Recurrent attacks of blurred or double vision, loss of coordination, or dizziness caused by reduced blood flow to the base of the brain when one arm (usually the left) is moved.

The cause is narrowing of the arteries that carry blood to the arms, usually due to atherosclerosis.

Treatment is by arterial reconstructive surgery.... subclavian steal syndrome

Sublingual

A term meaning under the tongue. Drugs taken sublingually, either as tablets or spray, are rapidly absorbed into the bloodstream via the lining of the mouth. For example, nitrate tablets are given sublingually to provide rapid relief of an angina attack.... sublingual

Sucralfate

An ulcer-healing drug used to treat peptic ulcer.

Possible side effects are constipation and abdominal pain.... sucralfate

Sudden Infant Death Syndrome

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

Sulfinpyrazone

A drug that reduces the frequency of attacks of gout.

Side effects include nausea and abdominal pain.... sulfinpyrazone

Sunstroke

A common form of heatstroke.... sunstroke

Superego

The part of the personality, as described in psychoanalytic theory, that is responsible for maintaining a person’s standards of behaviour.

Popularly termed the “conscience”, the superego arises as a result of a child incorporating the moral views of those in authority (usually parents).... superego

Superficial

Situated near the surface.... superficial

Superinfection

A second infection that occurs during the course of an existing infection. The term usually refers to an infection by a microorganism that is resistant to drugs being used against the original infection.... superinfection

Supernumerary

A term meaning more than the normal number.... supernumerary

Surgical Spirit

A liquid preparation, consisting mainly of ethyl alcohol, that has a soothing and hardening effect when applied to the skin.

It may be used before injections as an antiseptic.... surgical spirit

Swallowing

The process by which food or liquid is conveyed from the mouth tothe stomach via the oesophagus. Once food has been chewed and mixed with saliva to form a bolus, the tongue pushes the bolus to the back of the mouth and the voluntary muscles in the palate push it into the throat. The rest of the swallowing process occurs by a series of reflexes. Entry of food into the throat causes the epiglottis to tilt down to seal the trachea and the soft palate to move back in order to close off the naval cavity. The throat muscles push the food into the oesophagus. Waves of contraction (peristalsis) along the oesophagus propel the food towards the stomach. swallowing difficulty A common symptom with various possible causes, including a foreign object in the throat; insufficient production of saliva (see mouth, dry); a disorder of the oesophagus such as oesophageal stricture; pressure on the oesophagus, for example from a goitre; a nervous system disorder such as myasthenia gravis or stroke; or a psychological problem such as globus hystericus.

Investigations of swallowing difficulty may include oesophagoscopy or barium swallow (see barium X-ray examinations).

Treatment depends on the cause.... swallowing

Sydenham’s Chorea

A rare childhood disorder of the central nervous system that causes involuntary jerky movements of the head, face, limbs, and fingers. Voluntary movements are clumsy, and the limbs become floppy. The disorder usually follows an attack of rheumatic fever.

Sydenham’s chorea usually clears up after 2–3 months and has no long-term adverse effects.... sydenham’s chorea

Sympathectomy

An operation in which the ganglia (nerve terminals) of sympathetic nerves are destroyed to interrupt the nerve pathway. This may be performed to improve blood supply to a limb (as a treatment for peripheral vascular disease) or to relieve chronic pain, for example causalgia.... sympathectomy

Synaesthesia

A condition in which stimulation of one of the senses (by a sound, for example) produces an additional response, such as the appearance of a colour in addition to the normal perception associated with that stimulus.... synaesthesia

Systemic Sclerosis

Also known as scleroderma, a rare autoimmune disorder that can affect many organs and tissues, particularly the skin, arteries, kidneys, lungs, heart, gastrointestinal tract, and

joints. The condition is 3 times as common in women and is most likely to appear between the age of 30 and 50.

The number and severity of symptoms varies. The most common symptom is Raynaud’s phenomenon. Also common are changes in the skin, especially of the face and fingers, which becomes shiny, tight, and thickened, leading to difficulty with movements. Other parts of the body may also be affected, leading to difficulty in swallowing, shortness of breath, palpitations, high blood pressure, joint pain, or muscle weakness. Progression of scleroderma is often rapid in the first few years and then slows down or even stops. In a minority of people, degeneration is rapid, and leads to death from heart failure, respiratory failure, or kidney failure.

There is no cure for scleroderma, but many of the symptoms can be relieved.... systemic sclerosis

Temporomandibular Joint Syndrome

Pain and other symptoms affecting the head, jaw, and face, thought to result when the temporomandibular joints and the muscles and ligaments attached to them do not work together correctly. Causes include spasm of the chewing muscles, an incorrect bite (see malocclusion), jaw, head, or neck injuries, or osteoarthritis. Common symptoms include headaches, tenderness of the jaw muscles, and aching facial pain. Treatment involves correction of any underlying abnormality, analgesic drugs, and, in some cases, injection of corticosteroid drugs into the joint.... temporomandibular joint syndrome

Testicular Feminization Syndrome

A rare inherited condition in which a genetic male with internal testes has the external appearance of a female. The syndrome is a form of intersex and is the most common form of male pseudohermaphroditism.

The cause is a defective response of the body tissues to testosterone.

The causative genes are carried on the X chromosome, and so females can be carriers. Affected individuals appear to be girls throughout childhood, and most develop female secondary sexual characteristics at puberty; but amenorrhoea occurs, and a diagnosis is usually made during investigations to find its cause. Chromosome analysis shows the presence of male chromosomes and blood tests show male levels of testosterone. Treatment of testicular feminization syndrome involves surgical removal of the testes, to prevent cancerous change in later life, and therapy with oestrogen drugs. An affected person is not fertile but can live a normal life as a woman.... testicular feminization syndrome

Tietze’s Syndrome

Chest pain localized to an area on the front of the chest wall, usually made worse by movement of the arms or trunk or by pressure on the chest wall. The syndrome is caused by inflammation of 1 or several rib cartilages and symptoms may persist for months. Treatment is with analgesics, nonsteroidal anti-inflammatory drugs, or local injections of corticosteroid drugs into the cartilage.... tietze’s syndrome

Tourette’s Syndrome

See Gilles de la Tourette’s syndrome.... tourette’s syndrome

Transcutaneous Electrical Nerve Stimulation

See TENS.... transcutaneous electrical nerve stimulation

Turner’s Syndrome

A disorder caused by a chromosomal abnormality that only affects females. The abnormality may arise in 1 of 3 ways: affected females may have only 1 X chromosome instead of 2; they may have 1 normal and 1 defective X chromosome; or they may have a mixture of cells (see mosaicism), in which some of the cells are missing an X chromosome, some have extra chromosomes, and others have the normal complement of chromosomes. Turner’s syndrome causes short stature; webbing of the skin of the neck; absence or retarded development of sexual characteristics; amenorrhea, coarctation of the aorta, and abnormalities of the eyes and bones.

Treatment with growth hormone from infancy helps girls with Turner’s syndrome to achieve near normal height. Coarctation of the aorta is treated surgically. Treatment with oestrogen drugs induces menstruation, but it does not make affected girls fertile.... turner’s syndrome

Acacia Senegal

Willd.

Synonym: A. verek Guillem and Perr.

Family: Mimosaceae.

Habitat: Native to Sudan. Cultivated in dry parts of western India.

English: Gum arabic tree.

Ayurvedic: Shveta Babbuula.

Action: The tree yields the true Gum arabic of commerce. Mucilaginous, demulcent, emulsifying agent. Used as an ingredient in compounds for treatment of diarrhoea, catarrh.

Bechic, antihaemorrhagic, antiinflammatory. Stembark—antiinflammatory, spasmolytic. Root— used for dysentery and urinary discharges.

The gum consists mainly of arabin. It is the salt of an organic acid, arabic acid, with metals such as calcium, magnesium and potassium.

The stembark gives octacosanol, beta-amyrin, uvaol, beta-stosterol and its glucoside and erthrodiol. An alkaloid, dimethyltryptamine has been isolated from the leaves.... acacia senegal

Acacia Suma

Buch.-Ham.

Synonym: A. polycantha willd.

Family: Mimosaceae.

Habitat: West Bengal, Bihar, western peninsula.

Ayurvedic: Shveta Khadira, Kadara, Somavalkala.

Unani: Khor, Safed Khair.

Action: Cutch is prepared from the heartwood. See A. catechu.

Acacia ferruginea DC. is also equated with Shveta Khadira.... acacia suma

Accreditation Standard

A standard against which facilities or programmes are evaluated to determine if they will be accredited.... accreditation standard

Aconitum Spicatum

Stapf.

Family: Ranunculaceae.

Habitat: The alpine zone of the Himalayas of Sikkim and Chumbi. Principal source of Bikh or Bish of Kolkata market. English: Nepal Aconite. Ayurvedic: Vatsanaabha (related sp.).

Action: Antipyretic, analgesic.

The roots yield 1.75% of alkaloids which contain mainly pseudoaconitine and bikhaconitine.... aconitum spicatum

Acquired Immune Deficiency Syndrome (aids)

A severe manifestation of infection with the Human immunodeficiency virus (HIV).... acquired immune deficiency syndrome (aids)

Actaea Spicata

Linn.

Synonym: A. acuminata Wall. ex Royle

Family: Ranunculaceae.

Habitat: Native to Europe; grows in temperate Himalayas from Hazara to Bhutan.

English: Baneberry Grapewort.

Folk: Visha-phale (Kannada).

Action: Root—antirheumatic, anti-inflammatory, nerve sedative, emetic, purgative; used in the treatment of rheumatic fever, lumbago, scrofula, nervous disorders, chorea.

The plant is reported to contain trans-aconitic acid, which shows a strong cytostatic action. Its Me ether is active against Ehrlich's ascites tumours.

In folk medicine, roots are used in cases of ovarian neuralgia, uterine tenderness and sub-involution. They are adulterant of the roots of Helleborus niger. Berries are poisonous; used topically for skin diseases. The toxic constituent is protoanemonin (lactone). It is irritant to mucous membrane.... actaea spicata

Action On Smoking And Health

See ASH.... action on smoking and health

Acute Respiratory Distress Syndrome (ards)

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)

Advance Statements About Medical Treatment

See LIVING WILL.... advance statements about medical treatment

Advocacy Scheme

Services which seek to ensure that a person’s views are heard and his or her interests represented.... advocacy scheme

All Payer System

A system in which prices for health services and payment methods are the same, regardless of who is paying. For instance, in an all payer system, federal or state government, a private insurer, a self-insured employer plan, an individual, or any other payer could pay the same rates. The uniform fee bars health care providers from shifting costs from one payer to another. See “cost shifting”.... all payer system

Allium Sativum

Linn.

Family: Liliaceae, Alliaceae.

Habitat: Native to Central Asia. Cultivated all over India.

English: Garlic.

Ayurvedic: Lashuna, Rasona, Yavaneshta, Ugragandha, Ma- haushadh, Arishta.

Unani: Seer, Lahsun.

Siddha/Tamil: Ullippoondu, Vellaip- pondu.

Action: Antibiotic, bacteriostatic, fungicide, anthelmintic, antithrom- bic, hypotensive, hypoglycaemic, hypocholesterolaemic. Also used for upper respiratory tract infections and catarrhal conditions.

Key application: As a supportive to dietary measures for elevated levels of lipids in blood; as a preventive measure for age-dependent vascular changes. (German Commission E, ESCOP, WHO, The British Herbal Pharmacopoeia.) Also as an antimicrobial. (The British Herbal Pharmacopoeia). Garlic has been shown to be effective in respiratory infections and catarrhal conditions. (The British Herbal Compendium.)

The Ayurvedic Pharmacopoeia ofIn- dia indicates the use of the bulb as a brain tonic in epilepsy and psychic disorders.

Heavy consumption of garlic prior to surgery led to increased clotting time or reduced platelet aggregation (in human case reports). Garlic tablets at a dose of 400 mg twice daily for 12 weeks reduced platelet aggregation 59% compared with placebo in 80 patients (in human clinical study). (Francis Brinker.)

Garlic cloves are high in sulphur- containing amino acids known as al- liin (no taste, no smell, no medicinal action). With crushing or chewing alli- in comes into contact with the enzyme alliinase. Alliinase, in less than 6 s, transforms alliin into allicin (strongly medicinal), which breaks down into a number of sulphur compounds including ajoene, vinyldithin and diallyl disulfide, and trisulfide. The antibiotic effect is attributed to allicin; hypogly- caemic effect to allicin and allylpro- phyldisulphide (also to S-allyl cysteine sulfoxide); anticarcinogenic activity to diallyl monosulfide; platelet aggregation inhibitory effect to diallyl-di- and tri-sulphides. Ajoene inactivated human gastric lipase, which is involved in digestion and absorption of dietary fats.

Diallyltetra, penta-, hexa- and hep- tasulphides are potential antioxidants.

Allium leptophyllum Wall. is equated with Vana Lashuna, Jangali Lahsun.

Dosage: Bulb—3 g (API Vol. III.)... allium sativum

Alpha (i) Statistic

A statistic commonly used to reflect the reliability of a measurement scale. See “reliability”.... alpha (i) statistic

Alternative Medical System

A complete system of theory and practices that has evolved independently of, and often prior to, the conventional biological approach. Many are traditional systems of medicine that are practised by individual cultures throughout the world. Traditional Oriental medicine and Ayurveda, India’s traditional system of medicine, are two examples.... alternative medical system

Ambulatory Setting

A type of institutional organized health setting in which health services are provided on an outpatient basis. Ambulatory care settings may be either mobile (when the facility is capable of being moved to different locations) or fixed (when the person seeking care must travel to a fixed service site).... ambulatory setting

Analytic Study

A study designed to examine associations, commonly putative or hypothesized causal relationships. An analytic study is usually concerned with identifying or measuring the effect of risk factors, or is concerned with the health effects of specific exposure(s).... analytic study

Ancillary Service

Support service provided in conjunction with medical or hospital care. Such services include laboratory, radiology, physical therapy and inhalation therapy, among others.... ancillary service

Animal Starch

See GLYCOGEN.... animal starch

Allium Schoenoprasum

Linn.

Family: Liliaceae, Alliaceae.

Habitat: Native to temperate northern Europe and the U.S.; distributed in the western Himalayas from Kashmir to Kumaon at altitudes of 2,400-3,000 m.

English: Chives.

Action: Used in place of young onions.

An alcoholic extract of the bulbs exhibited hypotensive and cardiac depressant activity.

The aerial parts (chives) gave alliins (alkylcysteine sulfoxides), particularly methyl alliin and pentylalliin.

Allium tuberosum Rottl. ex Spreng, found in eastern India and western Himalayas, is equated with Chinese Chives. It is available in Meghalaya.... allium schoenoprasum

Alpinia Speciosa

(Wendl.) K.Schum.

Synonym: A. Zerumbet Burtt and R.M. Smith

Family: Zingiberaceae.

Habitat: Native to East Indies. Occurs in the eastern Himalayas from West Bengal eastwards.

English: Light Galangal.

Siddha/Tamil: Chitraraththai.

Action: Rhizomes are used as a substitute for A. galanga and even for ginger; antiulcerative, spasmolytic.

The leaves and rhizomes yield an essential oil which contains alpha-and beta-pinene, borneol, campene and ci- neole as major constituents.... alpinia speciosa

Alstonia Scholaris

R. Br.

Family: Apocynaceae.

Habitat: Throughout moist regions of India, especially in West Bengal and west-coast forests of southern India.

English: Devil's tree, Dita Bark tree.

Ayurvedic: Saptaparna, Sapta- chhada, Saptaparni, Saptaahvaa, Vishaaltvak, Shaarada, Visham- chhada.

Unani: Chhaatim, Kaasim (Kaasim Roomi, Anjudaan Roomi is equated with Myrrhis odorata Scope.)

Siddha/Tamil: Ezhilamippalai, Mukkampalai.

Folk: Chhitavan, Sataunaa.

Action: Bark—febrifuge, antiperi- odic, spasmolytic, antidysenteric, uterine stimulant, hypotensive; used for internal fevers.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of stembark in phosphaturia and recommends it as a blood purifier.

Alstonia sp. is known as Fever Bark. A. constricta is native to Australia; A. scholaris to Australia and Southeast Asia. The bark of both the species contains indole alkaloids. A. constric- ta contains reserpine (a hyptotensive agent). A. scholaris contains echita- mine, which has also demonstrated hypotensive effects. Though A. schol- aris produces fall in the temperature of human patients with fever, there are conflicting reports about the activity of echitamine against Plasmodium berghei.

Dosage: Stembark—20-30 g for decoction. (API Vol. I.)... alstonia scholaris

Alternanthera Sessilis

(Linn.) R. Br. ex DC.

Synonym: A. triandra Lam. A. denticulata R. Br. A. repens Gmel. Non-Link.

Family: Amaranthaceae.

Habitat: Throughout the hotter parts of India, especially around tanks and ponds.

Ayurvedic: Matsyaakshi, Matsyaak- shika (a multimeaning name, also indicating Braahmi, Ain- dri), Matsyagandhaa, Matsyaa- dini, Minaakshi, Bahli, Gandali, Gartkalambukaa, Vaahlikaa.

Unani: Machhechhi.

Siddha/Tamil: Ponnonkanni keerai.

Folk: Gudari Saag.

Action: Febrifuge, galactagogue, cholagogue.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of dried whole plant in diseases due to vitiated blood and obstinate skin diseases.

Young shoots contain protein 5% and iron 16.7 mg/100 g. Leaves also contain a good amount of alpha- and beta-tocopherols.

The plant gave stigmasterol, beta- sitosterol, a saturated aliphatic hydrocarbon and aliphatic ester.

Dosage: Whole plant—2-6 g powder. (API Vol. II.)... alternanthera sessilis

Anterior Tibial Syndrome

See under MUSCLES, DISORDERS OF – Compression syndrome.... anterior tibial syndrome

Anxiety State

See NEUROSIS.... anxiety state

Appointment Scheduling System

A system for planning of appointments between resources such as clinicians and facilities and patients. It is used in order to minimize waiting times, prioritize appointments and optimize the utilization of resources.... appointment scheduling system

Amaranthus Spinosus

Linn.

Family: Amaranthaceae.

Habitat: Cultivated fields, waste places and along roadsides.

English: Spiny Amaranth, Thorny Amaranth, Spiny Pigweed.

Ayurvedic: Tanduliya, Tandulaka, Meghnaad, Megharava, Vishaghn, Alpamaarish.

Siddha/Tamil: Mullukkeerai.

Folk: Katili-chaulai.

Action: Galactogenic, laxative, emollient, spasmolytic, diuretic. Pollen extract—used for allergic asthma and allergic rhinitis. Root— used in menorrhoea.

Plant contains sterols. Leaves and stems contain alpha-spinasterol and hentriacontane. Leaves also contain amino acids with high content of lysine.

Dosage: Whole plant—10-20 ml juice; 400-800 mg powder. (CCRAS.)... amaranthus spinosus

Amomum Subulatum

Roxb.

Family: Zingiberaceae.

Habitat: Cultivated in swampy places in Bengal, Sikkim, Assam and Tamil Nadu.

English: Greater or Nepal Cardamom.

Ayurvedic: Sthula-elaa, Bhadraa, Bhadrailaa, Bahulaa, Prithivikaa, Triputaa, Truti.

Unani: Heel Kalaan, Qaaqule Kubaar.

Siddha/Tamil: Peria Elam, Kattu Elam, Beraelam.

Action: Stomachic, antiemetic, an- tibilious, astringent, alexipharmic; used for the treatment of indigestion, biliousness, abdominal pains, vomiting, in congestion of liver. Pericarp—in headache and stomatitis.

The seeds contain a chalcone (carda- monin), a flavonoid (alpinetin), petu- nidin-3, 5-diglucoside and leucocyani- din glucocide; also a aurone glycoside subulin. The essential oil (2.5%) contains cineole.

Dosage: Seed-1-3 g powder. (CCRAS.)... amomum subulatum

Apthous Stomatitis

Little ulcers or canker sores on the surface. of the tongue, lips, and cheek mucosa. In adults, they are often related to gastric reflux and dyspepsia.... apthous stomatitis

Asparagus Sarmentosus

Linn. has been equated with Mahaa-shataavari. Other related sp. are Asparagus curillus Buch.-Ham., A. filicinus Buch.-Ham. and A. gracilis Royle.

Dosage: Dried root—3-6 g powder. (API Vol. IV.)... asparagus sarmentosus

Assessment System

A structured process developed to ensure that assessment is relevant, consistent, fair and valid. The system requires rules of operation, a regular review process and competent assessors.... assessment system

Astragalus Strobiliferus

Royle.

Family: Fabaceae; Papilionaceae.

Habitat: The western Himalayas at 2,400-3,900 m, and Kashmir.

English: Indian Gum tragacanth.

Action: Gum—an Indian substitute for tragacanth (A. gummifer gum).... astragalus strobiliferus

Anethum Sowa

Roxb. ex Flem.

Synonym: A. graveolens Linn. var. sowa Roxb. A. graveolens DC. Peucedanum sowa Roxb. Peucedanum graveolens Benth.

Family: Umbelliferae; Apiaceae.

Habitat: Cultivated all over India.

English: Indian Dill, Sowa.

Ayurvedic: Shataahvaa. Shata- pushpaa (also accepted as Foenicu- lum vulgare Mill., equated with Mishreya, Mishi, Madhurikaa).

Unani: Shibt, Soyaa.

Siddha/Tamil: Sadakuppai.

Action: Carminative, stomachic, antispasmodic.

Key application: In dyspepsia. (German Commission E.)

The fresh and dried leaf is used for prevention and treatment of diseases and disorders of the gastrointestinal tract, kidney and urinary tract, for spasms and sleep disorders. (Included among unapproved herbs by German Commission E.)

An aqueous dill extract, administered intravenously, lowers blood pressure, dilates blood vessels, stimulates respiration and slows heart rate in animals. (Natural Medicines Comprehensive Database, 2007.)

Dill seeds contain up to 5% volatile oil (about half of which is carvone), flavonoids, coumarins, xanthones and triterpenes. The yield of the oil from Indian A. sowa varies from 1.3 to 3.5%. Carvone is the major constituent (19.569.7%). The oil from seeds is used for flatulence in children and enters into the preparations of gripe water. The oil is also antimicrobial and antifungal.

Dill apiol is considered undesirable and toxic. Vizag fruit var. from Andhra Pradesh is dill-apiol-free and with 54-56%, carvone content having same flavonoid pattern as A. sowa.

Dosage: Dried fruit—3-6 g powder. (API Vol. III.) Fruit, leaf—1-3 g powder. (CCRAS.)... anethum sowa

Annona Squamosa

Linn.

Family: Annonaceae.

Habitat: A native to South America and the West Indies; now cultivated throughout India.

English: Custard Apple, Sugar Apple, Sweet-sop.

Ayurvedic: Gandagaatra, Sitaa phala (also equated with Curcurbita maxima).

Unani: Sharifaa.

Siddha/Tamil: Sitaaphalam, Atta.

Action: Leaves—insecticide (seed powder, mixed with leaf juice is used for removing lice from scalp). Seeds—abortifacient. Root— purgative, used in blood dysentery.

Fruit—invigorating, sedative to heart, antibilious, antiemetic, expectorant. Dried, powdered unripe fruits—used for treating ulcers. Ripe fruit made into paste with betel leaves is applied to tumour to hasten suppuration. Leaves, bark, unripe fruit—strongly astringent; used for diarrhoea and dysentery.

A fraction of total alkaloid from roots exhibits antihypertensive, antispasmodic, antihistaminic and bron- chodilatory properties. Leaves contain a cardiotonic alkaloid, quinoline. Squamone and bullatacinone were selectively cytotoxic to human breast carcinoma.

In Cuban medicine, leaves are taken to reduce uric acid levels.... annona squamosa

Argyreia Speciosa

Sweet.

Synonym: A. nervosa (Burm. f.) Boj.

Family: Convolvulaceae.

Habitat: Found all over India, ascending to 300 m.

English: Elephant Creeper.

Ayurvedic: Vriddhadaaruka, Vriddhadaaru, Vriddhadaaraka, Bastaantri, Sthavira, Sthaviradaaru, Atarunadaaru, Samudrashosha. (Seeds of Salvia plebeia R. Br. are also known as Samudrashosha.)

Unani: Samunder sokh.

Siddha/Tamil: Ambgar, Samuddira- pacchai

Folk: Bidhaaraa.

Action: Root—aphrodisiac (considered as a rejuvenator), nervine (used in diseases of nervous system, sexual disorders), diuretic (used in strangury), antirheumatic. Seeds—hypotensive, spasmolytic. Leaves—used externally in skin diseases (ringworm, eczema, boils, swellings); rubefacient, topically stimulant.

The seeds contain hallucinogenic ergoline alkaloids, the main ones being ergine and isoergine. EtOH (50%) extract of seeds exhibits hypotensive activity. (Seeds of all species of Argyreia contain ergoline alkaloids and are hypotensive.) Leaves of Argyreia sp. contain sitosterol and are antiphlogistic.

In Indian medicine, A. speciosa is not used as a single drug for sexual disorders in men, but as a supporting drug for exerting its antiphlogistic, spasmolytic and hypotensive actions on the central nervous system. The drug, in itself, did not show anabolic- cum-androgen-like or spermogenetic activity experimentally.

Ipomoea petaloidea Chois and Ipo- moea biloba Forskofthe Convolvulacae family are also used as Vriddhadaaru.

In Western herbal medicine, Hawaiian Baby Woodrose is equated with Argyreia nervosa (synonym Argyreia speciosa; grows in Florida, California and Hawaii). The seed is used for pain relief and as a hallucinogen.

The seeds contain hallucinogens including ergonovine, isoergine (isoly- sergic acid amide) and ergine (lysergic acid amide). Four to eight seeds are equivalent to 10-100 mcg of LSD, a potent serotonin-1A (5-HT1A) agonist. The effects last 6-8 h. (Natural Medicines Comprehensive Database, 2007.)

Dosage: Root—3-5 g powder.

(CCRAS.)... argyreia speciosa

Atylosia Scarabaeoides

(L.) Benth.

Family: Papilionaceae; Fabaceae.

Habitat: Throughout India; up to 1,800 m in the western Himalayas.

Ayurvedic: Vana-kulattha.

Folk: Jangli Tur, Kulthi.

Action: Antidysenteric, anticholerin, febrifuge; also used in anaemia, anasarca and hemiplegia. Seeds— taeniafuge.

A flavone glucoside, atyloside, has been isolated from the leaves.... atylosia scarabaeoides

Arnica Tea: A Skin Aid

Arnica tea is a healing beverage, with a long history in treating a large array of ailments. It is used only externally, because of its toxicity. Arnica Tea description Arnica is a woodland plant from the same family as the sunflower. It normally grows in Central Europe and in the western United States, at high altitudes. It is known as mountain tobacco or smoke herb, because Native American Indians used to smoke this herb. Arnica tea has been used since the 16th century to calm digestive disorders, reduce fever and for topical treatment when dealing with skin disorders. At present, Arnica tea is recommended to be used only externally, because of its potential toxicity. Its flowers are dried and used to prepare ointments, creams and gels to treat bruises and sprains. Arnica Tea brewing To prepare Arnica tea:
  • Infuse 1 teaspoon of dried (or powdered) flower into ½ cup of hot water.
  • Allow the mix to steep for about 10 minutes.
 Arnica tea should not be ingested or drunk. Its usage is only external. Arnica Tea benefits Arnica Tea is recognized for its anti-inflammatory and wound-healing properties. This tea has been successfully used to treat:
  • muscle pains
  • contusions
  • sore feet
  • leg ulcers in diabetics
  • sprains and bruises
  • hair loss
  • acne
  • scars, eczemas and itching caused by poison ivy
Arnica Tea side effects It has been proved that Arnica tea applied on open wounds or broken skin can increase the blood pressure. Arnica tea should be avoided in case of pregnancy. Also, people with sensitive skin are recommended not to use it. Long periods of Arnica tea usage can lead to eczema, edemas, rash, swelling and dermatitis. Arnica tea is a healing beverage which can heal skin problems and also, lessen pain. It is recommended to people looking for a medicinal remedy for their health issues.... arnica tea: a skin aid

Asperger’s Syndrome

A lifelong personality disorder, evident from childhood and regarded as a mild form of AUTISM. Persons with the syndrome tend to have great di?culty with personal relationships. They tend to take what is said to them as literal fact and have great di?culty in understanding irony, metaphors or even jokes. They appear shy with a distant and aloof character, emotional rigidity and inability to adapt to new situations. They are often mocked and ill-treated at school by their fellows because they appear unusual. Many people with Asperger’s seem to take refuge in intense interests or hobbies, often conducted to an obsessional degree. Many become skilled in mathematics and particularly information technology. Frustration with the outside world which is so hard to comprehend may provoke aggressive outbursts when stressed.... asperger’s syndrome

Astragalus Sarcocola

Dymock.

Family: Fabaceae; Papilionaceae.

Habitat: The mountainous regions from Asia Minor to Iraq and Iran.

English: Sarcocola.

Ayurvedic: Rudanti (substitute).

Unani: Anzaroot, Kohal Kirmaani (Gum).

Action: Gum—antirheumatic, aperient, anthelmintic, emollient.

The rootbark yields alkaloids, atala- phylline and its N-methyl derivatives and atalaphyllidine, which have close structural similarities with the antitu- mour alkaloid, acronycine, and its co- geners. The rootbark also contains the limonoid, atalantin.

The leaf juice forms an ingredient of a compound liniment used in hemiplegia. The essential oil is used in paralysis. The oil contains higher terpene esters belonging to azulene group (29%). (Azulenes impart anti-inflammatory activity.)... astragalus sarcocola

Attention Deficit Disorder (hyperactivity Syndrome)

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)

Auto-suggestion

A self-induced receptive, hypnotic state which is believed to improve the body’s ability to help itself. Doctors have long realised that if they suggested to a patient that a particular treatment would work, it often did – a type of placebo e?ect. Some techniques now make use of this idea. For instance, people can be taught muscular relaxation to control their anxiety states – the BIOFEEDBACK principle.... auto-suggestion

Average Length Of Stay (alos)

A measure of how many days a patient, on average, spends in the hospital. Hence, this measure, when applied to individuals or specific groups of patients, may be an indicator of the severity of illness and resource use. It is often used as a comparison to assess efficiency of resource usage between hospitals.... average length of stay (alos)

Avena Sativa

Linn.

Family: Gramineae; Poaceae.

Habitat: A cereal and fodder crop of Europe and America; also cultivated in India.

English: Oat, Common oat.

Ayurvedic: Yavikaa. (Indian sp. is equated with A. byzantina C. Koch.)

Unani: Sult (Silt), Jao Birahnaa, Jao Gandum.

Action: Nervine tonic (used in spermatorrhoea, palpitation, sleeplessness), cardiac tonic (used in debility), stimulant, antispasmodic, thymoleptic, antidepressant (used in menopausal phase). Also used in diarrhoea, dysentery, colitis. Externally, emollient.

Key application: Oat straw— externally in baths for inflammatory and seborrhoeic skin diseases. (German Commission E.) The effect on blood sugar is less than that from most of the fiber-containing herbs and foods. (Sharon M. Herr.)

The seeds contain proteins and prolamines (avenins); C-glycosyl flavones; avenacosides (spirostanol glycosides); fixed oil, vitamin E, starch.

Silicon dioxide (2%) occurs in the leaves and in the straw in soluble form as esters of silicic acid with polyphenols and monosaccharides and oligosaccharides.

Oat straw contains a high content of iron (39 mg/kg dry weight), manganese (8.5 mg) and zinc (19.2 mg).

In an experimental study, oat straw stimulated the release of luteinizing hormone from the adenohypophysis of rats. (Expanded Commission E Monographs.)

An alcoholic extract of green oats was tried on opium addicts. Six chronic opium addicts gave up opium completely, two reduced their intake and two showed no change following regular use of 2 ml three times daily (human clinical study). A significant diminish- ment of the number of cigarettes used by habitual tobacco smokers resulted from using 1 ml (four times daily) of fresh Avena alcoholic extract of mature plants; however, a few studies gave disappointing results. (Francis Brinker.)

Oat polyphenol composition prevented the increase of cholesterol and beta-lipoprotein of blood serum of fasting rabbits. Antioxidant property of the oat flour remains unaffected by heat. Homoeopathic tincture of seeds is used as a nervine tonic. Beta-glucan from the oats stimulated immune functions.

Avenacosides exhibit strong anti- fungal activity in vitro.... avena sativa

B Nosed. The Test For Brain-stem Death Are:

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:

Barleria Strigosa

Willd.

Family: Acanthaceae.

Habitat: The Himalayas from Uttar Pradesh to West Bengal, up to an altitude of 1,200 m.

Ayurvedic: Sahachara (blue- flowered var.).

Siddha/Tamil: Nili.

Folk: Koilekhaa.

Action: Mild antiseptic, expectorant (given in spasmodic cough); also used as an antianaemic.

The plant gave beta-and gamma- sitosterol.... barleria strigosa

Basic Health Service

A network of health units providing essential health care to a population. Basic health services include communicable disease control, environmental sanitation, maintenance of records for statistical purposes, health education of the public, public health nursing and medical care.... basic health service

Bed Sores

See ULCER.... bed sores

Behçet’s Syndrome

This is a syndrome characterised by oral and genital ulceration, UVEITIS and ARTHROPATHY. THROMBOPHLEBITIS is a common complication, and involvement of the central nervous system may occur.... behçet’s syndrome

Bicarbonato De Sodio

Baking soda; used as a gargle for sore throat and tonsillitis, sometimes combined with vinagre blanco (white vinegar) or with limón (lemon) and miel de abeja (honey); can be combined with other herbal remedies such as poultices that are applied externally.... bicarbonato de sodio

Bipolar Staining

The effect of the two ends of a bacillus staining while the centre of the rod remains unstained (eg in Yersinia pestis, the cause of Bubonic Plague) when stained with Giemsa stain.... bipolar staining

Blepharispermum Subsessile

DC.

Family: Compositae; Asteraceae.

Habitat: Madhya Pradesh, Maharashtra, Karnataka.

Ayurvedic: Used as a substitute for Raasnaa in Madhya Pradesh.

Action: Anti-inflammatory (used internally and externally for rheumatic affections).... blepharispermum subsessile

Bean Sprouts

See also Beans.

Nutritional Profile Energy value (calories per serving): Low Protein: High Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Moderate Sodium: Low Major vitamin contribution: B vitamins, folate, vitamin C Major mineral contribution: Iron, potassium

About the Nutrients in This Food Because beans use stored starches and sugars to produce green shoots called sprouts, sprouted beans have less carbohydrate than the beans from which they grow. But bean sprouts are a good source of dietary fiber, including insoluble cellulose and lignin in leaf parts and soluble pectins and gums in the bean. The sprouts are also high in the B vitamin folate and vitamin C. One-half cup raw mung bean sprouts has 1.2 mg dietary fiber, 31.5 mcg folate (8 percent of the R DA), and 7 mg vitamin C (9 percent of the R DA for a woman, 7 percent of the R DA for a man). Raw beans contain anti-nutrient chemicals that inhibit the enzymes we use to digest proteins and starches; hemagglutinins (substances that make red blood cells clump together); and “factors” that may inactivate vita- min A. These chemicals are usually destroyed when the beans are heated. with the bean must be cooked before serving. Sprouted beans served

The Most Nutritious Way to Serve This Food Cooked (see Adverse effects associated with this food ).

Diets That May Restrict or Exclude This Food Low-fiber, low-residue diet

Buying This Food Look for: Fresh, crisp sprouts. The tips should be moist and tender. (The shorter the sprout, the more tender it will be.) It is sometimes difficult to judge bean sprouts packed in plastic bags, but you can see through to tell if the tip of the sprout looks fresh. Sprouts sold from water-filled bowls should be refrigerated, protected from dirt and debris, and served with a spoon or tongs, not scooped up by hands. Avoid: Mushy sprouts (they may be decayed) and soft ones (they have lost moisture and vitamin C).

Storing This Food Refrigerate sprouts in a plastic bag to keep them moist and crisp. If you bought them in a plastic bag, take them out and repack them in bags large enough that they do not crush each other. To get the most vitamin C, use the sprouts within a few days.

Preparing This Food R inse the sprouts thoroughly under cold running water to get rid of dirt and sand. Discard any soft or browned sprouts, then cut off the roots and cook the sprouts. Do not tear or cut the sprouts until you are ready to use them. When you slice into the sprouts, you tear cells, releasing enzymes that begin to destroy vitamin C.

What Happens When You Cook This Food Cooking destroys some of the heat-sensitive vitamin C in sprouts. To save it, steam the sprouts quickly, stir-fry them, or add them uncooked just before you serve the dish.

How Other Kinds of Processing Affect This Food Canning. Vitamin C is heat-sensitive, and heating the sprouts during the canning process reduces their vitamin C content.

Medical Uses and/or Benefits Lower risk of some birth defects. As many as t wo of ever y 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their mothers’ not having gotten adequate amounts of folate during pregnancy. The R DA for folate is 400 mcg for healthy adult men and women, 600 mcg for pregnant women, and 500 mcg for women who are nursing. Taking folate supplements before becoming pregnant and continuing through the first t wo months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Woman’s Hospital, in Boston, demonstrated that a diet provid- ing more than 400 mcg folate and 3 mg vitamin B6 daily, from either food or supplements, more than twice the current R DA for each, may reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the analysis, the results are assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane University examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to verif y whether taking folic acid supplements reduces the risk of cardiovascular disease.

Adverse Effects Associated with This Food Food poisoning: Reacting to an outbreak of Salmonella and E. coli O157:H7 food poisoning associated with eating raw alfalfa sprouts, the Food and Drug Administration issued a warn- ing in 1998 and again in summer 1999, cautioning those at high risk of food-borne illness not to eat any raw sprouts. The high-risk group includes children, older adults, and people with a weakened immune system (for example, those who are HIV-positive or undergoing cancer chemotherapy). Tests conducted by the U.S. Department of Agriculture in 1999 sug- gest that irradiating raw sprouts and bathing them in an antiseptic solution at the processing plant may eliminate disease organisms and prolong the vegetable’s shelf life; this remains to be proven.... bean sprouts

Bovine Spongiform

... bovine spongiform

Breast Screening

A set of investigations aimed at the early detection of breast cancer. It includes self-screening by monthly examination of the breasts, and formal programmes of screening by palpation and mammography in special clinics. In the UK the NHS o?ers regular mammography examinations to all women between 50 and 64 years of age; in 1995–6, 1.1 million women were screened – 76 per cent of those invited. More than 5,500 cancers were detected – 5.3 per 1,000 women screened.... breast screening

Benefits Of Lapsang Souchong Tea

Lapsang Souchong tea is a type of black tea originating from China. Out of all the types of black tea, this one is special thanks to its history, rich taste and health benefits. Find out more about the Lapsang Souchong tea in this article. About the Lapsang Souchong tea Lapsang Souchong tea is a type of black tea originating from China, from the Wuyi region of the Fujian province. It is the first type of black tea in history, having been discovered around the beginning of the 19th century. Later, people started to move the tea bushes even outside of China, for example to India or Sri Lanka. The flavor of this tea is smoky, rich and fruity. It goes well with salty and spicy dishes, as well as with cheese. Lapsang Souchong tea - a smoked tea It is said that the lapsang souchong tea was discovered by accident. During the Dao Guang era of the Qing Dynasty, an army unit passed through Xingcu village and decided to set camp at a tea factory filled with unprocessed tea leaves. The workers could only return at the company after the soldiers left. Discovering that they didn’t have enough time to let the leaves dry, the workers decided to speed up the process. What they did was to place the tea leaves into bamboo baskets and dry them over fires made from local pines. This is how the lapsang souchong tea was discovered. Because of this, it is also called “smoked tea”. Seeing as they are smoke-dried over fires made from pine wood, the lapsang souchong tea has a strong, smoky flavor. How to make lapsang souchong tea To make lapsang souchong tea, you need one teaspoon of leaves for a 6 ounce cup. Leave it to steep for 3-4 minutes before you remove the leaves. You can later use the leaves to resteep, but the flavor might differ after each steeping. The lapsang souchong tea is usually drunk without milk or sugar. People either love its taste, or completely hate it, so there’s no need to change it. Benefits of lapsang souchong tea The lapsang souchong tea, just like all other types of black teas, has many health benefits that should encourage you to drink more of it. First of all, drinking lapsang souchong tea can reduce your chances of getting cancer. It also helps reduce the risk of developing cardiovascular diseases, as it lowers the cholesterol in your blood and helps the blood flow better in your veins. The lapsang souchong tea helps strengthen your immunity, protecting you from viruses that lead to colds, the flu or other diseases. It also helps you fight against various types of inflammations. During diets, it is recommended to drink black tea; this includes the lapsang souchong tea, as well. It helps burn fats faster and, therefore, helps you lose weight. Side effects of lapsang souchong tea The side effects of the lapsang souchong tea are those found at other types of black tea, as well. They are related to the caffeine found in the tea’s composition, and drinking too much tea. If you know caffeine isn’t good for you, be careful when drinking lapsang souchong tea. It may cause you to experience the following symptoms: insomnia, anxiety, headache, dizziness, irritability, blurred vision and skin rashes. You also have to be careful if you’re pregnant or breastfeeding. In the case of pregnancy, the caffeine in the lapsang souchong tea (and caffeine in general) can cause miscarriages and birth defects. If you’re breastfeeding, lapsang souchong tea can affect the baby, who might get insomnia, heart palpitations and tremors. Also, if you’re suffering from ulcer, don’t drink too much lapsang souchong tea. The caffeine in its composition may increase the production of stomach acid and, therefore, aggravate the ulcer symptoms. It is recommended that you not drink more than six cups of tea per day. Otherwise, it might end up becoming harmful rather than helpful. The side effects that you might get are headaches, dizziness, insomnia, irregular heartbeats, vomiting, diarrhea and loss of appetite. If you encounter any of these symptoms, reduce the amount of tea you drink. This applies to all types of tea, including the lapsang souchong tea. If you want a special kind of black tea, try the lapsang souchong tea. The smoky, fruity flavor will definitely charm you. And don’t forget, it’s also good for your health!... benefits of lapsang souchong tea

Brown Snake

A poisonous snake found on the mainland of Australia. It belongs to the family Elapidae and is extremely venomous, having a potent neurotoxin.... brown snake

Brugmansia Suaveolens

Bercht. & Presl.

Synonym Datura suaveolens Humb. & Bonpl. ex Willd.

Habitat: Native to Mexico; grown in Indian gardens.

English: Angel's Trumpet.

Action: Leaf and flower—used to treat asthma; to induce hallucinations. Can cause severe toxicity.

All parts of the plant contain tropane alkaloids (concentration highest in the foliage and seeds), particularly atropine, hyoscyamine and hyoscine (scopolamine.)... brugmansia suaveolens

Brussels Sprouts

Nutritional Profile Energy value (calories per serving): Low Protein: High Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: High Sodium: Low Major vitamin contribution: Vitamin A, folate, vitamin C Major mineral contribution: Potassium, iron

About the Nutrients in This Food Brussels sprouts are high in dietary fiber, especially insoluble cellulose and lignan in the leaf ribs. They are also a good source of vitamin A and vitamin C. One-half cup cooked fresh brussels sprouts has three grams of dietary fiber, 1,110 IU vitamin A (48 percent of the R DA for a woman, 37 percent of the R DA for a man), 47 mcg folate (16 percent of the R DA), and 48 mg vitamin C (64 percent of the R DA for a woman, 53 percent of the R DA for a man). Brussels sprouts also contain an antinutrient, a natural chemical that splits the thiamin (vitamin B1) molecule so that it is no longer nutritionally useful. This thiamin inhibitor is inactivated by cooking.

The Most Nutritious Way to Serve This Food Fresh, lightly steamed to preserve the vitamin C and inactivate the antinutrient.

Diets That May Restrict or Exclude This Food Antiflatulence diet Low-fiber diet

Buying This Food Look for: Firm, compact heads with bright, dark-green leaves, sold loose so that you can choose the sprouts one at a time. Brussels sprouts are available all year round. Avoid: Puff y, soft sprouts with yellow or wilted leaves. The yellow carotenes in the leaves show through only when the leaves age and their green chlorophyll pigments fade. Wilting leaves and puff y, soft heads are also signs of aging. Avoid sprouts with tiny holes in the leaves through which insects have burrowed.

Storing This Food Store the brussels sprouts in the refrigerator. While they are most nutritious if used soon after harvesting, sprouts will keep their vitamins (including their heat-sensitive vitamin C) for several weeks in the refrigerator. Store the sprouts in a plastic bag or covered bowl to protect them from moisture loss.

Preparing This Food First, drop the sprouts into salted ice water to flush out any small bugs hiding inside. Next, trim them. Remove yellow leaves and leaves with dark spots or tiny holes, but keep as many of the darker, vitamin A–rich outer leaves as possible. Then, cut an X into the stem end of the sprouts to allow heat and water in so that the sprouts cook faster.

What Happens When You Cook This Food Brussels sprouts contain mustard oils (isothiocyanates), natural chemicals that break down into a variety of smelly sulfur compounds (including hydrogen sulfide and ammonia) when the sprouts are heated, a reaction that is intensified in aluminum pots. The longer you cook the sprouts, the more smelly compounds there will be. Adding a slice of bread to the cook- ing water may lessen the odor; keeping a lid on the pot will stop the smelly molecules from floating off into the air. But keeping the pot covered will also increase the chemical reaction that turns cooked brussels sprouts drab. Chlorophyll, the pigment that makes green vegetables green, is sensi- tive to acids. When you heat brussels sprouts, the chlorophyll in their green leaves reacts chemically with acids in the sprouts or in the cooking water to form pheophytin, which is brown. The pheophytin turns cooked brussels sprouts olive or, since they also contain yel- low carotenes, bronze. To keep cooked brussels sprouts green, you have to reduce the interaction between chlorophyll and acids. One way to do this is to cook the sprouts in a lot of water, so the acids will be diluted, but this increases the loss of vitamin C.* Another alternative is to leave the lid off the pot so that the hydrogen atoms can float off into the air, but this allows the smelly sulfur compounds to escape, too. The best solution is to steam the sprouts quickly in very little water, so they retain their vitamin C and cook before there is time for reaction between chlorophyll and hydrogen atoms to occur.

How Other Kinds of Processing Affect This Food Freezing. Frozen brussels sprouts contain virtually the same amounts of vitamins as fresh boiled sprouts.

Medical Uses and/or Benefits Protection against cancer. Naturally occurring chemicals (indoles, isothiocyanates, gluco- sinolates, dithiolethiones, and phenols) in brussels sprouts, broccoli, cabbage, cauliflower and other cruciferous vegetables appear to reduce the risk of some cancers, perhaps by pre- venting the formation of carcinogens in your body or by blocking cancer-causing substances from reaching or reacting with sensitive body tissues or by inhibiting the transformation of healthy cells to malignant ones. All cruciferous vegetables contain sulforaphane, a member of a family of chemicals known as isothiocyanates. In experiments with laboratory rats, sulforaphane appears to increase the body’s production of phase-2 enzymes, naturally occurring substances that inac- tivate and help eliminate carcinogens. At Johns Hopkins University in Baltimore, Maryland, 69 percent of the rats injected with a chemical known to cause mammary cancer developed tumors vs. only 26 percent of the rats given the carcinogenic chemical plus sulforaphane. In 1997, the Johns Hopkins researchers discovered that broccoli seeds and three- day-old broccoli sprouts contain a compound converted to sulforaphane when the seed and sprout cells are crushed. Five grams of three-day-old broccoli sprouts contain as much sulforaphane as 150 grams of mature broccoli. The sulforaphane levels in other cruciferous vegetables have not yet been calculated. Lower risk of some birth defects. Up to two or every 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their mothers’ not having gotten adequate amounts of folate during pregnancy. NOTE : The current R DA for folate is 180 mcg for a woman and 200 mcg for a man, but the FDA now recommends * Brussels sprouts will lose as much as 25 percent of their vitamin C if you cook them in water that is cold when you start. As it boils, water releases oxygen that would otherwise destroy vitamin C. You can cut the vitamin loss dramatically simply by letting the water boil for 60 seconds before adding the sprouts. 400 mcg for a woman who is or may become pregnant. Taking a folate supplement before becoming pregnant and continuing through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Possible lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Women’s Hospital, in Boston, demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 daily, either from food or supple- ments, might reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the study, the results were assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane Univer- sity examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to verif y whether taking folic acid supplements reduces the risk of cardiovascular disease. Vision protection. In 2004, the Johns Hopkins researchers updated their findings on sulfora- phane to suggest that it may also protect cells in the eyes from damage due to ultraviolet light, thus reducing the risk of macular degeneration, the most common cause of age-related vision loss.

Adverse Effects Associated with This Food Enlarged thyroid gland (goiter). Cruciferous vegetables, including brussels sprouts, contain goitrin, thiocyanate, and isothiocyanate. These chemicals, known collectively as goitrogens, inhibit the formation of thyroid hormones and cause the thyroid to enlarge in an attempt to produce more. Goitrogens are not hazardous for healthy people who eat moderate amounts of cruciferous vegetables, but they may pose problems for people who have a thyroid condi- tion or are taking thyroid medication. Intestinal gas. Bacteria that live naturally in the gut degrade the indigestible carbohydrates (food fiber) in brussels sprouts and produce gas that some people find distressing.

Food/Drug Interactions Anticoagulants Brussels sprouts are rich in vitamin K, the blood-clotting vitamin produced naturally by bacteria in the intestines. Consuming large quantities of this food may reduce the effectiveness of anticoagulants (blood thinners) such as warfarin (Coumadin). One cup of drained, boiled brussels sprouts contains 219 mcg vitamin K, nearly three times the R DA for a healthy adult.... brussels sprouts

Buffering System

The several blood factors that enable the acid waste products of metabolism to be carried in the alkaline blood without disrupting its chemistry. These include carbolic acid, carbonates, phosphates, electrolytes, blood proteins, and erythrocyte membranes.... buffering system

Button Spider

A South African spider similar to the Redback spider of Australia and the Black Widow spider of America. Belongs to the species Latrodectus indistinctus.... button spider

Calliper Splint

This is applied to a broken leg in such a way that in walking, the weight of the body is taken by the hip-bone and not by the foot.... calliper splint

Capparis Spinosa

Linn.

Capparis moonii Wight.

Family: Capparidaceae.

Habitat: Indigenous to New Zealand. Now distributed in Karnataka and Tamil Nadu.

Ayurvedic: Rudanti.

Action: Fruit—used in puerperal sepsis and septic wounds, also for debility and cough.

EtOH (50%) extract of aerial parts is CNS depressant.

Fruits contain l-stachydrine, rutin and beta-sitosterol.... capparis spinosa

Biophytum Sensitivum

(Linn.) DC.

Synonym: Oxalis sensitiva Linn.

Family: Oxalidaceae.

Habitat: Throughout tropical India.

Ayurvedic: Lajjaalu (var.) Vipareet Lajjaalu (non-classical), Alam- bushaa (Hindi commentators have equated it with Gorakh Mun- di, Sphaeranthus indicus Linn., Asteraceae.)

Folk: Lajoni, Jhalai, Lakajana.

Action: Plant—used in insomnia, convulsions, cramps, chest-complaints, inflammations, tumours, chronic skin diseases. Ash—in stomachache. Leaves— diuretic, astringent, antiseptic. Paste is applied to burns, contusions and wounds. Decoction is given in strangury, asthma and phthisis. Roots—decoction is given in lithia- sis. Mature leaves are recommended in diabetes; contain an insulin-like principle.

A saline extract of leaves showed hy- poglycaemic activity in rabbits.... biophytum sensitivum

Bistort Tea For Stomach Ailments

Bistort tea is widely known as an adjuvant in the areas of treating stomach, respiratory and bleeding problems. It can be intaken two or three times a day to fully enjoy its healthy benefits. Bistort Tea description Bistort is a perennially-growing plant from the Northern Hemisphere. It is normally grown as an ornamental plant because of its small white and pink blooms. It contains vitamins A and C, mucilage and antioxidants, acknowledged for their anti-cancer action. However, Bistort is also cultivated for medicinal purposes, being well-known as one of the most astringent herb. Bistort tea is the beverage resulting from brewing the abovementioned plant. Bistort Tea brewing Bistort tea can be made as a decoction:
  • Place one teaspoonful of the dried bistort rhizome in a 250 ml cup of water and boil the mix.
  • Let it steep for about 10 to 15 minutes.
  • Strain the liquid.
Bistort tea can be consumed twice or thrice a day. It can also be used as a gargle or mouthwash to treat infections inside the mouth. Bistort Tea benefits Bistort tea has been successfully used to:
  • treat diarrhea, dysentery and irritable bowel syndrome
  • aid in the treatment of diverticulitis
  • help treating oral and tongue inflammations
  • help fighting pharyngitis and sore throat
  • help in the treatment of jaundice
  • aid fighting measles and smallpox
  • fight hemorrhoids
  • ease menstrual bleeding
  • help in the healing of wounds, skin ruptures and burstings (when applied topically)
Bistort tea may also help expel worms. Bistort Tea side effects A long-term administration of Bistort tea is not recommended. Pregnant and nursing women are advised not to intake this tea. Bistort tea is a medicinal remedy against several digestive problems and, it also proved to be effective in treating menstrual bleeding, but not only.... bistort tea for stomach ailments

Boswellia Serrata

Roxb.

Family: Burseraceae.

Habitat: The drier parts of Peninsular India.

English: Indian Frankincense, Indian Olibanum.

Ayurvedic: Shallaki, Susravaa, Gajabhakshyaa, Salai. Gum— Kunduru.

Unani: Kundur (gum).

Siddha/Tamil: Parangisambirani, Kungli.

Folk: Salai Guggul.

Action: Gum-resin—antiseptic, anti-inflammatory, antiatheroscle- rotic, emmenagogue, analgesic, sedative, hypotensive. Also used in obesity, diarrhoea, dysentery, piles, urinary disorders, scrofulous affections. Oil—used topically in chronic ulcers, ringworm.

Nonphenolic fraction of gum-resin exhibited marked sedative and analgesic effect in rats. It produced a marked and long-lasting hypotension in anaesthetized dogs.

Many derivatives of 3-keto-methyl- beta-boswellic ester, isolated from the gum-resin., have been prepared; a py- razoline derivative exhibited maximum anti-inflammatory activity. (Gum-resin is used in osteoarthri- tis, juvenile rheumatoid arthritis, soft tissue fibrositis and spondylitis, also for cough, bronchitis, asthma, mouth sores.)

Essential oil from gum-resin—anti- fungal.

Gum-resin contains triterpenes of oleanane, ursane and euphane series. Stem and fruit—hypoglycaemic.

Dosage: Gum-resin—1-3 g (API Vol. IV.)... boswellia serrata

Carcinoma Simplex

Poorly differentiated adenocarcinoma.... carcinoma simplex

Care Supply

The types and volumes of services available.... care supply

Bites And Stings

Animal bites are best treated as puncture wounds and simply washed and dressed. In some cases ANTIBIOTICS may be given to minimise the risk of infection, together with TETANUS toxoid if appropriate. Should RABIES be a possibility, then further treatment must be considered. Bites and stings of venomous reptiles, amphibians, scorpions, snakes, spiders, insects and ?sh may result in clinical effects characteristic of that particular poisoning. In some cases speci?c ANTIVENOM may be administered to reduce morbidity and mortality.

Many snakes are non-venomous (e.g. pythons, garter snakes, king snakes, boa constrictors) but may still in?ict painful bites and cause local swelling. Most venomous snakes belong to the viper and cobra families and are common in Asia, Africa, Australia and South America. Victims of bites may experience various effects including swelling, PARALYSIS of the bitten area, blood-clotting defects, PALPITATION, respiratory di?culty, CONVULSIONS and other neurotoxic and cardiac effects. Victims should be treated as for SHOCK – that is, kept at rest, kept warm, and given oxygen if required but nothing by mouth. The bite site should be immobilised but a TOURNIQUET must not be used. All victims require prompt transfer to a medical facility. When appropriate and available, antivenoms should be administered as soon as possible.

Similar management is appropriate for bites and stings by spiders, scorpions, sea-snakes, venomous ?sh and other marine animals and insects.

Bites and stings in the UK The adder (Vipera berus) is the only venomous snake native to Britain; it is a timid animal that bites only when provoked. Fatal cases are rare, with only 14 deaths recorded in the UK since 1876, the last of these in 1975. Adder bites may result in marked swelling, weakness, collapse, shock, and in severe cases HYPOTENSION, non-speci?c changes in the electrocardiogram and peripheral leucocytosis. Victims of adder bites should be transferred to hospital even if asymptomatic, with the affected limb being immobilised and the bite site left alone. Local incisions, suction, tourniquets, ice packs or permanganate must not be used. Hospital management may include use of a speci?c antivenom, Zagreb®.

The weever ?sh is found in the coastal waters of the British Isles, Europe, the eastern Atlantic, and the Mediterranean Sea. It possesses venomous spines in its dorsal ?n. Stings and envenomation commonly occur when an individual treads on the ?sh. The victim may experience a localised but increasing pain over two hours. As the venom is heat-labile, immersion of the affected area in water at approximately 40 °C or as hot as can be tolerated for 30 minutes should ease the pain. Cold applications will worsen the discomfort. Simple ANALGESICS and ANTIHISTAMINE DRUGS may be given.

Bees, wasps and hornets are insects of the order Hymenoptera and the females possess stinging apparatus at the end of the abdomen. Stings may cause local pain and swelling but rarely cause severe toxicity. Anaphylactic (see ANAPHYLAXIS) reactions can occur in sensitive individuals; these may be fatal. Deaths caused by upper-airway blockage as a result of stings in the mouth or neck regions are reported. In victims of stings, the stinger should be removed as quickly as possible by ?icking, scraping or pulling. The site should be cleaned. Antihistamines and cold applications may bring relief. For anaphylactic reactions ADRENALINE, by intramuscular injection, may be required.... bites and stings

Brain-stem Death

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

Brucea Sativa

National Formulary of UnaniMedicine, Part I, equated Jirjeer with Brucea sativa Mill. or Nasturtium officinale R. Br.

Nasturtium officinale, found in Europe, is known as watercress. Indian cress is cultivated in gardens as a creeper. Brucea is a totally different species (Simaroubaceae). Taraamirra of Unani medicine should be equated with Eru- ca sativa and not with Brucea sativa.

Action: Taraamiraa (Jirjeer)— used in Unani medicine as a spermatic tonic (powder of seeds is administered with a half-fried egg), also as a blood purifier, diuretic, emmenagogue and deobstruent. Leaf juice—used as a lotion for blotches, spots and blemishes.

Nasturtium officinale (Brassicaceae): Antiscorbutic and stimulant. A rich source of vitamins A and E, also of ascorbic acid. Seeds contain glucon- casturtin. Used for metabolic disorders, anaemia, strangury, kidney and bladder disorders and catarrh of the respiratory tract.

Eruca sativa Mill.: Cultivated in North India; known as Taraamiraa, Siddhaartha, Bhutaghna. Seeds are used like mustard. Seeds—antibacterial. Crude juice of the plant inhibited E. coli, S. typhi and B. subtlis. Seeds contain (4-Me-thio)-Bu-glucosinolate (glucoerucin) as K and tetra-Me-N salts. A composition is used in induration of liver.... brucea sativa

Case Severity

A measure of intensity or gravity of a given condition or diagnosis for an older person.... case severity

Case Study

An in-depth study of an individual, group, institution, organization or programme. The advantage of the case study method is that it allows more intensive analyses of specific empirical details. However, it is difficult to use the results to generalize to other cases.... case study

Burns And Scalds

Burns are injuries caused by dry heat, scalds by moist heat, but the two are similar in symptoms and treatment. Severe burns are also caused by contact with electric wires, and by the action of acids and other chemicals. The burn caused by chemicals di?ers from a burn by ?re only in the fact that the outcome is more favourable, because the chemical destroys the bacteria on the affected part(s) so that less suppuration follows.

Severe and extensive burns are most frequently produced by the clothes – for example, of a child – catching ?re. This applies especially to cotton garments, which blaze up quickly. It should be remembered that such a ?ame can immediately be extinguished by making the individual lie on the ?oor so that the ?ames are uppermost, and wrapping him or her in a rug, mat or blanket. As prevention is always better than cure, particular care should always be exercised with electric ?res and kettles or pots of boiling water in houses where there are young children or old people. Children’s clothes, and especially night-clothes, should be made of non-in?ammable material: pyjamas are also much safer than nightdresses.

Severe scalds are usually produced by escape of steam in boiler explosions. Cigarettes are a common cause of ?res and therefore of burns; people who have fallen asleep in bed or in a chair while smoking may set ?re to the bed or chair. Discarded, unextinguished cigarettes are another cause.

Degrees of burns Burns are referred to as either super?cial (or partial-thickness) burns, when there is su?cient skin tissue left to ensure regrowth of skin over the burned site; and deep (or full-thickness) burns, when the skin is totally destroyed and grafting will be necessary.

Symptoms Whilst many domestic burns are minor and insigni?cant, more severe burns and scalds can prove to be very dangerous to life. The main danger is due to SHOCK, which arises as a result of loss of ?uid from the circulating blood at the site of a serious burn. This loss of ?uid leads to a fall in the volume of the circulating blood. As the maintenance of an adequate blood volume is essential to life, the body attempts to compensate for this loss by withdrawing ?uid from the uninjured areas of the body into the circulation. If carried too far, however, this in turn begins to affect the viability of the body cells. As a sequel, essential body cells, such as those of the liver and kidneys, begin to suffer, and the liver and kidneys cease to function properly. This will show itself by the development of JAUNDICE and the appearance of albumin in the urine (see PROTEINURIA). In addition, the circulation begins to fail with a resultant lack of oxygen (see ANOXIA) in the tissues, and the victim becomes cyanosed (see CYANOSIS), restless and collapsed: in some cases, death ensues. In addition, there is a strong risk of infection occurring. This is the case with severe burns in particular, which leave a large raw surface exposed and very vulnerable to any micro-organisms. The combination of shock and infection can all too often be life-threatening unless expert treatment is immediately available.

The immediate outcome of a burn is largely determined by its extent. This is of more signi?cance than the depth of the burn. To assess the extent of a burn in relation to the surface of the body, what is known as the Rule of Nine has been evolved. The head and each arm cover 9 per cent of the body surface, whilst the front of the body, the back of the body, and each leg each cover 18 per cent, with the perineum (or crutch) accounting for the remaining 1 per cent. The greater the extent of the burn, the more seriously ill will the victim become from loss of ?uid from his or her circulation, and therefore the more prompt should be his or her removal to hospital for expert treatment. The depth of the burn, unless this is very great, is mainly of import when the question arises as to how much surgical treatment, including skin grafting, will be required.

Treatment This depends upon the severity of the burn. In the case of quite minor burns or scalds, all that may be necessary if they are seen immediately is to hold the part under cold running water until the pain is relieved. Cooling is one of the most e?ective ways of relieving the pain of a burn. If the burn involves the distal part of a limb – for example, the hand and forearm – one of the most e?ective ways of relieving pain is to immerse the burned part in lukewarm water and add cold water until the pain disappears. As the water warms and pain returns, more cold water is added. After some three to four hours, pain will not reappear on warming, and the burn may be dressed in the usual way. Thereafter a simple dressing (e.g. a piece of sterile gauze covered by cotton-wool, and on top of this a bandage or adhesive dressing) should be applied. The part should be kept at rest and the dressing kept quite dry until healing takes place. Blisters should be pierced with a sterile needle, but the skin should not be cut away. No ointment or oil should be applied, and an antiseptic is not usually necessary.

In slightly more severe burns or scalds, it is probably advisable to use some antiseptic dressing. These are the cases which should be taken to a doctor – whether a general practitioner, a factory doctor, or to a hospital Accident & Emergency department. There is still no general consensus of expert opinion as to the best ‘antiseptic’ to use. Among those recommended are CHLORHEXIDINE, and antibiotics such as BACITRACIN, NEOMYCIN and polymixin. An alternative is to use a Tulle Gras dressing which has been impregnated with a suitable antibiotic.

In the case of severe burns and scalds, the only sound rule is immediate removal to hospital. Unless there is any need for immediate resuscitation, such as arti?cial respiration, or attention to other injuries there may be, such as fractures or haemorrhage, nothing should be done on the spot to the patient except to make sure that s/he is as comfortable as possible and to keep them warm, and to cover the burn with a sterile (or clean) cloth such as a sheet, pillowcases, or towels wrung out in cold water. If pain is severe, morphine should be given – usually intravenously. Once the victim is in hospital, the primary decision is as to the extent of the burn, and whether or not a transfusion is necessary. If the burn is more than 9 per cent of the body surface in extent, a transfusion is called for. The precise treatment of the burn varies, but the essential is to prevent infection if this has not already occurred, or, if it has, to bring it under control as quickly as possible. The treatment of severe burns has made great advances, with quick transport to specialised burns units, modern resuscitative measures, the use of skin grafting and other arti?cial covering techniques and active rehabilitation programmes, o?ering victims a good chance of returning to normal life.

CHEMICAL BURNS Phenol or lysol can be washed o? promptly before they do much damage. Acid or alkali burns should be neutralised by washing them repeatedly with sodium bicarbonate or 1 per cent acetic acid, respectively. Alternatively, the following bu?er solution may be used for either acid or alkali burns: monobasic potassium phosphate (70 grams), dibasic sodium phosphate (70 grams) in 850 millilitres of water. (See also PHOSPHORUS BURNS.)... burns and scalds

Butea Superba

Roxb.

Family: Papilionaceae; Fabaceae.

Habitat: Central and Southern India.

Ayurvedic: Lataa-Palaash (orange or orange scarlet-flowered var.).

Action: Seeds—sedative and anthelmintic; decoction emollient and used topically for piles. Seed oil—anthelmintic and hypotensive. Seeds exhibit haemagglutinating activity against human ABO red cells. Roots—hypotensive. Watery sap from stems is used for drinking purposes. Bark is used in tonics and elixirs.

White-flowered var. is equated with Butea parviflora Roxb.... butea superba

Caesalpinia Sappan

Linn.

Family: Caesalpiniaceae.

Habitat: Native to India and Malaysia. Cultivated in Bengal and South India, also grown as a hedge plant.

English: Sappan.

Ayurvedic: Pattanga, Patanga, Pattraanga, Raktasaara, Ranjana, Pataranjaka, Suranga, Kuchandana.

Unani: Bakam.

Siddha/Tamil: Patangam, Anaikun- trumani.

Folk: Patang.

Action: Wood decoction— emmenagogue, antidiarrhoeal; used in skin diseases.

The heartwood gave an anti-inflammatory principle brazilin; amyrin glu- coside, amino acids and carbohydrates. EtOH (50%) extract of stem exhibited semen coagulant activity Aqueous and chloroform extracts of the wood exhibited inhibitory action on cyclic AMP phosphodiesterase. The methanolic extract of the sappan lignan showed sleep-time-elongation effect in mice. Significant anti-hypercholes- terolaemic activity is attributed to ben- zilic compounds.

The oil exhibited antibacterial and antifungal activity.

Plant pigments find use in facials which are resistant to light, heat and water and are non-irritating.

Dosage: Heartwood—5-10 g (API Vol. IV.)... caesalpinia sappan

Camellia Sinensis

(Linn.) O. Kuntze.

Family: Ranunculaceae.

Habitat: Western temperate Himalayas from 2,500 to 4,000 m.

English: American cowslip, Marsh Marigold, Water Buttercup.

Folk: Mamiri (Punjab).

Family: Theaceae.

Habitat: Cultivated in Assam, Darjeeling, Travancore, the Nilgiris, Malabar, Bengal, Dehra Dun and Kumaon.

English: Tea.

Unani: Chaai, Shaahi, Shaayi.

Siddha/Tamil: Thaeyilai.

Action: Stimulant, diuretic, astringent. In China, used for diarrhoea and dysentery (causes gastrointestinal upsets and nervous irritability when consumed in excess). Green tea: anticancer effects have been observed in Chinese green tea, Camellia thea, extract; the extract of Japanese green tea showed antihepatotoxic effects.

Important constituents of leaf buds and very young leaves are: caffeine, with a much smaller amount of other xanthines (theophylline and theo- bromine); tannins (the main tannin in green tea is (-)-epigallocatechin); flavonoids, quercetin, kaempferol. The stimulant and diuretic are due to caffeine content, the astringency due to the tannins.

Drinking tea lowers thiamine and thiamine diphosphate losses in urine and blood serum respectively but increases niacin losses. Hot water extract of black tea facilitates Ca absorption in the body experimentally. Tea may decrease zinc bioavailability.

The tea, if added to the meal, significantly lower the availability of iron. Milk is as effective as ascorbic acid in countering the depressing effect of tea on iron availability (in vitro).

The green tea catechin inhibited car- cinogenesis in small intestines when given during or after carcinogen treatment to experimental rats. (-)-epi- gallocatechin gallate and theaflavin di- gallate from green tea inhibited the in- fectivity of both influenza A and B virus (in vitro).

Green tea, when added to a lard- cholesterol diet, decreased the cholesterol and triglyceride levels in fowls. Tea polyphenols exhibit hypocholes- terolaemic activity.

Tea polyphenols—(-)-epicatechin gallate, (-)-epigallocatechine galate, theaflavin monogallate A or B, and or theaflavin digallate—are used for treating hyperglycaemia.

Saponins from tea are used as an- tiulcer agents.

Concurrent use of tea and beta- adrenergic agonists may increase the risk of cardiac arrhythmias. Caffeine, a component of tea, may increase insulin resistance. (Sharon M. Herr.)... camellia sinensis

Canarium Strictum

Roxb.

Synonym: C. sikkimense King

Family: Burseraceae

Habitat: A large, deciduous tree distributed in West Ghats, Assam and Sikkim.

English: Black Dammar.

Ayurvedic: Raal Dhuup, Mand Dhuup.

Siddha/Tamil: Karunkungiliyam (gum).

Action: Resin—used for chronic cutaneous diseases, such as psoriasis, pityriasis; as a linament in rheumatic affections. Dammer Oil—used for rheumatism, asthma, venereal diseases.

Black dammer resin contains (+)- junenol, canarone and epikhusinal.

The plant contains a sesquiterpene ketone—canarone.

Canarium sikkimense King is known as Gogul Dhuup in Nepal.... canarium strictum

Cannabis Sativa

Linn.

Synonym: C. indica Linn.

Family: Cannabinaceae.

Habitat: Cultivated all over the country. Commonly occurs in waste grounds, along road side, often becoming gregarious along the irrigation channels of gardens.

English: Hemp, Indian Hemp.

Ayurvedic: Vijayaa, Bhangaa, Maadani, Maatulaani, Indraasana, Trailokya-vijayaa, Tribhuvana- vijayaa, Shukranaashana, Ganjaa, Bhangaa. (Bhangaa is consumed orally; Ganjaa and charas are usually smoked.)

Unani: Bhang, Charas, Qinnab.

Siddha/Tamil: Ganja.

Folk: Bhaanga.

Action: Hallucinogenic, hypnotic, sedative, analgesic, anti- inflammatory, Hemp derivatives are suggested for treating glaucoma and as an antiemetic in cancer chemotherapy. All variants produce initial excitement followed by depression.

Cannabis yields 421 chemicals of various classes—cannabinoids, canna- bispirans and alkaloids. More than 60 cannabinoids have been isolated, the most important one is delta-9- tetrahydrocannabinol (THC).

Toxic constituents are readily absorbed, excreted in urine and feces, stored in lipid tissues, especially CNS, crosses placenta. High doses in animals have damaged developing embryos and resulted in birth defects. (Francis Brinker.)

Dosage: Dried leaves, after removing turbity—125-250 mg powder. (API Vol. I.)... cannabis sativa

Capparis Sepiaria

Linn.

Family: Capparidaceae.

Habitat: Dry regions of the country, also planted as a hedge plant.

English: Indian Caper.

Ayurvedic: Himsraa, Gridhnakhi, Duh-pragharshaa, Kaakdaani, Kabara, Kanthaari.

Siddha/Tamil: Karunjurai.

Family: Cappariadaceae.

Habitat: Native to the Mediterranean region. Distributed in North-west India, Rajasthan, and Peninsular India.

English: Caper Bush.

Ayurvedic: Himsraa, Kaakdaani, Kabara.

Unani: Kabar.

Action: Anti-inflammatory, deob- struent to liver and spleen, diuretic, anthelmintic, vasoconstrictive. Bark—given in splenic, renal and hepatic complaints. Juice of leaves and fruits—anticystic, bactericidal and fungicidal. Dried flower buds— used in scurvy.

Plant gave glucosinolates—glucoi- berin, glucocapparin, sinigrin, gluco- cleomin and glucocapangatin. Rutin has also been reported from plant. The root bark, cortex and leaves gave stachydrine. Stachydrine, when given to dogs, rabbits and rats, quickened the coagulation of blood and reduced loss of blood.... capparis sepiaria

Cause Specific

These rates commonly are also age, death rate sex, or race specific. They are expressed as numbers of deaths assigned to a stated cause in a calendar year, divided by total population as of July 1st of that year, expressed in 100,000.... cause specific

Cell Salvage Transfusion

See TRANSFUSION.... cell salvage transfusion

Chalk-stones

See GOUT.... chalk-stones

Cheyne-stokes Breathing

A type of breathing which gets very faint for a short time, then gradually deepens until full inspirations are taken for a few seconds, and then gradually dies away to another quiet period, again increasing in depth after a few seconds and so on in cycles. It is seen in some serious neurological disorders, such as brain tumours and stroke, and also in the case of persons with advanced disease of the heart or kidneys. When well marked it is a sign that death is impending, though milder degrees of it do not carry such a serious implication in elderly patients.... cheyne-stokes breathing

Cardo Santo

Mexican prickly poppy (Argemone mexicana).

Plant Part Used: Leaf, flower, root and stem.Dominican Medicinal Uses: Leaf/whole herb: prepared as a tea for blood-cleansing, cancer, stomach ulcers, delayed menstruation, vaginal infection, menopause symptoms; prepared as a douche for vaginal infection and inflammation; as a multi-herb mixture for ovarian cysts, uterine fibroids and tumors; root: boiled tea for stomach pain.Safety: Entire plant shown to be hepatotoxic due to sanguinarine and alkaloid content, especially concentrated in the seeds; internal use strongly cautioned against.Contraindications: Pregnancy, lactation, children.Laboratory & Preclinical Data: In vitro: antifungal, anti-HIV, anti-tumor, morphine-withdrawal alleviation, uterine stimulant (organic plant extracts).* See entry for Cardo santo in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.

... cardo santo

Care Standards Act

Legislation (approved by the UK parliament in 2001) that sets up a new, independent regulatory body for social care and private and voluntary health-care services. The new body is called the National Care Standards Commission and covers England and Wales, but in the latter the National Assembly is the regulatory body. Independent councils register social-care workers, set social-care work standards and regulate the education and training of social workers in England and Wales. The Act also gives the Secretary of State for Health the authority to keep a list of individuals considered unsuitable to work with vulnerable adults. In addition, the legislation reforms the regulation of childminders and day-care provision for young children, responsibility for overseeing these services having been transferred from local authorities to the Chief Inspector of Schools. Services covered by the Act range from residential care homes and nursing homes, children’s homes, domiciliary-care agencies, fostering agencies and voluntary adoption agencies through to private and voluntary health-care services. This includes private hospitals and clinics and private primary-care premises. For the ?rst time, local authorities will have to meet the same standards as independent-sector providers.... care standards act

Cassia Sophera

Linn.

Family: Calsalpiniaceae.

Habitat: In gardens as hedge throughout India.

English: Sophera Senna.

Ayurvedic: Kaasamarda.

Unani: Kasondi.

Siddha/Tamil: Ponnaavaarai.

Action: Leaves, seeds, bark— cathartic; considered specific for ringworm and other skin diseases (bark may cause dermatitis); used for bronchitis and asthma.

A paste of leaves is used for treating piles. An infusion of fresh leaves, with sugar, is given in jaundice. Plant is spasmolytic. Alcoholic extract of leaves is intestinal and bronchial muscle relaxant.

The leaves contain a flavone glyco- side and sennoside. Root bark contains anthraquinones, chrysophanol, physcion and beta-sitosterol. Heart- wood gave isomeric derivatives, 1,2, 7-trihydroxy-3-methylanthraquinone, along with sopheranin, beta-sitosterol, chrysophanol, physcion, emodin, 1- octadecanol and quercetin.... cassia sophera

Childhood Immunization Schedule

The schedule laid down by most countries to recommend which routine immunizations should be given to children and the intervals at which boosters should be administered. Such routine immunizations usually include tetanus, diphtheria, pertussis, polio, Hepatitis B, Haemophilus influenzae type b (H.I.B.) and after one year of age, measles, rubella and mumps vaccines.... childhood immunization schedule

Chore Service

Help with chores, such as home repairs, gardening and heavy house cleaning.... chore service

Chorea, Sydenham’s

A disease or syndrome of children, usually following or companion to rheumatic fever, and having involuntary movements, anxiety and impaired memory. It usually clears up in two or three months.... chorea, sydenham’s

Chronic Sick And Disabled Act 1970

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

Clinical Information System

An information system that collects, stores and transmits information that is used to support clinical applications (e.g. transmission of laboratory test results, radiology results, prescription drug orders). Electronic medical records are one method by which clinical information systems can be created.... clinical information system

Clinical Significance

A conclusion that an intervention has an effect that is of practical meaning to older persons and health care providers. Even though an intervention is found to have a statistically significant effect, this effect may not be clinically significant. In a trial with a large number of participants, a small difference between treatment and control groups may be statistically significant, but clinically unimportant. In a trial with few participants, an important clinical difference may be observed that does not achieve statistical significance. (A larger trial may be needed to confirm that this is a statistically significant difference).... clinical significance

Cascara Sagrada Tea - A Powerful Laxative

Cascara Sagrada Tea has been known since ancient times as a great stimulant and laxative agent. In fact, the ones to discover its medical benefits were the American. The first proofs of this fact date from the 17th century, when American practitioners used Cascara Sagrada bark to treat many bacterial ailments of the digestive system. Cascara is a small shrub that grows mainly in the North America, in states like Idaho, California or Montana. Cascara never grows taller than 50 centimeters and has pale yellow greenish leaves and deep green leaves. Also known as rhamnus purshiana, Cascara has purple fruits or black berries that hide usually three hard seeds. Cascara Sagrada is harvested in the fall and can only be used dried (one year apart from the harvesting time) in order to release its curative benefits. Many people in Northern America specialize in Cascara Sagrada harvesting and herb processing (the plant needs to be properly dried and according to a list of specifications). Cascara Sagrada Tea Properties Cascara Sagrada Tea is known for its strong, stimulant and laxative properties. The main substances of this tea are very efficient in cases of nervous system failures and intestinal tract ailments. Cascara Sagrada Tea has a very bitter and therefore unpleasant taste. That’s why most people prefer to take it as capsules or extracts. Cascara Sagrada Tea Benefits Aside from its use as a constipation treatment, Cascara Sagrada Tea can also cure a variety of diseases involving the digestive tract, such as intestinal parasites or bacterial infections. However, make sure that you take this tea responsibly and don’t forget that this is a medical treatment wich only should be taking while you’re sick. Don’t try to replace your morning coffee with Cascara Sagrada Tea or you’ll face a series of complications! How to make Cascara Sagrada Tea Infusion When preparing Cascara Sagrada Tea, you have to make sure that you only use ingredients from a trusted provider. Nowadays, there are many illegal substances on the market sold as tea. Also, the herb you bought may be exactly what the label says it is, but not properly dried, in which case you’ll suffer from unwanted complications as well. Once you have the right ingredients, use a teaspoon of dried herbs for every cup of tea you want to make, add boiling water and wait 20 minutes for the wonderful benefits to be released. Strain the decoction and drink it hot or cold. You may also add honey or even sugar if the taste feels a bit unpleasant. Cascara Sagrada Tea Side Effects When taken in small amounts, Cascara Sagrada Tea is a safe treatment. However, high dosages may lead to various problems, such as urine discoloration, blood in stools, pain and vomiting. Make sure the dosage you’re using is the appropriate one or ask your doctor before making any moves: it’s better to be safe than sorry! Cascara Sagrada Contraindications Cascara Sagrada Tea is not recommended for pregnant or breastfeeding women, patients suffering from appendicitis or ulcerative colitis. Also, if you are on blood thinners or anticoagulants, avoid taking a treatment based on Cascara Sagrada Tea. To gather more information, talk to an herbalist or to your doctor! If he gives you the green light and you happen to be in a teashop, add Cascara Sagrada Tea to your shopping cart and enjoy its wonderful benefits responsibly!... cascara sagrada tea - a powerful laxative

Castanea Sativa

Mill.

Synonym: C. vulgaris Lam.

Family: Fagaceae.

Habitat: Darjeeling, Khasi Hills, Punjab and Himachal Pradesh.

English: Spanish Chestnut, Sweet Chestnut.

Folk: Singhaaraa (not to be confused with water-chestnut, Tripa natans L.)

Action: Leaves—astringent, antitussive and febrifuge (used for fevers and diseases of the respiratory tract). An infusion is used as a gargle in pharyngitis, proxysmal coughs, catarrh and whooping cough. Nuts—extract, as platelet inhibitor in thrombosis and atherosclerosis.

The leaves contain tannins (8-9%) flavone glycosides, triterpenoids, ursolic acid, lupeol and betulin. Heartwood contains 61.4% tannins and 25.7% nontannins. The wood and bark contain 714 and 8-14% tannins respectively.

Nuts are eaten raw, roasted or boiled like potatoes. Nuts contain protein,... castanea sativa

Clinical Signs

The physical manifestations of an illness elicited by a doctor when examining a patient – for example, a rash, lump, swelling, fever or altered physical function such as re?exes.... clinical signs

Clinical Symptoms

The experiences of a patient as communicated to a doctor, for example, pain, weakness, cough. They may or may not be accompanied by con?rmatory CLINICAL SIGNS.... clinical symptoms

Cold Sores

See HERPES SIMPLEX.... cold sores

Coma Scale

See GLASGOW COMA SCALE.... coma scale

Committee On Safety Of Medicines (csm)

An independent advisory committee – launched in 1971 in the United Kingdom – composed of doctors, pharmacists and other specialists. It advises the MEDICINES CONTROL AGENCY in the UK on the safety, e?cacy and pharmaceutical quality of MEDICINES for which licences are sought and also reviews reports of ADVERSE REACTIONS TO DRUGS, including spontaneous ‘Yellow Card’ reports from doctors or pharmacists who suspect that a patient has suffered an adverse reaction from a medicine. Its predecessor, the Committee for Safety of Drugs, was set up in 1963 in response to the THALIDOMIDE disaster.... committee on safety of medicines (csm)

Ceratonia Siliqua

Linn.

Family: Caesalpinaceae.

Habitat: Cultivated in Punjab. English: Locust Bean; St. John's Bread, Carob tree.

Unani: Kharnub Shaami.

Action: Pod and husk from seed— antidiarrhoeal (stools in gastroenteritis and colitis are known to solidify within 48 h).

The pods contain tannin from 0.88 to 4.09%.

Pulp of the pod contains 30-70% sugars, fats, starch, protein, amino acids, gallic acid; leucoanthocyanins and related phenolics. Leaves contain catechols.... ceratonia siliqua

Chloroxylon Swietenia

DC.

Family: Rutaceae.

Habitat: Dry, deciduous forests, throughout Peninsular India.

English: Indian Satinwood tree.

Ayurvedic: Provisionally equated with Bhillotaka.

Siddha/Tamil: Karumboraju, Kudavuboraju, Poraju.

Folk: Bhirraa, Bharahula, Raktaro- hidi.

Action: Leaves—anti-inflammatory, antiseptic. A paste is applied to wounds; also in rheumatism. Bark—astringent. A decoction is used in contusions and for painful joints. (The wood, its dust, moist dust of freshly cut wood, cause skin irritation and dermatitis.)

The bark contains the alkaloids— skimmianine, swietenidins A and B, chloroxylin and chloroxylonine. Chloroxylonine is a powerful irritant. The bark also contains the coumarins and lignans.

The leaves yield an essential oil which shows antibacterial and anti- fungal activity.... chloroxylon swietenia

Chronic Fatigue Syndrome (cfs)

See also MYALGIC ENCEPHALOMYELITIS (ME). A condition characterised by severe, disabling mental and physical fatigue brought on by mental or physical activity and associated with a range of symptoms including muscle pain, headaches, poor sleep, disturbed moods and impaired concentration. The prevalence of the condition is between 0.2 and 2.6 per cent of the population (depending on how investigators de?ne CFS/ME). Despite the stereotype of ‘yuppie ?u’, epidemiological research has shown that the condition occurs in all socioeconomic and ethnic groups. It is commoner in women and can also occur in children.

In the 19th century CFS was called neurasthenia. In the UK, myalgic encephalomyelitis (ME) is often used, a term originally introduced to describe a speci?c outbreak such as the one at the Royal Free Hospital, London in 1955. The term is inaccurate as there is no evidence of in?ammation of the brain and spinal cord (the meaning of encephalomyelitis). Doctors prefer the term CFS, but many patients see this as derogatory, perceiving it to imply that they are merely ‘tired all the time’ rather than having a disabling illness.

The cause (or causes) are unknown, so the condition is classi?ed alongside other ‘medically unexplained syndromes’ such as IRRITABLE BOWEL SYNDROME (IBS) and multiple chemical sensitivity – all of which overlap with CFS. In many patients the illness seems to start immediately after a documented infection, such as that caused by EPSTEIN BARR VIRUS, or after viral MENINGITIS, Q FEVER and TOXOPLASMOSIS. These infections seem to be a trigger rather than a cause: mild immune activation is found in patients, but it is not known if this is cause or e?ect. The body’s endocrine system is disturbed, particularly the hypothalamopituitary-adrenal axis, and levels of cortisol are often a little lower than normal – the opposite of what is found in severe depression. Psychiatric disorder, usually depression and/or anxiety, is associated with CFS, with rates too high to be explained solely as a reaction to the disability experienced.

Because we do not know the cause, the underlying problem cannot be dealt with e?ectively and treatments are directed at the factors leading to symptoms persisting. For example, a slow increase in physical activity can help many, as can COGNITIVE BEHAVIOUR THERAPY. Too much rest can be harmful, as muscles are rapidly weakened, but aggressive attempts at coercing patients into exercising can be counter-productive as their symptoms may worsen. Outcome is in?uenced by the presence of any pre-existing psychiatric disorder and the sufferer’s beliefs about its causes and treatment. Research continues.... chronic fatigue syndrome (cfs)

Community Health Services

Usually managed by NHS trusts, these are a complex variety of services provided to people outside hospital settings. The key parts are the services delivered by district nurses, health visitors and therapists – for example, physiotherapists and speech therapists.... community health services

Community Visitor Scheme

A scheme utilizing volunteers to visit, spend time with and become friends with an older person in his/her place of residence.... community visitor scheme

Community-based Care / Community-based Services / Programmes

The blend of health and social services provided to an individual or family in his/her place of residence for the purpose of promoting, maintaining or restoring health or minimizing the effects of illness and disability. These services are usually designed to help older people remain independent and in their own homes. They can include senior centres, transportation, delivered meals or congregate meals sites, visiting nurses or home health aides, adult day care and homemaker services.... community-based care / community-based services / programmes

Circulatory System Of The Blood

The course of the circulation is as follows: the veins pour their blood, coming from the head, trunk, limbs and abdominal organs, into the right atrium of the HEART. This contracts and drives the blood into the right ventricle, which then forces the blood into the LUNGS by way of the pulmonary artery. Here it is contained in thin-walled capillaries, over which the air plays freely, and through which gases pass readily out and in. The blood gives o? carbon dioxide (CO2) and takes up oxygen (see RESPIRATION), and passes on by the pulmonary veins to the left atrium of the heart. The left atrium expels it into the left ventricle, which forces it on into the aorta, by which it is distributed all over the body. Passing through capillaries in the various tissues, it enters venules, then veins, which ultimately unite into two great veins, the superior and the inferior vena cava, these emptying into the right atrium. This complete circle is accomplished by any particular drop of blood in about half a minute.

In one part of the body there is a further complication. The veins coming from the bowels, charged with food material and other products, split up, and their blood undergoes a second capillary circulation through the liver. Here it is relieved of some food material and puri?ed, and then passes into the inferior vena cava, and so to the right atrium. This is known as the portal circulation.

The circle is maintained always in one direction by four valves, situated one at the outlet from each cavity of the heart.

The blood in the arteries going to the body generally is bright red, that in the veins dull red in colour, owing to the former being charged with oxygen and the latter with carbon dioxide (see RESPIRATION). For the same reason the blood in the pulmonary artery is dark, that in the pulmonary veins is bright. There is no direct communication between the right and left sides of the heart, the blood passing from the right ventricle to the left atrium through the lungs.

In the embryo, before birth, the course of circulation is somewhat di?erent, owing to the fact that no nourishment comes from the bowels nor air into the lungs. Accordingly, two large arteries pass out of the navel, and convey blood to be changed by contact with maternal blood (see PLACENTA), while a large vein brings this blood back again. There are also communications between the right and left atria, and between pulmonary artery and aorta. The latter is known as the ductus arteriosus. At birth all these extra vessels and connections close and rapidly shrivel up.... circulatory system of the blood

Cleavers Tea - Best Tonic For The Lymphatic System Available In Nature

Cleavers tea has been used for centuries, even in ancient Greece. It is considered probably the best tonic for the lymphatic system available. Discover all of its benefits and learn how to make the most of this type of tea. Description of Cleavers tea Cleavers is an annual green plant that grows mostly in Britain, North America and Eurasia regions. The green to white flowers look like small balls and they are very sticky, similar to the leaves. Scientifically named gallium aparine, cleavers is also called bedstraw, barweed, catchweed, grip grass. The entire cleavers plant is used in herbal medicine and is harvested just before it blooms in early summer. The active constituents of cleavers tea are chlorophyll, citric acide, rubichloric acid, galiosin and tannins. To benefit the most from these constituents, you can consume cleavers, usually found in the form of tea, extracts, capsule, or fresh for many cooking recipes. The roasted seeds are used as a coffee substitute and the young leaves can be eaten like spinach. Cleavers tea has a slightly bitter taste and no odor. Cleavers tea brew For a tasty Cleavers tea, take 2 to 3 teaspoons of the dried above-ground parts of the plant and infuse them in a 250 mg cup of hot water for 10 or 15 minutes. You may add sugar or honey to improve its taste and drink up to three times per day. Cleavers tea  Benefits Cleavers tea is a strong detoxifying for the lymphatic system. It is diuretic, thus treating most of urinary tract infections. It cleans the blood, the liver and kidneys. The tea can be used together with Uva Ursi or Echinacea for best results. Applied topically, Cleavers tea helps in the treatment of many skin conditions like acne, eczema, psoriasis, dandruff, itchy scalp, sunburns or even wounds. Cleavers tea can be used as a facial tonner because it helps clear the complexion. Cleavers tea Side effects Cleavers tea has no known side effects. Though it is widely safe, children, pregnant or nursing women should drink it with precaution. Cleavers tea can surely be included in a healthy lifestyle. As long as you don’t exaggerate with it, you can enjoy the benefits of this tea and even use the plant to prepare many tasty recipes and salads.... cleavers tea - best tonic for the lymphatic system available in nature

Complement System

This is part of the body’s defence mechanism that comprises a series of 20 serum peptides (see PEPTIDE). These are sequentially activated to produce three signi?cant effects: ?rstly, the release of small peptides which provoke in?ammation and attract phagocytes (see PHAGOCYTE); secondly, the deposition of a substance (component C3b) on the membranes of invading bacteria or viruses, attracting phagocytes to destroy the microbes; thirdly, the activation of substances that damage cell membranes – called lytic components – which hasten the destruction of ‘foreign’ cells. (See IMMUNOLOGY.)... complement system

Comprehensive Health System

A health system that includes all the elements required to meet all the health needs of the population.... comprehensive health system

Cone Shells

Molluscs with cone-shaped shells, at least two species of which (Conus geographicus and C. textile) have been responsible for some 18 human deaths, usually from respiratory arrest. C. geographicus has caused at least one Australian death.... cone shells

Convenience Sample

A population being studied because they are conveniently accessible (for example, all the people at a certain hospital or attending a particular support centre). As they are not a random sample of the whole population, they may be unrepresentative.... convenience sample

Clerodendrum Serratum

(Linn.) Moon.

Family: Verbenaceae.

Habitat: A shrub distributed throughout the country, especially common in Assam and Bengal.

English: Blue-flowered Glory tree, Beetle Killer.

Ayurvedic: Bhaargi, Bhaaran- gi, Angaarvalli, Phanji, Braah- manyashtikaa, Kharshaak, Padma, Bhragubhavaa, Brahmayashtikaa.

Siddha/Tamil: Kandoorbarangi (root), cherutekku.

Action: Root—Antiasthmatic, antihistaminic, antispasmodic, antitussive carminative, febrifuge. Leaf—febrifuge.

The Ayurvedic Pharmacopoeia of India indicated the use of the dried roots in cough, bronchitis, dyspnoea, chest diseases and sinusitis.

The bark contains triterpenoids— serratagenic, oleanolic and queretaric acids; leaves contain alpha-spinasterol and flavonoids, including luteolin, api- genin, baicalein, scutellarein, phenolic acids—caffeic and ferulic acids.

EtOH (50%) extract of the plant exhibited hypotensive and spasmolytic activity. Polyhydric property on isolated guinea pig ileum. Antiasthmatic effect was also observed pharmacologically.

Dosage: Root—3-6 g powder; 1020 g for decoction. (API Vol. III.)... clerodendrum serratum

Computerised Decision-support Systems

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

Convolvulus Scammonia

Linn.

Family: Convolvulaceae.

Habitat: A native to the Mediterranean region.

English: Scammony.

Unani: Saqmunia.

Action: Resin from rhizomes—hy- dragogue, Cathartic, administered in dropsy and anascara.

Most of the resin available in India is imported from Syria and Asia Minor and is grossly adulterated.

The roots contain on an average 8% resin together with dihydroxy cinnam- ic acid, beta-methyl-esculetin, ipu- ranol, surcose, a reducing sugar and starch. The resin consists of the glyco- sides and methylpentosides of jalapi- nolic acid and its methyl ester.

Large doses cause acute gastro-intestinal irritation, and, if absorbed, produce cystitis and nephritis.... convolvulus scammonia

Coordination Within The Health Sector

Organized collaboration, as necessary, among those providing the services at the same and different levels of the health system in order to make the most efficient use of resources, as well as within and among the various categories of health workers following agreement on the division of labour. It also means coordination of programmes or services to avoid duplication or inconsistency.... coordination within the health sector

Coriandrum Sativum

Linn.

Family: Umbelliferae; Apiaceae.

Habitat: Cultivated chiefly in Madhya Pradesh, Maharashtra, Rajasthan, Andhra Pradesh, Tamil Nadu, Karnataka and Bihar.

English: Coriander.

Ayurvedic: Dhaanyaka, Kustum- buru, Dhaanyeyaka, Dhanika, Dhanikaa, Dhaanaa, Dhaanya, Dhaniyaa, Kunati, Chhatraa, Vitunnaka.

Unani: Kishneez.

Siddha/Tamil: Kotthamalli.

Action: Stimulant, stomachic, carminative, antispasmodic, diuretic; also hypoglycaemic and anti-inflammatory. Oil—bactericidal and larvicidal. Used in China as a remedy for measles, diabetes, aerophagy and gastroenteritis.

Key application: In dyspeptic complaints, loss of appetite. (German Commission E, British Herbal Pharmacopoeia, Indian Herbal Pharmacopoeia.)

Coriander contains 0.5-1% volatile oil, consisting mainly of delta-linalool (55-74%), alpha-pinene and terpinine. It also contains flavonoids, coumarins, phthalides and phenolic acids (including caffeic and chlorogenic).

Aqueous extract of the roasted seeds contains large amounts of acetylcho- line and its precursor choline. (Choline is found useful in preventing and curing certain liver disorders.) The extract shows cholinomimetic effects experimentally.

Coriandrin, an antiviral agent, has been synthesized from the aerial parts. The plant forms an ingredient of a Pakistani herbal drug (Intellan) which is considered to be a neuro-energizer.

In Unani medicine, an infusion of fruits is also used in bleeding piles, neuralgia, cephalalgia and spermatorrhoea.

Dosage: Fruit—1-3 g powder. (API Vol. I.)... coriandrum sativum

Cost Sharing

Payment method whereby a person is required to pay some health costs in order to receive medical care. The general set of financing arrangements whereby the consumer must pay out-of-pocket to receive care, either at the time of initiating care or during the provision of health care services, or both. Cost sharing can also occur when an insured person pays a portion of the monthly premium for health care insurance.... cost sharing

Cost Shifting

Recouping the cost of providing uncompensated care by increasing revenues from some payers to offset losses and lower net payments from other payers.... cost shifting

Corn Silk Tea Remedy

Have you ever thought that if you remove the corn silk from corn combs, you can use it as a remedy? While many people may not be familiar with this type of tea, in fact corn silk tea was used for a long time even by Native Americans as a remedy for heart problems, malaria or urinary tract infections. More about Corn silk tea Corn silk is in fact the thin, hair-like strands that cover the corn cob. These silky yellowish strands which form the stigma collect pollen to fertilize the corn, and they’re also used to make a healing tea. In corn silk there can be found many important components like flavonoids, allantoin, mucilage, saponins, vitamins C and K and potassium. Corn silk may also be combined with other herbs to increase its healing powers and range of medicinal uses. It’s also available in prepackaged teabags, or in a dried supplement form. Powdered corn silk is a common ingredient in face powders, due to its soothing qualities. Corn silk tea has a slightly sweet taste. If you decide to collect it in order to make a tea, make sure that the plants were not sprayed with pesticides. Brew corn silk tea In order to make a tasty healthy corn silk tea it is usually recommended to use fresh corn silk. If you don’t have it at your hand, the dried one works just fine. To prepare the infusion, use 2 teaspoons of fresh corn silk or 2.5 g of dried one and pour 1 cup of boiled water over it. Let it seep for 10 - 15 minutes and it is ready to serve. Corn silk tea benefits Corn silk tea has many health benefits for adults and for children. The most important benefit of this tea is for disorders in the urinary system : infections, cystitis, as well as bladder infections or gonorrhea. If you want your children to stop wetting their beds give them corn silk tea. Corn silk tea is also diuretic, demulcent, has anti-inflammatory properties and it fights kidney stones. Corn silk tea may help detoxify and flush out accumulated toxins in the body. Corn silk tea contains vitamin K, which has been shown to improve the body’s blood clotting process. Corn silk tea has also been shown to lower blood pressure, relieve arthritis pains, and help in the treatment of jaundice and prostate disorders. When applied topically, corn silk tea can help heal wounds and skin ulcers. Corn silk tea side effects In most cases, corn silk tea is suitable for daily consumption without special warnings. However, in rare cases, in you are allergic to corn, you may develop a skin rash. Corn silk tea can also decrease the level of potassium in your blood. So you should avoid it if you already have low potassium levels, problems with blood pressure, or diabetes. It is not recommended for children, during pregnancy or breastfeeding. Corn silk tea is safe to be included in your diet, but in order to enjoy its benefits, do not exceed 3 cups a day.... corn silk tea remedy

Costus Speciosus

(Koenig) Sm.

Family: Zingiberaceae.

Habitat: Assam, North Bengal, Khasi and Jaintia Hills, sub Himalayan tracts of Uttar Pradesh and Himachal Pradesh and Western Ghats.

English: Canereed, Wild Ginger.

Ayurvedic: Kebuka, Kembuka.

Siddha/Tamil: Krrauvam, Malai Vasambu, Ven Kottam.

Folk: Kebu.

Action: Astringent, purgative, depurative, anti-inflammatory (used in gout, rheumatism; bronchitis, asthma, catarrhal fevers, dysuria), anthelmintic, antivermin, maggoticide, antifungal.

The rhizomes contain saponins— dioscin, gracillin and beta-sitosterol- beta-D-glucoside. The alkaloids show papaverine-like smooth-muscle-relaxant activity, cardiotonic activity like that of digitalis and antispasmodic,

CNS-depressant, diuretic and hydro- choleretic activities. Saponins show significant anti-inflammatory and an- tiarthritic activity.

The seeds also contain saponins and exhibit potent and sustained hypoten- sive and bradycardiac activities in dogs with low toxicity and without any haemolytic activity; also weak spasmolytic activity on isolated guinea-pig ileum.

All parts of the plant yield steroidal sapogenin, diogenin (quantity varies from 0.32 to 4%).

(Not to be confused with Kushtha of Indian medicine, Saussurea lappa.)... costus speciosus

Cough Syncope

Temporary loss of consciousness that may be induced by a severe spasm of coughing. This is the result of the high pressure that may be induced in the chest – over 200 millimetres of mercury – by such a spasm, which prevents the return of blood to the heart. The veins in the neck begin to bulge and the blood pressure falls; this may so reduce the blood ?ow to the brain that the individual feels giddy and may then lose consciousness. (See FAINTING.)... cough syncope

Cracked-pot Sound

A peculiar resonance heard sometimes on percussion of the chest over a cavity in the lung, resembling the jarring sound heard on striking a cracked pot or bell. It is also heard on percussion over the skull in patients with diseases of the brain such as haemorrhages and tumours, and in certain cases of fracture of the skull.... cracked-pot sound

Crown-of-thorns Starfish

Colloquial term for the starfish Acanthaster planci. See Acanthaster planci.... crown-of-thorns starfish

Ct Scan

See COMPUTED TOMOGRAPHY.... ct scan

Crocus Sativus

Linn.

Family: Iridaceae.

Habitat: Cultivated in Kashmir up to 2,000 m and in Chaubattia in Uttar Pradesh.

English: Saffron, Crocus.

Ayurvedic: Kumkuma, Rudhira, Vadrika, Kaashmira, Kaashmiraka, Vaalhika, Agnishikhaa, Ghrusrrn, Rakta, Kshataja. Keshara (usually Keshara indicates Naagakeshara, Mesuaferrea Linn.)

Unani: Zaafraan.

Siddha/Tamil: Kumgumappoo (dried stigma).

Action: Stigma and style—nervine tonic, sedative, antispasmodic expectorant (in dry cough, whooping cough, bronchitis), stomachic, diaphoretic, emmenagogue.

The Ayurvedic Pharmacopoeia of India indicated the use of the stigma and style in migraine, chronic sinusitis, and in urinary obstruction, inflammation of the urinary tract.

The saffron is used in Chinese medicine for melancholia, depression, shock and menstrual disorders.

Saffron contains a volatile oil composed of terpenes, terpene alcohols and esters. The herb also contains crocin, picrocrocin, crocetin, carotenoids and riboflavin and thiamine.

Preliminary evidence suggests that crocetin may improved atherosclerosis by increasing plasma oxygen diffusion and decreasing cholesterol and triglyceride levels. In addition, cro- cetin binds to albumin, potentially increasing oxygen diffusion and improving atherosclerosis. (Natural Medicines Comprehensive Database, 2007.)

The stigma showed remarkable inhibitory effect on blood coagulation due to the presence of platelet aggregation inhibitor containing adenosine. It accelerated in vitro fibrinolytic activity of urokinase and plasmin.

Small amounts of Saffron stimulate gastric secretion; larger amounts stimulate uterine smooth muscle and exhibit emmenagogue and abortifacient effects.

Saffron extract showed cytotoxic and antimutagenic activity and antitu- mour activity against ascites tumours in mice. Chemical analysis indicated that the naturally occurring crocin may be the active principle responsible for the observed anticancer activity.

A xanthone, carotenoid glycosidic conjugate, mangi-crocin, isolated from saffron, showed significant adapto- genic activity. A natural antioxidant, isolated from saffron stem callus, showed better antioxidant activity than vitamin E. Saffron bulbs are toxic, stigmas in overdoses narcotic.

The dose of stigma and styles at 1.55.0 g is toxic. (Recommended dose : 0.5-1.5 g per day).

Dosage: Dried style and stigma—20-50 mg (API Vol. IV.)... crocus sativus

Ct Scanner

The machine which combines the use of a computer and X-rays to produce cross-sectional images of the body (see COMPUTED TOMOGRAPHY).... ct scanner

Cucumis Sativus

Linn.

Family: Cucurbitaceae.

Habitat: Cultivated for its edible fruits which are usually used as salad vegetable.

English: Cucumber.

Ayurvedic: Trapusha, Traapusha, Trapushi, Tiktakarkatikaa (bitter var.).

Unani: Khiyaar, Khiraa.

Siddha/Tamil: Vellarikkai.

Folk: Khiraa.

Action: Seed—used in dysuria, irritation of the urinary tract, cystitis. Reduces specific gravity of urine. Also used for tapeworms.

Cucumber contains rutin; seeds glu- cosides including cucurbitaside; leaves free cucurbitasides B & C, ferredox- in, alpha-spinasterol. Free and bound sterols are found in seedlings and in male and female flowers.

Presence of proteolytic enzymes, ascorbic acid oxidase and succinic and malic dehydrogenases has been reported.

Dosage: Seed—3-6 g powder; fruit juice—25-50 ml. (CCRAS.)... cucumis sativus

Cupressus Sempervirens

Linn.

Family: Cupressaceae.

Habitat: Native to Asia Minor, Syria and North Persia. The tree is a variety only known in the cultivated state in North-West India. (Chopra RN.)

English: Mediterranean Cypress.

Ayurvedic: Suraahva.

Unani: Saro.

Siddha/Tamil: Suram, Churam.

Action: Tincture—vasoconstrictor, antiseptic, sedative, antispasmodic, diuretic. Used for cough, cold, bronchitis, varicose veins, piles, menopausal cramps, leg-cramps. Essential oil—used only externally. Used in aromatherapy for massage (10 drops in 2 teaspoonful of almond oil).

The essential oil from the plant gave 73 compounds; major compound was alpha-pinene (47.00-52.76%); among others—D-camphane, D-silvestren, p- cymene, L-cadinenes, cedrol, terpine- ol, acetyl-and isovalerianyl monoter- pene ester.

No longer taken internally as a diluted essential oil. Medicinal parts are cones, branches and oil.... cupressus sempervirens

Cutaneous Means Belonging To The Skin.

... cutaneous means belonging to the skin.

Cyclo-oxygenase-2 Selective Inhibitors

See COX-2 INHIBITORS.... cyclo-oxygenase-2 selective inhibitors

Da Costa’s Syndrome

See EFFORT SYNDROME.... da costa’s syndrome

Dalbergia Sympathetica

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

Cushing’s Syndrome

Described in 1932 by Harvey Cushing, the American neurosurgeon, Cushing’s syndrome is due to an excess production of CORTISOL. It can thus result from a tumour of the ADRENAL GLANDS secreting cortisol, or from a PITUITARY GLAND tumour secreting ACTH and stimulating both adrenal cortexes to hypertrophy and secrete excess cortisol. It is sometimes the result of ectopic production of ACTH from non-endocrine tumours in the LUNGS and PANCREAS.

The patient gains weight and the obesity tends to have a characteristic distribution over the face, neck, and shoulder and pelvic girdles. Purple striae develop over the abdomen and there is often increased hairiness or hirsutism. The blood pressure is commonly raised and the bone softens as a result of osteoporosis. The best test to establish the diagnosis is to measure the amount of cortisol in a 24-hourly specimen of urine. Once the diagnosis has been established, it is then necessary to undertake further tests to determine the cause.... cushing’s syndrome

Cymbopogon Schoenanthus

Spreng.

Synonym: Andropogon schoenan- thus Linn.

Family: Poaceae.

Habitat: Warmer parts of India, from Punjab to Bengal and in South India.

English: Camel-Hay.

Ayurvedic: Rohisha (var.).

Unani: Rusaa Ghaas, Izkhar.

Siddha/Tamil: Karpurapul, Rohisha- trna.

Action: Roots and rhizome— carminative, stimulant, diaphoretic, emmenagogue; used for fever, cold and genitourinary affections.

Fresh leaves yield an essential oil (yield 0.8%). It contains a series of methyl ketones, along with limonene 19.5, camphene 8.0%, and a group of oxygenated sesquiterpenes, the major being elemol 4.5%.

The fragrant oil is known as Rusa or Geranium Oil and is used as a substitute for rose oil. It exhibits stimulant, carminative, antispasmodic and diaphoretic properties. It is applied externally in rheumatism and neuralgia.... cymbopogon schoenanthus

Cynara Scolymus

Linn.

Family: Compositae; Asteraceae.

Habitat: Monastery gardens of Europe. Now cultivated in India.

English: Globe Artichoke.

Unani: Harshaf.

Action: Herb—antitoxic, liver restorative, hypocholesterolaemic. Water soluble extract is used for liver and renal diseases for its cholagogic and choleretic action (flow of bile increases up to 60 per cent). Artichokes assist digestion of fats, are known as diabetic's potato in Europe.

Key application: In dyspeptic problems. (German Commission E.) The British Herbal Pharmacopoeia reported hepatic action.

All parts of the plant contains ses- quiterpene lactone cynaropecrin and inulin. The leaves contain cynarin. Hepatic activity of the leaves is due to polyphenols such as cynarin, caf- feoylquinic acid derivatives and flavon- oids. Cynarin and caffeic acid exhibited hepatoprotective activity in CCl4-treated rats. (A minimum of 1% polyphenols and 0.2% flavonoids in the dried leaves is required for the activity.)

The plant is included in indigenous compound formulations recommended for viral and drug-induced hepatitis. All parts of the plant stimulate digestive secretions, especially bile, and are used for the treatment of gallbladder problems. Plant is used as a diuretic in dropsy. The plant is also used against atherosclerosis and for lowering cholesterol levels.

The extract gave mixed results in preventing alcohol-induced hangover. (CMAJ, 169, 2003, 1269-73; Natural Medicines Comprehensive Database, 2007.)... cynara scolymus

Cyperus Scariosus

R.Br.

Family: Cyperaceae.

Habitat: Damp situations in Uttar Pradesh and eastern and southern parts of India.

English: Nut grass.

Ayurvedic: Bhadramustaa, Musta, Amoda, Naagaramustaka. (Naagara is a different drug, equated with Zingiber officinale Rosc.)

Siddha: Korai-kilangu (Tamil).

Folk: Naagara-mothaa.

Action: Essential oil—hypotensive, anti-inflammatory, CNS stimulant, antimicrobial. Rhizome—stomachic, cordial, antidiarrhoeal and diuretic.

See C. rotundus.... cyperus scariosus

Day Surgical Centre / Clinic

A free-standing ambulatory surgery centre, independent of a hospital.... day surgical centre / clinic

De Morgan’s Spots

De Morgan’s spots are a type of small HAEMANGIOMA occuring in the skin of middle-aged people. No more than 3 mm in diameter, they are rarely widespread and are not malignant.... de morgan’s spots

Dead Space

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

Decision Support System

See “decision analysis”.... decision support system

Cytisus Scoparius

(L.) Link.

Synonym: Sarothamnus scoparius (L.) Koch.

Family: Papilionaceae, Fabaceae.

Habitat: Mild climatic regions of south and central Europe, north Africa and West Asia. C. scoparius is fairly common in and around Oatacmund (Nilgiris) and is found wild as a garden escape. It grows also in Simla and neighbouring places. An allied species, C. monspessulanus Linn., White Broom, also occurs in the Nilgiri hills.

English: Broom, Scotch Broom, Yellow Broom.

Folk: Broom.

Action: Green twigs of the plant, collected before flowering, either fresh or after drying, are used as diuretic and cathartic. Emetic in large doses. The seeds are also used similarly. The herb is used chiefly in the form of sulphate in tachycardia and functional palpitation. (The action of the whole plant is stated to be different from that of isolated alkaloids.) The whole herb has been used to treat tumours.

Key application: For functional heart and circulatory disorders. Aqueous-ethanolic extracts are used internally. Simultaneous administration of MAO-inhibitors contraindicated due to the tyramine content. (German Commission E.) The British Herbal Pharmacopoeia reported antiarrhythmic and diuretic action of the herb.

The herb contains quinolizidine alkaloids; main alkaloids are (-)-spar- teine, lupanine, ammodendrine and various derivatives; biogenic amines, including tryramine, epinine, dopa- mine; isoflavone glycosides including genistein, scoparin; flavonoids; essential oil; caffeic acid and p-coumaric acids; tannins. Seeds contain lectins (phytohaemagglutinins).

The herb contains over 2% tyramine. Tyramine acts as an indirect sympa- thomimetic, vasoconstrictive and hy- potensive.

The herb is contraindicated in high blood pressure, A-V block and pregnancy.

Scoparin's action on renal mucous membrane is similar to that of Buchu and Uva-ursi. (A decoction or infusion of broom is used in dropsical complaints of cardiac origin.)

Sparteine produces a transient rise in arterial pressure followed by a longer period of decreased vascular tension (contradictory observations have been recorded). Some researchers are of the opinion that sparteine is a regulator in chronic vulvar disease. It showed no cumulative action like digitalis. In large doses, it is highly toxic and impairs the activity of respiratory organs.

C. monopessulanus (a related species) contains. 9% alkaloids.

Sparteine is toxic at more than 300 mg dose. (Francis Brinker.)... cytisus scoparius

Dalbergia Sissoides

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

Dalbergia Sissoo

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

Delima Scandens

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

Demand (for Health Services)

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)

Deprivation Score

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

Datura Stramonium

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

Delphinium Staphisagria

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

Dental Surgeon

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

Death, Signs Of

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

Descriptive Study

A study concerned with and designed only to describe the existing distribution of variables, without regard to causal or other hypotheses.... descriptive study

Descurainia Sophia

(Linn.) Webb ex Prantl.

Synonym: Sisymbrium sophia L.

Family: Brassicaceae.

Habitat: Temperate Himalaya from Kashmir to Kumaon at 2,200-4,100, also in eastern Himalaya.

English: Flix Weed, Flax Weed.

Action: Leaf and flower—astringent, antiscorbutic. Seed—expectorant, anti-inflammatory, febrifuge, antidysenteric. Aerial parts— antiviral, hypoglycaemic.

The plants has been used externally for ulcers, seeds are used as substitute or adulterant of the seeds of Sisymbrium iro Linn. (The source of Khaakasi, Khubb, Tukhm-e-Shahuh, Khuubkalaan of Unani medicine, known as Hedge Mustard or London Rocket.)... descurainia sophia

Devils Shoestring

Protection, Gambling, Luck, Power, Employment... devils shoestring

Dichotomous Scale

See “measurement scale”.... dichotomous scale

Distilled Spirits

(Brandy, gin, rum, tequila, whiskey, vodka)

Nutritional Profile Energy value (calories per serving): Moderate to high Protein: None Fat: None Saturated fat: None Cholesterol: None Carbohydrates: None (except for cordials which contain added sugar) Fiber: None Sodium: Low Major vitamin contribution: None Major mineral contribution: Phosphorus

About the Nutrients in This Food Spirits are the clear liquids produced by distilling the fermented sugars of grains, fruit, or vegetables. The yeasts that metabolize these sugars and convert them into alcohol stop growing when the concentration of alcohol rises above 12–15 percent. In the United States, the proof of an alcoholic beverage is defined as twice its alcohol content by volume: a beverage with 20 percent alcohol by volume is 40 proof. This is high enough for most wines, but not high enough for most whiskies, gins, vodkas, rums, brandies, and tequilas. To reach the concentra- tion of alcohol required in these beverages, the fermented sugars are heated and distilled. Ethyl alcohol (the alcohol in beer, wine, and spirits) boils at a lower temperature than water. When the fermented sugars are heated, the ethyl alcohol escapes from the distillation vat and condenses in tubes leading from the vat to a collection vessel. The clear liquid that collects in this vessel is called distilled spirits or, more technically, grain neutral spirits. Gins, whiskies, cordials, and many vodkas are made with spirits American whiskeys (which include bourbon, rye, and distilled from grains. blended whiskeys) and Canadian, Irish, and Scotch whiskies are all made from spirits aged in wood barrels. They get their flavor from the grains and their color from the barrels. (Some whiskies are also colored with caramel.) Vodka is made from spirits distilled and filtered to remove all flavor. By law, vodkas made in America must be made with spirits distilled from grains. Imported vodkas may be made with spirits distilled either from grains or potatoes and may contain additional flavoring agents such as citric acid or pepper. Aquavit, for example, is essentially vodka flavored with caraway seeds. Gin is a clear spirit flavored with an infusion of juniper berries and other herbs (botanicals). Cordials (also called liqueurs) and schnapps are flavored spirits; most are sweetened with added sugar. Some cordials contain cream. Rum is made with spirits distilled from sugar cane (molasses). Tequila is made with spirits distilled from the blue agave plant. Brandies are made with spirits distilled from fruit. (Arma- gnac and cognac are distilled from fermented grapes, calvados and applejack from fermented apples, kirsch from fermented cherries, slivovitz from fermented plums.) Unless they contain added sugar or cream, spirits have no nutrients other than alcohol. Unlike food, which has to be metabolized before your body can use it for energy, alcohol can be absorbed into the blood-stream directly from the gastrointestinal tract. Ethyl alcohol provides 7 calories per gram.

The Most Nutritious Way to Serve This Food The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits, and “moderate drinking” as two drinks a day for a man, one drink a day for a woman.

Diets That May Restrict or Exclude This Food Bland diet Lactose-free diet (cream cordials made with cream or milk) Low-purine (antigout) diet

Buying This Food Look for: Tightly sealed bottles stored out of direct sunlight, whose energy might disrupt the structure of molecules in the beverage and alter its flavor. Choose spirits sold only by licensed dealers. Products sold in these stores are manufac- tured under the strict supervision of the federal government.

Storing This Food Store sealed or opened bottles of spirits in a cool, dark cabinet.

Preparing This Food All spirits except unflavored vodkas contain volatile molecules that give the beverage its characteristic taste and smell. Warming the liquid excites these molecules and intensifies the flavor and aroma, which is the reason we serve brandy in a round glass with a narrower top that captures the aromatic molecules as they rise toward the air when we warm the glass by holding it in our hands. Whiskies, too, though traditionally served with ice in America, will have a more intense flavor and aroma if served at room temperature.

What Happens When You Cook This Food The heat of cooking evaporates the alcohol in spirits but leaves the flavoring intact. Like other alcoholic beverages, spirits should be added to a recipe near the end of the cooking time to preserve the flavor while cooking away any alcohol bite. Alcohol is an acid. If you cook it in an aluminum or iron pot, it will combine with metal ions to form dark compounds that discolor the pot and the food you are cooking. Any recipe made with spirits should be prepared in an enameled, glass, or stainless-steel pot.

Medical Uses and/or Benefits Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings. Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low density lipoproteins (LDLs), the protein and fat particles that carry cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carry cholesterol out of the body. Numerous later studies have confirmed these findings. Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moderate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How alcohol prevents stroke is still unknown, but it is clear that moderate use is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, reduce their risk of stroke. Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol. Dilation of blood vessels. Alcoholic beverages dilate the tiny blood vessels just under the skin, bringing blood up to the surface. That’s why moderate amounts of alcoholic beverages (0.2–1 gram per kilogram of body weight, or two ounces of whiskey for a 150-pound adult) temporarily warm the drinker. But the warm blood that flows up to the surface of the skin will cool down there, making you even colder when it circulates back into the center of your body. Then an alcohol flush will make you perspire, so you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.

Adverse Effects Associated with This Food Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart. Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, learning disabilities, and mental retarda- tion—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who drink three to four drinks a day or five drinks on any one occasion while pregnant. To date there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while preg- nant, but two studies at Columbia University have suggested that as few as two drinks a week while pregnant may raise a woman’s risk of miscarriage. (One drink is 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.) Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and distilled spirits. Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the A merican Cancer Societ y’s warn ing that men and women who consume more than t wo drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less. Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings. Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuses depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue. Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use every day to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tis- sues. Although individuals vary widely in their capacity to metabolize alcohol, an adult of average size can metabolize the alcohol in four ounces (120 ml) whiskey in approximately five to six hours. If he or she drinks more than that, the amount of alcohol in the body will exceed the available supply of ADH. The surplus, unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, the drinker will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining uric acid, which is irritating. The level of lactic acid in the body will increase, making him or her feel tired and out of sorts; the acid-base balance will be out of kilter; the blood vessels in the head will swell and throb; and the stomach, its lining irritated by the alcohol, will ache. The ultimate result is a hangover whose symptoms will disappear only when enough time has passed to allow the body to marshal the ADH needed to metabolize the extra alcohol in the person’s blood. Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature. Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection. Migraine headache. Some alcoholic beverages contain chemicals that inhibit PST, an enzyme that breaks down certain alcohols in spirits so that they can be eliminated from the body. If they are not broken down by PST, these alcohols will build up in the bloodstream and may trigger a migraine headache. Gin and vodka appear to be the distilled spirits least likely to trigger headaches, brandy the most likely.

Food/Drug Interactions Acetaminophen (Tylenol, etc.). FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetaminophen combination may cause liver failure. Anti-alcohol abuse drugs (disulfiram [Antabuse]). Taken concurrently with alcohol, the anti- alcoholism drug disulfiram can cause flushing, nausea, a drop in blood pressure, breathing difficulty, and confusion. The severity of the symptoms, which may var y among individu- als, generally depends on the amount of alcohol consumed and the amount of disulfiram in the body. Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners), intensif ying the effect of the drugs and increasing the risk of side effects such as spontane- ous nosebleeds. Antidepressants. Alcohol may strengthen the sedative effects of antidepressants. Aspirin, ibuprofen, ketoprofen, naproxen and nonsteroidal anti-inflammatory drugs. Like alco- hol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Com- bining the two intensifies the effect. Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia. Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antide- pressants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol intensifies the sedative effects of these medications and, depending on the dose, may cause drowsiness, sedation, respiratory depression, coma, or death. MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of natural enzymes that break down tyramine, a substance formed naturally when proteins are metabolized. Tyramine is a pressor amine, a chemical that constricts blood vessel and raises blood pressure. If you eat a food that contains tyramine while you are taking an M AO inhibitor, the pressor amine cannot be eliminated from your body and the result may be a hypertensive crisis (sustained elevated blood pressure). Brandy, a distilled spirit made from wine (which is fermented) contains tyramine. All other distilled spirits may be excluded from your diet when you are taking an M AO inhibitor because the spirits and the drug, which are both sedatives, may be hazard- ous in combination.... distilled spirits

Drug Substance

An active ingredient that is intended to furnish pharmacological activity or other direct effect in diagnosis, cure, mitigation, treatment or prevention of diseases or to effect the structure or any function of the human body... drug substance

Duchesnea Or Indian Strawberry

Duchesnea indica

Description: The duchesnea is a small plant that has runners and three-parted leaves. Its flowers are yellow and its fruit resembles a strawberry.

Habitat and Distribution: It is native to southern Asia but is a common weed in warmer temperate regions. Look for it in lawns, gardens, and along roads.

Edible Parts: Its fruit is edible. Eat it fresh.... duchesnea or indian strawberry

Discover Sarsaparilla Tea!

If you enjoy a cup of herbal tea, then sarsaparilla tea can count as a good choice for a daily beverage. The many health benefits should also tempt you to give it a try. Find out more about sarsaparilla tea. About Sarsaparilla Tea Sarsaparilla tea is made from the roots of sarsaparilla, a plant native to Central and South America. It is also known by the name Smilax regelii. In Spanish, it is called zarzaparrilla; “zarza” means “shrub” and “parrilla” means “little grape vine”. Sarsaparilla is a perennial plant which has a trailing vine with lots of wood-like stems and long thorns. It has small, greenish flowers which grow in axillary umbels. It is often used to flavor soft drinks. There is also the “false sarsaparilla”, native to South Asia. It belongs to a different plant family and genus, and it is often used in place of sarsaparilla. The false sarsaparilla is a slender shrub with woody and aromatic roots and many slender stems. It has small leaves and greenish flowers. Sarsaparilla Tea Constituents Both types of sarsaparilla have their own active constituents. The usual type includes sarsasaponin, sarsaparilloside, flavonoids, sarsapac acid, dextrose, and fatty acids. Meanwhile, the “false sarsaparilla” has some of the following constituents: coumarins, saraponins, starch, tannins, tannic acid, glucose, phenols, iron, and magnesium. Both the American type and the South Asian one can be used to make sarsaparilla tea, which gets the active constituents found in the roots. How to prepare Sarsaparilla Tea No matter the variety, you can easily prepare a cup of sarsaparilla tea. Just add about 1 gram of chopped dried root to a cup of freshly boiled water. Let it steep for about 10 minutes; then, stream to remove the root pieces. Sarsaparilla Tea Benefits The American and South Asian sarsaparilla root share a few health benefits, which are transferred to sarsaparilla tea, as well. They are used to treat various skin problems, such as eczema or psoriasis. Drinking sarsaparilla tea also helps you with arthritis, gout, and rheumatism. This tea is also included in the treatment of various sexual diseases, such as herpes, gonorrhea or syphilis. Drinking sarsaparilla tea might help improve your memory and mental concentration. It also helps with urinary tract infections, and menopausal symptoms. It can even be applied topically, to treat sores and burns. The tea made with the American sarsaparilla is believed to improve the sexual performance, and to enhance virility. If you’re using the ‘false sarsaparilla’ to make sarsaparilla tea, this can help fight various digestive problems and upper respiratory infections. Sarsaparilla Tea Side Effects It is recommended not to drink sarsaparilla tea if you’re pregnant or breastfeeding. Sarsaparilla tea can affect the baby in both cases. Also, don’t drink this tea if you’ve got asthma; it might worsen your condition. If you’re under any kind of medication (especially if you’re taking other diuretics), make sure you talk with your doctor first before you start drinking sarsaparilla tea. Also, be careful with the amount of sarsaparilla tea you drink. If you drink too much, it might cause digestive problems. Sarsaparilla tea is a pleasant everyday herbal tea. With its many health benefits, just one cup can help you stay healthy.... discover sarsaparilla tea!

Down’s (down) Syndrome

A genetic disorder in which the affected person usually carries an extra chromosome – 47 instead of the usual 46. The extra chromosome occurs in the no. 21 group, hence the disorder is described as trisomy 21. The condition was named after Dr J L H Down, the London doctor who ?rst described it in 1866. The incidence is around one in 600 births. The disorder is characterised by a particular physical appearance and learning diffculties, with the affected individuals having an INTELLIGENCE QUOTIENT (IQ) ranging from 30 to 80 (normal is 100). Most people with the syndrome have eyes that slope up at the outer corners with skin folds that cover the inner ones. The face and features are smaller than normal, while the tongue is larger; the back of the head is ?attened and the hands are usually short and broad. The facial features led to the syndrome being described as ‘mongolism’, a term that is no longer used.

Children with Down’s syndrome are usually friendly and ?t in well with the family. Despite their learning disabilities, some learn to read and, if they have appropriate educational and environmental stimulation, can make the most of their abilities.

A heart defect is present in around 25 per cent of the children at birth, and deafness and acute LEUKAEMIA occur more frequently than in unaffected youngsters. Those with the syndrome are particularly prone to developing ear infections. ATHEROSCLEROSIS often develops early in adults and ALZHEIMER’S DISEASE tends to occur as early as 40 years of age. A friendly home environment helps them to enjoy life, but a few individuals with the syndrome may eventually require institutional care. Improved social and medical care means that many now live until their 60s.

Routine screening tests early in pregnancy, starting with blood analysis but going on if necessary to AMNIOCENTESIS and chorionic villus sampling (see PRENATAL SCREENING OR DIAGNOSIS), can identify fetuses likely to develop the disorder. If a sample of fetal cells con?rms the chromosome defect (triple marker test – see PREGNANCY AND LABOUR), the parents may consider termination of the pregnancy. In the UK, screening is normally o?ered to women over 35 because of their increased risk. When younger parents have a child with Down’s syndrome, the chances of a subsequent child with the disorder are relatively high as it is probable that both parents carry a chromosome abnormality insu?cient to cause ill-health until combined. So they may wish to discuss with their medical advisers the question of further pregnancies.

Parents who have a child with Down’s syndrome will understandably feel a combination of strong emotions, including anger and guilt, and constructive counselling can be valuable. Among societies o?ering advice and support is the Down’s Syndrome Association.... down’s (down) syndrome

Effort Syndrome

Also known as Da Costa’s syndrome, this is a condition in which symptoms occur, such as palpitations and shortness of breath, which are attributed by the patient to disorder of the heart. There is no evidence, however, of heart disease, and psychological factors are thought to be of importance. (See PSYCHOSOMATIC DISEASES.)... effort syndrome

Eisenmenger Syndrome

A condition in which the subject suffers from a defect in one of the dividing walls (septum) of the HEART and this is accompanied by PULMONARY HYPERTENSION. The defect allows blood low in oxygen to ?ow from the right to the left side of the heart and be pumped into the aorta, which normally carries oxygenated blood to the body. The patient has a dusky blue appearance, becomes breathless and has a severely restricted exercise tolerance. There is an increase in red blood cells as the body attempts to compensate for the lowered oxygen delivery. The condition may be avoided by early surgical repair of the septal defect, but once it is evident, surgery may not be possible.... eisenmenger syndrome

Discover The Spectacle Of Dragon Well Green Tea

One of the most popular drinks in China, Dragon Well tea is part of the green teas family, having an inviting and a toasty flavor. A truly enjoyable and spectacular cup of tea.

Description of Dragon Well tea

Dragon Well tea is a type of pan-fried green tea, most commonly named Longjing tea from Hangzhou, Zheijang province in China, where is produced mainly by hand. During the production process, the Dragon Well is dried under a wood-fired Chinese pan called “wok”. This process removes the green, grassy taste and also inhibits enzyme activity. Due to the widespread opinion in China that the Dragon Well tea has a cooling effect, its popularity significantly increases especially during the spring and summer seasons. Often called the national tea of China, Dragon Well tea is often served to head of states and foreign delegations during their visits in China. Presented as a tribute to many generations, it was given even to Richard Nixon during his memorable encounter with Mao Zedong. This tea is very popular because of its unique properties:  jade color, vegetative aroma, mellow chestnut flavor and singular shape. It has a buttery, nutty, rich texture and an enjoyable dry finish. Commonly, Dragon Well tea is graded using a scale of six levels from superior quality to low quality so it is advisable to chose wisely when you decide to buy it. When the flavor can barely be sensed, it is clear that you deal with a poor quality.

How to store the Dragon Well tea

If the tea is sealed, keep it in a freezer. Cover with a box to insulate from temperature change. In order to get warm, leave it to room temperature before opening. This prevents condensation. After opening the package of Dragon Well tea, it is best to keep it away from light, moisture, smell and heat in an airtight container.

Ingredients of Dragon Well tea

Like most green teas, the Dragon Well tea contains amino acids, vitamins, flavonoids, proteins, calcium, iron, fluorine, theine and has one of the highest concentrations of catechins among teas, second only to white teas.

How to brew Dragon Well tea

When it comes to brewing Dragon Well tea, the best choice is a clear glass teacup, so that you can see the beauty of the leaves as they dance and unfurl in the water. It is really spectacular. Quality of tea is related directly to the beauty of the buds. Glass is most suitable also because it disperses heat quickly and prevents over-steeping. If you see that the buds have reached the bottom, this means that the tea is ready to drink. You should infuse a small amount of leaves in high temperature water for as long as it takes. Pour hot water at approximately 80 - 90 degrees Celsius. Immerse until most of the tea buds has sink to the bottom of the glass and the tea liquor turns yellow. This will take 5 to 10 minutes for the first infusion. During soaking, the tea brings out a soft, pure aroma, a yellow-green color and a rich flavor. Decant and leave a small quantity as you may use it as the seed for the next infusion. Infuse for another 2 to 4 times with progressively shorter steeping time.

Health Benefits of Dragon Well tea

All tea comes from the same plant named Camellia sinensis. The method of production creates the different types of tea. Dragon Well tea contains the highest content of antioxidant compounds. Antioxidants are proven to fight against certain cancers, lower cholesterol levels and blood pressure, reduce the likely-hood of getting the flu and other infections, boosting the immune function of our body and help reduce the signs of aging. It is also a fat burning accelerator so let’s not forget its important benefits for diets. There’s also enough fluoride found in green tea to aid against plaque and other oral bacteria.

Side effects of Dragon Well tea

Like any other green tea, Dragon Well tea may have few side effects like restlessness, palpitations, insomnia, anxiety, irritability, increased heart rate, and elevated blood pressure due to the caffeine content. It may also cause pain in the stomach area or reduce the body’s absorption of iron by 25% so it is contraindicated to people with anemia, faintness, gastritis with hyperacidity, stomach and duodenal ulcer. In spite of few side effects, it is worth trying it and get to know its flavor. The spectacle of drinking this type of tea is truly unique and the flavor really satisfying.... discover the spectacle of dragon well green tea

Drink Sassafras Tea!

Drinking sassafras tea has both its pros and cons. The health benefits tempt you to give it a try. However, you should be aware of its side effects, as well. Find out more about both the health benefits and the side effects of sassafras tea. About Sassafras Tea Sassafras tea is made from the roots or leaves of the sassafras tree. This tree can be found in eastern North America and eastern Asia. The tree’s height varies between 9m and 18m. It has a thick trunk, with many thin branches and a smooth, orange-brown bark. The leaves have three distinct patterns (unlobed, bilobed, trilobed); they have smooth margins and can be 7-20cm long. The trees have small, yellow flowers with five petals, and a blue-black, egg-shaped fruit. The leaves are often used to season dishes. Also, rootbeer got its name from the oil extracted from sassafras tree root. How to make Sassafras Tea Both sassafras tree root and leaves can be used to make a cup of sassafras tea. Add a handful of either root or leaves to a pot of boiling water. Cover and let it steep for about 20 minutes. Once the steeping time is done, strain to clear the liquid. Sassafras Tea Benefits Sassafras tea gets many active constituents from either the root or the leaves of the sassafras tree. Some of them include safrole, tannins, mucilage, asarone, and alpha-pinene. This leads to the tea having many health benefits. Sassafras tea works both as a blood thinner and as a blood purifier. Drinking it also promotes the process of extracting toxins from your body. Drinking sassafras tea can help if you’ve got a cold or the flu. Also, it can be used in the treatment for bronchitis and gonorrhea. With sassafras tea, you can also treat liver and kidney problems, urinary tract problems, arthritis and rheumatism. Drinking it will also help reduce menstrual cramps. Sassafras Tea Side Effects Among its active constituents, sassafras tea contains saffron, which is considered to trigger liver cancer. More researches are being done, though until it is known for sure, its trade has been restricted. This is why it is recommended that you not drink sassafras tea for a long period of time. The amount of tea you drink matters, as well. Don’t drink more than 3-4 cups of sassafras tea a day. If you drink too much, you might get hallucinations, heart palpitations, headaches, or you might feel nauseous. Pregnant and breastfeeding women shouldn’t drink sassafras tea, either. It can affect the baby, and even lead to miscarriages during pregnancy. Sassafras tea has both health benefits and side effects. Before you start consuming it, it’s considered best to talk to your doctor and balance the pros and cons, based on your health. If you’re safe to drink it, then enjoy your cup of sassafras tea!... drink sassafras tea!

Drink More Oat Straw Tea!

If you haven’t heard much about oat straw tea, it’s time to find out! It has a delicious, slightly sweet taste, as well as many benefits which will help you stay healthy. Read this article to find out more about this tea! About Oat Straw Tea Oat straw tea is made from oat straw, which is the part of the oat plant, found above the ground, and which remains after the grain has been harvested. While at first it was used only to stuff mattresses, now it is much more appreciated thanks to its health benefits, which you can get by drinking oat straw tea, as well. Oat is cultivated in temperate areas on almost all continents, even in a few places in Africa. It is used, for example, to make oat flour, oat bread; in Britain, it is also used to brew beer. It can also be fed to horses or cattle. Constituents of Oat Straw Tea Oat is considered an important “health food” and quite a nutritious one too. Oat straw has important, benefic constituents which are also included in oat straw tea. The main constituents, also found in oat straw tea, are carbohydrates and silicic acid. It is also rich in calcium, potassium, and magnesium, and has a reasonable amount of proteins. As for vitamins, it includes A, B complex, C and E. How to prepare Oat Straw Tea A classic way to prepare a cup of oat straw tea is to add a teaspoon of dried oat straw to a cup of boiling water. Let it steep for about 10 minutes before you strain to remove the oat straw plant. You can add milk or honey to sweeten the taste. If you can and want to prepare oat straw tea from scratch, you can do that too. Pick up the necessary amount (or even more, which you can keep for later uses), wash and cut off any dirty parts. For two cups of oat straw tea, you can use a single stalk, which you cut into small pieces and add in each cup. Then, pour the boiling water and let it steep for 4 hours, or even overnight. When it’s done, strain it and drink it, either cold or reheated. The same steps apply if you want to use dry oat straws for a few cups of oat straw tea. Oat Straw Tea Benefits Oat straw tea is especially good for strengthening and nourishing your bones, thanks to the amount of calcium it contains. This way, it helps you fight against osteoporosis. It is good to drink oat straw tea in order to stabilize the sugar in your blood, as it reduces cholesterol levels and improve blood circulation. Oat straw tea is also good at improving your immune system, and it is good at alleviating pains. Drinking it can reduce headaches and menstrual cramps. Drinking oat straw tea can also help you relax your nervous system. It has a calming effect, and helps you fight against stress, tension, anxiety and even depression. Also, a cup of oat straw tea before bed will help you sleep better. You don’t need to consider oat straw tea only as a beverage in order to make use of its health benefits. It can also be applied externally, on the skin, in order to treat skin irritations, such as eczema or rashes. Also, a bath in oat straw tea is helpful for children with chicken pox. Oat straw Side Effects First of all, it is recommended that you not drink more than three cups of oat straw tea a day. If you do, it might become harmful. Some of the symptoms you might experience are headaches, dizziness, insomnia, irregular heartbeats, vomiting, diarrhea and loss of appetite. Make sure you reduce the amount of oat straw tea you drink if you get any of these symptoms. If you’re allergic to oat flour, you should also stay away from oat straw tea. It might lead to an allergic reaction. In this case, the symptoms you might get are difficulty in breathing, rashes, itching, or swelling of the throat or mouth. Also, if you’re suffering from celiac diseases, you should avoid drinking oat straw tea.Oat straw contains gluten, which can be harmful in this case. Oat straw tea has plenty of health benefits which should convince you to give it a try and maybe even include it in your daily diet. It can be easily prepared from scratch, and also sweetened to fit with your taste. Just be careful with its side effects, and enjoy your cup of oat straw tea!... drink more oat straw tea!

Elaeocarpus Serratus

Linn.

Synonym: E. cuneatus Wt.

Family: Elaeocarpaceae.

Habitat: Eastern Himalayas and Western Ghats up to 1,000 m. English: Wild Olive tree, Ceylon Olive.

Ayurvedic: Rudraaksha (var.). Siddha/Tamil: Uttraccham, Ulankarei.

Action: Leaf—antirheumatic. Fruit—antidysenteric. Aerial parts—CVS and CNS active.

The leaves gave ellagic acid, myric- itrin, myricetin and mearnsetin. Fruit pulp gave citric acid and D-galactose. It contains pectin (2.57% fresh weight basis).... elaeocarpus serratus

Emergency Service

Service provided in response to the perceived individual need for immediate treatment or care.... emergency service

Epsom Salts

The popular name for magnesium sulphate, which was used as a saline purgative.... epsom salts

Escort Services

Transportation for older adults to services and appointments. May use buses, taxis, volunteer drivers, or van services that can accommodate wheelchairs and persons with other special needs.... escort services

Etherified Starch

Along with DEXTRAN and GELATIN, this is a substance with a large molecular structure used to treat shocked patients with burns (see BURNS AND SCALDS) or SEPTICAEMIA in order to expand and maintain their blood volume. Like other plasma substitutes, this form of starch can be used as an emergency, short-term treatment for severe bleeding until blood for transfusion is available. Plasma substitutes must be used with caution in patients who have heart disease or impairment of their kidney function. Patients should be monitored for hypersensitivity reactions and for changes in their BLOOD PRESSURE (see SHOCK).... etherified starch

Ewing’s Sarcoma

An uncommon but very malignant cancer of the bone in children and young adults, the condition was ?rst identi?ed as being di?erent from OSTEOSARCOMA by Dr J Ewing in 1921. It usually occurs in the limbs or pelvis and soon spreads to other parts of the body. Treatment is by RADIOTHERAPY and CYTOTOXIC drugs. Since the use of the latter, the number of patients who survive for ?ve years or more has much improved.... ewing’s sarcoma

Drink More Safflower Tea!

Safflower tea has a strong, but pleasant taste. As an herbal tea, it comes with many health benefits which are bound to help you stay healthy. Find out more about safflower tea! About Safflower Tea Safflower tea is made from the petals of safflower. The plant is an herbaceous, annual herb, which is cultivated in over sixty countries worldwide. It is a highly branched plant, with heights between 30cm and 150cm. Each branch has from one to five globular flower heads, with yellow, orange, or red flowers. The flower heads also contain 15-20 small seeds. The plant grows in open, arid environments; it is harvested during summertime. The plant was initially cultivated for its seeds, which are used to flavor and color food, as well as to make red and yellow dyes. Lately, the seeds are also used to make vegetable oil. How to prepare Safflower Tea You can easily prepare a cup of safflower tea. Just add a teaspoon of dried safflower petals to a cup of freshly boiled water. Let it steep for about 5 minutes, before you strain it to remove the petals. Your cup of safflower tea is ready! If the taste isn’t to your liking, you can sweeten the tea with honey or fruit juice. Safflower Tea Benefits A cup of safflower tea can help soothe your nerves, as well as relax you. Also, it can treat fevers, coughs and bronchial spasms. Generally, it is good at strengthening your immunity. Drinking safflower tea will also lower your bad cholesterol levels; this leads to preventing various heart diseases. It helps in the case of intestinal disorders, and it also facilitates bowel movement. Safflower tea can improve the conditions of cancer patients. This is why it is often included in the treatment for various types of cancer. Also, it can prevent osteoporosis, especially in the case of postmenopausal women. Safflower tea can be applied topically, as well. It is used to treat various bruises, open wounds, or rashes, as well as other skin disorders. Safflower Tea Side Effects Safflower tea doesn’t have many side effects. An important one is related to pregnant and breastfeeding women, who shouldn’t consume this tea. During pregnancy, it can even lead to miscarriages. It’s best not to drink thistea if you have bleeding problems. Safflower tea can slow down the blood clotting process, which might affect you if you’ve got hemorrhagic diseases, stomach or intestinal ulcers, or clotting disorders. Also, stop drinking it two weeks before a surgery, as it might cause bleeding during and after the surgery. Some people might be allergic to plants from the Asteraceae or Compositae family. Beside safflower, these include ragweed, chrysanthemums, marigolds, and daisies. Symptoms of an allergic reaction include swelling of the nose, lips and tongue, rashes and difficulty in breathing. If you get any of these, stop drinking safflower tea and contact your doctor.   Safflower tea is a good choice for an everyday tea. With this herbal tea, you get to enjoy both its taste and its many health benefits.... drink more safflower tea!

Emilia Sonchifolia

(L.) DC.

Family: Compositae; Asteraceae.

Habitat: Throughout India, ascending to 1,350 m in the hills.

Ayurvedic: Shash-shruti (non- classical).

Unani: Hirankhuri.

Folk: Sadamandi.

Action: Plant—sudorific, febrifuge, antiseptic. Used in infantile tympanitis and bowel complaints. Root—antidiarrhoeal. Leaf—used for otitis media under medical supervision.

The aerial parts contain pyrrolizi- dine alkaloids, senkirkine and doro- nine. Presence of simiaral, beta-sitos- terol, stigmasterol, palmitic and tria- contannic acids is also reported.... emilia sonchifolia

Entada Scandens

auct. non-Benth.

Synonym: E. phaseoloides Merrill. E. pursaetha DC. Mimosa entada Linn.

Family: Momosaceae.

Habitat: Eastern Himalayas, hills of Bihar, Orissa and South India.

English: Garbee Bean, Mackay Bean, Elephant Creeper.

Ayurvedic: Gil.

Siddha/Tamil: Chillu, Vattavalli.

Folk: Gil-gaachh.

Action: Seed—carminative, anodyne, spasmolytic bechic, anti-inflammatory, anthelmintic, antiperiodic. Used in liver complaints, glandular swellings, debility, skin diseases. The seed, stems and bark are poisonous. A paste of the seeds is applied locally for inflammatory glandular swellings. The juice of wood and bark is used as an external application for ulcers. The leaves are reported to be free from the toxic saponins. After soaking in water and roasting toxic principles can be removed from the white kernels of the seeds.

The seeds gave saponins of entagenic acid; a triterpenoid glucoside entanin; beta-sitosterol, alpha-amyrin, querce- tin, gallic acid, cyamidin chloride, lu- peol and a saponin mixture which gave prosapogenin A. Entanin exhibits anti- tumour activity. It inhibits Walker 256 tumours in rats without deaths.

Entadamide A (the sulphur-containing amide from the seed) is a 5-lipo-xygenase inhibitor and is found to be effective in the treatment of bronchial asthma. The bark is used for hair wash.

Entagenic acid, a sapogenin of entada saponin IV, imparts antifungal activity to the bark.... entada scandens

Experimental Study

A study in which conditions are under the direct control of the investigator.... experimental study

Explanatory Study

A study where the main objective is to explain, rather than merely describe, a situation by isolating the effects of specific variables and understanding the mechanisms of action.... explanatory study

Extra Care Sheltered Housing

Housing where there is additional support (such as the provision of meals and extra communal facilities) to that usually found in sheltered housing. Sometimes called ‘very sheltered housing’.... extra care sheltered housing

Fagus Sylvatica

Linn.

Family: Fagaceae.

Habitat: Cooler regions of northern hemisphere. Distributed in Kulu and the Nilgiris.

English: European Beech, Common Beech.

Action: Seeds and fatty oil— used externally in skin diseases, rheumatism and gout. Seeds— poisonous. Saponins cause severe gastrointestinal symptoms. Leaves also contain saponins. Wood tar— antiseptic, analgesic; mixed with talc, used as a dusting powder for gangrene and bed sores.... fagus sylvatica

Drink Pau D’arco Tea From South America

Get a taste of South America by drinking pau d’arco tea. It has a pleasant, earthy taste, astringent and just a bit bitter. Find out more about its health benefits and side effects! About Pau D’Arco Tea Pau D’Arco tea uses the inner bark of the Pink Ipê tree, also known as Pink Lapacho. The tree can be found in many South American countries. The Pink Lapacho is a large tree which can grow up to 30m tall. Usually, the trunk represents a third of that height, while the rest is used by the tree’s branches. The bark is dark brown, tough and hard to peel, and its branches spring up with opposite and petiolate leaves, and large, tubular-shaped pink flowers which bloom between July and September. How to make Pau D’Arco Tea To enjoy some pau d’arco tea, add 3 tablespoons to a pot containing 1 liter of water and bring it to boiling point. Once it reaches boiling point, lower the heat to medium-low and leave it like this for about 20 minutes. Once that’s done, strain the tea and pour it into cups. Pau d’arco tea can be served both hot and cold. If you want to, you can sweeten it with honey, stevia or fruit juice. Pau D’Arco Tea Benefits The inner bark of the Pink Lapacho tea has important active constituents, such as lapachol, lapachone and isolapachone, as well as various flavonoids and tannins. They are transferred to the pau d’arco tea; this way, the beverage helps us stay healthy. Pau d’arco tea plays an important role in the help against cancer. Cancer patients who have consumed this tea have shown progress, from alleviation of chemotherapy symptoms to complete remission of the cancerous tumors. Pau d’arco tea is also useful in the treatment of other diseases, such as diabetes, fibromyalgia, and lupus. Drinking pau d’arco tea can help if you’ve got a cold or the flu. It is also useful as a remedy for smoker’s cough, and acts as an expectorant, stimulating coughing in order to get rid of mucus. It was also discovered that pau d’arco tea increases the production of red blood cells. Although researches are still being made in this area, it is recommended in the treatment for leukemia, anemia and other blood disorders. Pau d’arco tea is also useful in fighting fungi. It is used to treat yeast infection and candida, due to its antifungal nature. It can help in the treatment for stomach ulcers, tuberculosis, pneumonia, and dysentery. It also protects you against tropical diseases (malaria, schistosomiasis). Pau D’Arco Tea Side Effects Pau d’arco tea may act like a blood thinner. Don’t drink this tea at least two weeks before a surgery, otherwise it might increase the risk of bleeding both during and after the surgery, and can decrease the blood clotting speed. You also shouldn’t drink pau d’arco tea if you’ve got a bleeding disorder (hemophilia) or if you’re taking anticoagulants. If you’re taking any medication, talk to your doctor first before drinking pau d’arco tea. It may interfere with various medications, for example aspirin, enoxaparin, warfarin, and dalteparin. It is also recommended that you not drink pau d’arco tea if you’re pregnant or breastfeeding. During pregnancy, it can lead to child defects or even death of the baby. It can also affect the baby during breastfeeding. Be careful with the amount of pau d’arco tea you drink a day. The maximum amount of tea you can drink a day is 1 liter. If you drink more, it might lead to nausea, vomiting or bleeding (in which case you should consult a doctor). Other symptoms include headaches, dizziness and diarrhea. Pau d’arco tea has lots of important health benefits, but it also has a few side effects which you should remember. If you make sure it’s safe to drink this tea, you can enjoy it with no worries!... drink pau d’arco tea from south america

Eruca Sativa

Mill.

Family: Cruciferae; Brassicaceae.

Habitat: Cultivated in Uttar Pradesh, Punjab, Delhi and Madhya Pradesh.

English: Rocket-Salad.

Ayurvedic: Tuvari, Tuvarikaa, Shveta-sursaa, Bhuutaghna, Darad- harsha, Siddaartha.

Unani: Jirjeer, Taraamiraa.

Folk: Safed Sarson.

Action: Tender leaf—stimulant, stomachic, diuretic, antiscorbutic, rubefacient. Seed—vesicant, antibacterial.

Seeds and fresh plant gave glu- coerucin (4-methylthiobutyl glucosi- nolate); leaves yielded iso-rhamnetin- 3-glucoside and iso-rhamnetin. The volatile oil of the seeds contains isoth- iocyanate derivatives. The oil at 0.004 and 0.008 ml/kg exhibits diuretic activity. The ethanolic extract of the seeds is diuretic at 20 and 40 mg/kg Seeds are used to induce vomiting in place of ipecac.

Crude juice of the plant inhibited E. coli, S. typhi and B. subttis.

For eating purposes, the plant should be gathered before flowering; for medicinal use when in flower.... eruca sativa

Falling Sickness

An old name for EPILEPSY.... falling sickness