wikidoc - User contributions [en]

Acromegaly (patient information)

2009-09-04T00:41:23Z

LBiller: /* Where to find medical care for yourdisease */

'''For the WikiDoc page for this topic, click [[Acromegaly|here]]'''
{{SI}}

'''Editor-in-Chief:'''Meagan E. Doherty

{{EJ}}

==What is Acromegaly?==
[[Image:Acromegaly facial features.JPEG|thumb|left|Facial aspect of a patient with acromegaly. The nose is widened and thickened, the [[cheekbones]] are obvious, the forehead bulges, the lips are thick and the facial lines are marked. The forehead and overlying skin is thickened, sometimes leading to [[frontal bossing]].]]

Acromegaly is a hormonal disorder that results from too much growth hormone (GH) in the body. The pituitary, a small gland in the brain, makes GH. In acromegaly, the pituitary produces excessive amounts of GH. Usually the excess GH comes from benign, or noncancerous, tumors on the pituitary. These benign tumors are called adenomas.

Acromegaly is most often diagnosed in middle-aged adults, although symptoms can appear at any age. If not treated, acromegaly can result in serious illness and premature death. Acromegaly is treatable in most patients, but because of its slow and often “sneaky” onset, it often is not diagnosed early or correctly. The most serious health consequences of acromegaly are type 2 diabetes, high blood pressure, increased risk of cardiovascular disease, and arthritis. Patients with acromegaly are also at increased risk for colon polyps, which may develop into colon cancer if not removed.

When GH-producing tumors occur in childhood, the disease that results is called gigantism rather than acromegaly. A child’s height is determined by the length of the so-called long bones in the legs. In response to GH, these bones grow in length at the growth plates—areas near either end of the bone. Growth plates fuse after puberty, so the excessive GH production in adults does not result in increased height. However, prolonged exposure to excess GH before the growth plates fuse causes increased growth of the long bones and thus increased height. Pediatricians may become concerned about this possibility if a child’s growth rate suddenly and markedly increases beyond what would be predicted by previous growth and how tall the child’s parents are.

==What are the symptoms of Acromegaly?==
[[Image:Acromegaly hands.JPEG|thumb|left|As compared with the hand of a typical person (left), the hand of a patient with acromegaly (right) is enlarged, the fingers are widened, thickened and stubby, and the soft tissue is thickened.]]
[[Image:Acromegaly prognathism.JPEG|thumb|left|[[Mandible|Mandibular]] overgrowth leads to [[prognathism]], maxillary widening, teeth separation and jaw [[malocclusion]].]]

The name acromegaly comes from the Greek words for “extremities” and “enlargement,” reflecting one of its most common symptoms—the abnormal growth of the hands and feet. Swelling of the hands and feet is often an early feature, with patients noticing a change in ring or shoe size, particularly shoe width. Gradually, bone changes alter the patient’s facial features: The brow and lower jaw protrude, the nasal bone enlarges, and the teeth space out.

Overgrowth of bone and cartilage often leads to arthritis. When tissue thickens, it may trap nerves, causing carpal tunnel syndrome, which results in numbness and weakness of the hands. Body organs, including the heart, may enlarge.

Other symptoms of acromegaly include
:* joint aches
:* thick, coarse, oily skin
:* skin tags
:* enlarged lips, nose, and tongue
:* deepening of the voice due to enlarged sinuses and vocal cords
:* sleep apnea—breaks in breathing during sleep due to obstruction of the airway
:* excessive sweating and skin odor
:* fatigue and weakness
:* headaches
:* impaired vision
:* abnormalities of the menstrual cycle and sometimes breast discharge in women
:* erectile dysfunction in men
:* decreased libido

==Causes of Acromegaly==
Acromegaly is caused by prolonged overproduction of GH by the pituitary gland. The pituitary produces several important hormones that control body functions such as growth and development, reproduction, and metabolism. But hormones never seem to act simply and directly. They usually “cascade” or flow in a series, affecting each other’s production or release into the bloodstream.

GH is part of a cascade of hormones that, as the name implies, regulates the physical growth of the body. This cascade begins in a part of the brain called the hypothalamus. The hypothalamus makes hormones that regulate the pituitary. One of the hormones in the GH series, or “axis,” is growth hormone-releasing hormone (GHRH), which stimulates the pituitary gland to produce GH.

Secretion of GH by the pituitary into the bloodstream stimulates the liver to produce another hormone called insulin-like growth factor I (IGF-I). IGF-I is what actually causes tissue growth in the body. High levels of IGF-I, in turn, signal the pituitary to reduce GH production.

The hypothalamus makes another hormone called somatostatin, which inhibits GH production and release. Normally, GHRH, somatostatin, GH, and IGF-I levels in the body are tightly regulated by each other and by sleep, exercise, stress, food intake, and blood sugar levels. If the pituitary continues to make GH independent of the normal regulatory mechanisms, the level of IGF-I continues to rise, leading to bone overgrowth and organ enlargement. High levels of IGF-I also cause changes in glucose (sugar) and lipid (fat) metabolism and can lead to diabetes, high blood pressure, and heart disease.

===Pituitary Tumors===

In more than 95 percent of people with acromegaly, a benign tumor of the pituitary gland, called an adenoma, produces excess GH. Pituitary tumors are labeled either micro- or macro-adenomas, depending on their size. Most GH-secreting tumors are macro-adenomas, meaning they are larger than 1 centimeter. Depending on their location, these larger tumors may compress surrounding brain structures. For example, a tumor growing upward may affect the optic chiasm—where the optic nerves cross—leading to visual problems and vision loss. If the tumor grows to the side, it may enter an area of the brain called the cavernous sinus where there are many nerves, potentially damaging them.

Compression of the surrounding normal pituitary tissue can alter production of other hormones. These hormonal shifts can lead to changes in menstruation and breast discharge in women and erectile dysfunction in men. If the tumor affects the part of the pituitary that controls the thyroid—another hormone-producing gland—then thyroid hormones may decrease. Too little thyroid hormone can cause weight gain, fatigue, and hair and skin changes. If the tumor affects the part of the pituitary that controls the adrenal gland, the hormone cortisol may decrease. Too little cortisol can cause weight loss, dizziness, fatigue, low blood pressure, and nausea.

Some GH-secreting tumors may also secrete too much of other pituitary hormones. For example, they may produce prolactin, the hormone that stimulates the mammary glands to produce milk. Rarely, adenomas may produce thyroid-stimulating hormone. Doctors should assess all pituitary hormones in people with acromegaly.

Rates of GH production and the aggressiveness of the tumor vary greatly among people with adenomas. Some adenomas grow slowly and symptoms of GH excess are often not noticed for many years. Other adenomas grow more rapidly and invade surrounding brain areas or the venous sinuses, which are located near the pituitary gland. Younger patients tend to have more aggressive tumors. Regardless of size, these tumors are always benign.

Most pituitary tumors develop spontaneously and are not genetically inherited. They are the result of a genetic alteration in a single pituitary cell, which leads to increased cell division and tumor formation. This genetic change, or mutation, is not present at birth, but happens later in life. The mutation occurs in a gene that regulates the transmission of chemical signals within pituitary cells. It permanently switches on the signal that tells the cell to divide and secrete GH. The events within the cell that cause disordered pituitary cell growth and GH oversecretion currently are the subject of intensive research.

===Nonpituitary Tumors===
Rarely, acromegaly is caused not by pituitary tumors but by tumors of the pancreas, lungs, and other parts of the brain. These tumors also lead to excess GH, either because they produce GH themselves or, more frequently, because they produce GHRH, the hormone that stimulates the pituitary to make GH. When these non-pituitary tumors are surgically removed, GH levels fall and the symptoms of acromegaly improve.

In patients with GHRH-producing, non-pituitary tumors, the pituitary still may be enlarged and may be mistaken for a tumor. Physicians should carefully analyze all “pituitary tumors” removed from patients with acromegaly so they do not overlook the rare possibility that a tumor elsewhere in the body is causing the disorder.

==How to know you have Acromegaly (Diagnosis)?==
===Blood tests===
If acromegaly is suspected, a doctor must measure the GH level in a person’s blood to determine if it is elevated. However, a single measurement of an elevated blood GH level is not enough to diagnose acromegaly: Because GH is secreted by the pituitary in impulses, or spurts, its concentration in the blood can vary widely from minute to minute. At a given moment, a person with acromegaly may have a normal GH level, whereas a GH level in a healthy person may even be five times higher.

More accurate information is obtained when GH is measured under conditions that normally suppress GH secretion. Health care professionals often use the oral glucose tolerance test to diagnose acromegaly because drinking 75 to 100 grams of glucose solution lowers blood GH levels to less than 1 nanogram per milliliter (ng/ml) in healthy people. In people with GH overproduction, this suppression does not occur. The oral glucose tolerance test is a highly reliable method for confirming a diagnosis of acromegaly.

Physicians also can measure IGF-I levels, which increase as GH levels go up, in people with suspected acromegaly. Because IGF-I levels are much more stable than GH levels over the course of the day, they are often a more practical and reliable screening measure. Elevated IGF-I levels almost always indicate acromegaly. However, a pregnant woman’s IGF-I levels are two to three times higher than normal. In addition, physicians must be aware that IGF-I levels decline with age and may also be abnormally low in people with poorly controlled diabetes or liver or kidney disease.

===Imaging===
After acromegaly has been diagnosed by measuring GH or IGF-I levels, a magnetic resonance imaging (MRI) scan of the pituitary is used to locate and detect the size of the tumor causing GH overproduction. MRI is the most sensitive imaging technique, but computerized tomography (CT) scans can be used if the patient should not have MRI. For example, people who have pacemakers or other types of implants containing metal should not have an MRI scan because MRI machines contain powerful magnets.

If a head scan fails to detect a pituitary tumor, the physician should look for non-pituitary “ectopic” tumors in the chest, abdomen, or pelvis as the cause of excess GH. The presence of such tumors usually can be diagnosed by measuring GHRH in the blood and by a CT scan of possible tumor sites.

Rarely, a pituitary tumor secreting GH may be too tiny to detect even with a sensitive MRI scan.

==When to seek urgent medical care==
You should talk to your doctor if you experience anything of the symptoms associated with Acromegaly

==Treatment options==
Currently, treatment options include surgical removal of the tumor, medical therapy, and radiation therapy of the pituitary.

Goals of treatment are to
* reduce excess hormone production to normal levels
* relieve the pressure that the growing pituitary tumor may be exerting on the surrounding brain areas
* preserve normal pituitary function or treat hormone deficiencies
* improve the symptoms of acromegaly

===Surgery===

Surgery is the first option recommended for most people with acromegaly, as it is often a rapid and effective treatment. The surgeon reaches the pituitary via an incision through the nose or inside the upper lip and, with special tools, removes the tumor tissue in a procedure called transsphenoidal surgery. This procedure promptly relieves the pressure on the surrounding brain regions and leads to a rapid lowering of GH levels. If the surgery is successful, facial appearance and soft tissue swelling improve within a few days.

Surgery is most successful in patients with blood GH levels below 45 ng/ml before the operation and with pituitary tumors no larger than 10 millimeters (mm) in diameter. Success depends in large part on the skill and experience of the surgeon, as well as the location of the tumor. Even with the most experienced neurosurgeon, the chance of a cure is small if the tumor has extended into critical brain structures or into the cavernous sinus where surgery could be risky.

The success rate also depends on what level of GH is defined as a cure. The best measure of surgical success is normalization of GH and IGF-I levels. The overall rate of remission—control of the disease—after surgery ranges from 55 to 80 percent. (See For More Information to locate a board-certified neurosurgeon.)

A possible complication of surgery is damage to the surrounding normal pituitary tissue, which requires lifelong use of pituitary hormone replacement. The part of the pituitary that stores antidiuretic hormone—a hormone important in water balance—may be temporarily or, rarely, permanently damaged and the patient may require medical therapy. Other potential problems include cerebrospinal fluid leaks and, rarely, meningitis. Cerebrospinal fluid bathes the brain and can leak from the nose if the incision area doesn’t heal well. Meningitis is a bacterial or viral infection of the meninges, the outer covering of the brain.

Even when surgery is successful and hormone levels return to normal, people with acromegaly must be carefully monitored for years for possible recurrence of the disease. More commonly, hormone levels improve, but do not return to normal. Additional treatment, usually medications, may be required.

===Medical Therapy===
Medical therapy is most often used if surgery does not result in a cure and sometimes to shrink large tumors before surgery. Three medication groups are used to treat acromegaly.

Somatostatin analogs (SSAs) are the first medication group used to treat acromegaly. They shut off GH production and are effective in lowering GH and IGF-I levels in 50 to 70 percent of patients. SSAs also reduce tumor size in around 0 to 50 percent of patients but only to a modest degree. Several studies have shown that SSAs are safe and effective for long-term treatment and in treating patients with acromegaly caused by nonpituitary tumors. Long-acting SSAs are given by intramuscular injection once a month.

Digestive problems—such as loose stools, nausea, and gas—are a side effect in about half of people taking SSAs. However, the effects are usually temporary and rarely severe. About 10 to 20 percent of patients develop gallstones, but the gallstones do not usually cause symptoms. In rare cases, treatment can result in elevated blood glucose levels. More commonly, SSAs reduce the need for insulin and improve blood glucose control in some people with acromegaly who already have diabetes.

The second medication group is the GH receptor antagonists (GHRAs), which interfere with the action of GH. They normalize IGF-I levels in more than 90 percent of patients. They do not, however, lower GH levels. Given once a day through injection, GHRAs are usually well-tolerated by patients. The long-term effects of these drugs on tumor growth are still under study. Side effects can include headaches, fatigue, and abnormal liver function.

Dopamine agonists make up the third medication group. These drugs are not as effective as the other medications at lowering GH or IGF-I levels, and they normalize IGF-I levels in only a minority of patients. Dopamine agonists are sometimes effective in patients who have mild degrees of excess GH and have both acromegaly and hyperprolactinemia—too much of the hormone prolactin. Dopamine agonists can be used in combination with SSAs. Side effects can include nausea, headache, and lightheadedness.

===Radiation Therapy===
Radiation therapy is usually reserved for people who have some tumor remaining after surgery and do not respond to medications. Because radiation leads to a slow lowering of GH and IGF-I levels, these patients often also receive medication to lower hormone levels. The full effect of this therapy may not occur for many years.

The two types of radiation delivery are conventional and stereotactic. Conventional radiation delivery targets the tumor with external beams but can damage surrounding tissue. The treatment delivers small doses of radiation multiple times over 4 to 6 weeks, giving normal tissue time to heal between treatments.

Stereotactic delivery allows precise targeting of a high-dose beam of radiation at the tumor from varying angles. The patient must wear a rigid head frame to keep the head still. The types of stereotactic radiation delivery currently available are proton beam, linear accelerator (LINAC), and gamma knife. With stereotactic delivery, the tumor must be at least 5 mm from the optic chiasm to prevent radiation damage. This treatment can sometimes be done in a single session, reducing the risk of damage to surrounding tissue.

All forms of radiation therapy cause a gradual decline in production of other pituitary hormones over time, resulting in the need for hormone replacement in most patients. Radiation also can impair a patient’s fertilit

==Diseases with similar symptoms==
*[[gigantism]]
*[[prolactinoma]] <ref>http://www.cureresearch.com/a/acromegaly/intro.htm</ref>

==Where to find medical care for Acromegaly==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|Acromegaly}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating Acromegaly]

==What to expect (Outlook/Prognosis)==
Pituitary surgery is successful in most patients, depending on the size of the tumor and the experience of the surgeon. Without treatment the symptoms will get worse, and the risk of cardiovascular disease increases.

===Possible Complications===
* [[Arthritis]]
* [[Cardiovascular disease]]
* [[Carpal tunnel syndrome]]
* [[Colonic polyps]]
* [[Glucose intolerance]] or [[diabetes]]
* High blood pressure
* [[Hypopituitarism]]
* [[Sleep apnea]]
* [[Spinal cord compression]]
* [[Uterine fibroids]]
* Vision abnormalities

==Sources==
*http://www.endocrine.niddk.nih.gov/pubs/acro/acro.htm
*http://www.cureresearch.com/a/acromegaly/intro.htm
*http://www.nlm.nih.gov/medlineplus/ency/article/000321.htm#Expectations%20(prognosis)

[[Category:Patient Information]] {{WH}} {{WS}}

Acromegaly (patient information)

2009-09-04T00:40:38Z

LBiller: /* Where to find medical care for yourdisease */

'''For the WikiDoc page for this topic, click [[Acromegaly|here]]'''
{{SI}}

'''Editor-in-Chief:'''Meagan E. Doherty

{{EJ}}

==What is Acromegaly?==
[[Image:Acromegaly facial features.JPEG|thumb|left|Facial aspect of a patient with acromegaly. The nose is widened and thickened, the [[cheekbones]] are obvious, the forehead bulges, the lips are thick and the facial lines are marked. The forehead and overlying skin is thickened, sometimes leading to [[frontal bossing]].]]

Acromegaly is a hormonal disorder that results from too much growth hormone (GH) in the body. The pituitary, a small gland in the brain, makes GH. In acromegaly, the pituitary produces excessive amounts of GH. Usually the excess GH comes from benign, or noncancerous, tumors on the pituitary. These benign tumors are called adenomas.

Acromegaly is most often diagnosed in middle-aged adults, although symptoms can appear at any age. If not treated, acromegaly can result in serious illness and premature death. Acromegaly is treatable in most patients, but because of its slow and often “sneaky” onset, it often is not diagnosed early or correctly. The most serious health consequences of acromegaly are type 2 diabetes, high blood pressure, increased risk of cardiovascular disease, and arthritis. Patients with acromegaly are also at increased risk for colon polyps, which may develop into colon cancer if not removed.

When GH-producing tumors occur in childhood, the disease that results is called gigantism rather than acromegaly. A child’s height is determined by the length of the so-called long bones in the legs. In response to GH, these bones grow in length at the growth plates—areas near either end of the bone. Growth plates fuse after puberty, so the excessive GH production in adults does not result in increased height. However, prolonged exposure to excess GH before the growth plates fuse causes increased growth of the long bones and thus increased height. Pediatricians may become concerned about this possibility if a child’s growth rate suddenly and markedly increases beyond what would be predicted by previous growth and how tall the child’s parents are.

==What are the symptoms of Acromegaly?==
[[Image:Acromegaly hands.JPEG|thumb|left|As compared with the hand of a typical person (left), the hand of a patient with acromegaly (right) is enlarged, the fingers are widened, thickened and stubby, and the soft tissue is thickened.]]
[[Image:Acromegaly prognathism.JPEG|thumb|left|[[Mandible|Mandibular]] overgrowth leads to [[prognathism]], maxillary widening, teeth separation and jaw [[malocclusion]].]]

The name acromegaly comes from the Greek words for “extremities” and “enlargement,” reflecting one of its most common symptoms—the abnormal growth of the hands and feet. Swelling of the hands and feet is often an early feature, with patients noticing a change in ring or shoe size, particularly shoe width. Gradually, bone changes alter the patient’s facial features: The brow and lower jaw protrude, the nasal bone enlarges, and the teeth space out.

Overgrowth of bone and cartilage often leads to arthritis. When tissue thickens, it may trap nerves, causing carpal tunnel syndrome, which results in numbness and weakness of the hands. Body organs, including the heart, may enlarge.

Other symptoms of acromegaly include
:* joint aches
:* thick, coarse, oily skin
:* skin tags
:* enlarged lips, nose, and tongue
:* deepening of the voice due to enlarged sinuses and vocal cords
:* sleep apnea—breaks in breathing during sleep due to obstruction of the airway
:* excessive sweating and skin odor
:* fatigue and weakness
:* headaches
:* impaired vision
:* abnormalities of the menstrual cycle and sometimes breast discharge in women
:* erectile dysfunction in men
:* decreased libido

==Causes of Acromegaly==
Acromegaly is caused by prolonged overproduction of GH by the pituitary gland. The pituitary produces several important hormones that control body functions such as growth and development, reproduction, and metabolism. But hormones never seem to act simply and directly. They usually “cascade” or flow in a series, affecting each other’s production or release into the bloodstream.

GH is part of a cascade of hormones that, as the name implies, regulates the physical growth of the body. This cascade begins in a part of the brain called the hypothalamus. The hypothalamus makes hormones that regulate the pituitary. One of the hormones in the GH series, or “axis,” is growth hormone-releasing hormone (GHRH), which stimulates the pituitary gland to produce GH.

Secretion of GH by the pituitary into the bloodstream stimulates the liver to produce another hormone called insulin-like growth factor I (IGF-I). IGF-I is what actually causes tissue growth in the body. High levels of IGF-I, in turn, signal the pituitary to reduce GH production.

The hypothalamus makes another hormone called somatostatin, which inhibits GH production and release. Normally, GHRH, somatostatin, GH, and IGF-I levels in the body are tightly regulated by each other and by sleep, exercise, stress, food intake, and blood sugar levels. If the pituitary continues to make GH independent of the normal regulatory mechanisms, the level of IGF-I continues to rise, leading to bone overgrowth and organ enlargement. High levels of IGF-I also cause changes in glucose (sugar) and lipid (fat) metabolism and can lead to diabetes, high blood pressure, and heart disease.

===Pituitary Tumors===

In more than 95 percent of people with acromegaly, a benign tumor of the pituitary gland, called an adenoma, produces excess GH. Pituitary tumors are labeled either micro- or macro-adenomas, depending on their size. Most GH-secreting tumors are macro-adenomas, meaning they are larger than 1 centimeter. Depending on their location, these larger tumors may compress surrounding brain structures. For example, a tumor growing upward may affect the optic chiasm—where the optic nerves cross—leading to visual problems and vision loss. If the tumor grows to the side, it may enter an area of the brain called the cavernous sinus where there are many nerves, potentially damaging them.

Compression of the surrounding normal pituitary tissue can alter production of other hormones. These hormonal shifts can lead to changes in menstruation and breast discharge in women and erectile dysfunction in men. If the tumor affects the part of the pituitary that controls the thyroid—another hormone-producing gland—then thyroid hormones may decrease. Too little thyroid hormone can cause weight gain, fatigue, and hair and skin changes. If the tumor affects the part of the pituitary that controls the adrenal gland, the hormone cortisol may decrease. Too little cortisol can cause weight loss, dizziness, fatigue, low blood pressure, and nausea.

Some GH-secreting tumors may also secrete too much of other pituitary hormones. For example, they may produce prolactin, the hormone that stimulates the mammary glands to produce milk. Rarely, adenomas may produce thyroid-stimulating hormone. Doctors should assess all pituitary hormones in people with acromegaly.

Rates of GH production and the aggressiveness of the tumor vary greatly among people with adenomas. Some adenomas grow slowly and symptoms of GH excess are often not noticed for many years. Other adenomas grow more rapidly and invade surrounding brain areas or the venous sinuses, which are located near the pituitary gland. Younger patients tend to have more aggressive tumors. Regardless of size, these tumors are always benign.

Most pituitary tumors develop spontaneously and are not genetically inherited. They are the result of a genetic alteration in a single pituitary cell, which leads to increased cell division and tumor formation. This genetic change, or mutation, is not present at birth, but happens later in life. The mutation occurs in a gene that regulates the transmission of chemical signals within pituitary cells. It permanently switches on the signal that tells the cell to divide and secrete GH. The events within the cell that cause disordered pituitary cell growth and GH oversecretion currently are the subject of intensive research.

===Nonpituitary Tumors===
Rarely, acromegaly is caused not by pituitary tumors but by tumors of the pancreas, lungs, and other parts of the brain. These tumors also lead to excess GH, either because they produce GH themselves or, more frequently, because they produce GHRH, the hormone that stimulates the pituitary to make GH. When these non-pituitary tumors are surgically removed, GH levels fall and the symptoms of acromegaly improve.

In patients with GHRH-producing, non-pituitary tumors, the pituitary still may be enlarged and may be mistaken for a tumor. Physicians should carefully analyze all “pituitary tumors” removed from patients with acromegaly so they do not overlook the rare possibility that a tumor elsewhere in the body is causing the disorder.

==How to know you have Acromegaly (Diagnosis)?==
===Blood tests===
If acromegaly is suspected, a doctor must measure the GH level in a person’s blood to determine if it is elevated. However, a single measurement of an elevated blood GH level is not enough to diagnose acromegaly: Because GH is secreted by the pituitary in impulses, or spurts, its concentration in the blood can vary widely from minute to minute. At a given moment, a person with acromegaly may have a normal GH level, whereas a GH level in a healthy person may even be five times higher.

More accurate information is obtained when GH is measured under conditions that normally suppress GH secretion. Health care professionals often use the oral glucose tolerance test to diagnose acromegaly because drinking 75 to 100 grams of glucose solution lowers blood GH levels to less than 1 nanogram per milliliter (ng/ml) in healthy people. In people with GH overproduction, this suppression does not occur. The oral glucose tolerance test is a highly reliable method for confirming a diagnosis of acromegaly.

Physicians also can measure IGF-I levels, which increase as GH levels go up, in people with suspected acromegaly. Because IGF-I levels are much more stable than GH levels over the course of the day, they are often a more practical and reliable screening measure. Elevated IGF-I levels almost always indicate acromegaly. However, a pregnant woman’s IGF-I levels are two to three times higher than normal. In addition, physicians must be aware that IGF-I levels decline with age and may also be abnormally low in people with poorly controlled diabetes or liver or kidney disease.

===Imaging===
After acromegaly has been diagnosed by measuring GH or IGF-I levels, a magnetic resonance imaging (MRI) scan of the pituitary is used to locate and detect the size of the tumor causing GH overproduction. MRI is the most sensitive imaging technique, but computerized tomography (CT) scans can be used if the patient should not have MRI. For example, people who have pacemakers or other types of implants containing metal should not have an MRI scan because MRI machines contain powerful magnets.

If a head scan fails to detect a pituitary tumor, the physician should look for non-pituitary “ectopic” tumors in the chest, abdomen, or pelvis as the cause of excess GH. The presence of such tumors usually can be diagnosed by measuring GHRH in the blood and by a CT scan of possible tumor sites.

Rarely, a pituitary tumor secreting GH may be too tiny to detect even with a sensitive MRI scan.

==When to seek urgent medical care==
You should talk to your doctor if you experience anything of the symptoms associated with Acromegaly

==Treatment options==
Currently, treatment options include surgical removal of the tumor, medical therapy, and radiation therapy of the pituitary.

Goals of treatment are to
* reduce excess hormone production to normal levels
* relieve the pressure that the growing pituitary tumor may be exerting on the surrounding brain areas
* preserve normal pituitary function or treat hormone deficiencies
* improve the symptoms of acromegaly

===Surgery===

Surgery is the first option recommended for most people with acromegaly, as it is often a rapid and effective treatment. The surgeon reaches the pituitary via an incision through the nose or inside the upper lip and, with special tools, removes the tumor tissue in a procedure called transsphenoidal surgery. This procedure promptly relieves the pressure on the surrounding brain regions and leads to a rapid lowering of GH levels. If the surgery is successful, facial appearance and soft tissue swelling improve within a few days.

Surgery is most successful in patients with blood GH levels below 45 ng/ml before the operation and with pituitary tumors no larger than 10 millimeters (mm) in diameter. Success depends in large part on the skill and experience of the surgeon, as well as the location of the tumor. Even with the most experienced neurosurgeon, the chance of a cure is small if the tumor has extended into critical brain structures or into the cavernous sinus where surgery could be risky.

The success rate also depends on what level of GH is defined as a cure. The best measure of surgical success is normalization of GH and IGF-I levels. The overall rate of remission—control of the disease—after surgery ranges from 55 to 80 percent. (See For More Information to locate a board-certified neurosurgeon.)

A possible complication of surgery is damage to the surrounding normal pituitary tissue, which requires lifelong use of pituitary hormone replacement. The part of the pituitary that stores antidiuretic hormone—a hormone important in water balance—may be temporarily or, rarely, permanently damaged and the patient may require medical therapy. Other potential problems include cerebrospinal fluid leaks and, rarely, meningitis. Cerebrospinal fluid bathes the brain and can leak from the nose if the incision area doesn’t heal well. Meningitis is a bacterial or viral infection of the meninges, the outer covering of the brain.

Even when surgery is successful and hormone levels return to normal, people with acromegaly must be carefully monitored for years for possible recurrence of the disease. More commonly, hormone levels improve, but do not return to normal. Additional treatment, usually medications, may be required.

===Medical Therapy===
Medical therapy is most often used if surgery does not result in a cure and sometimes to shrink large tumors before surgery. Three medication groups are used to treat acromegaly.

Somatostatin analogs (SSAs) are the first medication group used to treat acromegaly. They shut off GH production and are effective in lowering GH and IGF-I levels in 50 to 70 percent of patients. SSAs also reduce tumor size in around 0 to 50 percent of patients but only to a modest degree. Several studies have shown that SSAs are safe and effective for long-term treatment and in treating patients with acromegaly caused by nonpituitary tumors. Long-acting SSAs are given by intramuscular injection once a month.

Digestive problems—such as loose stools, nausea, and gas—are a side effect in about half of people taking SSAs. However, the effects are usually temporary and rarely severe. About 10 to 20 percent of patients develop gallstones, but the gallstones do not usually cause symptoms. In rare cases, treatment can result in elevated blood glucose levels. More commonly, SSAs reduce the need for insulin and improve blood glucose control in some people with acromegaly who already have diabetes.

The second medication group is the GH receptor antagonists (GHRAs), which interfere with the action of GH. They normalize IGF-I levels in more than 90 percent of patients. They do not, however, lower GH levels. Given once a day through injection, GHRAs are usually well-tolerated by patients. The long-term effects of these drugs on tumor growth are still under study. Side effects can include headaches, fatigue, and abnormal liver function.

Dopamine agonists make up the third medication group. These drugs are not as effective as the other medications at lowering GH or IGF-I levels, and they normalize IGF-I levels in only a minority of patients. Dopamine agonists are sometimes effective in patients who have mild degrees of excess GH and have both acromegaly and hyperprolactinemia—too much of the hormone prolactin. Dopamine agonists can be used in combination with SSAs. Side effects can include nausea, headache, and lightheadedness.

===Radiation Therapy===
Radiation therapy is usually reserved for people who have some tumor remaining after surgery and do not respond to medications. Because radiation leads to a slow lowering of GH and IGF-I levels, these patients often also receive medication to lower hormone levels. The full effect of this therapy may not occur for many years.

The two types of radiation delivery are conventional and stereotactic. Conventional radiation delivery targets the tumor with external beams but can damage surrounding tissue. The treatment delivers small doses of radiation multiple times over 4 to 6 weeks, giving normal tissue time to heal between treatments.

Stereotactic delivery allows precise targeting of a high-dose beam of radiation at the tumor from varying angles. The patient must wear a rigid head frame to keep the head still. The types of stereotactic radiation delivery currently available are proton beam, linear accelerator (LINAC), and gamma knife. With stereotactic delivery, the tumor must be at least 5 mm from the optic chiasm to prevent radiation damage. This treatment can sometimes be done in a single session, reducing the risk of damage to surrounding tissue.

All forms of radiation therapy cause a gradual decline in production of other pituitary hormones over time, resulting in the need for hormone replacement in most patients. Radiation also can impair a patient’s fertilit

==Diseases with similar symptoms==
*[[gigantism]]
*[[prolactinoma]] <ref>http://www.cureresearch.com/a/acromegaly/intro.htm</ref>

==Where to find medical care for yourdisease==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|Acromegaly}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating Acromegaly]

==What to expect (Outlook/Prognosis)==
Pituitary surgery is successful in most patients, depending on the size of the tumor and the experience of the surgeon. Without treatment the symptoms will get worse, and the risk of cardiovascular disease increases.

===Possible Complications===
* [[Arthritis]]
* [[Cardiovascular disease]]
* [[Carpal tunnel syndrome]]
* [[Colonic polyps]]
* [[Glucose intolerance]] or [[diabetes]]
* High blood pressure
* [[Hypopituitarism]]
* [[Sleep apnea]]
* [[Spinal cord compression]]
* [[Uterine fibroids]]
* Vision abnormalities

==Sources==
*http://www.endocrine.niddk.nih.gov/pubs/acro/acro.htm
*http://www.cureresearch.com/a/acromegaly/intro.htm
*http://www.nlm.nih.gov/medlineplus/ency/article/000321.htm#Expectations%20(prognosis)

[[Category:Patient Information]] {{WH}} {{WS}}

Endoscopic versus Open Harvesting of Saphenous Vein Grafts: Secondary PREVENT IV analysis published in New England Journal of Medicine

2009-07-16T19:36:05Z

LBiller:

'''''July 16, 2009:''''' Among patients undergoing [[coronary artery bypass surgery]] (CABG), [[endoscopic]] vein-graft harvesting was associated with higher rates of vein graft failure and adverse clinical outcomes than direct-vision open harvesting, according to an article published today in the ''New England Journal of Medicine''<ref name="pmid19553646">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, ''et al.'' |title=Endoscopic versus Open Vein-Graft Harvesting in Coronary-Artery Bypass Surgery|journal=N. Engl. J. Med. |volume=361 |issue=3 |pages=235-44|year=2009 |month=July |pmid= |doi= |url=http://content.nejm.org/cgi/content/short/361/3/235}}</ref>.

The use of endoscopic harvesting has been associated with reduced [[pain]] and improved cosmetic results in previous randomized trials <ref name="pmid12077689">{{cite journal |author=Schurr UP, Lachat ML, Reuthebuch O, ''et al.'' |title=Endoscopic saphenous vein harvesting for CABG -- a randomized, prospective trial |journal=Thorac Cardiovasc Surg |volume=50 |issue=3 |pages=160–3 |year=2002 |month=June |pmid=12077689 |doi=10.1055/s-2002-32412 |url=}}</ref> when compared to the more traditional “open harvesting” method, whereby veins are excavated by a series of incisions under direct vision. In order to assess the long term results of these harvesting strategies, investigators analyzed data from the PREVENT IV (Project of Ex-vivo Vein Graft Engineering via Transfection IV) Trial, a [[phase III]], multicenter, [[double-blind]], placebo controlled trial of 3014 CABG patients investigating the efficacy of graft pretreatment with edifoligide<ref name="pmid16287955">{{cite journal |author=Alexander JH, Hafley G, Harrington RA, ''et al.'' |title=Efficacy and safety of edifoligide, an E2F transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: a randomized controlled trial |journal=JAMA |volume=294 |issue=19 |pages=2446–54 |year=2005 |month=November |pmid=16287955 |doi=10.1001/jama.294.19.2446 |url=}}</ref>. For this secondary analysis, [[angiographic]] data 12 to 18 months post-surgery were available for 822 patients who underwent open harvesting (involving 1969 grafts) and 995 patients who underwent the endoscopic procedure (involving 2321 grafts) with 3 year follow-up event data available for 1247 and 1753 patients undergoing open and endoscopic harvesting respectively. The primary angiographic outcome was vein-graft failure (defined as stenosis >=75% the graft diameter as determined by an independent blinded core laboratory), and the primary clinical outcome measure was the composite of [[death]], [[myocardial infarction]], and repeat revascularization.

Compared to open harvesting, endoscopic harvesting was associated with higher rates of vein-graft failure when analyzed by patient (46.7% vs 38.0%; odds ratio 1.45 [95%CI: 1.20- 1.76]; p<0.001) or by graft (27.2% vs 22.6%; odds ratio:1.34 [95% CI:1.14-1.59]; p<0.001). The endoscopic strategy was also associated with a higher Kaplan-Meier estimate of the 3 year event rate of the primary clinical outcome measure (20.2% [350 events] vs 17.4% [214 events] for the open harvesting cohort; adjusted hazard ratio: 1.22 [95% CI: 1.01-1.47]; p=0.04).

The investigators noted that their study was not randomized and although the model was adjusted for [[weight]], duration of [[surgery]], worst graft quality, worst target-artery quality, and use of composite or non-composite grafts, other potential [[cofounders]] could exist. Additionally, PREVENT IV investigators did not collect measures of surgical experience or what type of device was used for the endoscopic harvesting procedure, and could therefore not determine whether differences in operator technique or device may have influenced their results.

The findings of this secondary PREVENT IV analysis suggest that despite the recognized short-term benefits of the endoscopic method of saphenous vein graft harvesting (lower rates of infection and pain, shorter hospital stays and improved cosmetic results), the high rates of vein-graft failure and rates of death, myocardial infarction and revascularization must be considered for patients undergoing coronary artery bypass surgery. Future randomized studies will be required to further investigate the effects of varying harvesting techniques.

==References==
{{reflist}}

Endoscopic versus Open Harvesting of Saphenous Vein Grafts: Secondary PREVENT IV analysis published in New England Journal of Medicine

2009-07-16T12:40:47Z

LBiller:

'''''July 16, 2009:''''' Among patients undergoing [[coronary artery bypass surgery]] (CABG), [[endoscopic]] vein-graft harvesting was associated with higher rates of vein graft failure and adverse clinical outcomes than direct-vision open harvesting, according to an article published today in the ''New England Journal of Medicine''<ref name="pmid19553646">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, ''et al.'' |title=Endoscopic versus Open Vein-Graft Harvesting in Coronary-Artery Bypass Surgery|journal=N. Engl. J. Med. |volume=361 |issue=3 |pages=235-44|year=2009 |month=July |pmid= |doi= |url=}}</ref>.

The use of endoscopic harvesting has been associated with reduced [[pain]] and improved cosmetic results in previous randomized trials <ref name="pmid12077689">{{cite journal |author=Schurr UP, Lachat ML, Reuthebuch O, ''et al.'' |title=Endoscopic saphenous vein harvesting for CABG -- a randomized, prospective trial |journal=Thorac Cardiovasc Surg |volume=50 |issue=3 |pages=160–3 |year=2002 |month=June |pmid=12077689 |doi=10.1055/s-2002-32412 |url=}}</ref> when compared to the more traditional “open harvesting” method, whereby veins are excavated by a series of incisions under direct vision. In order to assess the long term results of these harvesting strategies, investigators analyzed data from the PREVENT IV (Project of Ex-vivo Vein Graft Engineering via Transfection IV) Trial, a [[phase III]], multicenter, [[double-blind]], placebo controlled trial of 3014 CABG patients investigating the efficacy of graft pretreatment with edifoligide<ref name="pmid16287955">{{cite journal |author=Alexander JH, Hafley G, Harrington RA, ''et al.'' |title=Efficacy and safety of edifoligide, an E2F transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: a randomized controlled trial |journal=JAMA |volume=294 |issue=19 |pages=2446–54 |year=2005 |month=November |pmid=16287955 |doi=10.1001/jama.294.19.2446 |url=}}</ref>. For this secondary analysis, [[angiographic]] data 12 to 18 months post-surgery were available for 822 patients who underwent open harvesting (involving 1969 grafts) and 995 patients who underwent the endoscopic procedure (involving 2321 grafts) with 3 year follow-up event data available for 1247 and 1753 patients undergoing open and endoscopic harvesting respectively. The primary angiographic outcome was vein-graft failure (defined as stenosis >=75% the graft diameter as determined by an independent blinded core laboratory), and the primary clinical outcome measure was the composite of [[death]], [[myocardial infarction]], and repeat revascularization.

Compared to open harvesting, endoscopic harvesting was associated with higher rates of vein-graft failure when analyzed by patient (46.7% vs 38.0%; odds ratio 1.45 [95%CI: 1.20- 1.76]; p<0.001) or by graft (27.2% vs 22.6%; odds ratio:1.34 [95% CI:1.14-1.59]; p<0.001). The endoscopic strategy was also associated with a higher Kaplan-Meier estimate of the 3 year event rate of the primary clinical outcome measure (20.2% [350 events] vs 17.4% [214 events] for the open harvesting cohort; adjusted hazard ratio: 1.22 [95% CI: 1.01-1.47]; p=0.04).

The investigators noted that their study was not randomized and although the model was adjusted for [[weight]], duration of [[surgery]], worst graft quality, worst target-artery quality, and use of composite or non-composite grafts, other potential [[cofounders]] could exist. Additionally, PREVENT IV investigators did not collect measures of surgical experience or what type of device was used for the endoscopic harvesting procedure, and could therefore not determine whether differences in operator technique or device may have influenced their results.

The findings of this secondary PREVENT IV analysis suggest that despite the recognized short-term benefits of the endoscopic method of saphenous vein graft harvesting (lower rates of infection and pain, shorter hospital stays and improved cosmetic results), the high rates of vein-graft failure and rates of death, myocardial infarction and revascularization must be considered for patients undergoing coronary artery bypass surgery. Future randomized studies will be required to further investigate the effects of varying harvesting techniques.

==References==
{{reflist}}

Endoscopic versus Open Harvesting of Saphenous Vein Grafts: Secondary PREVENT IV analysis published in New England Journal of Medicine

2009-07-16T12:37:06Z

LBiller: New page: ''July 16, 2009:'' Among patients undergoing coronary artery bypass surgery (CABG), endoscopic vein-graft harvesting was associated with greater rates of vein graft failure and adv...

''July 16, 2009:'' Among patients undergoing [[coronary artery bypass surgery]] (CABG), [[endoscopic]] vein-graft harvesting was associated with greater rates of vein graft failure and adverse clinical outcomes than direct-vision open harvesting, according to an article published today in the ''New England Journal of Medicine''<ref name="pmid19553646">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, ''et al.'' |title=Endoscopic versus Open Vein-Graft Harvesting in Coronary-Artery Bypass Surgery|journal=N. Engl. J. Med. |volume=361 |issue=3 |pages=235-44|year=2009 |month=July |pmid= |doi= |url=}}</ref>.

The use of endoscopic harvesting has been associated with reduced [[pain]] and improved cosmetic results in previous randomized trials <ref name="pmid12077689">{{cite journal |author=Schurr UP, Lachat ML, Reuthebuch O, ''et al.'' |title=Endoscopic saphenous vein harvesting for CABG -- a randomized, prospective trial |journal=Thorac Cardiovasc Surg |volume=50 |issue=3 |pages=160–3 |year=2002 |month=June |pmid=12077689 |doi=10.1055/s-2002-32412 |url=}}</ref> when compared to the more traditional “open harvesting” method, whereby veins are excavated by a series of incisions under direct vision. In order to assess the long term results of these harvesting strategies, investigators analyzed data from the PREVENT IV (Project of Ex-vivo Vein Graft Engineering via Transfection IV) Trial, a [[phase III]], multicenter, [[double-blind]], placebo controlled trial of 3014 CABG patients investigating the efficacy of graft pretreatment with edifoligide<ref name="pmid16287955">{{cite journal |author=Alexander JH, Hafley G, Harrington RA, ''et al.'' |title=Efficacy and safety of edifoligide, an E2F transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: a randomized controlled trial |journal=JAMA |volume=294 |issue=19 |pages=2446–54 |year=2005 |month=November |pmid=16287955 |doi=10.1001/jama.294.19.2446 |url=}}</ref>. For this secondary analysis, [[angiographic]] data 12 to 18 months post-surgery were available for 822 patients who underwent open harvesting (involving 1969 grafts) and 995 patients who underwent the endoscopic procedure (involving 2321 grafts) with 3 year follow-up event data available for 1247 and 1753 patients undergoing open and endoscopic harvesting respectively. The primary angiographic outcome was vein-graft failure (defined as stenosis >=75% the graft diameter as determined by an independent blinded core laboratory), and the primary clinical outcome measure was the composite of [[death]], [[myocardial infarction]], and repeat revascularization.

Compared to open harvesting, endoscopic harvesting was associated with higher rates of vein-graft failure when analyzed by patient (46.7% vs 38.0%; odds ratio 1.45 [95%CI: 1.20- 1.76]; p<0.001) or by graft (27.2% vs 22.6%; odds ratio:1.34 [95% CI:1.14-1.59]; p<0.001). The endoscopic strategy was also associated with a higher Kaplan-Meier estimate of the 3 year event rate of the primary clinical outcome measure (20.2% [350 events] vs 17.4% [214 events] for the open harvesting cohort; adjusted hazard ratio: 1.22 [95% CI: 1.01-1.47]; p=0.04).

The investigators noted that their study was not randomized and although the model was adjusted for [[weight]], duration of [[surgery]], worst graft quality, worst target-artery quality, and use of composite or non-composite grafts, other potential [[cofounders]] could exist. Additionally, PREVENT IV investigators did not collect measures of surgical experience or what type of device was used for the endoscopic harvesting procedure, and could therefore not determine whether differences in operator technique or device may have influenced their results.

The findings of this secondary PREVENT IV analysis suggest that despite the recognized short-term benefits of the endoscopic method of saphenous vein graft harvesting (lower rates of infection and pain, shorter hospital stays and improved cosmetic results), the high rates of vein-graft failure and rates of death, myocardial infarction and revascularization must be considered for patients undergoing coronary artery bypass surgery. Future randomized studies will be required to further investigate the effects of varying harvesting techniques.

==References==
{{reflist}}

Aortic stenosis (patient information)

2009-07-15T18:04:42Z

LBiller:

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==
The [[aorta]] is the main artery leaving the [[heart]]. When [[blood]] leaves the heart, it flows from the lower chamber (the [[left ventricle]]), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow from the heart to the rest of the body.
<gallery>
Image:Apikal4D.gif|Echocardiogram showing normal valvular function. The [[aortic valve]] can be seen in the upper part of the righthand image.
Image:Aortic_stenosis_rotated.jpg|Calcification narrows the opening of the aortic valve, producing [[aortic stenosis]].
</gallery>

==What are the symptoms of aortic stenosis?==
You may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when your healthcare provider heard a [[heart murmur]] and then performed additional tests.

===Symptoms in adults===
*[[Breathlessness]] with activity
*[[Chest pain]], [[angina]]-type
**Crushing, squeezing, pressure, tightness
**Pain increases with exercise, relieved with rest
**Under the chest bone, may move to other areas
*[[Fainting]], [[weakness]], or [[dizziness]] with activity
*Sensation of feeling the [[heart beat]] ([[palpitations]])

===Symptoms in infants and children===
*Becoming tired or [[fatigue]]d with exertion more easily than others (in mild cases)
*Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing an infection of the heart valves ([[bacterial endocarditis]]).

==What are the causes of aortic stenosis?==
In the United States, aortic stenosis often results from calcium deposits on the aortic valve. These deposits occur naturally with age and have no relationship with the amount of calcium in the diet. Approximately 2% of all people have a [[bicuspid aortic valve]], which increases the risk of these calcifications and makes them more likely to develop aortic stenosis. Worldwide, [[rheumatic heart disease]] is a common cause of aortic stenosis.

As the [[aortic valve]] becomes more narrow, the pressure increases inside the lower chamber of the heart (the left [[ventricle]]). This causes the left ventricle to become thicker, decreasing blood flow and can lead to [[chest pain]]. As the pressure continues to rise, blood may back up into the lungs, and you may feel short of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. This can cause lightheadedness and fainting.

==Who is at risk for aortic stenosis?==
Aortic stenosis occurs more often in men than in women. The calcifications that cause most cases of aortic stenosis are more likely to occur in patients above the age of 50, who are overweight, who smoke, and who have [[diabetes mellitus|diabetes]], [[high blood pressure]], and [[high cholesterol]]. These are the same risk factors for [[atherosclerosis]] of the coronary blood vessels.

People who had [[rheumatic fever]] as a child also have a somewhat higher risk of developing aortic stenosis, but rheumatic fever is very rare in the United States. [[Radiation therapy]] for treatment of cancer, such as [[breast cancer]] or [[lymphoma]], may also increase the risk of aortic stenosis.

==How does my health care provider know if I have aortic stenosis?==
===Heart murmur===
When listening to your heart, your health care provider may hear a new [[heart murmur]] associated with aortic stenosis. This murmur is not always there in aortic stenosis. If a new murmur is heard and your health care provider is concerned about aortic stenosis or another form of heart disease, further tests may be ordered. It is important to remember that not all heart murmurs mean you have a harmful heart condition.

===Blood pressure===
You may have high [[blood pressure]] if you have mild aortic stenosis. In rare cases of severe aortic stenosis, your blood pressure may actually be low.

===Tests your doctor might perform===
* Chest [[x-ray]]
* [[Electrocardiogram]], where sensors on the chest measure electrical activity of the heart
* [[Echocardiography]], which is an ultrasound of the heart
* [[Exercise stress testing]], where your doctor monitors your electrocardiogram while you exercise
* [[MRI of the heart]], where you lay in a magnet that takes pictures of your heart
* [[Cardiac catheterization]], where a catheter is inserted into the arteries of your heart and pictures are taken

==How do I know if my child has aortic stenosis?==
Infants and children may be:
*Extremely [[tired]]
*[[Sweaty]]
*Have pale skin
*Fast breathing.
*They may also be smaller than other children their age.

==When should I seek urgent medical care?==
Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new symptoms develop.

==Treatment options==
If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider. Patients with aortic stenosis may be told not to play competitive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

===Medication===
Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly [[atrial fibrillation]]). These include [[diuretic]]s (water pills), [[nitrate]]s, and [[beta-blocker]]s. High [[blood pressure]] should also be treated.

===Lifestyle changes===
*Stop smoking and be treated for high [[cholesterol]].
*See a cardiologist every 3 to 6 months.

===Surgery===
[[Surgery]] to repair or replace the aortic valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on [[#Tests your doctor might perform|diagnostic tests]] may also require surgery.

====[[Valvuloplasty]]====
Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon [[valvuloplasty]] may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

====[[Percutaneous aortic valve replacement (patient information)|Percutaneous Aortic Valve Replacement]]====
Percutaneous aortic valvular replacement (PAVR) is a new less invasive procedure that does not require open heart surgery. In this procedure, a new replacement or [[prosthetic valve]] is implanted into the heart. The device is inserted through a small hole in the artery that runs to the leg <ref name="cleveland">{{cite web |url=http://my.clevelandclinic.org/heart/percutaneous/percutaneousvalve.aspx |title=Heart Valve Disease - Percutaneous Interventions |format= |work= |accessdate=}}</ref>. It is a relatively new procedure and is currently under study. It has the benefits of not requiring general anesthesia, causing less pain, less blood loss, and a lower risk of infection. There is also a faster recovery after PAVR than with traditional open heart surgery to replace the aortic valve.

==Treatment options for children==
Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

===Surgery===
[[Valvuloplasty]] is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve, called a Ross procedure.

==Prevention of aortic stenosis==
Treat [[strep throat]] promptly to prevent [[rheumatic fever]], which can cause aortic stenosis.

Follow your health care provider's treatment recommendation for conditions that may cause valve disease. Notify you provider if there is a family history of congenital heart diseases.

==What is the outlook and prognosis?==
People with mild aortic stenosis may do very well using a watchful waiting approach with their health care provider. They may be treated medically for some conditions associated with aortic stenosis, such as [[high blood pressure]], and may have a normal life expectancy.

Those with more severe symptoms, such as chest pain or signs of heart failure like shortness of breath and leg swelling, generally do poorly without surgery. However, surgery does have the potential to cure a person's aortic stenosis. The success of surgery depends on a number of factors, including patient age, overall activity level, and presence of other medical conditions. As with any operation, aortic valve surgery has some risks, most of which occur during the first 1-2 days after surgery. These include an [[irregular heart rhythm]] and [[blood clot]]s in the legs. There is also a chance that the new or repaired valve may stop working which might require another surgery.

==Sources==
*{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000178.htm |title=MedlinePlus Medical Encyclopedia: Aortic stenosis |format= |work= |accessdate=2009-07-15}}

{{SIB}}
{{WH}}
{{WS}}
[[Category:Patient Information]]

Aortic stenosis (patient information)

2009-07-15T17:56:56Z

LBiller: /* Surgery */

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==
The [[aorta]] is the main artery leaving the [[heart]]. When [[blood]] leaves the heart, it flows from the lower chamber (the [[left ventricle]]), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow from the heart to the rest of the body.
<gallery>
Image:Apikal4D.gif|Echocardiogram showing normal valvular function. The [[aortic valve]] can be seen in the upper part of the righthand image.
Image:Aortic_stenosis_rotated.jpg|Calcification narrows the opening of the aortic valve, producing [[aortic stenosis]].
</gallery>

==What are the symptoms of aortic stenosis?==
You may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when your healthcare provider heard a [[heart murmur]] and then performed additional tests.

====Symptoms in adults====
*[[Breathlessness]] with activity
*[[Chest pain]], [[angina]]-type
**Crushing, squeezing, pressure, tightness
**Pain increases with exercise, relieved with rest
**Under the chest bone, may move to other areas
*[[Fainting]], [[weakness]], or [[dizziness]] with activity
*Sensation of feeling the [[heart beat]] ([[palpitations]])

====Symptoms in infants and children====
*Becoming tired or [[fatigue]]d with exertion more easily than others (in mild cases)
*Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing an infection of the heart valves ([[bacterial endocarditis]]).

==What are the causes of aortic stenosis?==
In the United States, aortic stenosis often results from calcium deposits on the aortic valve. These deposits occur naturally with age and have no relationship with the amount of calcium in the diet. Approximately 2% of all people have a [[bicuspid aortic valve]], which increases the risk of these calcifications and makes them more likely to develop aortic stenosis. Worldwide, [[rheumatic heart disease]] is a common cause of aortic stenosis.

As the [[aortic valve]] becomes more narrow, the pressure increases inside the lower chamber of the heart (the left [[ventricle]]). This causes the left ventricle to become thicker, decreasing blood flow and can lead to [[chest pain]]. As the pressure continues to rise, blood may back up into the lungs, and you may feel short of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. This can cause lightheadedness and fainting.

==Who is at risk for aortic stenosis?==
Aortic stenosis occurs more often in men than in women. The calcifications that cause most cases of aortic stenosis are more likely to occur in patients above the age of 50, who are overweight, who smoke, and who have [[diabetes mellitus|diabetes]], [[high blood pressure]], and [[high cholesterol]]. These are the same risk factors for [[atherosclerosis]] of the coronary blood vessels.

People who had [[rheumatic fever]] as a child also have a somewhat higher risk of developing aortic stenosis, but rheumatic fever is very rare in the United States. [[Radiation therapy]] for treatment of cancer, such as [[breast cancer]] or [[lymphoma]], may also increase the risk of aortic stenosis.

==How does my health care provider know if I have aortic stenosis?==
===Heart murmur===
When listening to your heart, your health care provider may hear a new [[heart murmur]] associated with aortic stenosis. This murmur is not always there in aortic stenosis. If a new murmur is heard and your health care provider is concerned about aortic stenosis or another form of heart disease, further tests may be ordered. It is important to remember that not all heart murmurs mean you have a harmful heart condition.

===Blood pressure===
You may have high [[blood pressure]] if you have mild aortic stenosis. In rare cases of severe aortic stenosis, your blood pressure may actually be low.

===Tests your doctor might perform===
* Chest [[x-ray]]
* [[Electrocardiogram]], where sensors on the chest measure electrical activity of the heart
* [[Echocardiography]], which is an ultrasound of the heart
* [[Exercise stress testing]], where your doctor monitors your electrocardiogram while you exercise
* [[MRI of the heart]], where you lay in a magnet that takes pictures of your heart
* [[Cardiac catheterization]], where a catheter is inserted into the arteries of your heart and pictures are taken

==How do I know if my child has aortic stenosis?==
Infants and children may be:
*Extremely [[tired]]
*[[Sweaty]]
*Have pale skin
*Fast breathing.
*They may also be smaller than other children their age.

==When should I seek urgent medical care?==
Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new symptoms develop.

==Treatment options==
If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider. Patients with aortic stenosis may be told not to play competitive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

===Medication===
Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly [[atrial fibrillation]]). These include [[diuretic]]s (water pills), [[nitrate]]s, and [[beta-blocker]]s. High [[blood pressure]] should also be treated.

===Lifestyle changes===
*Stop smoking and be treated for high [[cholesterol]].
*See a cardiologist every 3 to 6 months.

===Surgery===
[[Surgery]] to repair or replace the aortic valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on [[#Tests your doctor might perform|diagnostic tests]] may also require surgery.

====[[Valvuloplasty]]====
Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon [[valvuloplasty]] may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

====[[Percutaneous aortic valve replacement (patient information)|Percutaneous Aortic Valve Replacement]]====
Percutaneous aortic valvular replacement (PAVR) is a new less invasive procedure that does not require open heart surgery. In this procedure, a new replacement or [[prosthetic valve]] is implanted into the heart. The device is inserted through a small hole in the artery that runs to the leg <ref name="cleveland">{{cite web |url=http://my.clevelandclinic.org/heart/percutaneous/percutaneousvalve.aspx |title=Heart Valve Disease - Percutaneous Interventions |format= |work= |accessdate=}}</ref>. It is a relatively new procedure and is currently under study. It has the benefits of not requiring general anesthesia, causing less pain, less blood loss, and a lower risk of infection. There is also a faster recovery after PAVR than with traditional open heart surgery to replace the aortic valve.

==Treatment options for children==
Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

====Surgery====
[[Valvuloplasty]] is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve, called a Ross procedure.

==Prevention of aortic stenosis==
Treat [[strep throat]] promptly to prevent [[rheumatic fever]], which can cause aortic stenosis.

Follow your health care provider's treatment recommendation for conditions that may cause valve disease. Notify you provider if there is a family history of congenital heart diseases.

==What is the outlook and prognosis?==
People with mild aortic stenosis may do very well using a watchful waiting approach with their health care provider. They may be treated medically for some conditions associated with aortic stenosis, such as [[high blood pressure]], and may have a normal life expectancy.

Those with more severe symptoms, such as chest pain or signs of heart failure like shortness of breath and leg swelling, generally do poorly without surgery. However, surgery does have the potential to cure a person's aortic stenosis. The success of surgery depends on a number of factors, including patient age, overall activity level, and presence of other medical conditions. As with any operation, aortic valve surgery has some risks, most of which occur during the first 1-2 days after surgery. These include an [[irregular heart rhythm]] and [[blood clot]]s in the legs. There is also a chance that the new or repaired valve may stop working which might require another surgery.

==Sources==
*{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000178.htm |title=MedlinePlus Medical Encyclopedia: Aortic stenosis |format= |work= |accessdate=2009-07-15}}

{{WH}}
{{WS}}
[[Category:Patient Information]]

Aortic stenosis (patient information)

2009-07-15T17:53:54Z

LBiller: /* Surgery */

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==
The [[aorta]] is the main artery leaving the [[heart]]. When [[blood]] leaves the heart, it flows from the lower chamber (the [[left ventricle]]), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow from the heart to the rest of the body.
<gallery>
Image:Apikal4D.gif|Echocardiogram showing normal valvular function. The [[aortic valve]] can be seen in the upper part of the righthand image.
Image:Aortic_stenosis_rotated.jpg|Calcification narrows the opening of the aortic valve, producing [[aortic stenosis]].
</gallery>

==What are the symptoms of aortic stenosis?==
You may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when your healthcare provider heard a [[heart murmur]] and then performed additional tests.

====Symptoms in adults====
*[[Breathlessness]] with activity
*[[Chest pain]], [[angina]]-type
**Crushing, squeezing, pressure, tightness
**Pain increases with exercise, relieved with rest
**Under the chest bone, may move to other areas
*[[Fainting]], [[weakness]], or [[dizziness]] with activity
*Sensation of feeling the [[heart beat]] ([[palpitations]])

====Symptoms in infants and children====
*Becoming tired or [[fatigue]]d with exertion more easily than others (in mild cases)
*Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing an infection of the heart valves ([[bacterial endocarditis]]).

==What are the causes of aortic stenosis?==
In the United States, aortic stenosis often results from calcium deposits on the aortic valve. These deposits occur naturally with age and have no relationship with the amount of calcium in the diet. Approximately 2% of all people have a [[bicuspid aortic valve]], which increases the risk of these calcifications and makes them more likely to develop aortic stenosis. Worldwide, [[rheumatic heart disease]] is a common cause of aortic stenosis.

As the [[aortic valve]] becomes more narrow, the pressure increases inside the lower chamber of the heart (the left [[ventricle]]). This causes the left ventricle to become thicker, decreasing blood flow and can lead to [[chest pain]]. As the pressure continues to rise, blood may back up into the lungs, and you may feel short of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. This can cause lightheadedness and fainting.

==Who is at risk for aortic stenosis?==
Aortic stenosis occurs more often in men than in women. The calcifications that cause most cases of aortic stenosis are more likely to occur in patients above the age of 50, who are overweight, who smoke, and who have [[diabetes mellitus|diabetes]], [[high blood pressure]], and [[high cholesterol]]. These are the same risk factors for [[atherosclerosis]] of the coronary blood vessels.

People who had [[rheumatic fever]] as a child also have a somewhat higher risk of developing aortic stenosis, but rheumatic fever is very rare in the United States. [[Radiation therapy]] for treatment of cancer, such as [[breast cancer]] or [[lymphoma]], may also increase the risk of aortic stenosis.

==How does my health care provider know if I have aortic stenosis?==
===Heart murmur===
When listening to your heart, your health care provider may hear a new [[heart murmur]] associated with aortic stenosis. This murmur is not always there in aortic stenosis. If a new murmur is heard and your health care provider is concerned about aortic stenosis or another form of heart disease, further tests may be ordered. It is important to remember that not all heart murmurs mean you have a harmful heart condition.

===Blood pressure===
You may have high [[blood pressure]] if you have mild aortic stenosis. In rare cases of severe aortic stenosis, your blood pressure may actually be low.

===Tests your doctor might perform===
* Chest [[x-ray]]
* [[Electrocardiogram]], where sensors on the chest measure electrical activity of the heart
* [[Echocardiography]], which is an ultrasound of the heart
* [[Exercise stress testing]], where your doctor monitors your electrocardiogram while you exercise
* [[MRI of the heart]], where you lay in a magnet that takes pictures of your heart
* [[Cardiac catheterization]], where a catheter is inserted into the arteries of your heart and pictures are taken

==How do I know if my child has aortic stenosis?==
Infants and children may be:
*Extremely [[tired]]
*[[Sweaty]]
*Have pale skin
*Fast breathing.
*They may also be smaller than other children their age.

==When should I seek urgent medical care?==
Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new symptoms develop.

==Treatment options==
If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider. Patients with aortic stenosis may be told not to play competitive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

===Medication===
Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly [[atrial fibrillation]]). These include [[diuretic]]s (water pills), [[nitrate]]s, and [[beta-blocker]]s. High [[blood pressure]] should also be treated.

===Lifestyle changes===
*Stop smoking and be treated for high [[cholesterol]].
*See a cardiologist every 3 to 6 months.

===[[Surgery]]===
[[Surgery]] to repair or replace the aortic valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on [[#Tests your doctor might perform|diagnostic tests]] may also require surgery.

*[[Valvuloplasty]]
Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon [[valvuloplasty]] may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

*[[Percutaneous aortic valve replacement (patient information)|Percutaneous Aortic Valve Replacement]]
Percutaneous aortic valvular replacement (PAVR) is a new less invasive procedure that does not require open heart surgery. In this procedure, a new replacement or [[prosthetic valve]] is implanted into the heart. The device is inserted through a small hole in the artery that runs to the leg <ref name="cleveland">{{cite web |url=http://my.clevelandclinic.org/heart/percutaneous/percutaneousvalve.aspx |title=Heart Valve Disease - Percutaneous Interventions |format= |work= |accessdate=}}</ref>. It is a relatively new procedure and is currently under study. It has the benefits of not requiring general anesthesia, causing less pain, less blood loss, and a lower risk of infection. There is also a faster recovery after PAVR than with traditional open heart surgery to replace the aortic valve.

==Treatment options for children==
Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

====Surgery====
[[Valvuloplasty]] is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve, called a Ross procedure.

==Prevention of aortic stenosis==
Treat [[strep throat]] promptly to prevent [[rheumatic fever]], which can cause aortic stenosis.

Follow your health care provider's treatment recommendation for conditions that may cause valve disease. Notify you provider if there is a family history of congenital heart diseases.

==What is the outlook and prognosis?==
People with mild aortic stenosis may do very well using a watchful waiting approach with their health care provider. They may be treated medically for some conditions associated with aortic stenosis, such as [[high blood pressure]], and may have a normal life expectancy.

Those with more severe symptoms, such as chest pain or signs of heart failure like shortness of breath and leg swelling, generally do poorly without surgery. However, surgery does have the potential to cure a person's aortic stenosis. The success of surgery depends on a number of factors, including patient age, overall activity level, and presence of other medical conditions. As with any operation, aortic valve surgery has some risks, most of which occur during the first 1-2 days after surgery. These include an [[irregular heart rhythm]] and [[blood clot]]s in the legs. There is also a chance that the new or repaired valve may stop working which might require another surgery.

==Sources==
*{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000178.htm |title=MedlinePlus Medical Encyclopedia: Aortic stenosis |format= |work= |accessdate=2009-07-15}}

{{WH}}
{{WS}}
[[Category:Patient Information]]

Aortic stenosis (patient information)

2009-07-15T17:48:23Z

LBiller: /* What is aortic stenosis? */

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==
The [[aorta]] is the main artery leaving the [[heart]]. When [[blood]] leaves the heart, it flows from the lower chamber (the [[left ventricle]]), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow from the heart to the rest of the body.
<gallery>
Image:Apikal4D.gif|Echocardiogram showing normal valvular function. The [[aortic valve]] can be seen in the upper part of the righthand image.
Image:Aortic_stenosis_rotated.jpg|Calcification narrows the opening of the aortic valve, producing [[aortic stenosis]].
</gallery>

==What are the symptoms of aortic stenosis?==
You may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when your healthcare provider heard a [[heart murmur]] and then performed additional tests.

====Symptoms in adults====
*[[Breathlessness]] with activity
*[[Chest pain]], [[angina]]-type
**Crushing, squeezing, pressure, tightness
**Pain increases with exercise, relieved with rest
**Under the chest bone, may move to other areas
*[[Fainting]], [[weakness]], or [[dizziness]] with activity
*Sensation of feeling the [[heart beat]] ([[palpitations]])

====Symptoms in infants and children====
*Becoming tired or [[fatigue]]d with exertion more easily than others (in mild cases)
*Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing an infection of the heart valves ([[bacterial endocarditis]]).

==What are the causes of aortic stenosis?==
In the United States, aortic stenosis often results from calcium deposits on the aortic valve. These deposits occur naturally with age and have no relationship with the amount of calcium in the diet. Approximately 2% of all people have a [[bicuspid aortic valve]], which increases the risk of these calcifications and makes them more likely to develop aortic stenosis. Worldwide, [[rheumatic heart disease]] is a common cause of aortic stenosis.

As the [[aortic valve]] becomes more narrow, the pressure increases inside the lower chamber of the heart (the left [[ventricle]]). This causes the left ventricle to become thicker, decreasing blood flow and can lead to [[chest pain]]. As the pressure continues to rise, blood may back up into the lungs, and you may feel short of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. This can cause lightheadedness and fainting.

==Who is at risk for aortic stenosis?==
Aortic stenosis occurs more often in men than in women. The calcifications that cause most cases of aortic stenosis are more likely to occur in patients above the age of 50, who are overweight, who smoke, and who have [[diabetes mellitus|diabetes]], [[high blood pressure]], and [[high cholesterol]]. These are the same risk factors for [[atherosclerosis]] of the coronary blood vessels.

People who had [[rheumatic fever]] as a child also have a somewhat higher risk of developing aortic stenosis, but rheumatic fever is very rare in the United States. [[Radiation therapy]] for treatment of cancer, such as [[breast cancer]] or [[lymphoma]], may also increase the risk of aortic stenosis.

==How does my health care provider know if I have aortic stenosis?==
===Heart murmur===
When listening to your heart, your health care provider may hear a new [[heart murmur]] associated with aortic stenosis. This murmur is not always there in aortic stenosis. If a new murmur is heard and your health care provider is concerned about aortic stenosis or another form of heart disease, further tests may be ordered. It is important to remember that not all heart murmurs mean you have a harmful heart condition.

===Blood pressure===
You may have high [[blood pressure]] if you have mild aortic stenosis. In rare cases of severe aortic stenosis, your blood pressure may actually be low.

===Tests your doctor might perform===
* Chest [[x-ray]]
* [[Electrocardiogram]], where sensors on the chest measure electrical activity of the heart
* [[Echocardiography]], which is an ultrasound of the heart
* [[Exercise stress testing]], where your doctor monitors your electrocardiogram while you exercise
* [[MRI of the heart]], where you lay in a magnet that takes pictures of your heart
* [[Cardiac catheterization]], where a catheter is inserted into the arteries of your heart and pictures are taken

==How do I know if my child has aortic stenosis?==
Infants and children may be:
*Extremely [[tired]]
*[[Sweaty]]
*Have pale skin
*Fast breathing.
*They may also be smaller than other children their age.

==When should I seek urgent medical care?==
Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new symptoms develop.

==Treatment options==
If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider. Patients with aortic stenosis may be told not to play competitive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

===Medication===
Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly [[atrial fibrillation]]). These include [[diuretic]]s (water pills), [[nitrate]]s, and [[beta-blocker]]s. High [[blood pressure]] should also be treated.

===Lifestyle changes===
*Stop smoking and be treated for high [[cholesterol]].
*See a cardiologist every 3 to 6 months.

===Surgery===
[[Surgery]] to repair or replace the aortic valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on [[#Tests your doctor might perform|diagnostic tests]] may also require surgery.

Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon [[valvuloplasty]] may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

==Treatment options for children==
Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

====Surgery====
[[Valvuloplasty]] is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve, called a Ross procedure.

==Prevention of aortic stenosis==
Treat [[strep throat]] promptly to prevent [[rheumatic fever]], which can cause aortic stenosis.

Follow your health care provider's treatment recommendation for conditions that may cause valve disease. Notify you provider if there is a family history of congenital heart diseases.

==What is the outlook and prognosis?==
People with mild aortic stenosis may do very well using a watchful waiting approach with their health care provider. They may be treated medically for some conditions associated with aortic stenosis, such as [[high blood pressure]], and may have a normal life expectancy.

Those with more severe symptoms, such as chest pain or signs of heart failure like shortness of breath and leg swelling, generally do poorly without surgery. However, surgery does have the potential to cure a person's aortic stenosis. The success of surgery depends on a number of factors, including patient age, overall activity level, and presence of other medical conditions. As with any operation, aortic valve surgery has some risks, most of which occur during the first 1-2 days after surgery. These include an [[irregular heart rhythm]] and [[blood clot]]s in the legs. There is also a chance that the new or repaired valve may stop working which might require another surgery.

==Sources==
*{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000178.htm |title=MedlinePlus Medical Encyclopedia: Aortic stenosis |format= |work= |accessdate=2009-07-15}}

{{WH}}
{{WS}}
[[Category:Patient Information]]

Stomach cancer

2009-07-14T16:04:33Z

LBiller:

'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''

{{DiseaseDisorder infobox |
Name = Stomach cancer |
ICD10 = {{ICD10|C|16||c|15}} |
ICD9 = {{ICD9|151}} }}
{{SI}}
{{CMG}}

{{Editor Help}}

'''Stomach cancer''' (also called '''gastric cancer''') can develop in any part of the [[stomach]] and may spread throughout the stomach and to other organs; particularly the [[esophagus]] and the [[small intestine]]. Stomach cancer causes nearly one million deaths worldwide per year.<ref name="WHO">{{cite web | last = | first = | authorlink = | coauthors = | title =Cancer | work = | publisher =World Health Organization | date =Feb 2006 | url =http://www.who.int/mediacentre/factsheets/fs297/en/ | format = | doi = | accessdate =2007-05-24 }}</ref>

[[Image:Stomach_diagram.svg|thumb|200px|left|Diagram of the stomach]]

==Epidemiology==
Stomach cancer represents roughly 2% (25,500) cases of all new cancer cases yearly in the United States, but it is much more common in Korea, Japan, Great Britain, South America, and Iceland. It is associated with high [[edible salt|salt]] in the diet, [[smoking]], and low intake of fruits and vegetables. Infection with the bacterium ''[[H. pylori]]'' is the main risk factor in about 80% or more of gastric cancers. It is more common in men.

Gastric or stomach cancer has very high incidence in Korea and Japan. Gastric cancer is the leading cancer type in Korea with 20.8% of malignant neoplasms, the second leading cause of cancer deaths. It is suspected several risk factors are involved including diet, [[gastritis]], intestinal metaplasia and [[Helicobacter pylori]] infection. A Korean diet, high in salted, stewed and broiled foods, is thought to be a contributing factor. Ten percent of cases show a genetic component.<ref>AHyuk-Joon Lee, Han-Kwang Yang, Yoon-Ok Ahn, [http://www.springerlink.com/content/apxldeevperhlapj/ Gastric cancer in Korea] Gastric Cancer, Volume 5, Number 3 / September, 2002. DOI:10.1007/s101200200031]</ref> In Japan and other countries [[bracken]] consumption and spores are correlated to stomach cancer incidence.<ref>Alonso-Amelot ME, Avendano M., [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11945131&query_hl=4&itool=pubmed_docsum Human Carcinogenesis and Bracken Fern: A Review of the Evidence], Curr Med Chem. 2002 Mar;9(6):675-86</ref> Epidemiologists have yet to fully account for the high rates of gastric cancer as compared to other countries.

A very small percentage of diffuse-type gastric cancers (see Histopathology below) are thought to be genetic. Hereditary Diffuse Gastric Cancer (HDGC) has recently been identified and research is ongoing. However, genetic testing and treatment options are already available for families at risk ([http://jmg.bmjjournals.com/cgi/content/full/41/7/508 Brooks-Wilson et al., 2004]).

[[Metastasis]] occurs in 80-90% of individuals with stomach cancer, with a five year survival rate of 75% in those diagnosed in early stages and less than 30% of those diagnosed in late stages. The death rate is 12,400 a year in the United States.

==Symptoms==
[[Image:Linitis plastica 2.jpg|thumb|left|200px|Endoscopic image of [[linitis plastica]], a type of stomach cancer where the entire [[stomach]] is invaded, leading to a leather bottle-like appearance.]]
Stomach cancer is often asymptomatic or causes only nonspecific symptoms in its early stages. By the time symptoms occur, the cancer has generally [[metastasis|metastasized]] to other parts of the body, one of the main reasons for its poor prognosis.
Stomach cancer can cause the following signs and symptoms:

Early
*[[Indigestion]] or a burning sensation ([[heartburn]])
*[[Loss of appetite]], especially for meat
Late
*[[Abdominal pain]] or discomfort in the upper abdomen
*[[Nausea]] and [[vomiting]]
*[[Diarrhea]] or [[constipation]]
*[[Bloating]] of the stomach after meals
*[[Weight loss]]
*[[Weakness]] and [[fatigue (physical)|fatigue]]
*[[Bleeding]] ([[vomiting blood]] or having [[blood in the stool]]), which can lead to [[anemia]]

These can be symptoms such as a stomach virus or gastric ulcer, and diagnosis should be done by a [[gastroenterologist]] or an [[oncologist]].

==Diagnosis==

To find the cause of symptoms, the doctor asks about the patient's medical history, does a physical exam, and may order laboratory studies. The patient may also have one or all of the following exams:

* [[Gastroscopic exam]] is the diagnostic method of choice
* [[Upper GI series]] (may be called barium roentgenogram)
* [[Fecal occult blood|Fecal occult blood test]] is obsolete except possibly as a screening test; a negative test proves nothing and a positive result may result from a large number of other conditions beside gastric carcinoma.

Abnormal tissue seen in a gastroscope examination will be [[biopsy|biopsied]] by the [[surgery|surgeon]] or [[gastroenterologist]]. This tissue is then sent to a [[pathology|pathologist]] for [[histology|histological]] examination under a microscope to check for the presence of cancerous cells. A biopsy, with subsequent histological analysis, is the only sure way to confirm the presence of cancer cells.

A condition of darkened hyperplasia of the skin, frequently of the axilla and groin, known as [[acanthosis nigricans]], commonly prompts a study into gastric carcinoma. It should be noted that this hyperplasia can be found in obese individuals with no underlying cancer.

===Histopathology===
*''Gastric [[adenocarcinoma]]'' is a malignant epithelial tumor, originating from glandular epithelium of the gastric mucosa. It invades the gastric wall, infiltrating the [[muscularis mucosae]], the submucosa and thence the muscularis propria. Histologically, there are two major types of gastric cancer (Lauren classification): intestinal type and diffuse type.
*''Intestinal type adenocarcinoma'': tumor cells describe irregular tubular structures, harboring pluristratification, multiple lumens, reduced stroma ("back to back" aspect). Often, it associates intestinal metaplasia in neighboring mucosa. Depending on glandular architecture, cellular pleomorphism and mucosecretion, adenocarcinoma may present 3 degrees of differentiation: well, moderate and poorly differentiate.
*''Diffuse type adenocarcinoma (mucinous, colloid):'' Tumor cells are discohesive and secrete mucus which is delivered in the interstitium producing large pools of mucus/colloid (optically "empty" spaces). It is poorly differentiated. If the mucus remains inside the tumor cell, it pushes the nucleus at the periphery - "''signet-ring cell''".

==Staging==
If cancer cells are found in the tissue sample, the next step is to [[cancer staging|stage]], or find out the extent of the disease. Various tests determine whether the cancer has spread and, if so, what parts of the body are affected. Because stomach cancer can spread to the liver, the pancreas, and other organs near the stomach as well as to the lungs, the doctor may order a [[CT scan]], an ultrasound exam, or other tests to check these areas. Blood tests for [[tumor marker]]s, such as [[carcinoembryonic antigen]] (CEA) and carbohydrate antigen (CA) may be ordered, as their levels correlate to extent of metastasis, especially to the liver, and the cure rate.

Staging may not be complete until after surgery. The surgeon removes nearby lymph nodes and possibly samples of tissue from other areas in the abdomen for examination by a pathologist.

==Treatment==
Like any cancer, treatment is adapted to fit each person's individual needs and depends on the size, location, and extent of the tumor, the stage of the disease, and general health. Cancer of the stomach is difficult to cure unless it is found in an early stage (before it has begun to spread). Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made. Treatment for stomach cancer may include surgery, [[chemotherapy]], and/or [[radiation therapy]]. New treatment approaches such as biological therapy and improved ways of using current methods are being studied in clinical trials.

====Surgery====
Surgery is the most common treatment for stomach cancer. The surgeon removes part (subtotal or partial gastrectomy) or all (total [[gastrectomy]]) of the stomach, as well as some of the tissue around the stomach, with the basic goal of removing all cancer and a margin of normal tissue. Depending on the extent of invasion and the location of the tumor, surgery may also include removal of part of the [[esophagus]], [[splenectomy|spleen]], [[oophorectomy|ovaries]], intestine or pancreas . Tumors in the lower parts of the stomach may call for a Billroth I or Billroth II procedure. Endoscopic mucosal resection is a treatment for early gastric cancer that has been pioneered in Japan, but is available in the United States at some centers. In this procedure, the tumor is removed from the wall of the stomach using an endoscope, with the advantage in that it is a smaller operation than removing the stomach. Surgical interventions are currently curative in less than 40% of cases, and, in cases of metastasis, may only be [[palliative]].

====Chemotherapy====
[[Chemotherapy]] is the use of systemic drugs to fight the stomach cancer. Unfortunately, gastric cancer has not been especially sensitive to these drugs until recently, and historically served to palliatively reduce the size of the tumor and increase survival time. Some drugs used in stomach cancer treatment include: [[5-FU]] (fluorouracil), BCNU (carmustine), methyl-CCNU (Semustine), and [[doxorubicin]] (Adriamycin), as well as Mitomycin C, and more recently [[cisplatin]] and [[taxotere]] in various combinations. Scientists are exploring the benefits of giving chemotherapy before surgery to shrink the tumor, or as adjuvant therapy after surgery to destroy remaining cancer cells. Combination treatment with chemotherapy and radiation therapy is also under study. Doctors are testing a treatment in which anticancer drugs are put directly into the abdomen ([[intraperitoneal hyperthermic chemoperfusion]]). Chemotherapy also is being studied as a treatment for cancer that has spread, and as a way to relieve symptoms of the disease. The side effects of chemotherapy depend mainly on the drugs the patient receives.

====Radiation therapy====
[[Radiation therapy]] (also called radiotherapy) is the use of high-energy rays to damage cancer cells and stop them from growing. When used, it is generally in combination with surgery and chemotherapy, or used only with chemotherapy in cases where the individual is unable to undergo surgery. Radiation therapy may be used to relieve pain or blockage by shrinking the tumor for [[palliation]] of incurable disease

====Multimodality Therapy====
While previous studies of multimodality therapy (combinations of surgery, chemotherapy and radiation therapy) gave mixed results, the Intergroup 0116 (SWOG 9008) study ([http://content.nejm.org/cgi/content/abstract/345/10/725?andorexacttitleabs=and&search_tab=articles&tocsectionid=Original+Articles&tmonth=Aug&searchtitle=Articles&excludeflag=TWEEK_element&sortspec=Score+desc+PUBDATE_SORTDATE+desc&hits=20&where=titleabstract&tyear=2006&andorexactfulltext=and&fyear=1996&fmonth=Aug&searchterm=stomach+adenocarcinoma&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT NEJM study abstract]) showed a survival benefit to the combination of chemotherapy and radiation therapy in patients with nonmetastatic, completely resected gastric cancer. Patients were randomized after surgery to the standard group of observation alone, or the study arm of combination chemotherapy and radiation therapy. Those in the study arm receiving chemotherapy and radiation therapy survived on average 36 months, compared to 27 seconds with observation.

====Biological therapy====

Biologic therapy is still in the testing stages for stomach cancer. The side effects of biological therapy vary with the type of treatment. Some cause flu-like symptoms, such as chills, fever, weakness, nausea, vomiting, and diarrhea. Patients sometimes get a rash, and they may bruise or bleed easily. These problems may be severe, and patients may need to stay in the hospital during treatment.

==External links==
* Article on [http://jmg.bmjjournals.com/cgi/content/full/41/7/508 Hereditary Diffuse Gastric Cancer]
* National Cancer Institute [http://www.cancer.gov/cancertopics/pdq/treatment/gastric/HealthProfessional/page1 Gastric cancer treatment guidelines]
* Photos at: [http://www.pathologyatlas.ro/Gastric%20Carcinoma%20Intestinal%20Type.html Atlas of Pathology]

==References==
{{reflist|2}}
<ref>Lewis, S.M., Heitkemper, M.M., & Dirksen, S.R. Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 6th ed. St. Louis: Mosby, 2004.</ref>
<ref>McCance, K., & Huether, S. Pathophysiology: The Biologic Basis for Disease in Adults & Children, 4th ed. St. Louis: Mosby, 2002.</ref>

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Aortic stenosis (patient information)

2009-07-10T17:19:49Z

LBiller:

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==
The [[aorta]] is the main artery leaving the [[heart]]. When [[blood]] leaves the heart, it flows from the lower chamber (the [[left ventricle]]), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow.

==How do I know if I have aortic stenosis and what are the symptoms of aortic stenosis?==
You may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when your healthcare provider heard a [[heart murmur]] and then performed additional tests.

====Symptoms in adults====
*[[Breathlessness]] with activity
*[[Chest pain]], [[angina]]-type
**Crushing, squeezing, pressure, tightness
**Pain increases with exercise, relieved with rest
**Under the chest bone, may move to other areas
*[[Fainting]], [[weakness]], or [[dizziness]] with activity
*Sensation of feeling the [[heart beat]] ([[palpitations]])

====Symptoms in infants and children====
*Becoming tired or [[fatigue]]d with exertion more easily than others (in mild cases)
*Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing a heart infection ([[bacterial endocarditis]]).

==What are the causes of aortic stenosis==
As the [[aortic valve]] becomes more narrow, the pressure increases inside the left heart [[ventricle]]. This causes the left heart ventricle to become thicker, which decreases blood flow and can lead to [[chest pain]]. As the pressure continues to rise, blood may back up into the lungs, and you may feel short of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. This can cause lightheadedness and fainting.

==Who is at risk for aortic stenosis?==
Aortic stenosis is not common. It occurs more often in men than in women. In adults, aortic stenosis occurs most commonly in those who've had [[rheumatic fever]], a condition that may develop after strep throat or scarlet fever. Valve problems do not develop for 5 - 10 years after rheumatic fever occurs. Rheumatic fever is increasingly rare in the United States.
If you have [[calcium]] deposits forming around the [[aortic valve]], or have had [[radiation]] treatment to the chest, or are on certain medications you may also be at a slight risk for aortic stenosis.

==How to know you have aortic stenosis?==

====How your heart sounds====
Your health care provider will be able to feel a vibration or movement when placing a hand over your heart. A [[heart murmur]], click, or other abnormal sound is almost always heard through a [[stethoscope]]. There may be a faint pulse or changes in the quality of the pulse in the neck (this is called pulsus parvus et tardus).

====Blood pressure====
[[Blood pressure]] may be low.

====Tests your Doctor might perform====
* Chest [[x-ray]]
* [[Doppler echocardiography]]
* [[ECG]]
* [[Exercise stress testing]]
* Left cardiac [[catheterization]]
* [[CMR|MRI of the heart]]
* [[Transesophageal echocardiogram]] (TEE)

==How to know if your child has aortic stenosis?==
Infants and children may be:
*Extremely [[tired]]
*[[Sweaty]]
*Have pale skin
*Fast breathing.
*They may also be smaller than other children their age.

==When to seek urgent medical care==
Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new ones develop.

==Treatment options==
If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider. Patients with aortic stenosis are usually told not to play competitive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

====Medication====
Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly [[atrial fibrillation]]). These include [[diuretics]] (water pills), [[nitrates]], and [[beta-blocker]]s. High [[blood pressure]] should also be treated.

====Lifestyle Changes====
*Stop smoking and be treated for high [[cholesterol]].
*See a cardiologist every 3 to 6 months.

====Surgery====
[[Surgery]] to repair or replace the valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on [[Aortic stenosis (patient information#Tests your Doctor might perform|diagnostic tests]] may also require surgery.

Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon [[valvuloplasty]] may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

==Treatment Options for Children==
Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

====Surgery====
[[Valvuloplasty]] is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve.

==Where to find medical care for aortic stenosis==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|aortic stenosis}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating aortic stenosis]

==Prevention of aortic stenosis==

Treat [[strep]] infections promptly to prevent [[rheumatic fever]], which can cause aortic stenosis. This condition itself often cannot be prevented, but some of the complications can be.

Follow you health care provider's treatment recommendation for conditions that may cause valve disease. Notify you provider if there is a family history of congenital heart diseases.

==What to expect (Outlook/Prognosis)==
Without surgery, a person with aortic stenosis who has angina or signs of heart failure may do poorly.

Aortic stenosis can be cured with surgery. After surgery there is a risk for irregular heart rhythms, which can cause sudden death, and blood clots, which can cause a [[stroke]]. There is also a risk that the new valve will stop working and need to be replaced.

==Sources==
[http://www.nlm.nih.gov/medlineplus/ency/article/000178.htm MedlinePlus Medical Encyclopedia - Aortic Stenosis]
{{WH}}
{{WS}}
[[Category:Patient Information]]

Aortic stenosis (patient information)

2009-07-10T17:01:20Z

LBiller: /* How to know you have aortic stenosis? */

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==
The aorta is the main artery leaving the heart. When blood leaves the heart, it flows from the lower chamber (the left ventricle), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow.

==How do I know if I have aortic stenosis and what are the symptoms of aortic stenosis?==
People with aortic stenosis may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when the healthcare provider heard a heart murmur and then performed additional tests.

====Symptoms in adults====
*Breathlessness with activity
*Chest pain, angina-type
**Crushing, squeezing, pressure, tightness
**Pain increases with exercise, relieved with rest
**Under the chest bone, may move to other areas
*Fainting, weakness, or dizziness with activity
*Sensation of feeling the heart beat (palpitations)

====Symptoms in infants and children====
*Becoming tired or fatigued with exertion more easily than others (in mild cases)
*Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing a heart infection (bacterial endocarditis).

==Who is at risk for aortic stenosis?==

==How to know you have aortic stenosis?==

===How your heart sounds===
The health care provider will be able to feel a vibration or movement when placing a hand over the person's heart. A heart murmur, click, or other abnormal sound is almost always heard through a stethoscope. There may be a faint pulse or changes in the quality of the pulse in the neck (this is called pulsus parvus et tardus).

===Blood pressure==
Blood pressure may be low.

===Tests your Doctor might perform==
* Chest x-ray
* Doppler echocardiography
* ECG
* Exercise stress testing
* Left cardiac catheterization
* MRI of the heart
* Transesophageal echocardiogram (TEE)

==How to know if your child has aortic stenosis?==
Infants and children may be:
*Extremely tired
*Sweaty
*Have pale skin
*Fast breathing.
*They may also be smaller than other children their age.

==When to seek urgent medical care==
Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new ones develop.

==Treatment options==
If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider.Patients with aortic stenosis are usually told not to play competetive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

====Medication====
Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates, and beta-blockers. High blood pressure should also be treated.

====Lifestyle Changes====
*Stop smoking and be treated for high cholestrol.
*See a cardiologist every 3 to 6 months.

====Surgery====
Surgery to repair or replace the valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on diagnostic tests may also require surgery.

Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon valvuloplasty may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

==Treatment Options for Children==
Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

====Surgery====
Valvuloplasty is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve.

==Diseases with similar symptoms==

==Where to find medical care for aortic stenosis==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|aortic stenosis}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating aortic stenosis]

==Prevention of aortic stenosis==

Treat strep infections promptly to prevent rheumatic fever, which can cause aortic stenosis. This condition itself often cannot be prevented, but some of the complications can be.

Follow the health care provider's treatment recommendation for conditions that may cause valve disease. Notify the provider if there is a family history of congenital heart diseases.

==What to expect (Outlook/Prognosis)==
Without surgery, a person with aortic stenosis who has angina or signs of heart failure may do poorly.

Aortic stenosis can be cured with surgery. After surgery there is a risk for irregular heart rhythms, which can cause sudden death, and blood clots, which can cause a stroke. There is also a risk that the new valve will stop working and need to be replaced.

==Sources==

{{WH}}
{{WS}}
[[Category:Patient Information]]

Aortic stenosis (patient information)

2009-07-10T16:56:48Z

LBiller: /* What to expect (Outlook/Prognosis) */

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==
The aorta is the main artery leaving the heart. When blood leaves the heart, it flows from the lower chamber (the left ventricle), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow.

==How do I know if I have aortic stenosis and what are the symptoms of aortic stenosis?==
People with aortic stenosis may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when the healthcare provider heard a heart murmur and then performed additional tests.

====Symptoms in adults====
*Breathlessness with activity
*Chest pain, angina-type
**Crushing, squeezing, pressure, tightness
**Pain increases with exercise, relieved with rest
**Under the chest bone, may move to other areas
*Fainting, weakness, or dizziness with activity
*Sensation of feeling the heart beat (palpitations)

====Symptoms in infants and children====
*Becoming tired or fatigued with exertion more easily than others (in mild cases)
*Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing a heart infection (bacterial endocarditis).

==Who is at risk for aortic stenosis?==

==How to know you have aortic stenosis?==

==When to seek urgent medical care==
Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new ones develop.

==Treatment options==
If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider.Patients with aortic stenosis are usually told not to play competetive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

====Medication====
Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates, and beta-blockers. High blood pressure should also be treated.

====Lifestyle Changes====
*Stop smoking and be treated for high cholestrol.
*See a cardiologist every 3 to 6 months.

====Surgery====
Surgery to repair or replace the valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on diagnostic tests may also require surgery.

Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon valvuloplasty may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

==Treatment Options for Children==
Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

====Surgery====
Valvuloplasty is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve.

==Diseases with similar symptoms==

==Where to find medical care for aortic stenosis==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|aortic stenosis}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating aortic stenosis]

==Prevention of aortic stenosis==

Treat strep infections promptly to prevent rheumatic fever, which can cause aortic stenosis. This condition itself often cannot be prevented, but some of the complications can be.

Follow the health care provider's treatment recommendation for conditions that may cause valve disease. Notify the provider if there is a family history of congenital heart diseases.

==What to expect (Outlook/Prognosis)==
Without surgery, a person with aortic stenosis who has angina or signs of heart failure may do poorly.

Aortic stenosis can be cured with surgery. After surgery there is a risk for irregular heart rhythms, which can cause sudden death, and blood clots, which can cause a stroke. There is also a risk that the new valve will stop working and need to be replaced.

==Sources==

{{WH}}
{{WS}}
[[Category:Patient Information]]

Aortic stenosis (patient information)

2009-07-10T16:55:40Z

LBiller: /* Prevention of aortic stenosis */

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==
The aorta is the main artery leaving the heart. When blood leaves the heart, it flows from the lower chamber (the left ventricle), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow.

==How do I know if I have aortic stenosis and what are the symptoms of aortic stenosis?==
People with aortic stenosis may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when the healthcare provider heard a heart murmur and then performed additional tests.

====Symptoms in adults====
*Breathlessness with activity
*Chest pain, angina-type
**Crushing, squeezing, pressure, tightness
**Pain increases with exercise, relieved with rest
**Under the chest bone, may move to other areas
*Fainting, weakness, or dizziness with activity
*Sensation of feeling the heart beat (palpitations)

====Symptoms in infants and children====
*Becoming tired or fatigued with exertion more easily than others (in mild cases)
*Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing a heart infection (bacterial endocarditis).

==Who is at risk for aortic stenosis?==

==How to know you have aortic stenosis?==

==When to seek urgent medical care==
Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new ones develop.

==Treatment options==
If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider.Patients with aortic stenosis are usually told not to play competetive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

====Medication====
Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates, and beta-blockers. High blood pressure should also be treated.

====Lifestyle Changes====
*Stop smoking and be treated for high cholestrol.
*See a cardiologist every 3 to 6 months.

====Surgery====
Surgery to repair or replace the valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on diagnostic tests may also require surgery.

Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon valvuloplasty may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

==Treatment Options for Children==
Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

====Surgery====
Valvuloplasty is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve.

==Diseases with similar symptoms==

==Where to find medical care for aortic stenosis==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|aortic stenosis}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating aortic stenosis]

==Prevention of aortic stenosis==

Treat strep infections promptly to prevent rheumatic fever, which can cause aortic stenosis. This condition itself often cannot be prevented, but some of the complications can be.

Follow the health care provider's treatment recommendation for conditions that may cause valve disease. Notify the provider if there is a family history of congenital heart diseases.

==What to expect (Outlook/Prognosis)==

==Sources==

{{WH}}
{{WS}}
[[Category:Patient Information]]

Aortic stenosis (patient information)

2009-07-10T16:54:42Z

LBiller:

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==
The aorta is the main artery leaving the heart. When blood leaves the heart, it flows from the lower chamber (the left ventricle), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow.

==How do I know if I have aortic stenosis and what are the symptoms of aortic stenosis?==
People with aortic stenosis may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when the healthcare provider heard a heart murmur and then performed additional tests.

====Symptoms in adults====
*Breathlessness with activity
*Chest pain, angina-type
**Crushing, squeezing, pressure, tightness
**Pain increases with exercise, relieved with rest
**Under the chest bone, may move to other areas
*Fainting, weakness, or dizziness with activity
*Sensation of feeling the heart beat (palpitations)

====Symptoms in infants and children====
*Becoming tired or fatigued with exertion more easily than others (in mild cases)
*Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing a heart infection (bacterial endocarditis).

==Who is at risk for aortic stenosis?==

==How to know you have aortic stenosis?==

==When to seek urgent medical care==
Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new ones develop.

==Treatment options==
If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider.Patients with aortic stenosis are usually told not to play competetive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

====Medication====
Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates, and beta-blockers. High blood pressure should also be treated.

====Lifestyle Changes====
*Stop smoking and be treated for high cholestrol.
*See a cardiologist every 3 to 6 months.

====Surgery====
Surgery to repair or replace the valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on diagnostic tests may also require surgery.

Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon valvuloplasty may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

==Treatment Options for Children==
Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

====Surgery====
Valvuloplasty is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve.

==Diseases with similar symptoms==

==Where to find medical care for aortic stenosis==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|aortic stenosis}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating aortic stenosis]

==Prevention of aortic stenosis==

==What to expect (Outlook/Prognosis)==

==Sources==

{{WH}}
{{WS}}
[[Category:Patient Information]]

Aortic stenosis (patient information)

2009-07-10T16:53:27Z

LBiller: /* When to seek urgent medical care */

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==
The aorta is the main artery leaving the heart. When blood leaves the heart, it flows from the lower chamber (the left ventricle), through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This restricts blood flow.

==How do I know if I have aortic stenosis and what are the symptoms of aortic stenosis?==
People with aortic stenosis may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when the healthcare provider heard a heart murmur and then performed additional tests.

====Symptoms in adults====
*Breathlessness with activity
*Chest pain, angina-type
**Crushing, squeezing, pressure, tightness
**Pain increases with exercise, relieved with rest
**Under the chest bone, may move to other areas
*Fainting, weakness, or dizziness with activity
*Sensation of feeling the heart beat (palpitations)

====Symptoms in infants and children====
*Becoming tired or fatigued with exertion more easily than others (in mild cases)
*Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as the get older. They also run the risk of developing a heart infection (bacterial endocarditis).

==Who is at risk for aortic stenosis?==

==How to know you have aortic stenosis?==

==When to seek urgent medical care==
Call your health care provider if you or your child have symptoms of aortic stenosis. For example, call if you or your child have a sensation of feeling the heart beat (palpitations) for more than a short period of time.

Also contact your doctor if you have been diagnosed with this condition and your symptoms get worse or new ones develop.

==Treatment options==
If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider.Patients with aortic stenosis are usually told not to play competetive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.

====Medication====
Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates, and beta-blockers. High blood pressure should also be treated.

====Lifestyle Changes====
*Stop smoking and be treated for high cholestrol.
*See a cardiologist every 3 to 6 months.

====Surgery====
Surgery to repair or replace the valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on diagnostic tests may also require surgery.

Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon valvuloplasty may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve.

==Treatment Options for Children==
Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities.

====Surgery====
Valvuloplasty is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve.

==Diseases with similar symptoms==

==Where to find medical care for aortic stenosis==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|aortic stenosis}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating aortic stenosis]

==Prevention of aortic stenosis==

==What to expect (Outlook/Prognosis)==

==Copyleft Sources==

{{WH}}
{{WS}}
[[Category:Patient Information]]

Aortic stenosis (patient information)

2009-07-10T16:52:42Z

LBiller: /* How do I know if I have aortic stenosis and what are the symptoms of aortic stenosis? */

Aortic stenosis (patient information)

2009-07-10T16:51:51Z

LBiller:

Aortic stenosis (patient information)

2009-07-10T16:34:34Z

LBiller:

Aortic stenosis (patient information)

2009-07-10T15:07:35Z

LBiller:

{{SI}}

{{EJ}}

'''''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''''.

==What is aortic stenosis?==

==How do I know if I have aortic stenosis and what are the symptoms of aortic stenosis?==

==Who is at risk for aortic stenosis?==

==How to know you have aortic stenosis?==

==When to seek urgent medical care==

==Treatment options==

==Diseases with similar symptoms==

==Where to find medical care for aortic stenosis==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|aortic stenosis}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating aortic stenosis]

==Prevention of aortic stenosis==

==What to expect (Outook/Prognosis)==

==Copyleft Sources==

{{WH}}
{{WS}}
[[Category:Patient Information]]

Aortic stenosis

2009-07-10T15:05:20Z

LBiller:

{{DiseaseDisorder infobox |
Name = Aortic valve stenosis |
ICD10 = {{ICD10|I|35|0|i|30}}, {{ICD10|I|06|0|i|05}}, {{ICD10|Q|23|0|q|20}} |
ICD9 = {{ICD9|395.0}}, {{ICD9|396.0}}, {{ICD9|746.3}} |
ICDO = |
Image = Aortic_stenosis.jpg|
Caption = An [[aortic valve]] that, due to [[rheumatic heart disease]], has a severe stenosis (centre of image). The [[pulmonary trunk]] is seen at the lower right (of the image). The proximal portion of [[right coronary artery]] and its [[ostium]] can be seen at the lower left (of the image). The proximal [[left main coronary artery]] and its ostium are seen on the right (of the image). [[Autopsy]] specimen. |
OMIM = |
OMIM_mult = |
MedlinePlus = 000178 |
eMedicineSubj = med |
eMedicineTopic = 157 |
DiseasesDB = 844 |
}}

{{SI}}

{{WikiDoc Cardiology Network Infobox}}

{{CMG}}

'''Associate Editors-In-Chief:''' Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu]; [[User:Abdarabi|Abdul-Rahman Arabi, M.D.]] [mailto:abdarabi@yahoo.com]; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]

{{Editor Join}}

'''''For patient information click [[{{PAGENAME}} (patient information)|here]]'''''.

==Overview==

The [[aortic valve]] controls the direction of blood flow from the [[left ventricle]] to the [[aorta]]. When in good working order, the aortic valve does not impede the flow of blood between these two spaces. Under some circumstances, the aortic valve becomes narrower than normal, impeding the flow of blood. This is known as aortic valve stenosis, or aortic stenosis, often abbreviated as '''AS'''.

==Prevalence==
Aortic stenosis is a common problem. Approximately 2% of people over the age of 65, 3% of people over age 75, and 4% percent of people over age 85 have the disorder. In North America and Europe, at least, the population is aging. Hence, the prevalence of aortic stenosis is increasing. Since the disease carries with it considerable morbidity and mortality, both with large personal and economic impact, aortic stenosis is a major health problem.

==Etiology==
The etiology of Left-Sided Outflow Obstruction can be divided into two broad categories:
#Acquired Aortic Stenosis and
#Congenital Left-Sided Outflow Obstruction

Major causes and predisposing conditions of aortic stenosis include [[acute rheumatic fever]] and [[bicuspid aortic valve]]. As individuals age, calcification of the [[aortic valve]] may occur and result in stenosis. This is especially likely to occur in people with a bicuspid aortic valve, but also occurs in the setting of perfectly normal valves as a result of age-induced 'wear and tear'. Typically, aortic stenosis due to calcification of a bicuspid valve occurs in the 4th of 5th decade of life, whereas that due to calcification of a normal valve tends to occur later - around the 7th or 8th decade.

Of the various forms of aortic stenosis, the calcific type is predominant. Since calcific aortic stenosis shares many pathological features and risk factors with [[atherosclerosis]], and since atherosclerosis may be prevented and/or reversed by cholesterol lowering, there has been interest in attempting to modify the course of calcific aortic stenosis by cholesterol lowering with [[statin]] drugs. Although a number of small, [[observational studies]] demonstrated an association between lowered cholesterol and decreased progression, and even regression, of calcific aortic stenosis, a recent, large [[randomized clinical trial]], published in 2005, failed to find any predictable effect of cholesterol lowering on calcific aortic stenosis. However, a 2007 study did demonstrate a slowing of aortic stenosis with the statin [[rosuvastatin]].<ref>{{cite journal |author=Moura LM, Ramos SF, Zamorano JL, ''et al'' |title=Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis |journal=J. Am. Coll. Cardiol. |volume=49 |issue=5 |pages=554-61 |year=2007 |pmid=17276178 |doi=10.1016/j.jacc.2006.07.072}}</ref>

== Genetics ==

Congenital bicuspid valve is the most frequent form of congenital heart disease affecting approximately 1-2% of the population. 1/3rd of Supravalvular Aortic Stenosis cases are transmitted as an autosomal dominant trait as 60% of patients with supravalvular obstruction have Williams syndrome (supravalvular obstruction, intellectual impairment and facial abnormalities).

==Pathophysiology==
When the aortic valve becomes stenotic, it causes a pressure gradient between the left ventricle (LV) and the aorta.<ref name=Lilly>{{cite book | author = Lilly LS (editor) | title = Pathophysiology of Heart Disease | edition = 3rd ed. | publisher = Lippincott Williams & Wilkins | year = 2003 | id = ISBN 0-7817-4027-4 }}</ref> The more constricted the valve, the higher the gradient between the LV and the aorta. For instance, with a mild AS, the gradient may be 20 [[mmHg]]. This means that, at peak systole, while the LV may generate a pressure of 140 mmHg, the pressure that is transmitted to the aorta will only be 120 mmHg. So, while a [[Sphygmomanometer|blood pressure cuff]] may measure a normal [[systole|systolic]] [[blood pressure]], the actual pressure generated by the LV would be considerably [[hypertension|higher]].

In individuals with AS, the left ventricle (LV) has to generate an increased pressure in order to overcome the increased [[afterload]] caused by the stenotic aortic valve and eject blood out of the LV. The more severe the aortic stenosis, the higher the gradient is between the left ventricular systolic pressures and the aortic systolic pressures. Due to the increased pressures generated by the left ventricle, the [[myocardium]] (muscle) of the LV undergoes [[left ventricular hypertrophy|hypertrophy]] (increase in muscle mass). This is seen as thickening of the walls of the LV. The type of hypertrophy most commonly seen in AS is concentric hypertrophy, meaning that all the walls of the LV are (approximately) equally thickened.

== Differential diagnosis ==
* Fixed subvalvular obstruction
::Presence of subaortic membrane
::May be difficult to visualise in 2D echocardiography
::Presents in early adulthood
::Valve is not stenotic, but doppler shows increased gradient.
::Can be diagnosed with careful search using pulse wave doppler and colour flow mapping
*Dynamic subaortic obstruction
::Occurs with [[hypertrophic cardiomyopathy]]([[HOCM]])
::Other features of HCM
::late peaking, triangular CW doppler
::changes with provocative measures

==General Classifications==

===Acquired Aortic Stenosis===
Adult acquired aortic stenosis has two major causes, namely calcific disease of a structurally normal trileaflet valve or Rheumatic valve disease. Calcific aortic disease has many of the same risk factors as atherosclerotic disease and is characterized by fat deposition, inflammation, and calcification. it is also frequently seen in patients with renal failure. In comparison, Rheumatic valve disease involves fusion of the commissures between the leaflets, with a small central orifice.

===Congenital Left-Sided Outflow Obstruction===

Congenital Left-Sided Outflow Obstruction can be due to a variety of conditions, all of which culminate in obstruction of the left ventricular outflow tract. These conditions include:
#Malformation of the aortic valve such as a bicuspid aortic valve
#Unicuspid valve
#Hypoplasia of the annulus
#Supravalvular stenosis
#Subvalvular stenosis

==General Symptoms of Aortic Stenosis==

When [[symptomatic]], aortic stenosis can cause dizziness, [[syncope]], [[Angina pectoris|angina]] and [[congestive heart failure]]. More symptoms indicate a worse prognosis. Treatment requires [[aortic valve replacement|replacement]] of the diseased valve with an [[artificial heart valve]].

===Congestive Heart Failure===

[[Congestive heart failure]] (CHF) carries a grave prognosis in patients with AS. Patients with CHF that is attributed to AS have a 2 year mortality rate of 50%, if the aortic valve is not replaced.

CHF in the setting of AS is due to a combination of systolic dysfunction (a decrease in the [[ejection fraction]]) and [[diastolic dysfunction]] (elevated filling pressure of the LV).

===Syncope===

[[Fainting|Syncope]] in the setting of heart failure increases the risk of death. In patients with syncope, the 3 year mortality rate is 50%, if the aortic valve is not replaced.

It is unclear why aortic stenosis causes [[syncope]]. One popular theory is that severe AS produces a nearly fixed [[cardiac output]]. When the patient exercises, their [[peripheral vascular resistance]] will decrease as the blood vesels of the [[skeletal muscles]] dilate to allow the muscles to receive more blood to allow them to do more work. This decrease in peripheral vascular resistance is normally compensated for by an increase in the cardiac output. Since patients with severe AS cannot increase their cardiac output, the blood pressure falls and the patient will syncopize due to decreased blood perfusion to the [[brain]].

A second theory as to why syncope may occur in AS is that during exercise, the high pressures generated in the hypertrophied LV cause a vasodepressor response, which causes a secondary peripheral [[vasodilation]] which in turn causes decreased blood flow to the [[brain]]. Indeed, in aortic stenosis, because of the fixed obstruction to bloodflow out from the heart, it may be impossible for the heart to increase its output to offset peripheral vasodilation.

A third mechanism may sometimes be operative. Due to the hypertrophy of the [[left ventricle]] in aortic stenosis, including the consequent inability of the [[coronary arteries]] to adequately supply blood to the [[myocardium]] (see "Angina" below), [[arrhythmias]] may develop. These can lead to [[syncope]].

Finally, in calcific aortic stenosis at least, the calcification in and around the aortic valve can progress and extend to involve the [[electrical conduction system of the heart]]. If that occurs, the result may be [[heart block]] - a potentially lethal condition of which syncope may be a symptom.

===Angina===

[[Angina pectoris|Angina]] in the setting of heart failure also increases the risk of death. In patients with angina, the 5 year mortality rate is 50%, if the aortic valve is not replaced.

Angina in the setting of AS is secondary to the [[left ventricular hypertrophy]] (LVH) that is caused by the constant production of increased pressure required to overcome the pressure gradient caused by the AS. While the [[myocardium]] (i.e. heart muscle) of the LV gets thicker, the arteries that supply the muscle do not get significantly longer or bigger, so the muscle may become ischemic (i.e. doesn't receive an adequate blood supply). The [[ischemia]] may first be evident during exercise, when the heart muscle requires increased blood supply to compensate for the increased workload. The individual may complain of exertional angina. At this stage, a [[stress test]] with imaging may be suggestive of ischemia.

Eventually, however, the muscle will require more blood supply at rest than can be supplied by the coronary artery branches. At this point there may be signs of ''ventricular strain pattern'' on the [[EKG]], suggesting subendocardial ischemia. The subendocardium is the region that becomes ischemic because it is the most distant from the epicardial coronary arteries.

===Associated Symptoms===
In [[Heyde's syndrome]], aortic stenosis is associated with [[angiodysplasia]] of the [[colon (anatomy)|colon]]. Recent research has shown that the stenosis causes a form of [[von Willebrand disease]] by breaking down its associated [[coagulation]] factor ([[factor VIII]]-associated antigen, also called [[von Willebrand factor]]), due to increased turbulence around the stenosed valve.

==Physical Examination==

The critically ill patient may be in extremis. Peripheral edema may be present in the patient with CHF. Pulmonary rales may be present in the patient with CHF.

Aortic stenosis is most often diagnosed when it is [[asymptomatic]] and can sometimes be detected during routine examination of the heart and circulatory system. Good evidence exists to demonstrate that certain characteristics of the peripheral pulse can rule in the diagnosis.<ref>http://jama.ama-assn.org/cgi/content/abstract/277/7/564</ref> In particular, there may be a slow and/or sustained upstroke of the arterial pulse, and the pulse may be of low volume. This is sometimes referred to as ''[[pulsus tardus et parvus]]''. There may also be a noticeable delay between the [[heart sounds|first heart sound]] (on [[auscultation]]) and the corresponding pulse in the [[carotid]] artery (so-called 'apical-carotid delay'). Similarly, there may be a delay between the appearance of each pulse in the brachial artery (in the arm) and the radial artery (in the wrist).

An easily heard [[systole|systolic]], crescendo-decrescendo (i.e. 'ejection') [[heart murmur|murmur]] is heard loudest at the upper right sternal border, and radiates to the [[carotid artery|carotid arteries]] bilaterally. The murmur increases with squatting, decreases with standing and isometric muscular contraction, which helps distinguish it from [[hypertrophic obstructive cardiomyopathy]] (HOCM). The murmur is louder during expiration, but is also easily heard during inspiration. The more severe the degree of the stenosis, the later the peak occurs in the crescendo-decrescendo of the murmur.

The 2nd heart sound tends to become softer as the aortic stenosis becomes more severe. This is a result of the increasing calcification of the valve preventing it from "snapping" shut and producing a sharp, loud sound. Due to increases in [[left ventricular pressure]] from the stenotic aortic valve, over time the ventricle may hypertrophy, resulting in a diastolic dysfunction. As a result, one may hear a 4th heart sound due to the stiff ventricle. With continued increases in ventricular pressure, dilatation of the ventricle will occur, and a 3rd heart sound may be manifest.

Finally, aortic stenosis often co-exists with some degree of [[aortic insufficiency]]. Hence, the physical exam in aortic stenosis may also reveal signs of the latter, for example an early diastolic decrescendo murmur. Indeed, when both valve abnormalities are present, the expected findings of either may be modified or may not even be present. Rather, new signs emerge which reflect the presence of simultaneous aortic stenosis and insufficiency, e.g. [[pulsus bisferiens]].

According to a [[meta analysis]], the most useful findings for ruling in aortic stenosis in the clinical setting were slow rate of rise of the carotid pulse(positive [[likelihood ratio]] ranged 2.8-130 across studies), mid to late peak intensity of the murmur(positive likelihood ratio, 8.0-101), and decreased intensity of the second heart sound(positive likelihood ratio, 3.1-50).<ref>{{cite journal |author=Etchells E, Bell C, Robb K |title=Does this patient have an abnormal systolic murmur? |journal=JAMA |volume=277 |issue=7 |pages=564-71 |year=1997 |pmid=9032164 |doi=}}</ref>

===Peripheral Signs Include===
* a slow-rising, small volume carotid pulse
* narrowed pulse pressure
* sustained, thrusting apex beat which is usually not displaced unless the stenosis is severe

==Diagnostic tests==
===The [[electrocardiogram]] (ECG)===
Although aortic stenosis does not lead to any ''specific'' findings on the [[ECG]], it still often leads to a number of electrocardiographic abnormalities. ECG manifestations of [[left ventricular hypertrophy]] (LVH) are common in aortic stenosis and arise as a result of the stenosis having placed a chronically high pressure load on the [[left ventricle]] (with LVH being the expected response to chronic pressure loads on the left ventricle no matter how caused).

As noted below, the calcification process which occurs in aortic stenosis can progress to extend beyond the aortic valve and into the [[electrical conduction system of the heart]]. Evidence of this phenomenon may include [[heart block]] that is apparent on the ECG but otherwise undetectable.

==== Chest X Ray ====
Chest xray can show dilatation of the ascending aorta or an enlarged left ventricle of there is severe aortic regurgitation.

===Echocardiogram===
[[Echocardiogram]] (heart ultrasound) is the best non-invasive test to evaluate the aortic valve anatomy and function.

The aortic valve area can be [[Aortic valve area calculation|calculated]] non-invasively using echocardiographic flow velocities. Using the velocity of the blood through the valve, the pressure gradient across can be calculated by the equation: <blockquote>Gradient = 4(velocity)² mmHg</blockquote> A normal aortic valve has no gradient. If the mean gradient is <25 mm Hg, the stenosis is mild; if the mean gradient is between 25 mm Hg and 50 mm Hg, the stenosis is moderate; if the mean gradient is >50 mm Hg the stenosis is severe; and when the gradient is greater than 70 mm Hg, the stenosis is critical. A normal aortic valve area is >2 cm2. If the valve area is between 1.3 and 2.0 cm2, the stenosis is mild; if the valve area is between 1.0 and 1.3 cm2, the stenosis is moderate; if the valve area is between 0.7 and 1.0 cm2, the stenosis is moderate-severe; areas of less than 0.7 cm2 constitute severe aortic stenosis.

2D echocardiography of the aortic valve in the parasternal long axis view demonstrates right and non coronary leaflets. In the parasternal short axis view, leaflets open equally and forms a circular orifice during systole. During diastole, the normal leaflets form a three pointed star with prominence at the closing point. ([[nodules of Arentius]])

{|
|-
|[[Image:Diastolic_MR_Due_to_AS.jpg|thumb|350px|left|Diastolic mitral regurgitation due to severe aortic stenosis]]
|-
|}

== Severity summary ==
{| border = 1

|+ '''Severity of aortic stenosis'''

! |Severity|| mild||moderate || severe
|-
| Valve area || 2.0 - 1.5 || 1- 1.5 || <1
|-
| peak velocity (m/s) || 2 -3 || 3-4 || >4
|-
| Peak gradient (mmHg)|| <35 || 35-65 || >65
|-
| Mean gradient (mmHg) || <20 || 20-40 || >40

|}

* Calcific Aortic Stenosis

<googlevideo>-7545394293366400735&hl=en</googlevideo>

==== MRI and CT ====
Cardiovascular MRI (CMR) is a useful tool in diagnosis and evaluation of bicuspid aortic valve. Stead-state free precession sequences are used to obtain a slice in the place of the valve, and show the anatomy of the valve well. Differentiation may be made between an anatomically bicuspid valve, and anatomically trileaflet valve with fused comissures ("functionally-bicuspid valve"). In addition, CMR is invaluable in defining anatomic valve area, in quantification of aortic regurgitation, and in diagnosis of concomitant cardiovascular abnormalities, such as thoracic aortic dilatation/aneurysm and mitral valve abnormalities.

===Heart catheterization===
[[Image:Aortic Stenosis - Hemodynamic Pressure Tracing.png|thumb|right|300px|Simultaneous left ventricular and aortic pressure tracings demonstrate a pressure gradient between the left ventricle and aorta, suggesting aortic stenosis. The left ventricle generates higher pressures than what is transmitted to the aorta. The pressure gradient, caused by aortic stenosis, is represented by the green shaded area. (AO = ascending aorta; LV = left ventricle; ECG = electrocardiogram.)]]The heart may be [[cardiac catheterization|catheterized]] to directly measure the pressure on both sides of the aortic valve. The pressure gradient may be used as a decision point for treatment. Catheterization is accurate for moderate velocity stenosis, while Doppler echo is more accurate at faster velocities.

==Precautions==
People with aortic stenosis of any aetiology are at risk for the development of infection of their stenosed valve, i.e. [[infective endocarditis]]. To lessen the chance of developing that serious complication, people with AS are usually advised to take antibiotic prophylaxis around the time of certain dental/medical/surgical procedures. Such procedures may include dental extraction, deep scaling of the teeth, gum surgery, dental implants, treatment of [[esophageal varices]], dilation of [[esophageal stricture]]s, gastrointestinal ''surgery'' where the intestinal [[mucosa]] will be disrupted, [[prostate]] surgery, [[urethral stricture]] dilation, and [[cystoscopy]]. Note that routine upper and lower GI [[endoscopy]] (i.e. [[gastroscopy]] and [[colonoscopy]]), with or without [[biopsy]], are not usually considered indications for antibiotic prophylaxis.

Notwithstanding the foregoing, the American Heart Association has recently changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to 1. those with prosthetic heart valves, 2. those with previous episode(s) of endocarditis, and 3. those with certain types of congenital heart disease.<ref>http://www.americanheart.org/presenter.jhtml?identifier=4436</ref>

Since the stenosed aortic valve may limit the heart's output, people with aortic stenosis are at risk of [[syncope]] and dangerously low blood pressure should they use any of a number of common medications. Ironically, these same medicines are used to treat a variety of cardiovascular diseases, many of which may co-exist with aortic stenosis. Examples include [[nitroglycerin]], [[nitrates]], [[ACE inhibitor]]s, [[terazosin]] (Hytrin), and [[hydralazine]]. Note that all of these substances lead to peripheral [[vasodilation]]. Normally, however, in the absence of aortic stenosis, the heart is able to increase its output and thereby offset the effect of the dilated blood vessels. In some cases of aortic stenosis, however, due to the obstruction of blood flow out of the heart caused by the stenosed aortic valve, [[cardiac output]] cannot be increased. Low blood pressure or [[syncope]] may ensue.

==Bicuspid Aortic Stenosis==

===Epidemiology===
The most common congenital abnormality of the heart is the bicuspid aortic valve. Approximately 1-2% of the population have bicuspid aortic valves, and the majority will cause no problems. It can be manifested as a murmur. In this condition, instead of three cusps, the aortic valve has two cusps which results from the fusing of one of the commissures.

This condition is often undiagnosed until later in life when the person develops symptomatic aortic stenosis. Aortic stenosis occurs in this condition usually in patients in their 40s or 50s, an average of 10 years earlier than can occur in people with congenitally normal aortic valves. 30% of cases are diagnosed in adolescence.

The congenital bicuspid aortic valve may become calcified, which may lead to half the cases of surgically important pure aortic stenosis in adults, with varying degrees of severity of aortic stenosis and aortic regurgitation.

Congenital aortic stenosis accounts for 5% of congenital heart defects, is the most common congenital anomaly and is more common in men than women (3:1 to 5:1).

=== Anatomy ===
In 1513, Leonardo da Vinci was the first artist who first sketched the bicuspid aortic valve as cuspal inquelity.

The Bicuspid Aortic Valve has two cusps: one larger than the other. It is considered unobstructive if the edges of the cusps are free. If the edges are fused or no free the aortic valve is considered obstructive developing a dome during systole.

There are five varieties of congenitally abnormal aortic valves based on the number and types of cusps and commisures:

#Unicuspid:
##Acommissural
##Unicommissural
#Bicuspid
#Tricuspid:
##Miniature (small aortic ring)
##Dysplastic
##Cuspal inequality
#Quadricuspid
#Six-cuspid

===Pathophysiology and Natural History===
A congenital bicuspid aortic valve may be associated with the development of either progressive clacific stenosis or regurgitation. The defect is the leading cause of acquired calcified aortic stenosis (see above section on acquired aortic stenosis).

===Clinical Features===

===Signs and Symptoms===
Symptoms may not develop until adolescence (in later adulthood with acquired AS) and include DOE, exertional dizziness or syncope, exertional angina and heart failure. Occassionally patients with aortic stenosis may present with fever and bacteremia as these patients are highly susceptible to bacterial endocarditis. Lastly, patients with congenital bicuspid aortic valves may present with aortic aneurysms or dissections as aortic root enlargement from cystic medial changes occur commonly in these patients.

===Physical Examination===
*There is a systolic murmur from birth (occurs later in life in acquired AS),
*Unlike acquired AS, the contour of the carotid pulse is not a good predictor of severity in congenital AS because it is so variable.
*Because the valve is not calcified early on in the case of a fused valve, a click is present unlike acquired AS.
*Patients often have an S4.

===Imaging Studies===
*2 D ECHO plays an important role in the diagnosis of bicuspid AS.
*Short axis is useful, doming of valve can be seen on the parasternal long axis.
*Important to diagnose because of risk of endocarditis and calcification with progressive valvular stenosis.
*Only 25% of patients with congenital AS have AI compared with 75% of cases with acquired AS.
*In 75% of those with acquired AS, there is associated mitral valve disease. This association is rare in congenital AS.
*Congenital AS may occur with one or three cusps, but two cusps is the most common.
*Echocardiographic features that are associated with a poor prognosis in asymptomatic patients and progression to a symptomatic state include moderate to severe calcification and a peak aortic velocity > 4.0 M/s. <ref>Cohn LH, Edmunds LH Jr. Cardiac Surgery in the Adult. McGraw-Hill, 2003.</ref>

<youtube v=8B5BWhPgbjk/>

* Bicuspid Aortic Valve by Transesophageal Echo 1

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* Bicuspid Aortic Valve by Transesophageal Echo 2

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* Bicuspid Aortic Valve by Transesophageal Echo 3

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* Bicuspid Aortic Valve by Transesophageal Echo 4

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* Bicuspid Aortic Valve by Transesophageal Echo 5

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* Bicuspid Aortic Valve by Transesophageal Echo 6

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* Bicuspid Aortic Valve by Transesophageal Echo 7

<googlevideo>-1456550005760918044&hl=en</googlevideo>

==Aortic Subvalvular Stenosis==

===Epidemiology and Demographics===

Aortic subvalvular stenosis is the second most common level of congenital obtruction of LV outflow, located just beneath the aortic valve and occurs in 8-30% of all forms of left ventricular outflow tract obstruction. '''IHSS is not present at birth and is not considered a congenital lesion.'''

The lesion is caused by accumulation of fibrous elastic tissue which most often

===Anatomy===

There are several varieties of Congenital Aortic Subvalvular Stenosis (or subaortic stenosis):

#Membranous
*A fixed localized membrane .5 to 2 cm below the level of the aortic valve and attached to the septum and the base of the anterior mitral leaflet.
#Fibromuscular, tunnel
*More commonly there is a fibromuscular membrane or tunnel with a significant muscular component which can sometimes be hard to distinguish from IHSS. This is a more severe form and is often associated with a small aortic root.
* Associated aortic insufficiency (AI) is often present due to the high speed jet of blood through the aortic cusps resulting in fibrosis and retraction.
#Congenital anomalies of the mitral valve (attachment to ventricular septum of accesory
chordae from anterior mitral leaflet, redundant AV valve tissue can also cause subaortic obstruction.
#Aneurysm of the membranous ventricular septum

===Clinical Features===

*Similar to that of valvular AS. Differentiation difficult.
*AI more common in this form (50 to 75% of patients).
*Symptoms begin in infancy or early adulthood.

==Aortic Supravalvular Stenosis==
Most uncommon cause of left ventricular outflow tract obstruction accounting for 8% of congenital LVOT obstruction.

===Anatomy===

#Obstruction occurs just above the coronary ostium at the level of the sinotubular junction:
##Hourglass type (the most common)
##Hypoplastic type: uniform narrowing of the ascending aorta.
#Associated lesion is peripheral pulmonary arterial stenosis
#Because of high perfusion pressure of the coronary arteries there is premature CAD.
#Coronary arteries may be obstructed by an adjacent stenotic ring.

===Clinical Features===

#1/3rd of cases are transmitted as an autosomal dominant trait.
#50% have a characteristically greater pulse and systolic blood pressure in the right carotid and brachial arteries than in the left.
#The systolic murmur is maximal below the right clavicle and radiates primarily to the right carotid artery.
#No ejection click, no diastolic murmur.

==Subaortic Membrane==

* Sub Aortic Membrane 1

<googlevideo>-3205002409975813384&hl=en</googlevideo>

* Sub Aortic Membrane 2

<googlevideo>-7362420301573743800&hl=en</googlevideo>

* Sub Aortic Membrane 3

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* Sub Aortic Membrane 4

<googlevideo>-3036066620374246618&hl=en</googlevideo>

* Sub Aortic membrane 5

<googlevideo>-4319660165214545760&hl=en</googlevideo>

==Treatment==

=== Pharmacotherapy ===

Aortic stenosis may be medically treated to control symptoms. Extreme care should be taken to avoid excess vasodilation in the patient with critical aortic stenosis which could precipitate a downward spiral of low forward output, impaired subendocardial perfusion, ischemia and further reductions in forward output.

=== Mechanical and Device Based Therapy ===

Aortic stenosis requires [[aortic valve replacement]] if medical management does not successfully control symptoms.
According to a prospective, single-center, nonrandomized study of 25 patients, percutaneous implantation of an aortic valve prosthesis in high risk patients with aortic stenosis results in marked hemodynamic and clinical improvement when successfully completed.<ref>{{cite journal |author=Grube E, Laborde JC, Gerckens U, ''et al'' |title=Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study |journal=Circulation |volume=114 |issue=15 |pages=1616-24 |year=2006 |pmid=17015786 |doi=10.1161/CIRCULATIONAHA.106.639450}}</ref>

*Bileaflet Mechanical Aortic Valve

<googlevideo>4541951625687665949&hl=en</googlevideo>

===Aortic valvuloplasty===

===Patient selection and treatment choices===
* Surgical Aortic valve replacement is the treatment of choice for aortic stenosis but many patients are not good candidates due to advanced age and multiple co-morbidities
* Percutaneous aortic valve replacement is in its infancy and thus aortic valvuloplasty can offer palliation of symptoms and potentially prolong survival for these high risk patients in class III-IV heart failure
* It can be performed emergently in patients with end-stage heart failure due to aortic stenosis: patients in cardiogenic shock, as a bridge to aortic valve replacement, patients with critical aortic stenosis needing emergent non-cardiac surgery, poor surgical candidates and nonagenerians, patients with congenital or rheumatic aortic stenosis
* Results usually last 6 months up to 2 years (with repeat procedures possible if aortic regurgitation is not severe)
* Valvuloplasty tends to alleviate heart failure symptoms and improve hemodynamics but rarely does it alleviate angina

====Technique====
The retrograde technique is the most commonly used technique.

*8 French femoral sheath can usually accommodate a 20 mm balloon and minimizes vascular complications
*Alternatively two 6 Fr sheath from bilateral femoral approach and two smaller balloons can be used
*The letter may be necessary in female elderly patients with concomitant peripheral vascular disease
*0.035” straight wire is commonly used to cross the valve and advance via pig-tail or Amplatz catheter; Right heart catheterization is done and transaortic gradient is typically measured pre-procedure
*The 0.035” wire is then exchanged for a stiffer 0.038”Amplatz exchange length wire with the tip shaped into a pig-tail shape so as not to injure the LV
*The 20-23 mmX 6 cm balloon is advance over the wire and positioned to straddle the aortic valve
*The balloon is manually inflated with a 60 cc syringe containing diluted contrast (slowly)
*Meticulous control of balloon position must be maintained at all times by backward traction on the balloon to prevent jumping forward and injuring/perforating the LV apex

==Complications==

*Vascular complications are most common thus suture (Perclose) or Angioseal closure after the procedure in this tenuous patient population is preferable
*It follows that attention to meticulous access technique is mandatory
*Antegrade approach ie venous access with transseptal approach can be done in select patients, however, hemodynamic effects of mitral valve incompetence as a stiff wire is placed across the mitral valve are often poorly tolerated; mitral valve injury has been reported in this approach

==Outcomes==

*30% reduction in gradient is expected as the immediate result Patient survival after repeat BAV is higher than that of untreated patients.

==Pathological Findings==
Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology]

<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve1.jpg|Aortic Stenosis, Bicuspid valve: Gross; excellent image of bicuspid and calcific valve showing a false raphe.
Image:Bicuspid aortic valve2.jpg|Aortic Stenosis, Bicuspid valve: Gross; good example of bicuspid valve
</gallery>
</div>

<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve3.jpg|Aortic Stenosis, Bicuspid valve: Gross; image of bicuspid aortic valve, an excellent example
Image:Bicuspid aortic valve4.jpg|Aortic Stenosis, Bicuspid valve: Gross; close-up image of bicuspid aortic valve.
</gallery>
</div>

<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve5.jpg|Aortic Stenosis, Bicuspid valve: Gross; close-up image of bicuspid aortic valve.
Image:Bicuspid aortic valve6.jpg|Bicuspid aortic valve
</gallery>
</div>

<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve7.jpg|Gross natural color opened first portion aortic arch with bicuspid aortic valve shows stenosis and aortic root is dilated
Image:Bicuspid aortic valve8.jpg|Aortic Stenosis Bicuspid: Gross; natural color opened left ventricular outflow tract with calcific masses on valve as well as anterior leaflet mitral valve probably did not cause significant stenosis
</gallery>
</div>

<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve9.jpg|Bicuspid Aortic Valve with Repaired Aorta Coarctation: Gross natural color opened left ventricular outflow tract with uncomplicated bicuspid aortic valve repaired coarctation barely visible ruptured postoperative young female with ovaries Turner mosaic not ruled out
Image:Bicuspid aortic valve10.jpg|Bicuspid Aortic Stenosis: Gross; fixed tissue
</gallery>
</div>

<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve11.jpg|Aortic Stenosis, Bicuspid: Gross; fixed tissue view of stenotic valve through ventricular outlet track
Image:Bicuspid aortic valve12.jpg|Aortic Stenosis Bicuspid: Gross; fixed tissue. Bicuspid valve and false raphe classical
</gallery>
</div>

<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve13.jpg|Bicuspid aortic valve
Image:Bicuspid aortic valve14.jpg|Bicuspid aortic valve
</gallery>
</div>

<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve15.jpg|Bicuspid aortic valve
Image:Bicuspid aortic valve16.jpg|Left ventricular hypertrophy due to bicuspid aortic valve
</gallery>
</div>

<div align="left">
<gallery heights="150" widths="150">
Image:Congenital aortic stenosis.jpg|Congenital aortic stenosis: Gangrene toe In Infant: Gross, natural color, 1 month old child with congenital aortic stenosis
Image:Unicuspid aortic stenosis.jpg|Unicuspid aortic stenosis
</gallery>
</div>

==An Autopsy Report==

A 68-year-old man initially sought medical advice five years prior to his death. His symptoms at that time were [[exercise intolerance]] and occasional [[peripheral edema]]. He gave a history of a "[[heart murmur]]" that was diagnosed 25 years ago during an employment physical. No follow up care had been given for this murmur.

The patient's terminal admission was for signs of severe [[heart failure]]--the patient had marked [[peripheral edema]] and [[shortness of breath]] and [[chest x-ray]] revealed significant cardiac enlargement and [[pulmonary edema]] with bilateral [[pleural effusion]]s. He sustained a [[cardiac arrest]] shortly after admission and could not be resuscitated.

===Autopsy Findings===

Autopsy disclosed a markedly enlarged heart weighing 650 grams and having dilated chambers. The aortic valve was calcified and showed evidence of stenosis and insufficiency. The coronary arteries were narrowed 60 to 70% by atherosclerosis. No acute coronary occlusions were found and there was no evidence of [[myocardial infarction]].

<div align="left">
<gallery heights="150" widths="150">
Image:Comparison of hypertrophic myocardium and normal Gross.JPG|This is a gross photograph of a cross section of a normal human heart taken at autopsy (right) and the heart from this case, which demonstrates concentric hypertrophy of the left ventricular wall. Note the marked thickening of the left ventricular wall. There is also moderate thickening of the right ventricular wall.
Image:Comparison of hypertrophy and normal myocardial micro 1.JPG|This low-power photomicrograph shows normal myocardium (left) compared to hypertrophied myocardium (right).
</gallery>
</div>

<div align="left">
<gallery heights="150" widths="150">
Image:Comparison of hypertrophy and normal myocardial micro 2.JPG|Normal myocardium (left) is compared here to hypertrophied myocardium (right). The muscle fibers are thicker and the nuclei are larger and darker in the hypertrophied myocardium.The clear spaces between the muscle fibers are due to processing artifacts and are not present during life.
Image:Comparison of hypertrophy and normal myocardial micro 3.JPG|Normal myocardium (left) is compared to hypertrophied myocardium (right). This high power view demonstrates the large dark nuclei (arrow) found in hypertrophied cardiac muscle cells. Polyploidy is a common feature in cardiac hypertrophy. Also note the increased size (thickness) of the individual cardiac muscle cell on the right compared to normal cardiac myocytes (left).
</gallery>
</div>

==Comorbidities==

<div align="left">
<gallery heights="250" widths="250">
Image:Diastolic MR Due to AS.jpg|Diastolic [[mitral regurgitation]] due to severe [[aortic stenosis]]
</gallery>
</div>

<div align="left">
<gallery heights="250" widths="250">
Image:Diastolic MR Due to AS 1.jpg|Diastolic [[mitral regurgitation]] due to severe [[aortic stenosis]]
</gallery>
</div>

<div align="left">
<gallery heights="250" widths="250">
Image:Diastolic MR Due to AS 2.jpg|Diastolic [[mitral regurgitation]] due to severe [[aortic stenosis]]
</gallery>
</div>

* <googlevideo>424719160215823743&hl=en</googlevideo>

* <googlevideo>-1316686479831791521&hl=en</googlevideo>

==References==
{{Reflist|2}}

==External links==
* [http://heartcenter.seattlechildrens.org/conditions_treated/aortic_stenosis.asp Aortic stenosis information] from Seattle Children's Hospital Heart Center
* [http://www.mitralvalverepair.org Mitral Valve Repair at The Mount Sinai Hospital]

== See also ==
[[Aortic valve area calculation]]

==Additional Reading==

* Moss and Adams' Heart Disease in Infants, Children, and Adolescents Hugh D. Allen, Arthur J. Moss, David J. Driscoll, Forrest H. Adams, Timothy F. Feltes, Robert E. Shaddy, 2007 ISBN 0781786843
* Hurst's the Heart, Fuster V, 12th ed. 2008, ISBN 978-0-07-149928-6
* Willerson JT, Cardiovascular Medicine, 3rd ed., 2007, ISBN 978-1-84628-188-4
 

{{Circulatory system pathology}}
{{Congenital malformations and deformations of circulatory system}}
{{SIB}}
[[Category:DiseaseState]]
[[Category:Signs and symptoms]]
[[Category:Physical Examination]]
[[Category:Valvular heart disease]]
[[Category:Cardiology]]
[[Category:Congenital heart disease]]

[[de:Aortenstenose (angeboren)]]
[[es:Estenosis aórtica]]
[[fr:Rétrécissement aortique]]
[[no:Aortastenose]]
[[nn:Aortastenose]]
[[pl:Stenoza Aortalnej]]
[[pt:Estenose aórtica]]
[[ro:Stenoza Aortică]]
[[sv:Aortastenos]]
[[tr:Aort darlığı]]

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Aortic stenosis (patient information)

2009-07-10T15:00:36Z

LBiller: New page: '''For the WikiDoc page for this topic, click here'''. {{SI}} '''Editor-in-Chief:''' {{EJ}} ==What is aortic stenosis?== ==How do I know if I have aortic stenosis...

'''For the WikiDoc page for this topic, click [[Aortic stenosis|here]]'''.

{{SI}}

'''Editor-in-Chief:'''

{{EJ}}

==What is aortic stenosis?==

==How do I know if I have aortic stenosis and what are the symptoms of aortic stenosis?==

==Who is at risk for aortic stenosis?==

==How to know you have aortic stenosis?==

==When to seek urgent medical care==

==Treatment options==

==Diseases with similar symptoms==

==Where to find medical care for aortic stenosis==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|aortic stenosis}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating aortic stenosis]

==Prevention of aortic stenosis==

==What to expect (Outook/Prognosis)==

==Copyleft Sources==

{{WH}}
{{WS}}
[[Category:Patient Information]]

Template:WikiPatient - Patient Resources

2009-07-10T14:58:01Z

LBiller:

Congestive heart failure (patient information)

2009-07-08T22:00:37Z

LBiller:

==What is " "==

==How do I know if I have " " and What are the Symptoms of " "?==

==How " " Is Spread and Who is at Risk for " "?==

==How to know you have " " (Diagnosis)==

==When to Seek Urgent Medical Care==

==Treatment Options==

==Diseases With Similar Symptoms==

==Where to find Medical Care for " "==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|" "}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating " "]

==Prevention of " "==

==What to Expect (Outlook/Prognosis)==

==Copyleft Sources==
{{WH}}
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[[Category:Patient Information]]

Angioma (patient information)

2009-07-08T20:41:47Z

LBiller:

'''For the WikiDoc page for this topic, click [[Angioma|here]]'''

==What is " "==

==How do I know if I have " " and What are the Symptoms of " "?==

==How " " Is Spread and Who is at Risk for " "?==

==How to know you have " " (Diagnosis)==

==When to Seek Urgent Medical Care==

==Treatment Options==

==Diseases With Similar Symptoms==

==Where to find Medical Care for " "==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|" "}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating " "]

==Prevention of " "==

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Sudden cardiac death (patient information)

2009-07-08T19:57:35Z

LBiller:

'''For the WikiDoc page for this topic, click [[Sudden cardiac death|here]]'''

ST elevation myocardial infarction

2009-07-08T19:06:37Z

LBiller:

'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''

{{Infobox_Disease |
Name = Myocardial infarction|
DiseasesDB = 8664 |
ICD10 = {{ICD10|I|21||i|20}}-{{ICD10|I|22||i|20}} |
ICD9 = {{ICD9|410}} |
ICDO = |
OMIM = |
MedlinePlus = 000195 |
eMedicineSubj = med |
eMedicineTopic = 1567 |
eMedicine_mult = {{eMedicine2|emerg|327}} {{eMedicine2|ped|2520}} |
MeshID = |
}}
__NOEDITSECTION__
{{SI}}

{{WikiDoc Cardiology Network Infobox}}

{{CMG}}

In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme used by the ACC / AHA guidelines. [[ACC AHA Guidelines Classification Scheme|Read more about the classification scheme used by the ACC / AHA Guidelines Committee here]].
----
'''''Keywords and synonyms:''''' AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis 

==Overview==

===[[ST elevation myocardial infarction overview|Overview]]===

===[[ST Elevation Myocardial Infarction: Epidemiology and Demographics | Epidemiology and Demographics]]===

==Pathophysiology==

===[[ST Elevation Myocardial Infarction Risk Factors|Risk Factors]]===

===[[ST Elevation Myocardial Infarction Triggers|Triggers]]===

===[[ST Elevation Myocardial Infarction Pathophysiology|Pathophysiology of Vessel Occlusion]]===

===[[ST Elevation Myocardial Infarction: Pathophysiology of Reperfusion |Pathophysiology of Reperfusion]]===

==Diagnosis==

===[[ST Elevation Myocardial Infarction Diagnosis|Diagnosis, classification and biomarkers]]===

===[[ST Elevation Myocardial Infarction Symptoms|Symptoms]]===

===[[Chest pain|Differential diagnosis of chest pain]]===

===[[ST Elevation Myocardial Infarction Physical Examination|Physical Examination]]===

===[[ST Elevation Myocardial Infarction Electrocardiogram|Electrocardiogram]]===

===[[ST Elevation Myocardial Infarction Coronary Angiography|Coronary Angiography]]===

===[[ST Elevation Myocardial Infarction Gross Pathology|Gross Pathology]]===

===[[ST Elevation Myocardial Infarction Histopathology|Histopathology]]===

==Treatment==

===[[ST Elevation Myocardial Infarction Pre-Hospital Care|Pre-Hospital Care]]===

===[[ST Elevation Myocardial Infarction Initial Care|Initial Care]]===

[[ST Elevation Myocardial Infarction Oxygen Therapy|Oxygen]] | [[ST Elevation Myocardial Infarction Nitrate Therapy|Nitrates]] | [[ST Elevation Myocardial Infarction Analgesic Therapy|Analgesics]] | [[ST Elevation Myocardial Infarction Aspirin Therapy|Aspirin]] | [[ST Elevation Myocardial Infarction Beta Blocker Therapy|Beta Blockers]] | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombins]] | [[Coronary care unit|The coronary care unit]] | [[Step Down Unit|The step down unit]]

'''Pharmacologic Reperfusion''' | [[ST Elevation Myocardial Infarction Reperfusion Therapy|Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)]] | [[ST Elevation Myocardial Infarction Fibrinolytic Therapy|Fibrinolysis]]

'''Mechanical Reperfusion''' | [[Door-to-Balloon| The importance of reducing Door-to-Balloon times]] | [[ST Elevation Myocardial Infarction Primary Percutaneous Coronary Intervention|Primary PCI]] | [[ST Elevation Myocardial Infarction Percutaneous Coronary Intervention Following Fibrinolytic Administration|Adjunctive and Rescue PCI]] | [[ST elevation myocardial infarction rescue percutaneous coronary intervention|Rescue PCI]] |
[[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Facilitated PCI]] |
[[ST Elevation Myocardial Infarction Adjunctive Percutaneous Coronary Intervention|Adjunctive PCI]] |
[[ST Elevation Myocardial Infarction Coronary Artery Bypass Grafting|CABG]] | [[ST Elevation Myocardial Infarction Management of Patients Who Were Not Reperfused|Management of Patients Who Were Not Reperfused]] | [[ST Elevation Myocardial Infarction Assessing Success of Reperfusion|Assessing Success of Reperfusion]]

'''Antithrombin Therapy''' • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombin therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Unfractionated Heparin|Unfractionated heparin]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Enoxaparin| Low Molecular Weight Heparinoid Therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Bivalirudin| Direct Thrombin Inhibitor Therapy]] • [[ ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Fondaparinux|Factor Xa Inhibition]]

'''Antiplatelet Agents''' | [[ST Elevation Myocardial Infarction Aspirin Therapy|Aspirin]] | [[ST Elevation Myocardial Infarction Thienopyridine Therapy|Thienopyridine Therapy]] | [[ST Elevation Myocardial Infarction Glycoprotein IIbIIIa Inhibition|Glycoprotein IIbIIIa Inhibition]]

'''Other Initial Therapy''' | [[ST Elevation Myocardial Infarction Inhibition of the Renin-Angiotensin-Aldosterone System|Inhibition of the Renin-Angiotensin-Aldosterone System]] | [[ST Elevation Myocardial Infarction Magnesium Therapy|Magnesium Therapy]] | [[ST Elevation Myocardial Infarction Glucose Control|Glucose Control]] | [[ST Elevation Myocardial Infarction Calcium Channel Blocker Therapy|Calcium Channel Blocker Therapy]]

==Discharge Care==
[[ST Elevation Myocardial Infarction Secondary Prevention|Secondary Prevention]] | [[ST Elevation Myocardial Infarction Inhibition of the Renin-Angiotensin-Aldosterone System at Discharge|Inhibition of the Renin-Angiotensin-Aldosterone System]] |
[[ST Elevation Myocardial Infarction Cardiac Rehabilitation|Cardiac Rehabilitation]] | [[ST Elevation Myocardial Infarction Prognosis|Prognosis]] | [[ST elevation myocardial infarction pacemaker implantation|Pacemaker Implantation]]

==Complications==

===[[ST Elevation Myocardial Infarction Complications|Overview]]===

'''Ischemic Complications:''' [[Reinfarction]]

'''Mechanical Complications:'''[[Cardiogenic shock]] | [[Left ventricular aneurysm]] | [[Myocardial rupture]] | [[Left ventricular aneurysm|Pseudoaneurysm]] | [[Papillary muscle rupture]] |
[[Rupture of the ventricular septum]]

'''Arrhythmic Complications:''' [[Sudden cardiac death]]

'''Embolic Complications:''' [[Stroke]]

'''Pericarditis:''' [[Post myocardial infarction pericarditis]] | [[Dressler's syndrome]]

==See also==
* [[The Living Guidelines: STEMI]]

==Disclaimer==
Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the [[wikidoc:General disclaimer|disclaimers]] page for important information regarding limitations of the information found here.

==External links==

* [http://www.themdtv.org The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research]
* [http://www.clinicaltrialresults.org Clinical Trial Results: An up to date resource of Cardiovascular Research]
* [http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack - based on information of the Framingham Heart Study from the United States National Heart, Lung and Blood Institute]
* [http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Attack overview from MedlinePlus]
* [http://ww2.heartandstroke.ca/Page.asp?PageID=1975&ArticleID=5288 Heart Attack Warning Signals from the Heart and Stroke Foundation of Canada]
* [http://www.regionalpci-stemi.org/index.html A Regional PCI and Resource Center for STEMI]
* [http://www.stemisystems.org/ STEMI Systems' Quarterly newsletter]
* [http://d2b.acc.org/ American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.]
* [http://www.americanheart.org/heartattack American Heart Association's Heart Attack web site]

{{STEMI}}

[[ar:احتشاء قلبي]]
[[bg:Инфаркт на миокарда]]
[[cs:Infarkt myokardu]]
[[de:Myokardinfarkt]]
[[et:Müokardi infarkt]]
[[es:Infarto agudo de miocardio]]
[[eu:Miokardio infartu akutu]]
[[fr:Infarctus du myocarde]]
[[ko:심근경색]]
[[hr:Infarkt miokarda]]
[[id:Serangan jantung]]
[[it:Infarto del miocardio]]
[[he:התקף לב]]
[[ku:Mirina masûlkeyên dil]]
[[la:Infarctus cordis]]
[[mk:Срцев напад]]
[[ms:Sakit jantung]]
[[nl:Hartaanval]]
[[ja:心筋梗塞]]
[[no:Hjerteinfarkt]]
[[pl:Zawał mięśnia sercowego]]
[[pt:Infarto agudo do miocárdio]]
[[ru:Острый инфаркт миокарда]]
[[sq:Infarkti miokardial]]
[[sr:Срчани удар]]
[[fi:Sydäninfarkti]]
[[sv:Hjärtinfarkt]]
[[ur:احتشاء عضل قلب]]
[[vi:Nhồi máu cơ tim]]
[[tr:Miyokardiyal enfarktüs]]
[[uk:Гострий інфаркт міокарду]]
[[yi:הארץ אטאקע]]
[[zh:心肌梗死]]

[[Category:Cardiology]]
[[Category:Intensive care medicine]]
[[Category:Emergency medicine]]

{{keywords|acute MI|heart attack|\bSTEMI|fibrinolysis|door to balloon|rescue PCI|facilitated PCI|myocardial infarct|coronary thrombosis}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

ST elevation myocardial infarction

2009-07-08T18:49:11Z

LBiller:

'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''

{{Infobox_Disease |
Name = Myocardial infarction|
DiseasesDB = 8664 |
ICD10 = {{ICD10|I|21||i|20}}-{{ICD10|I|22||i|20}} |
ICD9 = {{ICD9|410}} |
ICDO = |
OMIM = |
MedlinePlus = 000195 |
eMedicineSubj = med |
eMedicineTopic = 1567 |
eMedicine_mult = {{eMedicine2|emerg|327}} {{eMedicine2|ped|2520}} |
MeshID = |
}}
__NOEDITSECTION__
{{SI}}

{{WikiDoc Cardiology Network Infobox}}

{{CMG}}

In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme used by the ACC / AHA guidelines. [[ACC AHA Guidelines Classification Scheme|Read more about the classification scheme used by the ACC / AHA Guidelines Committee here]].
----
'''''Keywords and synonyms:''''' AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis 

==Overview==

===[[ST Elevation Myocardial Infarction (patient information) ST Elevation Myocardial Infarction Overview|Overview]]===

===[[ST Elevation Myocardial Infarction: Epidemiology and Demographics | Epidemiology and Demographics]]===

==Pathophysiology==

===[[ST Elevation Myocardial Infarction Risk Factors|Risk Factors]]===

===[[ST Elevation Myocardial Infarction Triggers|Triggers]]===

===[[ST Elevation Myocardial Infarction Pathophysiology|Pathophysiology of Vessel Occlusion]]===

===[[ST Elevation Myocardial Infarction: Pathophysiology of Reperfusion |Pathophysiology of Reperfusion]]===

==Diagnosis==

===[[ST Elevation Myocardial Infarction Diagnosis|Diagnosis, classification and biomarkers]]===

===[[ST Elevation Myocardial Infarction Symptoms|Symptoms]]===

===[[Chest pain|Differential diagnosis of chest pain]]===

===[[ST Elevation Myocardial Infarction Physical Examination|Physical Examination]]===

===[[ST Elevation Myocardial Infarction Electrocardiogram|Electrocardiogram]]===

===[[ST Elevation Myocardial Infarction Coronary Angiography|Coronary Angiography]]===

===[[ST Elevation Myocardial Infarction Gross Pathology|Gross Pathology]]===

===[[ST Elevation Myocardial Infarction Histopathology|Histopathology]]===

==Treatment==

===[[ST Elevation Myocardial Infarction Pre-Hospital Care|Pre-Hospital Care]]===

===[[ST Elevation Myocardial Infarction Initial Care|Initial Care]]===

[[ST Elevation Myocardial Infarction Oxygen Therapy|Oxygen]] | [[ST Elevation Myocardial Infarction Nitrate Therapy|Nitrates]] | [[ST Elevation Myocardial Infarction Analgesic Therapy|Analgesics]] | [[ST Elevation Myocardial Infarction Aspirin Therapy|Aspirin]] | [[ST Elevation Myocardial Infarction Beta Blocker Therapy|Beta Blockers]] | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombins]] | [[Coronary care unit|The coronary care unit]] | [[Step Down Unit|The step down unit]]

'''Pharmacologic Reperfusion''' | [[ST Elevation Myocardial Infarction Reperfusion Therapy|Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)]] | [[ST Elevation Myocardial Infarction Fibrinolytic Therapy|Fibrinolysis]]

'''Mechanical Reperfusion''' | [[Door-to-Balloon| The importance of reducing Door-to-Balloon times]] | [[ST Elevation Myocardial Infarction Primary Percutaneous Coronary Intervention|Primary PCI]] | [[ST Elevation Myocardial Infarction Percutaneous Coronary Intervention Following Fibrinolytic Administration|Adjunctive and Rescue PCI]] | [[ST elevation myocardial infarction rescue percutaneous coronary intervention|Rescue PCI]] |
[[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Facilitated PCI]] |
[[ST Elevation Myocardial Infarction Adjunctive Percutaneous Coronary Intervention|Adjunctive PCI]] |
[[ST Elevation Myocardial Infarction Coronary Artery Bypass Grafting|CABG]] | [[ST Elevation Myocardial Infarction Management of Patients Who Were Not Reperfused|Management of Patients Who Were Not Reperfused]] | [[ST Elevation Myocardial Infarction Assessing Success of Reperfusion|Assessing Success of Reperfusion]]

'''Antithrombin Therapy''' • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombin therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Unfractionated Heparin|Unfractionated heparin]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Enoxaparin| Low Molecular Weight Heparinoid Therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Bivalirudin| Direct Thrombin Inhibitor Therapy]] • [[ ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Fondaparinux|Factor Xa Inhibition]]

'''Antiplatelet Agents''' | [[ST Elevation Myocardial Infarction Aspirin Therapy|Aspirin]] | [[ST Elevation Myocardial Infarction Thienopyridine Therapy|Thienopyridine Therapy]] | [[ST Elevation Myocardial Infarction Glycoprotein IIbIIIa Inhibition|Glycoprotein IIbIIIa Inhibition]]

'''Other Initial Therapy''' | [[ST Elevation Myocardial Infarction Inhibition of the Renin-Angiotensin-Aldosterone System|Inhibition of the Renin-Angiotensin-Aldosterone System]] | [[ST Elevation Myocardial Infarction Magnesium Therapy|Magnesium Therapy]] | [[ST Elevation Myocardial Infarction Glucose Control|Glucose Control]] | [[ST Elevation Myocardial Infarction Calcium Channel Blocker Therapy|Calcium Channel Blocker Therapy]]

==Discharge Care==
[[ST Elevation Myocardial Infarction Secondary Prevention|Secondary Prevention]] | [[ST Elevation Myocardial Infarction Inhibition of the Renin-Angiotensin-Aldosterone System at Discharge|Inhibition of the Renin-Angiotensin-Aldosterone System]] |
[[ST Elevation Myocardial Infarction Cardiac Rehabilitation|Cardiac Rehabilitation]] | [[ST Elevation Myocardial Infarction Prognosis|Prognosis]] | [[ST elevation myocardial infarction pacemaker implantation|Pacemaker Implantation]]

==Complications==

===[[ST Elevation Myocardial Infarction Complications|Overview]]===

'''Ischemic Complications:''' [[Reinfarction]]

'''Mechanical Complications:'''[[Cardiogenic shock]] | [[Left ventricular aneurysm]] | [[Myocardial rupture]] | [[Left ventricular aneurysm|Pseudoaneurysm]] | [[Papillary muscle rupture]] |
[[Rupture of the ventricular septum]]

'''Arrhythmic Complications:''' [[Sudden cardiac death]]

'''Embolic Complications:''' [[Stroke]]

'''Pericarditis:''' [[Post myocardial infarction pericarditis]] | [[Dressler's syndrome]]

==See also==
* [[The Living Guidelines: STEMI]]

==Disclaimer==
Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the [[wikidoc:General disclaimer|disclaimers]] page for important information regarding limitations of the information found here.

==External links==

* [http://www.themdtv.org The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research]
* [http://www.clinicaltrialresults.org Clinical Trial Results: An up to date resource of Cardiovascular Research]
* [http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack - based on information of the Framingham Heart Study from the United States National Heart, Lung and Blood Institute]
* [http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Attack overview from MedlinePlus]
* [http://ww2.heartandstroke.ca/Page.asp?PageID=1975&ArticleID=5288 Heart Attack Warning Signals from the Heart and Stroke Foundation of Canada]
* [http://www.regionalpci-stemi.org/index.html A Regional PCI and Resource Center for STEMI]
* [http://www.stemisystems.org/ STEMI Systems' Quarterly newsletter]
* [http://d2b.acc.org/ American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.]
* [http://www.americanheart.org/heartattack American Heart Association's Heart Attack web site]

{{STEMI}}

[[ar:احتشاء قلبي]]
[[bg:Инфаркт на миокарда]]
[[cs:Infarkt myokardu]]
[[de:Myokardinfarkt]]
[[et:Müokardi infarkt]]
[[es:Infarto agudo de miocardio]]
[[eu:Miokardio infartu akutu]]
[[fr:Infarctus du myocarde]]
[[ko:심근경색]]
[[hr:Infarkt miokarda]]
[[id:Serangan jantung]]
[[it:Infarto del miocardio]]
[[he:התקף לב]]
[[ku:Mirina masûlkeyên dil]]
[[la:Infarctus cordis]]
[[mk:Срцев напад]]
[[ms:Sakit jantung]]
[[nl:Hartaanval]]
[[ja:心筋梗塞]]
[[no:Hjerteinfarkt]]
[[pl:Zawał mięśnia sercowego]]
[[pt:Infarto agudo do miocárdio]]
[[ru:Острый инфаркт миокарда]]
[[sq:Infarkti miokardial]]
[[sr:Срчани удар]]
[[fi:Sydäninfarkti]]
[[sv:Hjärtinfarkt]]
[[ur:احتشاء عضل قلب]]
[[vi:Nhồi máu cơ tim]]
[[tr:Miyokardiyal enfarktüs]]
[[uk:Гострий інфаркт міокарду]]
[[yi:הארץ אטאקע]]
[[zh:心肌梗死]]

[[Category:Cardiology]]
[[Category:Intensive care medicine]]
[[Category:Emergency medicine]]

{{keywords|acute MI|heart attack|\bSTEMI|fibrinolysis|door to balloon|rescue PCI|facilitated PCI|myocardial infarct|coronary thrombosis}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

ST elevation myocardial infarction

2009-07-08T13:31:16Z

LBiller:

{{Infobox_Disease |
Name = Myocardial infarction|
DiseasesDB = 8664 |
ICD10 = {{ICD10|I|21||i|20}}-{{ICD10|I|22||i|20}} |
ICD9 = {{ICD9|410}} |
ICDO = |
OMIM = |
MedlinePlus = 000195 |
eMedicineSubj = med |
eMedicineTopic = 1567 |
eMedicine_mult = {{eMedicine2|emerg|327}} {{eMedicine2|ped|2520}} |
MeshID = |
}}
__NOEDITSECTION__
{{SI}}

'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''

{{WikiDoc Cardiology Network Infobox}}

{{CMG}}

In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme used by the ACC / AHA guidelines. [[ACC AHA Guidelines Classification Scheme|Read more about the classification scheme used by the ACC / AHA Guidelines Committee here]].
----
'''''Keywords and synonyms:''''' AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis 

==Overview==

===[[ST Elevation Myocardial Infarction Overview|Overview]]===

===[[ST Elevation Myocardial Infarction: Epidemiology and Demographics | Epidemiology and Demographics]]===

==Pathophysiology==

===[[ST Elevation Myocardial Infarction Risk Factors|Risk Factors]]===

===[[ST Elevation Myocardial Infarction Triggers|Triggers]]===

===[[ST Elevation Myocardial Infarction Pathophysiology|Pathophysiology of Vessel Occlusion]]===

===[[ST Elevation Myocardial Infarction: Pathophysiology of Reperfusion |Pathophysiology of Reperfusion]]===

==Diagnosis==

===[[ST Elevation Myocardial Infarction Diagnosis|Diagnosis, classification and biomarkers]]===

===[[ST Elevation Myocardial Infarction Symptoms|Symptoms]]===

===[[Chest pain|Differential diagnosis of chest pain]]===

===[[ST Elevation Myocardial Infarction Physical Examination|Physical Examination]]===

===[[ST Elevation Myocardial Infarction Electrocardiogram|Electrocardiogram]]===

===[[ST Elevation Myocardial Infarction Coronary Angiography|Coronary Angiography]]===

===[[ST Elevation Myocardial Infarction Gross Pathology|Gross Pathology]]===

===[[ST Elevation Myocardial Infarction Histopathology|Histopathology]]===

==Treatment==

===[[ST Elevation Myocardial Infarction Pre-Hospital Care|Pre-Hospital Care]]===

===[[ST Elevation Myocardial Infarction Initial Care|Initial Care]]===

[[ST Elevation Myocardial Infarction Oxygen Therapy|Oxygen]] | [[ST Elevation Myocardial Infarction Nitrate Therapy|Nitrates]] | [[ST Elevation Myocardial Infarction Analgesic Therapy|Analgesics]] | [[ST Elevation Myocardial Infarction Aspirin Therapy|Aspirin]] | [[ST Elevation Myocardial Infarction Beta Blocker Therapy|Beta Blockers]] | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombins]] | [[Coronary care unit|The coronary care unit]] | [[Step Down Unit|The step down unit]]

'''Pharmacologic Reperfusion''' | [[ST Elevation Myocardial Infarction Reperfusion Therapy|Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)]] | [[ST Elevation Myocardial Infarction Fibrinolytic Therapy|Fibrinolysis]]

'''Mechanical Reperfusion''' | [[Door-to-Balloon| The importance of reducing Door-to-Balloon times]] | [[ST Elevation Myocardial Infarction Primary Percutaneous Coronary Intervention|Primary PCI]] | [[ST Elevation Myocardial Infarction Percutaneous Coronary Intervention Following Fibrinolytic Administration|Adjunctive and Rescue PCI]] | [[ST elevation myocardial infarction rescue percutaneous coronary intervention|Rescue PCI]] |
[[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Facilitated PCI]] |
[[ST Elevation Myocardial Infarction Adjunctive Percutaneous Coronary Intervention|Adjunctive PCI]] |
[[ST Elevation Myocardial Infarction Coronary Artery Bypass Grafting|CABG]] | [[ST Elevation Myocardial Infarction Management of Patients Who Were Not Reperfused|Management of Patients Who Were Not Reperfused]] | [[ST Elevation Myocardial Infarction Assessing Success of Reperfusion|Assessing Success of Reperfusion]]

'''Antithrombin Therapy''' • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombin therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Unfractionated Heparin|Unfractionated heparin]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Enoxaparin| Low Molecular Weight Heparinoid Therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Bivalirudin| Direct Thrombin Inhibitor Therapy]] • [[ ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Fondaparinux|Factor Xa Inhibition]]

'''Antiplatelet Agents''' | [[ST Elevation Myocardial Infarction Aspirin Therapy|Aspirin]] | [[ST Elevation Myocardial Infarction Thienopyridine Therapy|Thienopyridine Therapy]] | [[ST Elevation Myocardial Infarction Glycoprotein IIbIIIa Inhibition|Glycoprotein IIbIIIa Inhibition]]

'''Other Initial Therapy''' | [[ST Elevation Myocardial Infarction Inhibition of the Renin-Angiotensin-Aldosterone System|Inhibition of the Renin-Angiotensin-Aldosterone System]] | [[ST Elevation Myocardial Infarction Magnesium Therapy|Magnesium Therapy]] | [[ST Elevation Myocardial Infarction Glucose Control|Glucose Control]] | [[ST Elevation Myocardial Infarction Calcium Channel Blocker Therapy|Calcium Channel Blocker Therapy]]

==Discharge Care==
[[ST Elevation Myocardial Infarction Secondary Prevention|Secondary Prevention]] | [[ST Elevation Myocardial Infarction Inhibition of the Renin-Angiotensin-Aldosterone System at Discharge|Inhibition of the Renin-Angiotensin-Aldosterone System]] |
[[ST Elevation Myocardial Infarction Cardiac Rehabilitation|Cardiac Rehabilitation]] | [[ST Elevation Myocardial Infarction Prognosis|Prognosis]] | [[ST elevation myocardial infarction pacemaker implantation|Pacemaker Implantation]]

==Complications==

===[[ST Elevation Myocardial Infarction Complications|Overview]]===

'''Ischemic Complications:''' [[Reinfarction]]

'''Mechanical Complications:'''[[Cardiogenic shock]] | [[Left ventricular aneurysm]] | [[Myocardial rupture]] | [[Left ventricular aneurysm|Pseudoaneurysm]] | [[Papillary muscle rupture]] |
[[Rupture of the ventricular septum]]

'''Arrhythmic Complications:''' [[Sudden cardiac death]]

'''Embolic Complications:''' [[Stroke]]

'''Pericarditis:''' [[Post myocardial infarction pericarditis]] | [[Dressler's syndrome]]

==See also==
* [[The Living Guidelines: STEMI]]

==Disclaimer==
Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the [[wikidoc:General disclaimer|disclaimers]] page for important information regarding limitations of the information found here.

==External links==

* [http://www.themdtv.org The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research]
* [http://www.clinicaltrialresults.org Clinical Trial Results: An up to date resource of Cardiovascular Research]
* [http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack - based on information of the Framingham Heart Study from the United States National Heart, Lung and Blood Institute]
* [http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Attack overview from MedlinePlus]
* [http://ww2.heartandstroke.ca/Page.asp?PageID=1975&ArticleID=5288 Heart Attack Warning Signals from the Heart and Stroke Foundation of Canada]
* [http://www.regionalpci-stemi.org/index.html A Regional PCI and Resource Center for STEMI]
* [http://www.stemisystems.org/ STEMI Systems' Quarterly newsletter]
* [http://d2b.acc.org/ American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.]
* [http://www.americanheart.org/heartattack American Heart Association's Heart Attack web site]

{{STEMI}}

[[ar:احتشاء قلبي]]
[[bg:Инфаркт на миокарда]]
[[cs:Infarkt myokardu]]
[[de:Myokardinfarkt]]
[[et:Müokardi infarkt]]
[[es:Infarto agudo de miocardio]]
[[eu:Miokardio infartu akutu]]
[[fr:Infarctus du myocarde]]
[[ko:심근경색]]
[[hr:Infarkt miokarda]]
[[id:Serangan jantung]]
[[it:Infarto del miocardio]]
[[he:התקף לב]]
[[ku:Mirina masûlkeyên dil]]
[[la:Infarctus cordis]]
[[mk:Срцев напад]]
[[ms:Sakit jantung]]
[[nl:Hartaanval]]
[[ja:心筋梗塞]]
[[no:Hjerteinfarkt]]
[[pl:Zawał mięśnia sercowego]]
[[pt:Infarto agudo do miocárdio]]
[[ru:Острый инфаркт миокарда]]
[[sq:Infarkti miokardial]]
[[sr:Срчани удар]]
[[fi:Sydäninfarkti]]
[[sv:Hjärtinfarkt]]
[[ur:احتشاء عضل قلب]]
[[vi:Nhồi máu cơ tim]]
[[tr:Miyokardiyal enfarktüs]]
[[uk:Гострий інфаркт міокарду]]
[[yi:הארץ אטאקע]]
[[zh:心肌梗死]]

[[Category:Cardiology]]
[[Category:Intensive care medicine]]
[[Category:Emergency medicine]]

{{keywords|acute MI|heart attack|\bSTEMI|fibrinolysis|door to balloon|rescue PCI|facilitated PCI|myocardial infarct|coronary thrombosis}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Clopidogrel resistance

2009-07-08T13:24:01Z

LBiller: /* Gold Standard Tests of Clopidogrel Responsiveness */

{{SI}}

'''Editors-in-Chief:''' Dominick Angiolillo, M.D. [mailto:dominick.angiolillo@jax.ufl.edu], [[C. Michael Gibson]], M.S., M.D. [mailto:mgibson@perfuse.org], [[User:Philippe Gabriel Steg|Gabriel Steg]], M.D.[mailto:gabriel.steg@bch.aphp.fr], Tabassome Simon, M.D. [mailto:tabassome.simon@sat.aphp.fr] and Paul Gurbel, M.D. [mailto:pgurbel@lifebridgehealth.org]

'''Associate Editors-in-Chief:''' Davide Capodanno, M.D. [mailto:Davide.Capodanno@jax.ufl.edu]

'''Assistant Editor-in-Chief:''' Leah Biller

{{EJ}}

'''''Synonyms and related keywords:''''' Clopidogrel non-responders, clopidogrel hyporesponders, clopidogrel non-responsiveness, clopidogrel hyporesponsiveness, clopidogrel failure

==Overview==

Administration of the same dose of a drug to all patients has the advantages of simplicity and ease of use. However, data regarding the variability in platelet inhibition across patients highlights the potential importance of tailoring the antiplatelet or dose of an antiplatelet to the pharmacodynamic response of the patient. Patients who do not achieve adequate inhibition in response to a dose of clopidogrel are variably termed “Clopidogrel non-responders” or “Clopidogrel hyporesponders”. A recent European Society of Cardiology working group has suggested the term "elevated platelet reactivity despite treatment".<ref name="pmid19174428">{{cite journal |author=Kuliczkowski W, Witkowski A, Polonski L, ''et al'' |title=Interindividual variability in the response to oral antiplatelet drugs: a position paper of the Working Group on antiplatelet drugs resistance appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, endorsed by the Working Group on Thrombosis of the European Society of Cardiology |journal=Eur. Heart J. |volume=30 |issue=4 |pages=426–35 |year=2009 |month=February |pmid=19174428 |doi=10.1093/eurheartj/ehn562 |url=}}</ref>

This chapter reviews the underlying etiology and clinical relevance of clopidogrel non-responsiveness.

==Definitions of Clopidogrel Non Responsiveness==

There are multiple definitions of clopidogrel non-responsiveness <ref name="pmid16703219">{{cite journal |author=Barsky AA, Arora RR |title=Clopidogrel resistance: myth or reality? |journal=J. Cardiovasc. Pharmacol. Ther. |volume=11 |issue=1 |pages=47–53 |year=2006 |month=March |pmid=16703219 |doi= |url=http://cpt.sagepub.com/cgi/pmidlookup?view=long&pmid=16703219}}</ref>

:

# '''Gurbel et al:''' Change in inhibition of platelet aggregation (IPA) of < 10% using light transmittance aggregometry (LTA)<ref name="pmid12796140">{{cite journal |author=Gurbel PA, Bliden KP, Hiatt BL, O'Connor CM |title=Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity |journal=Circulation |volume=107 |issue=23 |pages=2908–13 |year=2003 |month=June |pmid=12796140 |doi=10.1161/01.CIR.0000072771.11429.83 |url=}}</ref>
# '''Angiolillo et al:''' IPA < 40% by LTA <ref name="pmid15567460">{{cite journal |author=Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, ''et al'' |title=Identification of low responders to a 300-mg clopidogrel loading dose in patients undergoing coronary stenting |journal=Thromb. Res. |volume=115 |issue=1-2 |pages=101–8 |year=2005 |pmid=15567460 |doi=10.1016/j.thromres.2004.07.007 |url=}}</ref>
# '''Lau et al:''' Platelet aggregation >= to 70% by LTA <ref name="pmid12515739">{{cite journal |author=Lau WC, Waskell LA, Watkins PB, Neer CJ, Horowitz K, Hopp AS, Tait AR, Carville DG, Guyer KE, Bates ER |title=Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: a new drug-drug interaction |journal=Circulation |volume=107 |issue=1 |pages=32–7 |year=2003 |month=January |pmid=12515739 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12515739 |accessdate=2009-04-28}}</ref>

It should also be noted that the degree of non-responsiveness will also vary depending upon the timing following clopidogrel administration that responsiveness is tested. For instance, Gurbel et al have shown that using the same assay and the same definition, at 2 hours following clopidogrel administration, the rate of non-responsiveness was 60%; by one day the number was 33%, and by one month the number was 15%. Thus, non-responsiveness may vary depending upon the degree of activation of the platelets themselves. As the platelets become less activated following an acute coronary syndrome episode, the rate of non-responsiveness may be lower. This variability in platelet activation and variability in non-responsiveness raises important questions regarding the potential differences in the optimal acute dose and the optimal chronic dose of clopidogrel and other thienopyridines.

==Incidence of Clopidogrel Resistance==
The incidence of clopidogrel resistance varies significantly from 5% to 44%. The incidence varies depending upon

#The definition of clopidogrel resistance
#The timing of assessing clopidogrel resistance in relation to an acute coronary syndrome episode
#There may be [[circadian rhythm]] to platelet aggregation
 
 

{| class="wikitable" border="1"
|+ Clopidogrel Resistance: World Experience 
''(Courtesy of Paul Gurbel MD)''
! Investigators !! n !! Patients !! Clopidogrel Dose (mg Load) !! Resistance
|-
|Jaremo ''et al.'' <ref name="pmid12270003">{{cite journal |author=Järemo P, Lindahl TL, Fransson SG, Richter A |title=Individual variations of platelet inhibition after loading doses of clopidogrel |journal=J. Intern. Med. |volume=252 |issue=3 |pages=233–8 |year=2002 |month=September |pmid=12270003 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0954-6820&date=2002&volume=252&issue=3&spage=233}}</ref>
|| 18
|| PCI
|| 300
||28%
|-
|Gurbel ''et al.''<ref name="pmid12796140">{{cite journal |author=Gurbel PA, Bliden KP, Hiatt BL, O'Connor CM |title=Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity |journal=Circulation |volume=107 |issue=23 |pages=2908–13 |year=2003 |month=June |pmid=12796140 |doi=10.1161/01.CIR.0000072771.11429.83 |url=}}</ref>
|| 92
|| PCI
|| 300
|| 31%
|-
|Muller ''et al.'' <ref name="pmid12719773">{{cite journal |author=Müller I, Besta F, Schulz C, Massberg S, Schönig A, Gawaz M |title=Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement |journal=Thromb. Haemost. |volume=89 |issue=5 |pages=783–7 |year=2003 |month=May |pmid=12719773 |doi=10.1267/THRO03050783 |url=}}</ref>
|| 105
|| PCI
|| ''600''
||''5-11%''
|-
|Mobley ''et al.''<ref name="pmid14969622">{{cite journal |author=Mobley JE, Bresee SJ, Wortham DC, Craft RM, Snider CC, Carroll RC |title=Frequency of nonresponse antiplatelet activity of clopidogrel during pretreatment for cardiac catheterization |journal=Am. J. Cardiol. |volume=93 |issue=4 |pages=456–8 |year=2004 |month=February |pmid=14969622 |doi=10.1016/j.amjcard.2003.10.042 |url=}}</ref>
|| 50
|| PCI
|| 300
|| 30%
|-
|Lepantalo ''et al.''<ref name="pmid15039127">{{cite journal |author=Lepäntalo A, Virtanen KS, Heikkilä J, Wartiovaara U, Lassila R |title=Limited early antiplatelet effect of 300 mg clopidogrel in patients with aspirin therapy undergoing percutaneous coronary interventions |journal=Eur. Heart J. |volume=25 |issue=6 |pages=476–83 |year=2004 |month=March |pmid=15039127 |doi=10.1016/j.ehj.2003.12.016 |url=}}</ref>
|| 50
|| PCI
|| 300
|| 40%
|-
|Angiolillo ''et al.''<ref name="pmid15567460">{{cite journal |author=Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, ''et al'' |title=Identification of low responders to a 300-mg clopidogrel loading dose in patients undergoing coronary stenting |journal=Thromb. Res. |volume=115 |issue=1-2 |pages=101–8 |year=2005 |pmid=15567460 |doi=10.1016/j.thromres.2004.07.007 |url=}}</ref>
|| 48
|| PCI
|| 300
|| 44%
|-
|Matetzky ''et al.''<ref name="pmid15184279">{{cite journal |author=Matetzky S, Shenkman B, Guetta V, ''et al'' |title=Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction |journal=Circulation |volume=109 |issue=25 |pages=3171–5 |year=2004 |month=June |pmid=15184279 |doi=10.1161/01.CIR.0000130846.46168.03 |url=}}</ref>
|| 60
|| PCI
|| 300
|| 25%
|-
|Dziewierz ''et al.''<ref name="pmid15815794">{{cite journal |author=Dziewierz A, Dudek D, Heba G, Rakowski T, Mielecki W, Dubiel JS |title=Inter-individual variability in response to clopidogrel in patients with coronary artery disease |journal=Kardiol Pol |volume=62 |issue=2 |pages=108–17; discussion 118 |year=2005 |month=February |pmid=15815794 |doi= |url=http://www.kardiologiapolska.pl/archieve.php?vol=62&iss=2&pg=108&lang=en}}</ref>
|| 31
|| Stable angina
|| 300
|| 23%
|-
|Gurbel ''et al.''<ref name="pmid15862408">{{cite journal |author=Gurbel PA, Bliden KP, Hayes KM, Yoho JA, Herzog WR, Tantry US |title=The relation of dosing to clopidogrel responsiveness and the incidence of high post-treatment platelet aggregation in patients undergoing coronary stenting |journal=J. Am. Coll. Cardiol. |volume=45 |issue=9 |pages=1392–6 |year=2005 |month=May |pmid=15862408 |doi=10.1016/j.jacc.2005.01.030 |url=}}</ref>
|| 190
|| PCI
|| 300/''600''
|| ''8''-32%
|-
|Lev ''et al.''<ref name="pmid16386660">{{cite journal |author=Lev EI, Patel RT, Maresh KJ, ''et al'' |title=Aspirin and clopidogrel drug response in patients undergoing percutaneous coronary intervention: the role of dual drug resistance |journal=J. Am. Coll. Cardiol. |volume=47 |issue=1 |pages=27–33 |year=2006 |month=January |pmid=16386660 |doi=10.1016/j.jacc.2005.08.058 |url=}}</ref>
|| 150
|| PCI
|| 300
|| 24%
|-
| '''Total'''
|| '''794'''
|
|
||'''5-44%'''
|-
|}
 
 

==Association of Clopidogrel Non-Responsiveness with Adverse Clinical Outcomes==

There are a large number of studies associating clopidogrel non-responsiveness with adverse outcomes:

{| class="wikitable" border="1"
|+ Studies Linking Ex-Vivo Platelet Function to Clinical Events 
''(Courtesy of Paul Gurbel MD)''
! Study !! Results !! Clinical Relevance
|-
| Barragan ''et al.'' <ref name="pmid12822144">{{cite journal |author=Barragan P, Bouvier JL, Roquebert PO, ''et al'' |title=Resistance to thienopyridines: clinical detection of coronary stent thrombosis by monitoring of vasodilator-stimulated phosphoprotein phosphorylation |journal=Catheter Cardiovasc Interv |volume=59 |issue=3 |pages=295–302 |year=2003 |month=July |pmid=12822144 |doi=10.1002/ccd.10497 |url=}}</ref>
|| ↑ P2Y12 reactivity ratio (VASP-P levels) || Stent Thrombosis
|-
| Ajzenberg ''et al.''<ref name="pmid15936600">{{cite journal |author=Ajzenberg N, Aubry P, Huisse MG, ''et al'' |title=Enhanced shear-induced platelet aggregation in patients who experience subacute stent thrombosis: a case-control study |journal=J. Am. Coll. Cardiol. |volume=45 |issue=11 |pages=1753–6 |year=2005 |month=June |pmid=15936600 |doi=10.1016/j.jacc.2004.10.079 |url=}}</ref>
||↑ Shear- Induced platelet aggregation
||Stent Thrombosis
|-
| Gurbel ''et al.''
 (CREST study)<ref name="pmid16286166">{{cite journal |author=Gurbel PA, Bliden KP, Samara W, ''et al'' |title=Clopidogrel effect on platelet reactivity in patients with stent thrombosis: results of the CREST Study |journal=J. Am. Coll. Cardiol. |volume=46 |issue=10 |pages=1827–32 |year=2005 |month=November |pmid=16286166 |doi=10.1016/j.jacc.2005.07.056 |url=}}</ref>
||↑ADP- induced aggregation 
↑Stimulated GPIIb/IIIa expression
|| Stent Thrombosis
|-
| Matetzky ''et al.''<ref name="pmid15184279">{{cite journal |author=Matetzky S, Shenkman B, Guetta V, ''et al'' |title=Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction |journal=Circulation |volume=109 |issue=25 |pages=3171–5 |year=2004 |month=June |pmid=15184279 |doi=10.1161/01.CIR.0000130846.46168.03 |url=}}</ref>
||↑ ADP-Induced platelet aggregation
|| Recurrent Cardiac Events (4th quartile)
|-
| Gurbel ''et al.''
(CLEAR PLATELETS<ref name="pmid15738352">{{cite journal |author=Gurbel PA, Bliden KP, Zaman KA, Yoho JA, Hayes KM, Tantry US |title=Clopidogrel loading with eptifibatide to arrest the reactivity of platelets: results of the Clopidogrel Loading With Eptifibatide to Arrest the Reactivity of Platelets (CLEAR PLATELETS) study |journal=Circulation |volume=111 |issue=9 |pages=1153–9 |year=2005 |month=March |pmid=15738352 |doi=10.1161/01.CIR.0000157138.02645.11 |url=}}</ref> and CLEAR PLATELETS Ib<ref name="pmid17161243">{{cite journal |author=Gurbel PA, Bliden KP, Tantry US |title=Effect of clopidogrel with and without eptifibatide on tumor necrosis factor-alpha and C-reactive protein release after elective stenting: results from the CLEAR PLATELETS 1b study |journal=J. Am. Coll. Cardiol. |volume=48 |issue=11 |pages=2186–91 |year=2006 |month=December |pmid=17161243 |doi=10.1016/j.jacc.2005.12.084 |url=}}</ref>) 
||↑ Periprocedural platelet aggregation
||Myonecrosis and Inflammation Marker Release
|-
| Bliden ''et al.''<ref name="pmid17291930">{{cite journal |author=Bliden KP, DiChiara J, Tantry US, Bassi AK, Chaganti SK, Gurbel PA |title=Increased risk in patients with high platelet aggregation receiving chronic clopidogrel therapy undergoing percutaneous coronary intervention: is the current antiplatelet therapy adequate? |journal=J. Am. Coll. Cardiol. |volume=49 |issue=6 |pages=657–66 |year=2007 |month=February |pmid=17291930 |doi=10.1016/j.jacc.2006.10.050 |url=}}</ref>
||↑ Platelet aggregation (pre-PCI) on chronic clopidogrel
||1 yr Post-PCI Events
|-
| Cuisset ''et al.''<ref name="pmid16371119">{{cite journal |author=Cuisset T, Frere C, Quilici J, ''et al'' |title=High post-treatment platelet reactivity identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascular events after stenting for acute coronary syndrome |journal=J. Thromb. Haemost. |volume=4 |issue=3 |pages=542–9 |year=2006 |month=March |pmid=16371119 |doi=10.1111/j.1538-7836.2005.01751.x |url=}}</ref>
||↑ Platelet aggregation
|| 30-day Post-PCI events
|-
| Lev et al.<ref name="pmid16386660">{{cite journal |author=Lev EI, Patel RT, Maresh KJ, ''et al'' |title=Aspirin and clopidogrel drug response in patients undergoing percutaneous coronary intervention: the role of dual drug resistance |journal=J. Am. Coll. Cardiol. |volume=47 |issue=1 |pages=27–33 |year=2006 |month=January |pmid=16386660 |doi=10.1016/j.jacc.2005.08.058 |url=}}</ref>
|| Clopidogrel/Aspirin resistant patients
||Post-PCI Myonecrosis
|-
| Cuisset ''et al.''<ref name="pmid17010792">{{cite journal |author=Cuisset T, Frere C, Quilici J, ''et al'' |title=Benefit of a 600-mg loading dose of clopidogrel on platelet reactivity and clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing coronary stenting |journal=J. Am. Coll. Cardiol. |volume=48 |issue=7 |pages=1339–45 |year=2006 |month=October |pmid=17010792 |doi=10.1016/j.jacc.2006.06.049 |url=}}</ref>
||↑ Platelet aggregation
|| 30-day Post-PCI events, 600mg - less events
|-
| Hochholzer ''et al.''<ref name="pmid17084243">{{cite journal |author=Hochholzer W, Trenk D, Bestehorn HP, ''et al'' |title=Impact of the degree of peri-interventional platelet inhibition after loading with clopidogrel on early clinical outcome of elective coronary stent placement |journal=J. Am. Coll. Cardiol. |volume=48 |issue=9 |pages=1742–50 |year=2006 |month=November |pmid=17084243 |doi=10.1016/j.jacc.2006.06.065 |url=}}</ref>
||↑ Platelet aggregation (Upper quartile)
|| 30 day MACE
|}

Despite these associations of clopidogrel hyporesponsiveness with adverse outcomes, there is no large scale data suggesting that acting upon test results and modifying therapy based upon test results is associated with improved outcomes. It is important to ascertain if the patient has been compliant with the medication before declaring that the patient is a clopidogrel non-responder.

==Is there a Threshold Effect to Efficacy or are Clinical Outcomes Improved with Higher and Higher Doses (a Continuous Relationship to Clinical Outcomes)==

One unresolved question is whether there is a “threshold effect” whereby clinical outcomes are not further improved above a certain level of platelet inhibition, or alternatively whether clinical outcomes are further improved with higher and higher doses in which case there is a “continuous variable” relationship between platelet inhibition and clinical outcomes. Data supporting a potential threshold effect comes from Gurbel et al. <ref>Gurbel P, et al. J Am Coll Cardiol. 2005;46(10):1827-1832 </ref> <ref>Gurbel P, et al. J Am Coll Cardiol. 2005;46(10):1820-1826 </ref>When data regarding the relationship between stent thrombosis and clinical outcomes was plotted as a cumulative distribution function rather than a bell curve, it was noted that stent thrombosis was infrequent above 40-50% inhibition.

==Mechanisms Underlying Clopidogrel Resistance==

There are multpiple mechanisms underlying clopidogrel resistance:
<ref> Angiolillio DJ et al. J Am Coll Cardiol. 2007;49:1505-1516</ref>

===Clinical Factors===
*Poor patient compliance
*Under-dosing: Some patients may alter the dosing to take the drug every other day
*Poor absorption
*The presence of an [[acute coronary syndrome]] and increased platelet activation
*Co-morbidities such as [[diabetes]] mellitus that is known to be assoicated with heightened platelet activation <ref> Angiolillo DJ et al. Diabetes. 2005;54:2430-2435. </ref>
*Elevated body mass index
*Elevated platelet count

===Cellular Factors===
*Accelerated platelet turnover
*Reduced CYP3A metabolic activity
*Increased ADP exposure
*Up-regulation of the P2Y12 pathway
*Up-regulation of the P2Y1 pathway
*Up-regulation of the P2Y–independent pathways (collagen, epinephrine, thomboxane A2, thrombin)

===Genetic Basis===

Clopidogrel is a pro-drug. When it appears in the bloodstream following absorption, it is not in the active form. This inactive metabolite or pro-drug must circulate to the liver to be metabolized and converted to the active metabolite (there appear to be 4 active isomers). Genetic polymorphisms that have been related to variability in clopidogrel metabolism include:

*Polymorphisms of CYP
*Polymorphisms of GPIa
*Polymorphisms of P2Y12
*Polymorphisms of GPIIIa

Variability in the function of the CYP 2C19 allele has been postulated to be related to the ability to metabolize clopidogrel. <ref name="pmid19106084">{{cite journal |author=Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT, Walker JR, Antman EM, Macias W, Braunwald E, Sabatine MS |title=Cytochrome p-450 polymorphisms and response to clopidogrel |journal=The New England Journal of Medicine |volume=360 |issue=4 |pages=354–62 |year=2009 |month=January |pmid=19106084 |doi=10.1056/NEJMoa0809171 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19106084&promo=ONFLNS19 |accessdate=2009-04-28}}</ref>

The three individual alleles and their relative ability to metabolize clopidogrel are as follows:
*<nowiki>*17</nowiki> hypermetabolizer allele
*<nowiki>*1</nowiki> normal metabolizer allele
*<nowiki>*2</nowiki> poor metabolizer allele, genetic functional variant 681 G>A

Based upon the combinations (pairs) of these three alleles, four types of metabolizers have been identified based upon the ability of the patients to generate active metabolite and pharmacodynamics:
*'''Ultra-metabolizers (UM):''' (30% of patients)
:<nowiki>*1 / *17</nowiki> allele
:<nowiki>*17 / *17</nowiki> allele

*'''Extensive metabolizers (EM):''' (36% of patients)
: <nowiki>*1 / *1</nowiki> allele

*'''Intermediate metabolizers (IM):''' (29% of patients)
: <nowiki>*1 / *2</nowiki> allele

*'''Poor metabolizers (PM):''' (5% of patients)
: <nowiki>*2 / *2</nowiki> allele

It should be noted that the active metabolites of clopidogrel and prasugrel are equally potent, <ref> Sugidachi A et al. J Thromb Haemos. 2007;5:1545-1551</ref> and that differences in pharmacodynamic and clinical outcomes are due to differences in the generation of active metabolite rather than potency of the active metabolite. Carriers of the allele (those patients with a least one copy of the *2 allele) had a higher 450 day event rate (12.1%) versus those patients with no copies of the allele (an 8.0% event rate, HR 1.53, p=0.014).

<ref name="pmid19108880">{{cite journal |author=Collet JP, Hulot JS, Pena A, Villard E, Esteve JB, Silvain J, Payot L, Brugier D, Cayla G, Beygui F, Bensimon G, Funck-Brentano C, Montalescot G |title=Cytochrome P450 2C19 polymorphism in young patients treated with clopidogrel after myocardial infarction: a cohort study |journal=Lancet |volume=373 |issue=9660 |pages=309–17 |year=2009 |month=January |pmid=19108880 |doi=10.1016/S0140-6736(08)61845-0 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)61845-0 |accessdate=2009-04-28}}</ref>

In a similar but slightly different finding, Simon et al have demonstrated that it was only those patients who carried two copies of the *2 allele (*2 / *2) and not just one copy (*1 / *2) who had a higher risk of adverse events (death, MI, stroke).<ref name="pmid19106083">{{cite journal |author=Simon T, Verstuyft C, Mary-Krause M, Quteineh L, Drouet E, Méneveau N, Steg PG, Ferrières J, Danchin N, Becquemont L |title=Genetic determinants of response to clopidogrel and cardiovascular events |journal=The New England Journal of Medicine |volume=360 |issue=4 |pages=363–75 |year=2009 |month=January |pmid=19106083 |doi=10.1056/NEJMoa0808227 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19106083&promo=ONFLNS19 |accessdate=2009-04-28}}</ref>

In a third study, Collet et al demonstrated that among 259 young survivors of a first myocardial infarction who were treated with chronic clopidogrel, death, MI, and urgent revascularization occurred more often in carriers (*2 / *2 or *1 / *2) than in non-carriers (*1 / *1)(HR = 3.69 [95% CI 1.69-8.05], p=0.0005), as did stent thrombosis (HR = 6.02 [1.81-20.04], p=0.0009). <ref name="pmid19108880">{{cite journal |author=Collet JP, Hulot JS, Pena A, Villard E, Esteve JB, Silvain J, Payot L, Brugier D, Cayla G, Beygui F, Bensimon G, Funck-Brentano C, Montalescot G |title=Cytochrome P450 2C19 polymorphism in young patients treated with clopidogrel after myocardial infarction: a cohort study |journal=Lancet |volume=373 |issue=9660 |pages=309–17 |year=2009 |month=January |pmid=19108880 |doi=10.1016/S0140-6736(08)61845-0 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)61845-0 |accessdate=2009-04-28}}</ref> These findings were true in a multivariate model of potential confounders.

Although both [[prasugrel]] and [[clopidogrel]] require cytochrome P450 (CYP) enzymes for activation, a substudy of 1,466 patients enrolled in the TRITON-TIMI 38 study found that CYP variations did not affect:

*Levels of prasugrel's active metabolite

*Prasugrel's inhibition of platelet aggregation, or

*Clinical cardiovascular event rates in persons treated with prasugrel <ref name="urlCytochrome P450 Genetic Polymorphisms and the Response to Prasugrel. Relationship to Pharmacokinetic, Pharmacodynamic, and Clinical Outcomes -- Mega et al., 10.1161/CIRCULATIONAHA.109.851949 -- Circulation">{{cite web|url=http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.109.851949v1 |title=Cytochrome P450 Genetic Polymorphisms and the Response to Prasugrel. Relationship to Pharmacokinetic, Pharmacodynamic, and Clinical Outcomes -- Mega et al., 10.1161/CIRCULATIONAHA.109.851949 -- Circulation |format= |work= |accessdate=}}</ref>

===Inhibition of Metabolism by Co-Ingestion of Other Drugs===

====Statins====

Statins have been found to interfere with the generation of clopidogrel’s active metabolite. <ref name="pmid12515739">{{cite journal |author=Lau WC, Waskell LA, Watkins PB, Neer CJ, Horowitz K, Hopp AS, Tait AR, Carville DG, Guyer KE, Bates ER |title=Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: a new drug-drug interaction |journal=Circulation |volume=107 |issue=1 |pages=32–7 |year=2003 |month=January |pmid=12515739 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12515739 |accessdate=2009-04-28}}</ref> <ref name="pmid14707025">{{cite journal |author=Lau WC, Gurbel PA, Watkins PB, Neer CJ, Hopp AS, Carville DG, Guyer KE, Tait AR, Bates ER |title=Contribution of hepatic cytochrome P450 3A4 metabolic activity to the phenomenon of clopidogrel resistance |journal=Circulation |volume=109 |issue=2 |pages=166–71 |year=2004 |month=January |pmid=14707025 |doi=10.1161/01.CIR.0000112378.09325.F9 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14707025 |accessdate=2009-04-28}}</ref> <ref name="pmid15302813">{{cite journal |author=Lau WC, Carville DG, Bates ER |title=Clinical significance of the atorvastatin-clopidogrel drug-drug interaction |journal=Circulation |volume=110 |issue=6 |pages=e66–7; author reply e66–7 |year=2004 |month=August |pmid=15302813 |doi=10.1161/01.CIR.0000137956.92971.4A |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15302813 |accessdate=2009-04-28}}</ref> One statin that does not interfere with clopidogrel metabolism is [[pravastatin]]. Non-randomized data from clinical trials have not confirmed a higher risk of adverse outcomes among patients co-ingesting statins in addition to clopidogrel versus those treated with clopidogrel alone. It is possible that the higher loading dose of 600 mg used in current clinical pracitce overcomes this interference.

====Omeprazole and Proton Pump Inhibitors====

Omeprazole induces a conformational change in the CYP enzyme system and may alter the metabolism of clopidogrel. In a double-blind placebo-controlled trial, stented patients treated with clopidogrel were randomized to treatment with either omeprazole (20 mg/day) or placebo. Following 7 days of treatment, the residual platelet aggregation was significantly hgiher in the omeprazole group (p < 0.0001). <ref name="pmid18206732">{{cite journal |author=Gilard M, Arnaud B, Cornily JC, Le Gal G, Lacut K, Le Calvez G, Mansourati J, Mottier D, Abgrall JF, Boschat J |title=Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the randomized, double-blind OCLA (Omeprazole CLopidogrel Aspirin) study |journal=Journal of the American College of Cardiology |volume=51 |issue=3 |pages=256–60 |year=2008 |month=January |pmid=18206732 |doi=10.1016/j.jacc.2007.06.064 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)03433-X |accessdate=2009-04-28}}</ref> The clinical impact of this finding and whether this inhibition can be overcome with a higher dose of clopidogrel is not clear.

There have been non-randomized retrospective analyses of the clinical outcomes among patients treated with omeprazole vs no omeprazole. <ref>Aubert RE et al. Circulation. 2008;118:S_815.</ref> <ref name="pmid19258584">{{cite journal |author=Ho PM, Maddox TM, Wang L, Fihn SD, Jesse RL, Peterson ED, Rumsfeld JS |title=Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome |journal=JAMA : the Journal of the American Medical Association |volume=301 |issue=9 |pages=937–44 |year=2009 |month=March |pmid=19258584 |doi=10.1001/jama.2009.261 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=19258584 |accessdate=2009-04-28}}</ref> <ref> Dunn SP et al. Circulation. 2008;118:S_815 </ref> However, these non-randomized analyses are very confounded by the fact that patients treated with omeprazole are more often diabetics, had undergone CABG, had a history of cerebrovascular disease and peripheral arterial disease, had previously been on clopidogrel, and more often had renal disease. <ref name="pmid19258584">{{cite journal |author=Ho PM, Maddox TM, Wang L, Fihn SD, Jesse RL, Peterson ED, Rumsfeld JS |title=Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome |journal=JAMA : the Journal of the American Medical Association |volume=301 |issue=9 |pages=937–44 |year=2009 |month=March |pmid=19258584 |doi=10.1001/jama.2009.261 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=19258584 |accessdate=2009-04-28}}</ref> Indeed, it is notable that among patients not treated with clopidogrel, treatment with a proton pump inhibitor (PPI) was associated with a 1.6 fold higher event rate in CREDO despite multivariate adjustment for confounders <ref> Dunn SP et al. Circulation. 2008;118:S_815 </ref> This points to the potential role of unidentified confounders in the association of PPIs with clinical outcomes.

Pantoprazole and esomeprazole are not associated with a phramcodynamic or clinical effect in non-randomized analyses <ref> Sibbing D et al. Thromb Haemost. 2009;101:714-719 </ref>

==Gold Standard Tests of Clopidogrel Responsiveness==

'''Light transmittance aggregometry (LTA):''' This is a laboratory based study that evaluates the aggregation or clumping of [[platelets]] in response to aggregating stimuli. For historical reasons, it is broadly accepted as the gold standard in-vitro test of platelet function. The most immediate information for basic diagnostic considerations is obtained by using agents such as [[adenosine diphosphate]] (ADP), [[epinephrine]] and [[collagen]]. Both ADP and epinephrine are contained in storages [[organelles]] within the platelets and are released during formation of the primary hemostatic plug thus enhancing further platelet aggregation. Conversely, collagen is found in the supporting connective tissue of the vessels and is considered to be the first proagulant factor that the platelet encounters following vessel’s injury. Other reagents such as arachidonic acid, [[ristocetin]], [[serotonin]], [[calcium]] and [[Factor VIII]] are also used to study platelet response for more specific purposes. Different aggregating agents stimulate alternative pathways of activation in the platelets and different concentrations of the same [[agonist]] are often used to elicit dose-dependent response.

Aside from the detection and diagnosis of acquired or congenital qualitative platelet defects, LTA has an important role to reveal patterns of [[GPIIb/IIIa]]-dependent platelet-to-platelet aggregation in response to specific agonists (e.g. [[arachidonic acid]] to assess [[aspirin]] response; ADP to test [[thienopyridines]] response).
The chambers of a typical aggregometer are designed so that a beam of infrared light shines through two cuvettes. One of these contains the sample, namely a suspension of platelet rich plasma (PRP) obtained by a relatively low centrifugal force [[centrifugation]]. The other cuvette contains a reference sample of platelet poor plasma (PPP) obtained by centrifuging the blood sample at a relatively high force. [[Silicon]] photodiodes detect the light able to pass through the samples, with PRP arbitrarily considered to be 0% light transmission (or 0% aggregation) and PPP considered to be 100% light transmission (or 100% aggregation). The optical aggregation output is proportional to the continuously measured difference in light transmission between the PRP and PPP samples. Following the addition of a stimulus to the cuvette containing PRP, changes in light transmission occur as a consequence of platelet response and are recorded over time. In fact, the larger size of activated platelet allows less light to pass through the PRP: this is recorded as less light transmission relative to the PPP. Conversely, when platelets form aggregates, more light is able to pass through the test sample.
Aggregation recordings are curves characterized by several features:
#Shape changes;
#A first wave of aggregation that may reverse (primary aggregation);
#A second wave of aggregation that occurs when the granule contents become the stimulus and lead to further aggregation;
#Maximum amount of change in light transmission caused by the stimulus (percent aggregation);
#Late amount of aggregation recorded after a certain timeframe;
#Slope of the aggregation, or percentage of aggregation per minute.
Designed as a measure of defective [[platelet]] function, the main disadvantage of LTA is that the test is time-consuming, expensive, weakly standardized and need to be performed in specialized lab by specialized personnel. Additionally, several procedural variables may account for poor reproducibility.

'''Vasodilator-Stimulated Phosphoprotein (VASP)''' The phosphorylation (P) of vasodilator-stimulated phosphoprotein (VASP) is a test based on flow cytometry which is very specific to the P2Y12 signaling pathway. It is commercially available as a kit marketed as PLT VASP/P2Y12 (BioCytex, Marseilles, France).
VASP is an intracellular platelet protein that is not phosphorilated at baseline. VASP-P is mediated by the cAMP cascade, which is enhanced by prostaglandin E1 (PGE1) and inhibited by the link between ADP and P2Y12 receptors. Therefore, VASP-P is a marker of P2Y12 receptor inhibition, whereas its non-phosphorylated counterpart correlates with the non-inhibited form of the P2Y12 receptor.
By using the PLT VASP/P2Y12 kit, the effect of clopidogrel can be demonstrated by the persistence of VASP in its phosphorylated state (VASP-P) induced by PGE1 despite the simultaneous addition of ADP.
More in detail, the blood sample is first incubated with PGE1 alone or PGE1 + ADP. Subsequently, after a cellular permeabilization, VASP-P is labeled by indirect no wash immunofluorescence using a specific monoclonal antibody. The two tested conditions are then evaluated by means of dual color flow cytometry analysis. Final results are usually expressed in terms of platelet reactivity index (PRI), which is calculated using corrected mean fluorescence intensities (MFIc) in the presence of PGE1 alone or PGE1 and ADP simultaneously, according to the following formula:

PRI = [(MFIcPGE1 - MFIc PGE1+ADP)/ MFIcPGE1]x100

Assessment of VASP-P requires a low sample volume and is performed on whole blood. Another advantage is the opportunity to ship blood samples at room temperature to a central core laboratory. Ultimately, it correlates well with light transmittance aggregometry and VerifyNow technologies. However, sample preparation is time consuming and the reliability of the results is highly dependent from the presence of a skilled technician. Also, a flow cytometer is required.

==Point of Care Devices==

===VerifyNow===
The VerifyNow system (Accumetrics, San Diego, Ca, USA; [http://www.accumetrics.com]) is a bedside test that allows for monitoring of the efficacy of [[thienopyridine]]s, [[aspirin]], and [[glycoprotein IIbIIIa inhibitors]].
Formerly known as the Ultegra rapid platelet function analyzer, the VerifyNow system is a turbidimetric based optical detection system which measures [[platelet induced aggregation]] as an increase in light transmittance.
This system is a point-of-care and consists of an instrument, a disposable assay device and controls. The assay device contains a lyophilized preparation of human [[fibrinogen]]-coated beads, [[platelet]] [[agonist]], [[preservative]] and [[buffer]].
Three assays are currently available, which differ according to the platelet agonist contained in the mixing chamber:

{| class="wikitable" cellspacing="0" cellpadding="0" border="1"
! Assay device !! Platelet agonist !! Drug(s) of interest
|-
| VerifyNow GP IIb/IIIa
| Thombin receptor-activating peptide (TRAP) [iso-TRAP]
| [[Abciximab]], [[eptifibatide]], [[tirofiban]]
|-
| VerifyNow Aspirin
| [[Arachidonic acid]]
| [[Aspirin]]
|-
| VerifyNow P2Y12
| [[Adenosine diphosphate]]
| | [[Clopidogrel]], [[prasugrel]]
|}

After activation, the GP IIb/IIIa receptors on platelets will bind to the [[fibrinogen]]-coated microbeads and cross link to other microbeads resulting in a clearing of the beads and platelets within the detection well. The instrument uses light transmittance to measure the rate at which this clearing occurs.
The main advantage of this test is that the patient sample is a low sample volume of 3.2% citrated whole blood, which is automatically dispensed from the [[blood]] collection tube into the assay device by the instrument, with no blood handling required by the user. Another advantage is that the instrument provides the results in minutes.

===Platelet Function Analyzer (PFA-100)===

The Platelet Function Analyzer-100(PFA-100, Siemens Healthcare Diagnostics, Inc., Deerfield, IL) is a test based on the principle of shear-induced [[aggregation]]. Although it is not a COX-1specific [[assay]], it allows monitoring of [[aspirin]] effects by providing a quantitative measure of platelet-related [[hemostasis]] in anticoagulated whole [[blood]].

The system comprises a microprocessor-controlled tool and a disposable test cartridge containing a biologically active [[nitrocellulose]] membrane. To perform the test, 0.8 ml of [[citrated]] whole blood is transferred into the reservoir of the cartridge within 4 h of blood sampling. After warming the anticoagulated blood to 37 °C, the instrument aspirates a [[blood]] sample under vacuum from the reservoir through a 200 μm diameter stainless steel capillary and a 150 μm aperture cut into the membrane, which is coated with [[collagen]] and [[epinephrine]] (CEPI) or [[collagen]] and [[ADP]] (CADP).

The presence of these biochemical stimuli, and the high shear rates of 5000–6000 s−1 generated under the standardized flow conditions, result in platelet aggregate forms that block the aperture of the membrane. The time required to obtain full occlusion of the aperture is reported as the closure time (CT).

Prolonged CT with only the CEPI cartridge is observed with mild inherited platelet function disorders and with aspirin ingestion, while prolonged CTs with both CEPI and CADP cartridges are associated with more severe inherited platelet dysfunctions.
An advantage of the PFA-100 application as a [[platelet]] function assay is that it is a rapid, accurate, simple, and reproducible test that requires only a small volume of blood. It cannot be considered as a point of care as minimal pipetting is required to use this test. One of its major disadvantages is that it is poorly sensitive in detecting effects of [[thienopyridines]] and therefore should not be used for this purpose. Newer generation assays are currently under development to assess thienopyridine effects.

==Clinical Utility of Point of Care Testing Versus Genetic Testing==

In so far as point of care testing results are more readily available, these may be a more suitable choice for use in clinical practice as compared to genetic testing. Furthermore, there may be mechanisms other than variability in metabolism that account for differences in response to clopidogrel which are assessed by point of care tests and not by genetic testing.

==Strategies to Overcome Clopidogrel Non-Responsiveness==
Due to the severity of its consequences, how to manage suboptimal [[clopidogrel]] response is a major clinical problem. The most important aspect is to guarantee patient compliance. The second aspect to evaluate is any potential drug-drug interactions. Studies are currently ongoing with the goal to better elucidate the interaction between clopidogrel and [[PPI]]s. The following strategies can be proposed to overcome inadequate clopidogrel responsiveness:
#increase clopidogrel dosing
#triple antiplatelet therapy
#using a different P2Y12 antiplatelet agent.

===Increase [[clopidogrel]] dosing===
Several studies have shown that a high clopidogrel [[loading dose]] regimen (≥ 600 mg) achieves more potent platelet inhibition when compared to a standard 300 mg loading dose<ref name="pmid16260639">{{cite journal |author=von Beckerath N, Taubert D, Pogatsa-Murray G, Schömig E, Kastrati A, Schömig A |title=Absorption, metabolization, and antiplatelet effects of 300-, 600-, and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) Trial |journal=Circulation |volume=112 |issue=19 |pages=2946–50 |year=2005 |month=November |pmid=16260639 |doi=10.1161/CIRCULATIONAHA.105.559088 |url=}}</ref><ref name="pmid15522469">{{cite journal |author=Angiolillo DJ, Fernández-Ortiz A, Bernardo E, ''et al'' |title=High clopidogrel loading dose during coronary stenting: effects on drug response and interindividual variability |journal=Eur. Heart J. |volume=25 |issue=21 |pages=1903–10 |year=2004 |month=November |pmid=15522469 |doi=10.1016/j.ehj.2004.07.036 |url=}}</ref><ref name="pmid16949482">{{cite journal |author=Montalescot G, Sideris G, Meuleman C, ''et al'' |title=A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial |journal=J. Am. Coll. Cardiol. |volume=48 |issue=5 |pages=931–8 |year=2006 |month=September |pmid=16949482 |doi=10.1016/j.jacc.2006.04.090 |url=}}</ref><ref>{{cite journal |author=Gurbel PA, Bliden KP, Hayes KM, Yoho JA, Herzog WR, Tantry US |title=The relation of dosing to clopidogrel responsiveness and the incidence of high post-treatment platelet aggregation in patients undergoing coronary stenting |journal=J. Am. Coll. Cardiol. |volume=45 |issue=9 |pages=1392–6 |year=2005 |month=May |pmid=15862408 |doi=10.1016/j.jacc.2005.01.030 |url=}}</ref>. This has also been associated with better clinical outcomes in patients undergoing [[PCI]] <ref name="pmid15750189">{{cite journal |author=Patti G, Colonna G, Pasceri V, Pepe LL, Montinaro A, Di Sciascio G |title=Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study |journal=Circulation |volume=111 |issue=16 |pages=2099–106 |year=2005 |month=April |pmid=15750189 |doi=10.1161/01.CIR.0000161383.06692.D4 |url=}}</ref><ref name="pmid18993148">{{cite journal |author=Bonello L, Lemesle G, De Labriolle A, ''et al'' |title=Impact of a 600-mg loading dose of clopidogrel on 30-day outcome in unselected patients undergoing percutaneous coronary intervention |journal=Am. J. Cardiol. |volume=102 |issue=10 |pages=1318–22 |year=2008 |month=November |pmid=18993148 |doi=10.1016/j.amjcard.2008.07.007 |url=}}</ref><ref name="pmid17010792">{{cite journal |author=Cuisset T, Frere C, Quilici J, ''et al'' |title=Benefit of a 600-mg loading dose of clopidogrel on platelet reactivity and clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing coronary stenting |journal=J. Am. Coll. Cardiol. |volume=48 |issue=7 |pages=1339–45 |year=2006 |month=October |pmid=17010792 |doi=10.1016/j.jacc.2006.06.049 |url=}}</ref>. ]. A high maintenance dose (150 mg/day) dose regimen of clopidogrel has found to be associated with enhanced platelet inhibition compared to the currently recommended 75 mg/day <ref name="pmid18217149">{{cite journal |author=Angiolillo DJ, Bernardo E, Palazuelos J, ''et al'' |title=Functional impact of high clopidogrel maintenance dosing in patients undergoing elective percutaneous coronary interventions. Results of a randomized study |journal=Thromb. Haemost. |volume=99 |issue=1 |pages=161–8 |year=2008 |month=January |pmid=18217149 |doi=10.1160/TH07-09-0562 |url=}}</ref><ref name="pmid17261652">{{cite journal |author=Angiolillo DJ, Shoemaker SB, Desai B, ''et al'' |title=Randomized comparison of a high clopidogrel maintenance dose in patients with diabetes mellitus and coronary artery disease: results of the Optimizing Antiplatelet Therapy in Diabetes Mellitus (OPTIMUS) study |journal=Circulation |volume=115 |issue=6 |pages=708–16 |year=2007 |month=February |pmid=17261652 |doi=10.1161/CIRCULATIONAHA.106.667741 |url=}}</ref><ref name="pmid17272357">{{cite journal |author=von Beckerath N, Kastrati A, Wieczorek A, ''et al'' |title=A double-blind, randomized study on platelet aggregation in patients treated with a daily dose of 150 or 75 mg of clopidogrel for 30 days |journal=Eur. Heart J. |volume=28 |issue=15 |pages=1814–9 |year=2007 |month=August |pmid=17272357 |doi=10.1093/eurheartj/ehl489 |url=}}</ref>, in particular in patients with high posttreatment platelet reactivity while on 75mg <ref name="pmid18217149">{{cite journal |author=Angiolillo DJ, Bernardo E, Palazuelos J, ''et al'' |title=Functional impact of high clopidogrel maintenance dosing in patients undergoing elective percutaneous coronary interventions. Results of a randomized study |journal=Thromb. Haemost. |volume=99 |issue=1 |pages=161–8 |year=2008 |month=January |pmid=18217149 |doi=10.1160/TH07-09-0562 |url=}}</ref>. The [[OPTIMUS]] (Optimizing antiPlatelet Therapy In diabetes MellitUS) study selectively evaluated [[type 2 diabetes mellitus]] patients with high platelet reactivity while on 75mg clopidogrel and showed that 150 mg clopidogrel maintenance dose induced greater platelet inhibition compared with 75 mg dosing <ref name="pmid17261652">{{cite journal |author=Angiolillo DJ, Shoemaker SB, Desai B, ''et al'' |title=Randomized comparison of a high clopidogrel maintenance dose in patients with diabetes mellitus and coronary artery disease: results of the Optimizing Antiplatelet Therapy in Diabetes Mellitus (OPTIMUS) study |journal=Circulation |volume=115 |issue=6 |pages=708–16 |year=2007 |month=February |pmid=17261652 |doi=10.1161/CIRCULATIONAHA.106.667741 |url=}}</ref>. In a recently published observational study<ref name="pmid19185648">{{cite journal |author=Lemesle G, Delhaye C, Sudre A, ''et al'' |title=Impact of high loading and maintenance dose of clopidogrel within the first 15 days after percutaneous coronary intervention on patient outcome |journal=Am. Heart J. |volume=157 |issue=2 |pages=375–82 |year=2009 |month=February |pmid=19185648 |doi=10.1016/j.ahj.2008.09.013 |url=}}</ref>, Lemesle et al. showed better clinical outcomes in PCI patients treated with 600-mg loading dose followed by a high maintenance dose (150 mg/day) without a significant increase in bleeding events. The ongoing [[CURRENT/OASIS-7]] (Clopidogrel optimal loading dose Usage to Reduce recurrent EveNTs/Optimal Antiplatelet Strategy for InterventionS; [http://clinicaltrials.gov/ct2/show/NCT00335452?term=NCT00335452&rank=1 NCT00335452]) will evaluate the efficacy of higher loading and maintenance doses of clopidogrel in ACS patients undergoing PCI. Several currently ongoing clinical trials are evaluating safety and/or efficacy of a tailored treatment with high clopidogrel maintenance dose in patients with inadequate response to clopidogrel. These include [[GRAVITAS]] (Gauging Responsiveness with a VerifyNow Assay: Impact on Thrombosis And Safety; [http://clinicaltrials.gov/ct2/show/NCT00645918?term=NCT00645918&rank=1 NCT00645918]), [[ARCTIC]] (Double Randomization of a Monitoring Adjusted Antiplatelet Treatment Versus a Common Antiplatelet Treatment for DES Implantation, and Interruption Versus Continuation of Double Antiplatelet Therapy; [http://clinicaltrials.gov/ct2/show/NCT00827411?term=NCT00827411&rank=1 NCT00827411]), and [[DANTE]] (Dual Antiplatelet Therapy Tailored on the Extent of Platelet Inhibition, [http://clinicaltrials.gov/ct2/show/NCT00774475?term=NCT00774475&rank=1 NCT00774475]).

===Triple Antiplatelet Therapy===
In the acute phase of therapy, adding a [[glycoprotein IIb/IIIa]] inhibitor may be considered as this leads to more potent [[platelet]] inhibition. Recently, Cuisset et al. showed that the rate of cardiovascular events at 1 month was significantly lower when [[abciximab]] was added compared to conventional dual [[antiplatelet]] therapy in [[clopidogrel nonresponders]] (n=149) referred for elective PCI <ref>Cuisset T, Frere C, Quilici J, et al. Glycoprotein IIb/IIIa inhibitors improve outcome after coronary stenting in clopidogrel nonresponders. J Am Coll Cardiol Interv 2008;1:649-53.</ref>. The [[3T/2R trial]] showed that better clinical outcomes in aspirin or [[clopidogrel]] non responders undergoing elective PCI treated with [[tirofiban]]<ref>Valgimigli M, Campo G, de Cesare N, et al. Intensifying Platelet Inhibition With Tirofiban in Poor Responders to Aspirin and/orClopidogrel Undergoing Elective Coronary Intervention. Results from the double-blind, prospective, randomized 3T/2R study. Circulation 2009 (in press)</ref>. In the maintenance phase of therapy, triple antiplatelet therapy achieved with the adjunctive use of [[cilostazol]], a [[phosphodiesterase]] III inhibitor, is another option. The [[OPTIMUS-2]] study showed that in a diabetic population cilostazol markedly enhances P2Y12 inhibition<ref name="pmid18567918">{{cite journal |author=Angiolillo DJ, Capranzano P, Goto S, ''et al'' |title=A randomized study assessing the impact of cilostazol on platelet function profiles in patients with diabetes mellitus and coronary artery disease on dual antiplatelet therapy: results of the OPTIMUS-2 study |journal=Eur. Heart J. |volume=29 |issue=18 |pages=2202–11 |year=2008 |month=September |pmid=18567918 |doi=10.1093/eurheartj/ehn287 |url=}}</ref>This may explain the reduced stent thrombosis rates observed with this triple [[antiplatelet]] treatment regimen compared to standard dual antiplatelet therapy and reduced target lesion [[revascularization]] rates in patients treated with both bare-metal and [[drug-eluting stent]]s with greater effects among diabetics<ref name="pmid16286167">{{cite journal |author=Lee SW, Park SW, Hong MK, ''et al'' |title=Triple versus dual antiplatelet therapy after coronary stenting: impact on stent thrombosis |journal=J. Am. Coll. Cardiol. |volume=46 |issue=10 |pages=1833–7 |year=2005 |month=November |pmid=16286167 |doi=10.1016/j.jacc.2005.07.048 |url=}}</ref><ref name="pmid17884371">{{cite journal |author=Lee SW, Park SW, Kim YH, ''et al'' |title=Comparison of triple versus dual antiplatelet therapy after drug-eluting stent implantation (from the DECLARE-Long trial) |journal=Am. J. Cardiol. |volume=100 |issue=7 |pages=1103–8 |year=2007 |month=October |pmid=17884371 |doi=10.1016/j.amjcard.2007.05.032 |url=}}</ref><ref name="pmid16246948">{{cite journal |author=Douglas JS, Holmes DR, Kereiakes DJ, ''et al'' |title=Coronary stent restenosis in patients treated with cilostazol |journal=Circulation |volume=112 |issue=18 |pages=2826–32 |year=2005 |month=November |pmid=16246948 |doi=10.1161/CIRCULATIONAHA.104.530097 |url=}}</ref><ref name="pmid18513523">{{cite journal |author=Biondi-Zoccai GG, Lotrionte M, Anselmino M, ''et al'' |title=Systematic review and meta-analysis of randomized clinical trials appraising the impact of cilostazol after percutaneous coronary intervention |journal=Am. Heart J. |volume=155 |issue=6 |pages=1081–9 |year=2008 |month=June |pmid=18513523 |doi=10.1016/j.ahj.2007.12.024 |url=}}</ref><ref name="pmid18355656">{{cite journal |author=Lee SW, Park SW, Kim YH, ''et al'' |title=Drug-eluting stenting followed by cilostazol treatment reduces late restenosis in patients with diabetes mellitus the DECLARE-DIABETES Trial (A Randomized Comparison of Triple Antiplatelet Therapy with Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Diabetic Patients) |journal=J. Am. Coll. Cardiol. |volume=51 |issue=12 |pages=1181–7 |year=2008 |month=March |pmid=18355656 |doi=10.1016/j.jacc.2007.11.049 |url=}}</ref>. All the above strategies have not been associated with increased [[bleeding]].

===Using a different P2Y12 receptor antagonists===
Although [[clopidogrel]] has largely replace [[ticlopidine]] due to its better safety profile, it has been shown that ticlopidine may improve platelet inhibition among suboptimal responders<ref name="pmid17868803">{{cite journal |author=Campo G, Valgimigli M, Gemmati D, ''et al'' |title=Poor responsiveness to clopidogrel: drug-specific or class-effect mechanism? Evidence from a clopidogrel-to-ticlopidine crossover study |journal=J. Am. Coll. Cardiol. |volume=50 |issue=12 |pages=1132–7 |year=2007 |month=September |pmid=17868803 |doi=10.1016/j.jacc.2007.04.092 |url=}}</ref>.
However, the future likely resides with the use of newer agents. New [[P2Y12 receptor antagonist]]s are currently under different phases of clinical development (e.g. prasugrel, cangrelor, ticagrelor, elinogrel)<ref name="pmid18657683">{{cite journal |author=Angiolillo DJ, Guzman LA |title=Clinical overview of promising nonthienopyridine antiplatelet agents |journal=Am. Heart J. |volume=156 |issue=2 Suppl |pages=S23–8 |year=2008 |month=August |pmid=18657683 |doi=10.1016/j.ahj.2008.06.006 |url=}}</ref><ref name="pmid19166712">{{cite journal |author=Angiolillo DJ, Bhatt DL, Gurbel PA, Jennings LK |title=Advances in antiplatelet therapy: agents in clinical development |journal=Am. J. Cardiol. |volume=103 |issue=3 Suppl |pages=40A–51A |year=2009 |month=February |pmid=19166712 |doi=10.1016/j.amjcard.2008.11.023 |url=}}</ref><ref name="pmid18937620">{{cite journal |author=Angiolillo DJ, Suryadevara S, Capranzano P, Bass TA |title=Prasugrel: a novel platelet ADP P2Y12 receptor antagonist. A review on its mechanism of action and clinical development |journal=Expert Opin Pharmacother |volume=9 |issue=16 |pages=2893–900 |year=2008 |month=November |pmid=18937620 |doi=10.1517/14656566.9.16.2893 |url=}}</ref>. These agents have more potent and less variable inhibitory effects than [[clopidogrel]]. [[Prasugrel]], a third generation [[thienopyridine]], has already completed its [[phase III]] investigation and received approval for clinical use in Europe <ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, ''et al'' |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=N. Engl. J. Med. |volume=357 |issue=20 |pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482 |url=}}</ref>. If prasugrel yields better clinical outcomes without increasing bleeding hazards in clopidogrel non-responders is under investigation.

==References==
{{reflist|2}}
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Suggestions

2009-07-07T23:40:29Z

LBiller:

== '''Functions''' ==
We need the following:

Ability to indicate who trained who (a geneology function)

Ability to import an End Note Library

Ability to machine translate content into another language

Ability to program in risk calculators

Digg plug in

Ability to date and time stamp approvals by the Editors

Ability to see who is online? and how many users are online?

Ability to have my favorites. "An editable button may link to desired page(s)/chapter"

== '''Program Bugs''' ==

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==List of Templates to be removed==
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Light transmittance aggregometry

2009-07-07T20:37:30Z

LBiller: New page: {{SI}} '''Associate Editors-in-Chief:''' Davide Capodanno, M.D. [mailto:Davide.Capodanno@jax.ufl.edu] {{EJ}} ==Overview== '''Light transmittance aggregometry (LTA):''' This is a laborato...

{{SI}}
'''Associate Editors-in-Chief:''' Davide Capodanno, M.D. [mailto:Davide.Capodanno@jax.ufl.edu]

{{EJ}}

==Overview==
'''Light transmittance aggregometry (LTA):''' This is a laboratory based study that evaluates the aggregation or clumping of [[platelets]] in response to aggregating stimuli. For historical reasons, it is broadly accepted as the gold standard in-vitro test of platelet function. The most immediate information for basic diagnostic considerations is obtained by using agents such as [[adenosine diphosphate]] (ADP), [[epinephrine]] and [[collagen]]. Both ADP and epinephrine are contained in storages [[organelles]] within the platelets and are released during formation of the primary hemostatic plug thus enhancing further platelet aggregation. Conversely, collagen is found in the supporting connective tissue of the vessels and is considered to be the first proagulant factor that the platelet encounters following vessel’s injury. Other reagents such as arachidonic acid, [[ristocetin]], [[serotonin]], [[calcium]] and [[Factor VIII]] are also used to study platelet response for more specific purposes. Different aggregating agents stimulate alternative pathways of activation in the platelets and different concentrations of the same [[agonist]] are often used to elicit dose-dependent response.

Aside from the detection and diagnosis of acquired or congenital qualitative platelet defects, LTA has an important role to reveal patterns of [[GPIIb/IIIa]]-dependent platelet-to-platelet aggregation in response to specific agonists (e.g. [[arachidonic acid]] to assess [[aspirin]] response; ADP to test [[thienopyridines]] response).
The chambers of a typical aggregometer are designed so that a beam of infrared light shines through two cuvettes. One of these contains the sample, namely a suspension of platelet rich plasma (PRP) obtained by a relatively low centrifugal force [[centrifugation]]. The other cuvette contains a reference sample of platelet poor plasma (PPP) obtained by centrifuging the blood sample at a relatively high force. [[Silicon]] photodiodes detect the light able to pass through the samples, with PRP arbitrarily considered to be 0% light transmission (or 0% aggregation) and PPP considered to be 100% light transmission (or 100% aggregation). The optical aggregation output is proportional to the continuously measured difference in light transmission between the PRP and PPP samples. Following the addition of a stimulus to the cuvette containing PRP, changes in light transmission occur as a consequence of platelet response and are recorded over time. In fact, the larger size of activated platelet allows less light to pass through the PRP: this is recorded as less light transmission relative to the PPP. Conversely, when platelets form aggregates, more light is able to pass through the test sample.
Aggregation recordings are curves characterized by several features:
#Shape changes;
#A first wave of aggregation that may reverse (primary aggregation);
#A second wave of aggregation that occurs when the granule contents become the stimulus and lead to further aggregation;
#Maximum amount of change in light transmission caused by the stimulus (percent aggregation);
#Late amount of aggregation recorded after a certain timeframe;
#Slope of the aggregation, or percentage of aggregation per minute.
Designed as a measure of defective [[platelet\\ function, the main disadvantage of LTA is that the test is time-consuming, expensive, weakly standardized and need to be performed in specialized lab by specialized personnel. Additionally, several procedural variables may account for poor reproducibility.

{{SIB}}
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GPIIb/IIIa

2009-07-07T18:46:57Z

LBiller: ←Redirected page to Glycoprotein IIb/IIIa

#REDIRECT[[Glycoprotein IIb/IIIa]]

Clopidogrel resistance

2009-07-07T18:41:46Z

LBiller: /* Gold Standard Tests of Clopidogrel Responsiveness */

{{SI}}

'''Editors-in-Chief:''' Dominick Angiolillo, M.D. [mailto:dominick.angiolillo@jax.ufl.edu], [[C. Michael Gibson]], M.S., M.D. [mailto:mgibson@perfuse.org], [[User:Philippe Gabriel Steg|Gabriel Steg]], M.D.[mailto:gabriel.steg@bch.aphp.fr], Tabassome Simon, M.D. [mailto:tabassome.simon@sat.aphp.fr] and Paul Gurbel, M.D. [mailto:pgurbel@lifebridgehealth.org]

'''Associate Editors-in-Chief:''' Davide Capodanno, M.D. [mailto:Davide.Capodanno@jax.ufl.edu]

'''Assistant Editor-in-Chief:''' Leah Biller

{{EJ}}

'''''Synonyms and related keywords:''''' Clopidogrel non-responders, clopidogrel hyporesponders, clopidogrel non-responsiveness, clopidogrel hyporesponsiveness, clopidogrel failure

==Overview==

Administration of the same dose of a drug to all patients has the advantages of simplicity and ease of use. However, data regarding the variability in platelet inhibition across patients highlights the potential importance of tailoring the antiplatelet or dose of an antiplatelet to the pharmacodynamic response of the patient. Patients who do not achieve adequate inhibition in response to a dose of clopidogrel are variably termed “Clopidogrel non-responders” or “Clopidogrel hyporesponders”. A recent European Society of Cardiology working group has suggested the term "elevated platelet reactivity despite treatment".<ref name="pmid19174428">{{cite journal |author=Kuliczkowski W, Witkowski A, Polonski L, ''et al'' |title=Interindividual variability in the response to oral antiplatelet drugs: a position paper of the Working Group on antiplatelet drugs resistance appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, endorsed by the Working Group on Thrombosis of the European Society of Cardiology |journal=Eur. Heart J. |volume=30 |issue=4 |pages=426–35 |year=2009 |month=February |pmid=19174428 |doi=10.1093/eurheartj/ehn562 |url=}}</ref>

This chapter reviews the underlying etiology and clinical relevance of clopidogrel non-responsiveness.

==Definitions of Clopidogrel Non Responsiveness==

There are multiple definitions of clopidogrel non-responsiveness <ref name="pmid16703219">{{cite journal |author=Barsky AA, Arora RR |title=Clopidogrel resistance: myth or reality? |journal=J. Cardiovasc. Pharmacol. Ther. |volume=11 |issue=1 |pages=47–53 |year=2006 |month=March |pmid=16703219 |doi= |url=http://cpt.sagepub.com/cgi/pmidlookup?view=long&pmid=16703219}}</ref>

:

# '''Gurbel et al:''' Change in inhibition of platelet aggregation (IPA) of < 10% using light transmittance aggregometry (LTA)<ref name="pmid12796140">{{cite journal |author=Gurbel PA, Bliden KP, Hiatt BL, O'Connor CM |title=Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity |journal=Circulation |volume=107 |issue=23 |pages=2908–13 |year=2003 |month=June |pmid=12796140 |doi=10.1161/01.CIR.0000072771.11429.83 |url=}}</ref>
# '''Angiolillo et al:''' IPA < 40% by LTA <ref name="pmid15567460">{{cite journal |author=Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, ''et al'' |title=Identification of low responders to a 300-mg clopidogrel loading dose in patients undergoing coronary stenting |journal=Thromb. Res. |volume=115 |issue=1-2 |pages=101–8 |year=2005 |pmid=15567460 |doi=10.1016/j.thromres.2004.07.007 |url=}}</ref>
# '''Lau et al:''' Platelet aggregation >= to 70% by LTA <ref name="pmid12515739">{{cite journal |author=Lau WC, Waskell LA, Watkins PB, Neer CJ, Horowitz K, Hopp AS, Tait AR, Carville DG, Guyer KE, Bates ER |title=Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: a new drug-drug interaction |journal=Circulation |volume=107 |issue=1 |pages=32–7 |year=2003 |month=January |pmid=12515739 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12515739 |accessdate=2009-04-28}}</ref>

It should also be noted that the degree of non-responsiveness will also vary depending upon the timing following clopidogrel administration that responsiveness is tested. For instance, Gurbel et al have shown that using the same assay and the same definition, at 2 hours following clopidogrel administration, the rate of non-responsiveness was 60%; by one day the number was 33%, and by one month the number was 15%. Thus, non-responsiveness may vary depending upon the degree of activation of the platelets themselves. As the platelets become less activated following an acute coronary syndrome episode, the rate of non-responsiveness may be lower. This variability in platelet activation and variability in non-responsiveness raises important questions regarding the potential differences in the optimal acute dose and the optimal chronic dose of clopidogrel and other thienopyridines.

==Incidence of Clopidogrel Resistance==
The incidence of clopidogrel resistance varies significantly from 5% to 44%. The incidence varies depending upon

#The definition of clopidogrel resistance
#The timing of assessing clopidogrel resistance in relation to an acute coronary syndrome episode
#There may be [[circadian rhythm]] to platelet aggregation
 
 

{| class="wikitable" border="1"
|+ Clopidogrel Resistance: World Experience 
''(Courtesy of Paul Gurbel MD)''
! Investigators !! n !! Patients !! Clopidogrel Dose (mg Load) !! Resistance
|-
|Jaremo ''et al.'' <ref name="pmid12270003">{{cite journal |author=Järemo P, Lindahl TL, Fransson SG, Richter A |title=Individual variations of platelet inhibition after loading doses of clopidogrel |journal=J. Intern. Med. |volume=252 |issue=3 |pages=233–8 |year=2002 |month=September |pmid=12270003 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0954-6820&date=2002&volume=252&issue=3&spage=233}}</ref>
|| 18
|| PCI
|| 300
||28%
|-
|Gurbel ''et al.''<ref name="pmid12796140">{{cite journal |author=Gurbel PA, Bliden KP, Hiatt BL, O'Connor CM |title=Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity |journal=Circulation |volume=107 |issue=23 |pages=2908–13 |year=2003 |month=June |pmid=12796140 |doi=10.1161/01.CIR.0000072771.11429.83 |url=}}</ref>
|| 92
|| PCI
|| 300
|| 31%
|-
|Muller ''et al.'' <ref name="pmid12719773">{{cite journal |author=Müller I, Besta F, Schulz C, Massberg S, Schönig A, Gawaz M |title=Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement |journal=Thromb. Haemost. |volume=89 |issue=5 |pages=783–7 |year=2003 |month=May |pmid=12719773 |doi=10.1267/THRO03050783 |url=}}</ref>
|| 105
|| PCI
|| ''600''
||''5-11%''
|-
|Mobley ''et al.''<ref name="pmid14969622">{{cite journal |author=Mobley JE, Bresee SJ, Wortham DC, Craft RM, Snider CC, Carroll RC |title=Frequency of nonresponse antiplatelet activity of clopidogrel during pretreatment for cardiac catheterization |journal=Am. J. Cardiol. |volume=93 |issue=4 |pages=456–8 |year=2004 |month=February |pmid=14969622 |doi=10.1016/j.amjcard.2003.10.042 |url=}}</ref>
|| 50
|| PCI
|| 300
|| 30%
|-
|Lepantalo ''et al.''<ref name="pmid15039127">{{cite journal |author=Lepäntalo A, Virtanen KS, Heikkilä J, Wartiovaara U, Lassila R |title=Limited early antiplatelet effect of 300 mg clopidogrel in patients with aspirin therapy undergoing percutaneous coronary interventions |journal=Eur. Heart J. |volume=25 |issue=6 |pages=476–83 |year=2004 |month=March |pmid=15039127 |doi=10.1016/j.ehj.2003.12.016 |url=}}</ref>
|| 50
|| PCI
|| 300
|| 40%
|-
|Angiolillo ''et al.''<ref name="pmid15567460">{{cite journal |author=Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, ''et al'' |title=Identification of low responders to a 300-mg clopidogrel loading dose in patients undergoing coronary stenting |journal=Thromb. Res. |volume=115 |issue=1-2 |pages=101–8 |year=2005 |pmid=15567460 |doi=10.1016/j.thromres.2004.07.007 |url=}}</ref>
|| 48
|| PCI
|| 300
|| 44%
|-
|Matetzky ''et al.''<ref name="pmid15184279">{{cite journal |author=Matetzky S, Shenkman B, Guetta V, ''et al'' |title=Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction |journal=Circulation |volume=109 |issue=25 |pages=3171–5 |year=2004 |month=June |pmid=15184279 |doi=10.1161/01.CIR.0000130846.46168.03 |url=}}</ref>
|| 60
|| PCI
|| 300
|| 25%
|-
|Dziewierz ''et al.''<ref name="pmid15815794">{{cite journal |author=Dziewierz A, Dudek D, Heba G, Rakowski T, Mielecki W, Dubiel JS |title=Inter-individual variability in response to clopidogrel in patients with coronary artery disease |journal=Kardiol Pol |volume=62 |issue=2 |pages=108–17; discussion 118 |year=2005 |month=February |pmid=15815794 |doi= |url=http://www.kardiologiapolska.pl/archieve.php?vol=62&iss=2&pg=108&lang=en}}</ref>
|| 31
|| Stable angina
|| 300
|| 23%
|-
|Gurbel ''et al.''<ref name="pmid15862408">{{cite journal |author=Gurbel PA, Bliden KP, Hayes KM, Yoho JA, Herzog WR, Tantry US |title=The relation of dosing to clopidogrel responsiveness and the incidence of high post-treatment platelet aggregation in patients undergoing coronary stenting |journal=J. Am. Coll. Cardiol. |volume=45 |issue=9 |pages=1392–6 |year=2005 |month=May |pmid=15862408 |doi=10.1016/j.jacc.2005.01.030 |url=}}</ref>
|| 190
|| PCI
|| 300/''600''
|| ''8''-32%
|-
|Lev ''et al.''<ref name="pmid16386660">{{cite journal |author=Lev EI, Patel RT, Maresh KJ, ''et al'' |title=Aspirin and clopidogrel drug response in patients undergoing percutaneous coronary intervention: the role of dual drug resistance |journal=J. Am. Coll. Cardiol. |volume=47 |issue=1 |pages=27–33 |year=2006 |month=January |pmid=16386660 |doi=10.1016/j.jacc.2005.08.058 |url=}}</ref>
|| 150
|| PCI
|| 300
|| 24%
|-
| '''Total'''
|| '''794'''
|
|
||'''5-44%'''
|-
|}
 
 

==Association of Clopidogrel Non-Responsiveness with Adverse Clinical Outcomes==

There are a large number of studies associating clopidogrel non-responsiveness with adverse outcomes:

{| class="wikitable" border="1"
|+ Studies Linking Ex-Vivo Platelet Function to Clinical Events 
''(Courtesy of Paul Gurbel MD)''
! Study !! Results !! Clinical Relevance
|-
| Barragan ''et al.'' <ref name="pmid12822144">{{cite journal |author=Barragan P, Bouvier JL, Roquebert PO, ''et al'' |title=Resistance to thienopyridines: clinical detection of coronary stent thrombosis by monitoring of vasodilator-stimulated phosphoprotein phosphorylation |journal=Catheter Cardiovasc Interv |volume=59 |issue=3 |pages=295–302 |year=2003 |month=July |pmid=12822144 |doi=10.1002/ccd.10497 |url=}}</ref>
|| ↑ P2Y12 reactivity ratio (VASP-P levels) || Stent Thrombosis
|-
| Ajzenberg ''et al.''<ref name="pmid15936600">{{cite journal |author=Ajzenberg N, Aubry P, Huisse MG, ''et al'' |title=Enhanced shear-induced platelet aggregation in patients who experience subacute stent thrombosis: a case-control study |journal=J. Am. Coll. Cardiol. |volume=45 |issue=11 |pages=1753–6 |year=2005 |month=June |pmid=15936600 |doi=10.1016/j.jacc.2004.10.079 |url=}}</ref>
||↑ Shear- Induced platelet aggregation
||Stent Thrombosis
|-
| Gurbel ''et al.''
 (CREST study)<ref name="pmid16286166">{{cite journal |author=Gurbel PA, Bliden KP, Samara W, ''et al'' |title=Clopidogrel effect on platelet reactivity in patients with stent thrombosis: results of the CREST Study |journal=J. Am. Coll. Cardiol. |volume=46 |issue=10 |pages=1827–32 |year=2005 |month=November |pmid=16286166 |doi=10.1016/j.jacc.2005.07.056 |url=}}</ref>
||↑ADP- induced aggregation 
↑Stimulated GPIIb/IIIa expression
|| Stent Thrombosis
|-
| Matetzky ''et al.''<ref name="pmid15184279">{{cite journal |author=Matetzky S, Shenkman B, Guetta V, ''et al'' |title=Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction |journal=Circulation |volume=109 |issue=25 |pages=3171–5 |year=2004 |month=June |pmid=15184279 |doi=10.1161/01.CIR.0000130846.46168.03 |url=}}</ref>
||↑ ADP-Induced platelet aggregation
|| Recurrent Cardiac Events (4th quartile)
|-
| Gurbel ''et al.''
(CLEAR PLATELETS<ref name="pmid15738352">{{cite journal |author=Gurbel PA, Bliden KP, Zaman KA, Yoho JA, Hayes KM, Tantry US |title=Clopidogrel loading with eptifibatide to arrest the reactivity of platelets: results of the Clopidogrel Loading With Eptifibatide to Arrest the Reactivity of Platelets (CLEAR PLATELETS) study |journal=Circulation |volume=111 |issue=9 |pages=1153–9 |year=2005 |month=March |pmid=15738352 |doi=10.1161/01.CIR.0000157138.02645.11 |url=}}</ref> and CLEAR PLATELETS Ib<ref name="pmid17161243">{{cite journal |author=Gurbel PA, Bliden KP, Tantry US |title=Effect of clopidogrel with and without eptifibatide on tumor necrosis factor-alpha and C-reactive protein release after elective stenting: results from the CLEAR PLATELETS 1b study |journal=J. Am. Coll. Cardiol. |volume=48 |issue=11 |pages=2186–91 |year=2006 |month=December |pmid=17161243 |doi=10.1016/j.jacc.2005.12.084 |url=}}</ref>) 
||↑ Periprocedural platelet aggregation
||Myonecrosis and Inflammation Marker Release
|-
| Bliden ''et al.''<ref name="pmid17291930">{{cite journal |author=Bliden KP, DiChiara J, Tantry US, Bassi AK, Chaganti SK, Gurbel PA |title=Increased risk in patients with high platelet aggregation receiving chronic clopidogrel therapy undergoing percutaneous coronary intervention: is the current antiplatelet therapy adequate? |journal=J. Am. Coll. Cardiol. |volume=49 |issue=6 |pages=657–66 |year=2007 |month=February |pmid=17291930 |doi=10.1016/j.jacc.2006.10.050 |url=}}</ref>
||↑ Platelet aggregation (pre-PCI) on chronic clopidogrel
||1 yr Post-PCI Events
|-
| Cuisset ''et al.''<ref name="pmid16371119">{{cite journal |author=Cuisset T, Frere C, Quilici J, ''et al'' |title=High post-treatment platelet reactivity identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascular events after stenting for acute coronary syndrome |journal=J. Thromb. Haemost. |volume=4 |issue=3 |pages=542–9 |year=2006 |month=March |pmid=16371119 |doi=10.1111/j.1538-7836.2005.01751.x |url=}}</ref>
||↑ Platelet aggregation
|| 30-day Post-PCI events
|-
| Lev et al.<ref name="pmid16386660">{{cite journal |author=Lev EI, Patel RT, Maresh KJ, ''et al'' |title=Aspirin and clopidogrel drug response in patients undergoing percutaneous coronary intervention: the role of dual drug resistance |journal=J. Am. Coll. Cardiol. |volume=47 |issue=1 |pages=27–33 |year=2006 |month=January |pmid=16386660 |doi=10.1016/j.jacc.2005.08.058 |url=}}</ref>
|| Clopidogrel/Aspirin resistant patients
||Post-PCI Myonecrosis
|-
| Cuisset ''et al.''<ref name="pmid17010792">{{cite journal |author=Cuisset T, Frere C, Quilici J, ''et al'' |title=Benefit of a 600-mg loading dose of clopidogrel on platelet reactivity and clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing coronary stenting |journal=J. Am. Coll. Cardiol. |volume=48 |issue=7 |pages=1339–45 |year=2006 |month=October |pmid=17010792 |doi=10.1016/j.jacc.2006.06.049 |url=}}</ref>
||↑ Platelet aggregation
|| 30-day Post-PCI events, 600mg - less events
|-
| Hochholzer ''et al.''<ref name="pmid17084243">{{cite journal |author=Hochholzer W, Trenk D, Bestehorn HP, ''et al'' |title=Impact of the degree of peri-interventional platelet inhibition after loading with clopidogrel on early clinical outcome of elective coronary stent placement |journal=J. Am. Coll. Cardiol. |volume=48 |issue=9 |pages=1742–50 |year=2006 |month=November |pmid=17084243 |doi=10.1016/j.jacc.2006.06.065 |url=}}</ref>
||↑ Platelet aggregation (Upper quartile)
|| 30 day MACE
|}

Despite these associations of clopidogrel hyporesponsiveness with adverse outcomes, there is no large scale data suggesting that acting upon test results and modifying therapy based upon test results is associated with improved outcomes. It is important to ascertain if the patient has been compliant with the medication before declaring that the patient is a clopidogrel non-responder.

==Is there a Threshold Effect to Efficacy or are Clinical Outcomes Improved with Higher and Higher Doses (a Continuous Relationship to Clinical Outcomes)==

One unresolved question is whether there is a “threshold effect” whereby clinical outcomes are not further improved above a certain level of platelet inhibition, or alternatively whether clinical outcomes are further improved with higher and higher doses in which case there is a “continuous variable” relationship between platelet inhibition and clinical outcomes. Data supporting a potential threshold effect comes from Gurbel et al. <ref>Gurbel P, et al. J Am Coll Cardiol. 2005;46(10):1827-1832 </ref> <ref>Gurbel P, et al. J Am Coll Cardiol. 2005;46(10):1820-1826 </ref>When data regarding the relationship between stent thrombosis and clinical outcomes was plotted as a cumulative distribution function rather than a bell curve, it was noted that stent thrombosis was infrequent above 40-50% inhibition.

==Mechanisms Underlying Clopidogrel Resistance==

There are multpiple mechanisms underlying clopidogrel resistance:
<ref> Angiolillio DJ et al. J Am Coll Cardiol. 2007;49:1505-1516</ref>

===Clinical Factors===
*Poor patient compliance
*Under-dosing: Some patients may alter the dosing to take the drug every other day
*Poor absorption
*The presence of an [[acute coronary syndrome]] and increased platelet activation
*Co-morbidities such as [[diabetes]] mellitus that is known to be assoicated with heightened platelet activation <ref> Angiolillo DJ et al. Diabetes. 2005;54:2430-2435. </ref>
*Elevated body mass index
*Elevated platelet count

===Cellular Factors===
*Accelerated platelet turnover
*Reduced CYP3A metabolic activity
*Increased ADP exposure
*Up-regulation of the P2Y12 pathway
*Up-regulation of the P2Y1 pathway
*Up-regulation of the P2Y–independent pathways (collagen, epinephrine, thomboxane A2, thrombin)

===Genetic Basis===

Clopidogrel is a pro-drug. When it appears in the bloodstream following absorption, it is not in the active form. This inactive metabolite or pro-drug must circulate to the liver to be metabolized and converted to the active metabolite (there appear to be 4 active isomers). Genetic polymorphisms that have been related to variability in clopidogrel metabolism include:

*Polymorphisms of CYP
*Polymorphisms of GPIa
*Polymorphisms of P2Y12
*Polymorphisms of GPIIIa

Variability in the function of the CYP 2C19 allele has been postulated to be related to the ability to metabolize clopidogrel. <ref name="pmid19106084">{{cite journal |author=Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT, Walker JR, Antman EM, Macias W, Braunwald E, Sabatine MS |title=Cytochrome p-450 polymorphisms and response to clopidogrel |journal=The New England Journal of Medicine |volume=360 |issue=4 |pages=354–62 |year=2009 |month=January |pmid=19106084 |doi=10.1056/NEJMoa0809171 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19106084&promo=ONFLNS19 |accessdate=2009-04-28}}</ref>

The three individual alleles and their relative ability to metabolize clopidogrel are as follows:
*<nowiki>*17</nowiki> hypermetabolizer allele
*<nowiki>*1</nowiki> normal metabolizer allele
*<nowiki>*2</nowiki> poor metabolizer allele, genetic functional variant 681 G>A

Based upon the combinations (pairs) of these three alleles, four types of metabolizers have been identified based upon the ability of the patients to generate active metabolite and pharmacodynamics:
*'''Ultra-metabolizers (UM):''' (30% of patients)
:<nowiki>*1 / *17</nowiki> allele
:<nowiki>*17 / *17</nowiki> allele

*'''Extensive metabolizers (EM):''' (36% of patients)
: <nowiki>*1 / *1</nowiki> allele

*'''Intermediate metabolizers (IM):''' (29% of patients)
: <nowiki>*1 / *2</nowiki> allele

*'''Poor metabolizers (PM):''' (5% of patients)
: <nowiki>*2 / *2</nowiki> allele

It should be noted that the active metabolites of clopidogrel and prasugrel are equally potent, <ref> Sugidachi A et al. J Thromb Haemos. 2007;5:1545-1551</ref> and that differences in pharmacodynamic and clinical outcomes are due to differences in the generation of active metabolite rather than potency of the active metabolite. Carriers of the allele (those patients with a least one copy of the *2 allele) had a higher 450 day event rate (12.1%) versus those patients with no copies of the allele (an 8.0% event rate, HR 1.53, p=0.014).

<ref name="pmid19108880">{{cite journal |author=Collet JP, Hulot JS, Pena A, Villard E, Esteve JB, Silvain J, Payot L, Brugier D, Cayla G, Beygui F, Bensimon G, Funck-Brentano C, Montalescot G |title=Cytochrome P450 2C19 polymorphism in young patients treated with clopidogrel after myocardial infarction: a cohort study |journal=Lancet |volume=373 |issue=9660 |pages=309–17 |year=2009 |month=January |pmid=19108880 |doi=10.1016/S0140-6736(08)61845-0 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)61845-0 |accessdate=2009-04-28}}</ref>

In a similar but slightly different finding, Simon et al have demonstrated that it was only those patients who carried two copies of the *2 allele (*2 / *2) and not just one copy (*1 / *2) who had a higher risk of adverse events (death, MI, stroke).<ref name="pmid19106083">{{cite journal |author=Simon T, Verstuyft C, Mary-Krause M, Quteineh L, Drouet E, Méneveau N, Steg PG, Ferrières J, Danchin N, Becquemont L |title=Genetic determinants of response to clopidogrel and cardiovascular events |journal=The New England Journal of Medicine |volume=360 |issue=4 |pages=363–75 |year=2009 |month=January |pmid=19106083 |doi=10.1056/NEJMoa0808227 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19106083&promo=ONFLNS19 |accessdate=2009-04-28}}</ref>

In a third study, Collet et al demonstrated that among 259 young survivors of a first myocardial infarction who were treated with chronic clopidogrel, death, MI, and urgent revascularization occurred more often in carriers (*2 / *2 or *1 / *2) than in non-carriers (*1 / *1)(HR = 3.69 [95% CI 1.69-8.05], p=0.0005), as did stent thrombosis (HR = 6.02 [1.81-20.04], p=0.0009). <ref name="pmid19108880">{{cite journal |author=Collet JP, Hulot JS, Pena A, Villard E, Esteve JB, Silvain J, Payot L, Brugier D, Cayla G, Beygui F, Bensimon G, Funck-Brentano C, Montalescot G |title=Cytochrome P450 2C19 polymorphism in young patients treated with clopidogrel after myocardial infarction: a cohort study |journal=Lancet |volume=373 |issue=9660 |pages=309–17 |year=2009 |month=January |pmid=19108880 |doi=10.1016/S0140-6736(08)61845-0 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)61845-0 |accessdate=2009-04-28}}</ref> These findings were true in a multivariate model of potential confounders.

Although both [[prasugrel]] and [[clopidogrel]] require cytochrome P450 (CYP) enzymes for activation, a substudy of 1,466 patients enrolled in the TRITON-TIMI 38 study found that CYP variations did not affect:

*Levels of prasugrel's active metabolite

*Prasugrel's inhibition of platelet aggregation, or

*Clinical cardiovascular event rates in persons treated with prasugrel <ref name="urlCytochrome P450 Genetic Polymorphisms and the Response to Prasugrel. Relationship to Pharmacokinetic, Pharmacodynamic, and Clinical Outcomes -- Mega et al., 10.1161/CIRCULATIONAHA.109.851949 -- Circulation">{{cite web|url=http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.109.851949v1 |title=Cytochrome P450 Genetic Polymorphisms and the Response to Prasugrel. Relationship to Pharmacokinetic, Pharmacodynamic, and Clinical Outcomes -- Mega et al., 10.1161/CIRCULATIONAHA.109.851949 -- Circulation |format= |work= |accessdate=}}</ref>

===Inhibition of Metabolism by Co-Ingestion of Other Drugs===

====Statins====

Statins have been found to interfere with the generation of clopidogrel’s active metabolite. <ref name="pmid12515739">{{cite journal |author=Lau WC, Waskell LA, Watkins PB, Neer CJ, Horowitz K, Hopp AS, Tait AR, Carville DG, Guyer KE, Bates ER |title=Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: a new drug-drug interaction |journal=Circulation |volume=107 |issue=1 |pages=32–7 |year=2003 |month=January |pmid=12515739 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12515739 |accessdate=2009-04-28}}</ref> <ref name="pmid14707025">{{cite journal |author=Lau WC, Gurbel PA, Watkins PB, Neer CJ, Hopp AS, Carville DG, Guyer KE, Tait AR, Bates ER |title=Contribution of hepatic cytochrome P450 3A4 metabolic activity to the phenomenon of clopidogrel resistance |journal=Circulation |volume=109 |issue=2 |pages=166–71 |year=2004 |month=January |pmid=14707025 |doi=10.1161/01.CIR.0000112378.09325.F9 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14707025 |accessdate=2009-04-28}}</ref> <ref name="pmid15302813">{{cite journal |author=Lau WC, Carville DG, Bates ER |title=Clinical significance of the atorvastatin-clopidogrel drug-drug interaction |journal=Circulation |volume=110 |issue=6 |pages=e66–7; author reply e66–7 |year=2004 |month=August |pmid=15302813 |doi=10.1161/01.CIR.0000137956.92971.4A |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15302813 |accessdate=2009-04-28}}</ref> One statin that does not interfere with clopidogrel metabolism is [[pravastatin]]. Non-randomized data from clinical trials have not confirmed a higher risk of adverse outcomes among patients co-ingesting statins in addition to clopidogrel versus those treated with clopidogrel alone. It is possible that the higher loading dose of 600 mg used in current clinical pracitce overcomes this interference.

====Omeprazole and Proton Pump Inhibitors====

Omeprazole induces a conformational change in the CYP enzyme system and may alter the metabolism of clopidogrel. In a double-blind placebo-controlled trial, stented patients treated with clopidogrel were randomized to treatment with either omeprazole (20 mg/day) or placebo. Following 7 days of treatment, the residual platelet aggregation was significantly hgiher in the omeprazole group (p < 0.0001). <ref name="pmid18206732">{{cite journal |author=Gilard M, Arnaud B, Cornily JC, Le Gal G, Lacut K, Le Calvez G, Mansourati J, Mottier D, Abgrall JF, Boschat J |title=Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the randomized, double-blind OCLA (Omeprazole CLopidogrel Aspirin) study |journal=Journal of the American College of Cardiology |volume=51 |issue=3 |pages=256–60 |year=2008 |month=January |pmid=18206732 |doi=10.1016/j.jacc.2007.06.064 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)03433-X |accessdate=2009-04-28}}</ref> The clinical impact of this finding and whether this inhibition can be overcome with a higher dose of clopidogrel is not clear.

There have been non-randomized retrospective analyses of the clinical outcomes among patients treated with omeprazole vs no omeprazole. <ref>Aubert RE et al. Circulation. 2008;118:S_815.</ref> <ref name="pmid19258584">{{cite journal |author=Ho PM, Maddox TM, Wang L, Fihn SD, Jesse RL, Peterson ED, Rumsfeld JS |title=Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome |journal=JAMA : the Journal of the American Medical Association |volume=301 |issue=9 |pages=937–44 |year=2009 |month=March |pmid=19258584 |doi=10.1001/jama.2009.261 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=19258584 |accessdate=2009-04-28}}</ref> <ref> Dunn SP et al. Circulation. 2008;118:S_815 </ref> However, these non-randomized analyses are very confounded by the fact that patients treated with omeprazole are more often diabetics, had undergone CABG, had a history of cerebrovascular disease and peripheral arterial disease, had previously been on clopidogrel, and more often had renal disease. <ref name="pmid19258584">{{cite journal |author=Ho PM, Maddox TM, Wang L, Fihn SD, Jesse RL, Peterson ED, Rumsfeld JS |title=Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome |journal=JAMA : the Journal of the American Medical Association |volume=301 |issue=9 |pages=937–44 |year=2009 |month=March |pmid=19258584 |doi=10.1001/jama.2009.261 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=19258584 |accessdate=2009-04-28}}</ref> Indeed, it is notable that among patients not treated with clopidogrel, treatment with a proton pump inhibitor (PPI) was associated with a 1.6 fold higher event rate in CREDO despite multivariate adjustment for confounders <ref> Dunn SP et al. Circulation. 2008;118:S_815 </ref> This points to the potential role of unidentified confounders in the association of PPIs with clinical outcomes.

Pantoprazole and esomeprazole are not associated with a phramcodynamic or clinical effect in non-randomized analyses <ref> Sibbing D et al. Thromb Haemost. 2009;101:714-719 </ref>

==Gold Standard Tests of Clopidogrel Responsiveness==

'''Light transmittance aggregometry (LTA):''' This is a laboratory based study that evaluates the aggregation or clumping of [[platelets]] in response to aggregating stimuli. For historical reasons, it is broadly accepted as the gold standard in-vitro test of platelet function. The most immediate information for basic diagnostic considerations is obtained by using agents such as [[adenosine diphosphate]] (ADP), [[epinephrine]] and [[collagen]]. Both ADP and epinephrine are contained in storages [[organelles]] within the platelets and are released during formation of the primary hemostatic plug thus enhancing further platelet aggregation. Conversely, collagen is found in the supporting connective tissue of the vessels and is considered to be the first proagulant factor that the platelet encounters following vessel’s injury. Other reagents such as arachidonic acid, [[ristocetin]], [[serotonin]], [[calcium]] and [[Factor VIII]] are also used to study platelet response for more specific purposes. Different aggregating agents stimulate alternative pathways of activation in the platelets and different concentrations of the same [[agonist]] are often used to elicit dose-dependent response.

Aside from the detection and diagnosis of acquired or congenital qualitative platelet defects, LTA has an important role to reveal patterns of [[GPIIb/IIIa]]-dependent platelet-to-platelet aggregation in response to specific agonists (e.g. [[arachidonic acid]] to assess [[aspirin]] response; ADP to test [[thienopyridines]] response).
The chambers of a typical aggregometer are designed so that a beam of infrared light shines through two cuvettes. One of these contains the sample, namely a suspension of platelet rich plasma (PRP) obtained by a relatively low centrifugal force [[centrifugation]]. The other cuvette contains a reference sample of platelet poor plasma (PPP) obtained by centrifuging the blood sample at a relatively high force. [[Silicon]] photodiodes detect the light able to pass through the samples, with PRP arbitrarily considered to be 0% light transmission (or 0% aggregation) and PPP considered to be 100% light transmission (or 100% aggregation). The optical aggregation output is proportional to the continuously measured difference in light transmission between the PRP and PPP samples. Following the addition of a stimulus to the cuvette containing PRP, changes in light transmission occur as a consequence of platelet response and are recorded over time. In fact, the larger size of activated platelet allows less light to pass through the PRP: this is recorded as less light transmission relative to the PPP. Conversely, when platelets form aggregates, more light is able to pass through the test sample.
Aggregation recordings are curves characterized by several features:
#Shape changes;
#A first wave of aggregation that may reverse (primary aggregation);
#A second wave of aggregation that occurs when the granule contents become the stimulus and lead to further aggregation;
#Maximum amount of change in light transmission caused by the stimulus (percent aggregation);
#Late amount of aggregation recorded after a certain timeframe;
#Slope of the aggregation, or percentage of aggregation per minute.
Designed as a measure of defective [[platelet\\ function, the main disadvantage of LTA is that the test is time-consuming, expensive, weakly standardized and need to be performed in specialized lab by specialized personnel. Additionally, several procedural variables may account for poor reproducibility.

'''Vasodilator-Stimulated Phosphoprotein (VASP)''' The phosphorylation (P) of vasodilator-stimulated phosphoprotein (VASP) is a test based on flow cytometry which is very specific to the P2Y12 signaling pathway. It is commercially available as a kit marketed as PLT VASP/P2Y12 (BioCytex, Marseilles, France).
VASP is an intracellular platelet protein that is not phosphorilated at baseline. VASP-P is mediated by the cAMP cascade, which is enhanced by prostaglandin E1 (PGE1) and inhibited by the link between ADP and P2Y12 receptors. Therefore, VASP-P is a marker of P2Y12 receptor inhibition, whereas its non-phosphorylated counterpart correlates with the non-inhibited form of the P2Y12 receptor.
By using the PLT VASP/P2Y12 kit, the effect of clopidogrel can be demonstrated by the persistence of VASP in its phosphorylated state (VASP-P) induced by PGE1 despite the simultaneous addition of ADP.
More in detail, the blood sample is first incubated with PGE1 alone or PGE1 + ADP. Subsequently, after a cellular permeabilization, VASP-P is labeled by indirect no wash immunofluorescence using a specific monoclonal antibody. The two tested conditions are then evaluated by means of dual color flow cytometry analysis. Final results are usually expressed in terms of platelet reactivity index (PRI), which is calculated using corrected mean fluorescence intensities (MFIc) in the presence of PGE1 alone or PGE1 and ADP simultaneously, according to the following formula:

PRI = [(MFIcPGE1 - MFIc PGE1+ADP)/ MFIcPGE1]x100

Assessment of VASP-P requires a low sample volume and is performed on whole blood. Another advantage is the opportunity to ship blood samples at room temperature to a central core laboratory. Ultimately, it correlates well with light transmittance aggregometry and VerifyNow technologies. However, sample preparation is time consuming and the reliability of the results is highly dependent from the presence of a skilled technician. Also, a flow cytometer is required.

==Point of Care Devices==

===VerifyNow===
The VerifyNow system (Accumetrics, San Diego, Ca, USA; [http://www.accumetrics.com]) is a bedside test that allows for monitoring of the efficacy of [[thienopyridine]]s, [[aspirin]], and [[glycoprotein IIbIIIa inhibitors]].
Formerly known as the Ultegra rapid platelet function analyzer, the VerifyNow system is a turbidimetric based optical detection system which measures [[platelet induced aggregation]] as an increase in light transmittance.
This system is a point-of-care and consists of an instrument, a disposable assay device and controls. The assay device contains a lyophilized preparation of human [[fibrinogen]]-coated beads, [[platelet]] [[agonist]], [[preservative]] and [[buffer]].
Three assays are currently available, which differ according to the platelet agonist contained in the mixing chamber:

{| class="wikitable" cellspacing="0" cellpadding="0" border="1"
! Assay device !! Platelet agonist !! Drug(s) of interest
|-
| VerifyNow GP IIb/IIIa
| Thombin receptor-activating peptide (TRAP) [iso-TRAP]
| [[Abciximab]], [[eptifibatide]], [[tirofiban]]
|-
| VerifyNow Aspirin
| [[Arachidonic acid]]
| [[Aspirin]]
|-
| VerifyNow P2Y12
| [[Adenosine diphosphate]]
| | [[Clopidogrel]], [[prasugrel]]
|}

After activation, the GP IIb/IIIa receptors on platelets will bind to the [[fibrinogen]]-coated microbeads and cross link to other microbeads resulting in a clearing of the beads and platelets within the detection well. The instrument uses light transmittance to measure the rate at which this clearing occurs.
The main advantage of this test is that the patient sample is a low sample volume of 3.2% citrated whole blood, which is automatically dispensed from the [[blood]] collection tube into the assay device by the instrument, with no blood handling required by the user. Another advantage is that the instrument provides the results in minutes.

===Platelet Function Analyzer (PFA-100)===

The Platelet Function Analyzer-100(PFA-100, Siemens Healthcare Diagnostics, Inc., Deerfield, IL) is a test based on the principle of shear-induced [[aggregation]]. Although it is not a COX-1specific [[assay]], it allows monitoring of [[aspirin]] effects by providing a quantitative measure of platelet-related [[hemostasis]] in anticoagulated whole [[blood]].

The system comprises a microprocessor-controlled tool and a disposable test cartridge containing a biologically active [[nitrocellulose]] membrane. To perform the test, 0.8 ml of [[citrated]] whole blood is transferred into the reservoir of the cartridge within 4 h of blood sampling. After warming the anticoagulated blood to 37 °C, the instrument aspirates a [[blood]] sample under vacuum from the reservoir through a 200 μm diameter stainless steel capillary and a 150 μm aperture cut into the membrane, which is coated with [[collagen]] and [[epinephrine]] (CEPI) or [[collagen]] and [[ADP]] (CADP).

The presence of these biochemical stimuli, and the high shear rates of 5000–6000 s−1 generated under the standardized flow conditions, result in platelet aggregate forms that block the aperture of the membrane. The time required to obtain full occlusion of the aperture is reported as the closure time (CT).

Prolonged CT with only the CEPI cartridge is observed with mild inherited platelet function disorders and with aspirin ingestion, while prolonged CTs with both CEPI and CADP cartridges are associated with more severe inherited platelet dysfunctions.
An advantage of the PFA-100 application as a [[platelet]] function assay is that it is a rapid, accurate, simple, and reproducible test that requires only a small volume of blood. It cannot be considered as a point of care as minimal pipetting is required to use this test. One of its major disadvantages is that it is poorly sensitive in detecting effects of [[thienopyridines]] and therefore should not be used for this purpose. Newer generation assays are currently under development to assess thienopyridine effects.

==Clinical Utility of Point of Care Testing Versus Genetic Testing==

In so far as point of care testing results are more readily available, these may be a more suitable choice for use in clinical practice as compared to genetic testing. Furthermore, there may be mechanisms other than variability in metabolism that account for differences in response to clopidogrel which are assessed by point of care tests and not by genetic testing.

==Strategies to Overcome Clopidogrel Non-Responsiveness==
Due to the severity of its consequences, how to manage suboptimal [[clopidogrel]] response is a major clinical problem. The most important aspect is to guarantee patient compliance. The second aspect to evaluate is any potential drug-drug interactions. Studies are currently ongoing with the goal to better elucidate the interaction between clopidogrel and [[PPI]]s. The following strategies can be proposed to overcome inadequate clopidogrel responsiveness:
#increase clopidogrel dosing
#triple antiplatelet therapy
#using a different P2Y12 antiplatelet agent.

===Increase [[clopidogrel]] dosing===
Several studies have shown that a high clopidogrel [[loading dose]] regimen (≥ 600 mg) achieves more potent platelet inhibition when compared to a standard 300 mg loading dose<ref name="pmid16260639">{{cite journal |author=von Beckerath N, Taubert D, Pogatsa-Murray G, Schömig E, Kastrati A, Schömig A |title=Absorption, metabolization, and antiplatelet effects of 300-, 600-, and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) Trial |journal=Circulation |volume=112 |issue=19 |pages=2946–50 |year=2005 |month=November |pmid=16260639 |doi=10.1161/CIRCULATIONAHA.105.559088 |url=}}</ref><ref name="pmid15522469">{{cite journal |author=Angiolillo DJ, Fernández-Ortiz A, Bernardo E, ''et al'' |title=High clopidogrel loading dose during coronary stenting: effects on drug response and interindividual variability |journal=Eur. Heart J. |volume=25 |issue=21 |pages=1903–10 |year=2004 |month=November |pmid=15522469 |doi=10.1016/j.ehj.2004.07.036 |url=}}</ref><ref name="pmid16949482">{{cite journal |author=Montalescot G, Sideris G, Meuleman C, ''et al'' |title=A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial |journal=J. Am. Coll. Cardiol. |volume=48 |issue=5 |pages=931–8 |year=2006 |month=September |pmid=16949482 |doi=10.1016/j.jacc.2006.04.090 |url=}}</ref><ref>{{cite journal |author=Gurbel PA, Bliden KP, Hayes KM, Yoho JA, Herzog WR, Tantry US |title=The relation of dosing to clopidogrel responsiveness and the incidence of high post-treatment platelet aggregation in patients undergoing coronary stenting |journal=J. Am. Coll. Cardiol. |volume=45 |issue=9 |pages=1392–6 |year=2005 |month=May |pmid=15862408 |doi=10.1016/j.jacc.2005.01.030 |url=}}</ref>. This has also been associated with better clinical outcomes in patients undergoing [[PCI]] <ref name="pmid15750189">{{cite journal |author=Patti G, Colonna G, Pasceri V, Pepe LL, Montinaro A, Di Sciascio G |title=Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study |journal=Circulation |volume=111 |issue=16 |pages=2099–106 |year=2005 |month=April |pmid=15750189 |doi=10.1161/01.CIR.0000161383.06692.D4 |url=}}</ref><ref name="pmid18993148">{{cite journal |author=Bonello L, Lemesle G, De Labriolle A, ''et al'' |title=Impact of a 600-mg loading dose of clopidogrel on 30-day outcome in unselected patients undergoing percutaneous coronary intervention |journal=Am. J. Cardiol. |volume=102 |issue=10 |pages=1318–22 |year=2008 |month=November |pmid=18993148 |doi=10.1016/j.amjcard.2008.07.007 |url=}}</ref><ref name="pmid17010792">{{cite journal |author=Cuisset T, Frere C, Quilici J, ''et al'' |title=Benefit of a 600-mg loading dose of clopidogrel on platelet reactivity and clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing coronary stenting |journal=J. Am. Coll. Cardiol. |volume=48 |issue=7 |pages=1339–45 |year=2006 |month=October |pmid=17010792 |doi=10.1016/j.jacc.2006.06.049 |url=}}</ref>. ]. A high maintenance dose (150 mg/day) dose regimen of clopidogrel has found to be associated with enhanced platelet inhibition compared to the currently recommended 75 mg/day <ref name="pmid18217149">{{cite journal |author=Angiolillo DJ, Bernardo E, Palazuelos J, ''et al'' |title=Functional impact of high clopidogrel maintenance dosing in patients undergoing elective percutaneous coronary interventions. Results of a randomized study |journal=Thromb. Haemost. |volume=99 |issue=1 |pages=161–8 |year=2008 |month=January |pmid=18217149 |doi=10.1160/TH07-09-0562 |url=}}</ref><ref name="pmid17261652">{{cite journal |author=Angiolillo DJ, Shoemaker SB, Desai B, ''et al'' |title=Randomized comparison of a high clopidogrel maintenance dose in patients with diabetes mellitus and coronary artery disease: results of the Optimizing Antiplatelet Therapy in Diabetes Mellitus (OPTIMUS) study |journal=Circulation |volume=115 |issue=6 |pages=708–16 |year=2007 |month=February |pmid=17261652 |doi=10.1161/CIRCULATIONAHA.106.667741 |url=}}</ref><ref name="pmid17272357">{{cite journal |author=von Beckerath N, Kastrati A, Wieczorek A, ''et al'' |title=A double-blind, randomized study on platelet aggregation in patients treated with a daily dose of 150 or 75 mg of clopidogrel for 30 days |journal=Eur. Heart J. |volume=28 |issue=15 |pages=1814–9 |year=2007 |month=August |pmid=17272357 |doi=10.1093/eurheartj/ehl489 |url=}}</ref>, in particular in patients with high posttreatment platelet reactivity while on 75mg <ref name="pmid18217149">{{cite journal |author=Angiolillo DJ, Bernardo E, Palazuelos J, ''et al'' |title=Functional impact of high clopidogrel maintenance dosing in patients undergoing elective percutaneous coronary interventions. Results of a randomized study |journal=Thromb. Haemost. |volume=99 |issue=1 |pages=161–8 |year=2008 |month=January |pmid=18217149 |doi=10.1160/TH07-09-0562 |url=}}</ref>. The [[OPTIMUS]] (Optimizing antiPlatelet Therapy In diabetes MellitUS) study selectively evaluated [[type 2 diabetes mellitus]] patients with high platelet reactivity while on 75mg clopidogrel and showed that 150 mg clopidogrel maintenance dose induced greater platelet inhibition compared with 75 mg dosing <ref name="pmid17261652">{{cite journal |author=Angiolillo DJ, Shoemaker SB, Desai B, ''et al'' |title=Randomized comparison of a high clopidogrel maintenance dose in patients with diabetes mellitus and coronary artery disease: results of the Optimizing Antiplatelet Therapy in Diabetes Mellitus (OPTIMUS) study |journal=Circulation |volume=115 |issue=6 |pages=708–16 |year=2007 |month=February |pmid=17261652 |doi=10.1161/CIRCULATIONAHA.106.667741 |url=}}</ref>. In a recently published observational study<ref name="pmid19185648">{{cite journal |author=Lemesle G, Delhaye C, Sudre A, ''et al'' |title=Impact of high loading and maintenance dose of clopidogrel within the first 15 days after percutaneous coronary intervention on patient outcome |journal=Am. Heart J. |volume=157 |issue=2 |pages=375–82 |year=2009 |month=February |pmid=19185648 |doi=10.1016/j.ahj.2008.09.013 |url=}}</ref>, Lemesle et al. showed better clinical outcomes in PCI patients treated with 600-mg loading dose followed by a high maintenance dose (150 mg/day) without a significant increase in bleeding events. The ongoing [[CURRENT/OASIS-7]] (Clopidogrel optimal loading dose Usage to Reduce recurrent EveNTs/Optimal Antiplatelet Strategy for InterventionS; [http://clinicaltrials.gov/ct2/show/NCT00335452?term=NCT00335452&rank=1 NCT00335452]) will evaluate the efficacy of higher loading and maintenance doses of clopidogrel in ACS patients undergoing PCI. Several currently ongoing clinical trials are evaluating safety and/or efficacy of a tailored treatment with high clopidogrel maintenance dose in patients with inadequate response to clopidogrel. These include [[GRAVITAS]] (Gauging Responsiveness with a VerifyNow Assay: Impact on Thrombosis And Safety; [http://clinicaltrials.gov/ct2/show/NCT00645918?term=NCT00645918&rank=1 NCT00645918]), [[ARCTIC]] (Double Randomization of a Monitoring Adjusted Antiplatelet Treatment Versus a Common Antiplatelet Treatment for DES Implantation, and Interruption Versus Continuation of Double Antiplatelet Therapy; [http://clinicaltrials.gov/ct2/show/NCT00827411?term=NCT00827411&rank=1 NCT00827411]), and [[DANTE]] (Dual Antiplatelet Therapy Tailored on the Extent of Platelet Inhibition, [http://clinicaltrials.gov/ct2/show/NCT00774475?term=NCT00774475&rank=1 NCT00774475]).

===Triple Antiplatelet Therapy===
In the acute phase of therapy, adding a [[glycoprotein IIb/IIIa]] inhibitor may be considered as this leads to more potent [[platelet]] inhibition. Recently, Cuisset et al. showed that the rate of cardiovascular events at 1 month was significantly lower when [[abciximab]] was added compared to conventional dual [[antiplatelet]] therapy in [[clopidogrel nonresponders]] (n=149) referred for elective PCI <ref>Cuisset T, Frere C, Quilici J, et al. Glycoprotein IIb/IIIa inhibitors improve outcome after coronary stenting in clopidogrel nonresponders. J Am Coll Cardiol Interv 2008;1:649-53.</ref>. The [[3T/2R trial]] showed that better clinical outcomes in aspirin or [[clopidogrel]] non responders undergoing elective PCI treated with [[tirofiban]]<ref>Valgimigli M, Campo G, de Cesare N, et al. Intensifying Platelet Inhibition With Tirofiban in Poor Responders to Aspirin and/orClopidogrel Undergoing Elective Coronary Intervention. Results from the double-blind, prospective, randomized 3T/2R study. Circulation 2009 (in press)</ref>. In the maintenance phase of therapy, triple antiplatelet therapy achieved with the adjunctive use of [[cilostazol]], a [[phosphodiesterase]] III inhibitor, is another option. The [[OPTIMUS-2]] study showed that in a diabetic population cilostazol markedly enhances P2Y12 inhibition<ref name="pmid18567918">{{cite journal |author=Angiolillo DJ, Capranzano P, Goto S, ''et al'' |title=A randomized study assessing the impact of cilostazol on platelet function profiles in patients with diabetes mellitus and coronary artery disease on dual antiplatelet therapy: results of the OPTIMUS-2 study |journal=Eur. Heart J. |volume=29 |issue=18 |pages=2202–11 |year=2008 |month=September |pmid=18567918 |doi=10.1093/eurheartj/ehn287 |url=}}</ref>This may explain the reduced stent thrombosis rates observed with this triple [[antiplatelet]] treatment regimen compared to standard dual antiplatelet therapy and reduced target lesion [[revascularization]] rates in patients treated with both bare-metal and [[drug-eluting stent]]s with greater effects among diabetics<ref name="pmid16286167">{{cite journal |author=Lee SW, Park SW, Hong MK, ''et al'' |title=Triple versus dual antiplatelet therapy after coronary stenting: impact on stent thrombosis |journal=J. Am. Coll. Cardiol. |volume=46 |issue=10 |pages=1833–7 |year=2005 |month=November |pmid=16286167 |doi=10.1016/j.jacc.2005.07.048 |url=}}</ref><ref name="pmid17884371">{{cite journal |author=Lee SW, Park SW, Kim YH, ''et al'' |title=Comparison of triple versus dual antiplatelet therapy after drug-eluting stent implantation (from the DECLARE-Long trial) |journal=Am. J. Cardiol. |volume=100 |issue=7 |pages=1103–8 |year=2007 |month=October |pmid=17884371 |doi=10.1016/j.amjcard.2007.05.032 |url=}}</ref><ref name="pmid16246948">{{cite journal |author=Douglas JS, Holmes DR, Kereiakes DJ, ''et al'' |title=Coronary stent restenosis in patients treated with cilostazol |journal=Circulation |volume=112 |issue=18 |pages=2826–32 |year=2005 |month=November |pmid=16246948 |doi=10.1161/CIRCULATIONAHA.104.530097 |url=}}</ref><ref name="pmid18513523">{{cite journal |author=Biondi-Zoccai GG, Lotrionte M, Anselmino M, ''et al'' |title=Systematic review and meta-analysis of randomized clinical trials appraising the impact of cilostazol after percutaneous coronary intervention |journal=Am. Heart J. |volume=155 |issue=6 |pages=1081–9 |year=2008 |month=June |pmid=18513523 |doi=10.1016/j.ahj.2007.12.024 |url=}}</ref><ref name="pmid18355656">{{cite journal |author=Lee SW, Park SW, Kim YH, ''et al'' |title=Drug-eluting stenting followed by cilostazol treatment reduces late restenosis in patients with diabetes mellitus the DECLARE-DIABETES Trial (A Randomized Comparison of Triple Antiplatelet Therapy with Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Diabetic Patients) |journal=J. Am. Coll. Cardiol. |volume=51 |issue=12 |pages=1181–7 |year=2008 |month=March |pmid=18355656 |doi=10.1016/j.jacc.2007.11.049 |url=}}</ref>. All the above strategies have not been associated with increased [[bleeding]].

===Using a different P2Y12 receptor antagonists===
Although [[clopidogrel]] has largely replace [[ticlopidine]] due to its better safety profile, it has been shown that ticlopidine may improve platelet inhibition among suboptimal responders<ref name="pmid17868803">{{cite journal |author=Campo G, Valgimigli M, Gemmati D, ''et al'' |title=Poor responsiveness to clopidogrel: drug-specific or class-effect mechanism? Evidence from a clopidogrel-to-ticlopidine crossover study |journal=J. Am. Coll. Cardiol. |volume=50 |issue=12 |pages=1132–7 |year=2007 |month=September |pmid=17868803 |doi=10.1016/j.jacc.2007.04.092 |url=}}</ref>.
However, the future likely resides with the use of newer agents. New [[P2Y12 receptor antagonist]]s are currently under different phases of clinical development (e.g. prasugrel, cangrelor, ticagrelor, elinogrel)<ref name="pmid18657683">{{cite journal |author=Angiolillo DJ, Guzman LA |title=Clinical overview of promising nonthienopyridine antiplatelet agents |journal=Am. Heart J. |volume=156 |issue=2 Suppl |pages=S23–8 |year=2008 |month=August |pmid=18657683 |doi=10.1016/j.ahj.2008.06.006 |url=}}</ref><ref name="pmid19166712">{{cite journal |author=Angiolillo DJ, Bhatt DL, Gurbel PA, Jennings LK |title=Advances in antiplatelet therapy: agents in clinical development |journal=Am. J. Cardiol. |volume=103 |issue=3 Suppl |pages=40A–51A |year=2009 |month=February |pmid=19166712 |doi=10.1016/j.amjcard.2008.11.023 |url=}}</ref><ref name="pmid18937620">{{cite journal |author=Angiolillo DJ, Suryadevara S, Capranzano P, Bass TA |title=Prasugrel: a novel platelet ADP P2Y12 receptor antagonist. A review on its mechanism of action and clinical development |journal=Expert Opin Pharmacother |volume=9 |issue=16 |pages=2893–900 |year=2008 |month=November |pmid=18937620 |doi=10.1517/14656566.9.16.2893 |url=}}</ref>. These agents have more potent and less variable inhibitory effects than [[clopidogrel]]. [[Prasugrel]], a third generation [[thienopyridine]], has already completed its [[phase III]] investigation and received approval for clinical use in Europe <ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, ''et al'' |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=N. Engl. J. Med. |volume=357 |issue=20 |pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482 |url=}}</ref>. If prasugrel yields better clinical outcomes without increasing bleeding hazards in clopidogrel non-responders is under investigation.

==References==
{{reflist|2}}
{{SIB}}

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Template:WikiPatient - Patient Resources

2009-07-07T12:05:31Z

LBiller:

Blepharoplasty

2009-07-02T12:43:48Z

LBiller:

[[Image:Blepharoplasty_04.png|thumb|right|250px|Blepharoplasty of an upper eyelid]]

{{SI}}
'''Editor-In-Chief:''' Michel C. Samson, M.D., FRCSC, FACS [mailto:samsonm1@ccf.org]

{{EJ}}

==Overview==
'''Blepharoplasty''' can be both a functional or cosmetic surgical procedure intended to reshape the upper [[eyelid]] or lower eyelid by the removal and/or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons. When an advanced amount of upper eyelid skin is present, the skin may hang over the eyelashes and cause a loss of peripheral vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision. Patients with a less severe amount of excess skin may have a similar procedure performed for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin.

Blepharoplasty is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or from the inside surface of the lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until the final result becomes stable. Depending upon the scope of the procedure, the operation takes one to three hours to complete.

The anatomy of the upper/lower eyelids, patients' skin quality, patients' age, and the adjacent bony and soft tissue all affect the cosmetic and functional outcomes after blepharoplasty. Factors which are known to cause complications after surgery include failure to recognize factors such as
* preexisting dry eyes - which may become exacerbated by disrupting the natural tear film
* laxity (loosness) of the lower lid margin (edge) - which predisposes to lower lid malposition
* prominence of the eye in relation to the malar (cheek) complex - which predisposes to lower lid malposition

[http://www.surgery.org The American Society for Aesthetic Plastic Surgery]estimates the average physician/surgeon fee for blepharoplasty for [http://www.surgery.org/download/2006stats.pdf 2006 to be around $2,882.] These fees are for the physician/surgeon fees only and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments or any other miscellaneous costs related to the surgery. Physicians most qualified to perform blepharoplasties are [[plastic surgeons]], [[ophthalmologists]], [[oral and maxillofacial surgery|oral and maxillofacial surgeons]], and [[otolaryngologists]].

The manner in which blepharoplasty surgery can alter a person's appearance is best appreciated by comparing before and after photos of surgical patients. Photos are available on a number of surgeon websites including: [http://www.drmeronk.com/eyelid/photos.html Dr. Frank Meronk based in Southern California] , [http://www.spaldingplasticsurgery.com/browlift-eyelift-gallery.html Dr. Paul S. Nassif based in Beverly Hills, California] and [http://www.bostoneyelids.com/eyelid-surgery-photos.aspx Dr. Mitesh Kapadia based in Boston, Massachusetts].

An upper blepharoplasy in someone who is Asian is termed ''[[Asian blepharoplasty]]'' or ''double eyelid surgery''.<ref>McCurdy JA Jr. "Upper blepharoplasty in the Asian patient: the 'double eyelid' operation." ''Facial Plast Surg Clin North Am.'' 2005 Feb;13(1):47-64. Review. PMID 15519927.</ref> It is the most popular form of cosmetic surgery among those of east and southeast Asian background. Due to anatomic differences between the asian and occidental eyelid, about half of this population are born without a supratarsal eyelid crease and are called single-lidded. Surgery can be used to artificially create a crease above the eye.

Transconjunctival blepharoplasty involves removing lower eyelid fat through an incision on the back of the eyelid, eliminating the need for an external incision. Because there is no external incision, excess skin can not be removed during the surgery, but skin resurfacing with a chemical peel or carbon dioxide laser may be performed simultaneously. <ref>John Kitzmiller, “Blepharoplasty, Lower Lid Subciliary” 2006. eMedicine. Ed. 25 September 2006, http://www.emedicine.com/plastic/topic4.htm</ref> This allows for a faster recovery process.

==History==

Karl Ferdinand von Gräfe coined the phrase blepharoplasty in 1818 when the technique was used for repairing deformities caused by cancer in the eyelids.

The roots of the present cosmetic advancements began around 3000 years ago with the ancient Egyptians. Documents “written on papyrus text detail how surgeons, even in that primitive age performed reconstructions on lips, noses, and ears using skin grafts cut from folds from the forehead or cheek”. <ref>“History of Cosmetic Surgery”. ''Wise Medical & Health'', 26 September 2006, http://www.resources4cosmeticsurgery.com/topics/history.html</ref> As techniques began developing the ancient Greeks and Romans began writing down and collecting everything they knew involving these procedures. Aulus Cornelius Cellus, a first century Roman, described making an excision in the skin to relax the eyelids in his book ''De Medicine''.<ref> Cecilia Tran,“Preoperative Considerations in Blepharoplasty,” Baylor College of Medicine, 25 September 2006, http://www.bmc.edu/oto/grand/04_22_04.htm</ref> Knowledge of blood circulation and tissue health were discovered and spread throughout the ancient world allowing techniques to improve. However, during the middle ages, plastic surgery was prohibited because it was viewed as something that was spiritual and unethical. This ban was also due to poor hygiene. Luckily, during the Renaissance, modern intellectuals from ancient Greece and Rome developed text illustrating the rediscovery of [[surgical]] procedures and techniques.

As the 19th century approached developments were being made that would eventually be the foundation to modern cosmetic surgery. The First World War was the first major event that really relied on the dedication of surgeons and advancements in cosmetic surgery. This gave doctors a chance to practice and perfect reconstructive surgical procedures. It also prepared medical personnel for the tragedies of World War II and other subsequent catastrophes. As with any medical advancements, the development of surgical techniques goes through a period of trial and error as reconstructive surgery did during World War I. Each improvement eventually becomes the root of future advancements allowing physicians to combine procedures such as a basic lid fat resection and chemical peels insuring a speedy recovery.

==References==
<div class="references-small">
<references/>
</div>

==External links==
*[http://www.surgery.org/public/photos/eyelid_surgery Eyelid surgery patients from the American Society for Aesthetic Plastic Surgery]
*[http://www.plastsurgery.com/flash7/ypo.swf Blepharoplasty] [[Flash animation]]
*[http://commons.wikimedia.org/wiki/User:ISebestyen/Blepharoplasty Blepharoplasty images]

==See also==
*[[Eye surgery]]
*[[Oculoplastics]]
*[[Plastic surgery]]
*[[Maxillofacial surgery]]
*[[Asian blepharoplasty]]
{{Eye surgery}}
[[Category:Ophthalmology]]
[[Category:Surgical procedures]]

[[es:Blefaroplastia]]
[[it:Blefaroplastica]]
[[pt:Blefaroplastia]]

{{WH}}
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File:Blepharoplasty 04.png

2009-07-02T12:42:53Z

LBiller:

Vicodin

2009-07-01T13:07:55Z

LBiller:

{{Drugbox
| type = combo
| drug_name = Vicodin
| component1 = Hydrocodone
| class1 = [[Opioid|Opioid Analgesic]]
| component2 = Paracetamol
| class2 = [[Anilides|Anilide Analgesic]]
| component3 =
| class3 =
| component4 = 
| class4 = 
| CAS_number = 8055-08-1
| CAS_supplemental =
| ATC_prefix =
| ATC_suffix =
| ATC_supplemental =
| PubChem =
| DrugBank =
| ChemSpiderID =
| licence_EU = 
| licence_US = Vicodin
| pregnancy_AU = 
| pregnancy_US = 
| pregnancy_category= '''C'''
| legal_AU = 
| legal_CA = 
| legal_UK = 
| legal_US = Schedule III
| legal_status =
| dependency_liability =
| routes_of_administration = [[Mouth|Oral]]
}}

''For drug information from the FDA, click'' [[Hydrocodone|here]]

{{SI}}

{{EH}}

==Overview==
[[Image:BrandnameVicodin.jpg|thumb|left|Brand name Vicodin-hydrocodone and acetaminophen (also known as paracetamol or abbreviated as APAP) 5-500 tablets (Abbot Laboratories).]]'''Vicodin''' is a trademarked brand [[narcotic]] [[analgesic]] product containing [[hydrocodone]] and [[paracetamol]] ([[acetaminophen]] or more completely para-acetylaminophenol). It is usually found in tablet form with either the names ''Vicodin'', ''Vicodin ES'', or ''Vicodin HP'' imprinted on one side. Analgesics with the same chemical composition and a similar physical appearance are found under many other [[trade name]]s, including ''Anexsia'', ''Anolor DH5'', ''Bancap HC'', ''Dolacet'', ''Lorcet'', ''Lortab'', and ''Norco''. The [[hydrocodone]]/[[paracetamol]] drug formula is also available under [[Generic drug|generic brands]]. The paracetamol in the formula increases the effects of the hydrocodone. Hydrocodone also comes in a combination with [[ibuprofen]], available under the trade name ''Vicoprofen''.

==Ingredients==
Vicodin is made as a mixture of hydrocodone and paracetamol. Paracetamol, which is also called acetaminophen, acts as an [[analgesic]]/[[antipyretic]]. Hydrocodone is a synthetic mixture of the opiate [[codeine]] modified by an added hydrogen and the opiate alkaloid [[thebaine]]. Codeine acts as an antitussive, antidiarrheal and analgesic, while thebaine is added for its stimulatory effects.
* Vicodin contains 500 mg paracetamol and 5 mg hydrocodone
* Vicodin ES contains 750 mg paracetamol and 7.5 mg hydrocodone
* Vicodin HP contains 660 mg paracetamol and 10 mg hydrocodone
Non-active ingredients included in each pill as well: colloidal silicon dioxide, starch, croscarmellose sodium, dibasic calcium phosphate, magnesium stearate, microcrystalline cellulose, povidone, and stearic acid.<ref>[http://www.rxlist.com/vicodin-drug.htm Vicodin (Hydrocodone Bitartrate and Acetaminophen)] - RxList</ref>

==Regulation and scheduling==
In the [[United States]], Vicodin production is regulated in part by the [[Controlled Substances Act]] of 1970. This guarantees that all manufacturing, importing, possession, and distribution of drugs is to be overseen and regulated by the federal government.

In the U.S. Hydrocodone is a [[List of Schedule III drugs|Schedule III drug]]. Other drugs on this list include [[anabolic steroids]], [[dihydrocodeine]], [[dronabinol]], [[phendimetrazine]], [[ketamine]], [[paregoric]], and [[Xyrem]]; [[codeine]] and [[hydrocodone]] are also Schedule III but only when compounded with [[paracetamol]] or with an [[Non-steroidal anti-inflammatory drug|NSAID]]. Schedule III drugs are classified by the U.S. government as potentially causing moderate or low physical dependence or a high psychological dependence if abused. There is a high inclination for abuse of this drug.

==Manufacture==
The principal constituent of Vicodin, hydrocodone, has the same basic structure as morphine but is metabolized by different enzymes. There are three variations of Vicodin, with different amounts of hydrocodone / paracetamol (acetaminophen) in each. Hydrocodone is a strong drug which has similar effects as morphine, because of this, the pills are made with much less hydrocodone than paracetamol. The theory of using the mix comes from the idea that these drugs alleviate pain using different mechanisms and also that the adverse side effects of each separate drug are reduced by using reduced dosages of both drugs in order to get the same analgesic effect.<ref>Beaver W.T., and McMillan D. Methodological considerations in the evaluation of analgesic combinations: Acetaminophen (paracetamol) and hydrocodone in postpartum pain. ''Br. J. Clin. Pharmac.'' (1980), 10, 215S-223S</ref> Both hydrocodone and acetaminophen are white crystalline powders, which are then manufactured into pill form. There is also a theory that the acetaminophen is added in order to reduce abuse potential, as multiple doses will result in nausea symptoms and stomach complications.
Manufacturers of hydrocodone (generic or otherwise) include Abbott Laboratories (makers of trademark Vicodin), Amerisource Health Services Corp, Cardinal Health, Drx Pharmaceutical Consultants Inc, Eckerd Corp, Hospira Inc, Knoll Laboratories Div Knoll Pharmaceutical Co, Mallinckrodt Pharm. Quality Care, Pdrx Pharmaceuticals Inc, Physicians Total Care Inc, Rx Pak Div of Mckesson Corp, Sandhills Packaging Inc, and Watson Pharmaceuticals.

==Pharmacokinetics==
Besides the activity of hydrocodone and acetaminophen on their own, there is observed a factor of analgesia related to the two substances in tandem which is not altogether understood, but this independent synergy has been observed to be related to the inhibition of prostaglandins. The pharmacokinetics of a mixed drug such as Vicodin depends on the kinetics of the drugs that comprise it. We will look at the two main constituents separately, hydrocodone and paracetamol.
Hydrocodone: acts at mu [[opioid]] receptors.<ref name=Zacny>Zacny, J.P., Gutierrez, S. and Bolbolan, S.A. (2004) Profiling the subjective, psychomotor, and physiological effects of a hydrocodone/acetaminophen product in recreational drug users. Drug and Alcohol Dependence. 78 243-252</ref> Hydrocodone must be metabolized to its active state, [[hydromorphone]]. This metabolism occurs by the activity of cytochrome P450 2D6. Cytochrome 3A4 forms the active substrate norhydrocodone. Cytochromes are haemoprotiens found in the cells of all living organisms and are involved primarily with the electron transport chain producing ATP. Hydrocodone passes through the Blood Brain Barrier because of its modifications, the brain is typically where the analgesic effects are being carried out. Many of the side effects of this drug are caused by the fact that it so readily crosses the BBB. The half-life of hydrocodone is approximately 3.8 hrs. Paracetamol: the major active metabolites are sulphates and glucuronide conjugates. Its main mode of action is to inhibit the activity of the enzyme cyclooxygenase (COX). COX enzymes are necessary for the production of prostaglandins. Prostaglandins are a form of hormone (although rarely classified as such), which are indicated to be mediators of pain, fever and inflammation. The half-life of paracetamol may be measured either by salivary or plasma counts. Both measurements give a varying half-life between 1 and 4 hours.<ref>Lee, H.S., Ti, T.Y., Lye, W.C., Khoo, Y.M., and Tan, C.C. Paracetamol and its metabolites in saliva and plasma in chronic dialysis patients. Br. J. Clin. Pharmacology. 1996. 41: 41-47</ref> Peak levels are reached between 40–60 minutes after ingestion. It has been proposed that paracetamol aids in the reduction of pain by increasing seratonergic neurotransmissions.<ref>Garrone, B., Polenzani L., De Santi, S., Moreci, W., and Guglielmotti, A. Paraccetamol reduces neuropathic pain-like behaviour in rats by potentiating seratonergic neurotransmission. International Journal of Integrative Biology. 2007. 3:196-206</ref> Paracetamol is a peripherally acting drug, and hence does not cross the BBB as readily as hydrocodone.

==Indications==
Vicodin, like other [[opioid]] analgesics, is used to manage pain. It is most commonly prescribed for relief of moderate to moderately severe pain of acute, chronic, or post-operative types. It can also be used to treat severe cough.

==Pregnancy==
This drug is classified under pregnancy category C. Although not enough research has been done to deem this drug safe for pregnant women, if the positive effects outweigh the possible negatives, then it can be taken. If taken in the time before delivery, it may give rise to respiratory depression in the baby. Mothers who use any opioids regularly during pregnancy run the risk of their babies being substance dependent and therefore going through withdrawal symptoms after birth. Withdrawal symptoms include: excessive crying, vomiting, irritability, tremors and fever. Nursing mothers should not use this drug as [[paracetamol]] is transferred through breast milk and it is unknown if hydrocodone is. <ref>[http://www.drugs.com/pro/vicodin-hp.html Vicodin] HP Official FDA information, side effects and uses. - Drugs.com</ref>

==Side effects==
[[Image:Side effects of Vicodin.png|thumb|left|280px|Main side effects of Vicodin.<ref>[http://www.drugs.com/vicodin.html Vicodin] Information from Drugs.com</ref>]]

Side effects for Vicodin are most commonly upset stomach, nausea, and altered mental status (eg. dizziness, light headedness). Other more rare side effects include [[allergy|allergic reaction]], [[seizure]]s, clammy skin, hallucinations, severe weakness, [[dizziness]], [[hyperventilation]], [[unconsciousness]], [[jaundice]] (yellowing of eyes or skin), unusual [[fatigue (medical)|fatigue]], [[bleeding]], [[bruise|bruising]], stomach pain<ref>{{cite web
| author=Drugs.com | date=March 24, 2008
| url=http://www.drugs.com/vicodin.html | title=Vicodin
| publisher=Cerner Multum, Inc. | accessdate=2008-06-09 }}</ref>, [[constipation]], [[Xerostomia|dry mouth]], [[Anorexia (symptom)|decreased appetite]], [[Muscle contraction|muscle twitches]], [[Perspiration|sweating]], [[hot flash]]es, [[itch]]ing, [[tinnitus]], [[Hearing impairment|hearing loss]], decreased [[urination]], and altered [[Libido|sex drive]]. Vicodin also has [[depressant]] effects on the [[central nervous system]]. However, some of the less mundane effects can be desirable effects that are sought after by some. Those effects include [[Euphoria (emotion)|euphoria]] and [[Somnolence|drowsiness]], as well as slowing of the pulse. Unlike [[NSAIDs]], [[Paracetamol]] does not cause ulcers. Liver damage can manifest ranging from abdominal pain to outright liver failure, and can necessitate a liver transplant to avoid death. Paracetamol dosages should never exceed 4g a day; this is especially important and may be a smaller number when dealing with mixed drugs like Vicodin. It is imperative that users of this drug follow physician prescribed dosages.

==Behavioral effects==
Tolerance to this drug may develop rapidly, especially if it is misused. This tolerance will usually manifest itself by analgesic effects wearing off faster, and people needing higher dosages to reach the analgesic effects. It is commonly misused or used excessively because people take too much in order to relieve their pain faster. Taking more of the drug does increase its efficacy but it also increases its addictive properties. When tolerance does develop, people are often forced to seek out more and more Vicodin, but as it is a controlled substance, there are regulations on how much can be legally prescribed. This often leads to societal/legal consequences as people will visit many doctors and/or try to buy the drug illegally. The withdrawal effects of Vicodin include things such as insomnia, night sweats, tremors, and agitation.<ref>[http://www.drugabusehelp.com/drugs/vicodin/ Vicodin Information] - Drug Abuse Help</ref> People looking for the secondary effects of the drug often abuse many forms of prescription drugs. Vicodin is a potentially addictive drug, specifically due to the hydrocodone in it. People who are using Vicodin for non-medicinal purposes are typically using it to get the euphoric effects sometimes associated with it. Ten percent of American high school seniors have abused Vicodin; 4.7 percent report abusing Oxycontin in the past year.<ref>[http://www.injuryboard.com/national-news/middle-class-white-teens-abusing-vicodin-and-oxycontin.aspx?googleid=253158 Middle-Class White Teens Abusing Vicodin and OxyContin]</ref> There have been reports of severe hearing loss and deafness associated with the abuse of Vicodin. <ref>Oh, A.K., Ishiyama, A., and Baloh, R.W. Deafness associated with abuse of hydrocodone/acetaminophen. 2000. Neurology. 54:2345-2351</ref> If taken at the normal prescribed dosages, the risk of hearing loss is very minimal. It is interesting to note that in people who use these drugs for recreational purposes there are sex differences. Women tend to feel less "in control on their thoughts" and more report, "feeling bad" more often than men. People given logic examinations while under the influence of this drug showed an increase in incorrect answers, but spent more time on the exams. This suggests that this drug may be aiding in attention. It is again important to note that clinically prescribed dosages do not produce these effects; these effects are related to taking more of the drug than typically prescribed.<ref name="Zacny" />

==Paracetamol/Acetaminophen In The News==

On Jun 30 2009 an FDA advisory panel recommended that Vicodin and another painkiller, [[Percocet]], be removed from the market because they have allegedly caused over 400 deaths a year. The problem is with Paracetamol overdose and liver damage.<ref>[http://www.cnn.com/2009/HEALTH/06/30/acetaminophen.fda.hearing/index.html] - CNN: "FDA Advisers vote to take Vicodin, Percocet off market</ref>

==References==
{{Reflist|2}}

==External links==
*[http://www.usdoj.gov/dea/pubs/scheduling.html U.S. DEA Drug Schedule]
*[http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm U.S. Federal Regulations]

[[Category:Analgesics]]
{{SIB}}
[[cs:Vicodin]]
[[fr:Vicodin]]
[[nl:Vicodin]]
[[pl:Vicodin]]
[[pt:Vicodin]]
[[ru:Викодин]]
[[sr:Викодин]]
{{WH}}
{{WS}}

Vicodin

2009-07-01T13:01:29Z

LBiller:

{{Drugbox
| type = combo
| drug_name = Vicodin
| component1 = Hydrocodone
| class1 = [[Opioid|Opioid Analgesic]]
| component2 = Paracetamol
| class2 = [[Anilides|Anilide Analgesic]]
| component3 =
| class3 =
| component4 = 
| class4 = 
| CAS_number = 8055-08-1
| CAS_supplemental =
| ATC_prefix =
| ATC_suffix =
| ATC_supplemental =
| PubChem =
| DrugBank =
| ChemSpiderID =
| licence_EU = 
| licence_US = Vicodin
| pregnancy_AU = 
| pregnancy_US = 
| pregnancy_category= '''C'''
| legal_AU = 
| legal_CA = 
| legal_UK = 
| legal_US = Schedule III
| legal_status =
| dependency_liability =
| routes_of_administration = [[Mouth|Oral]]
}}

''For drug information from the FDA, click'' [[Hydrocodone|here]]

{{SI}}

{{EH}}

==Overview==
[[Image:BrandnameVicodin.jpg|thumb|left|Brand name Vicodin-hydrocodone and acetaminophen (also known as paracetamol or abbreviated as APAP) 5-500 tablets (Abbot Laboratories).]]'''Vicodin''' is a trademarked brand [[narcotic]] [[analgesic]] product containing [[hydrocodone]] and [[paracetamol]] ([[acetaminophen]] or more completely para-acetylaminophenol)]]. It is usually found in tablet form with either the names ''Vicodin'', ''Vicodin ES'', or ''Vicodin HP'' imprinted on one side. Analgesics with the same chemical composition and a similar physical appearance are found under many other [[trade name]]s, including ''Anexsia'', ''Anolor DH5'', ''Bancap HC'', ''Dolacet'', ''Lorcet'', ''Lortab'', and ''Norco''. The [[hydrocodone]]/[[paracetamol]] drug formula is also available under [[Generic drug|generic brands]]. The paracetamol in the formula increases the effects of the hydrocodone. Hydrocodone also comes in a combination with [[ibuprofen]], available under the trade name ''Vicoprofen''.

==Ingredients==
Vicodin is made as a mixture of hydrocodone and paracetamol. Paracetamol, which is also called acetaminophen, acts as an [[analgesic]]/[[antipyretic]]. Hydrocodone is a synthetic mixture of the opiate [[codeine]] modified by an added hydrogen and the opiate alkaloid [[thebaine]]. Codeine acts as an antitussive, antidiarrheal and analgesic, while thebaine is added for its stimulatory effects.
* Vicodin contains 500 mg paracetamol and 5 mg hydrocodone
* Vicodin ES contains 750 mg paracetamol and 7.5 mg hydrocodone
* Vicodin HP contains 660 mg paracetamol and 10 mg hydrocodone
Non-active ingredients included in each pill as well: colloidal silicon dioxide, starch, croscarmellose sodium, dibasic calcium phosphate, magnesium stearate, microcrystalline cellulose, povidone, and stearic acid.<ref>[http://www.rxlist.com/vicodin-drug.htm Vicodin (Hydrocodone Bitartrate and Acetaminophen)] - RxList</ref>

==Regulation and scheduling==
In the [[United States]], Vicodin production is regulated in part by the [[Controlled Substances Act]] of 1970. This guarantees that all manufacturing, importing, possession, and distribution of drugs is to be overseen and regulated by the federal government.

In the U.S. Hydrocodone is a [[List of Schedule III drugs|Schedule III drug]]. Other drugs on this list include [[anabolic steroids]], [[dihydrocodeine]], [[dronabinol]], [[phendimetrazine]], [[ketamine]], [[paregoric]], and [[Xyrem]]; [[codeine]] and [[hydrocodone]] are also Schedule III but only when compounded with [[paracetamol]] or with an [[Non-steroidal anti-inflammatory drug|NSAID]]. Schedule III drugs are classified by the U.S. government as potentially causing moderate or low physical dependence or a high psychological dependence if abused. There is a high inclination for abuse of this drug.

==Manufacture==
The principal constituent of Vicodin, hydrocodone, has the same basic structure as morphine but is metabolized by different enzymes. There are three variations of Vicodin, with different amounts of hydrocodone / paracetamol (acetaminophen) in each. Hydrocodone is a strong drug which has similar effects as morphine, because of this, the pills are made with much less hydrocodone than paracetamol. The theory of using the mix comes from the idea that these drugs alleviate pain using different mechanisms and also that the adverse side effects of each separate drug are reduced by using reduced dosages of both drugs in order to get the same analgesic effect.<ref>Beaver W.T., and McMillan D. Methodological considerations in the evaluation of analgesic combinations: Acetaminophen (paracetamol) and hydrocodone in postpartum pain. ''Br. J. Clin. Pharmac.'' (1980), 10, 215S-223S</ref> Both hydrocodone and acetaminophen are white crystalline powders, which are then manufactured into pill form. There is also a theory that the acetaminophen is added in order to reduce abuse potential, as multiple doses will result in nausea symptoms and stomach complications.
Manufacturers of hydrocodone (generic or otherwise) include Abbott Laboratories (makers of trademark Vicodin), Amerisource Health Services Corp, Cardinal Health, Drx Pharmaceutical Consultants Inc, Eckerd Corp, Hospira Inc, Knoll Laboratories Div Knoll Pharmaceutical Co, Mallinckrodt Pharm. Quality Care, Pdrx Pharmaceuticals Inc, Physicians Total Care Inc, Rx Pak Div of Mckesson Corp, Sandhills Packaging Inc, and Watson Pharmaceuticals.

==Pharmacokinetics==
Besides the activity of hydrocodone and acetaminophen on their own, there is observed a factor of analgesia related to the two substances in tandem which is not altogether understood, but this independent synergy has been observed to be related to the inhibition of prostaglandins. The pharmacokinetics of a mixed drug such as Vicodin depends on the kinetics of the drugs that comprise it. We will look at the two main constituents separately, hydrocodone and paracetamol.
Hydrocodone: acts at mu [[opioid]] receptors.<ref name=Zacny>Zacny, J.P., Gutierrez, S. and Bolbolan, S.A. (2004) Profiling the subjective, psychomotor, and physiological effects of a hydrocodone/acetaminophen product in recreational drug users. Drug and Alcohol Dependence. 78 243-252</ref> Hydrocodone must be metabolized to its active state, [[hydromorphone]]. This metabolism occurs by the activity of cytochrome P450 2D6. Cytochrome 3A4 forms the active substrate norhydrocodone. Cytochromes are haemoprotiens found in the cells of all living organisms and are involved primarily with the electron transport chain producing ATP. Hydrocodone passes through the Blood Brain Barrier because of its modifications, the brain is typically where the analgesic effects are being carried out. Many of the side effects of this drug are caused by the fact that it so readily crosses the BBB. The half-life of hydrocodone is approximately 3.8 hrs. Paracetamol: the major active metabolites are sulphates and glucuronide conjugates. Its main mode of action is to inhibit the activity of the enzyme cyclooxygenase (COX). COX enzymes are necessary for the production of prostaglandins. Prostaglandins are a form of hormone (although rarely classified as such), which are indicated to be mediators of pain, fever and inflammation. The half-life of paracetamol may be measured either by salivary or plasma counts. Both measurements give a varying half-life between 1 and 4 hours.<ref>Lee, H.S., Ti, T.Y., Lye, W.C., Khoo, Y.M., and Tan, C.C. Paracetamol and its metabolites in saliva and plasma in chronic dialysis patients. Br. J. Clin. Pharmacology. 1996. 41: 41-47</ref> Peak levels are reached between 40–60 minutes after ingestion. It has been proposed that paracetamol aids in the reduction of pain by increasing seratonergic neurotransmissions.<ref>Garrone, B., Polenzani L., De Santi, S., Moreci, W., and Guglielmotti, A. Paraccetamol reduces neuropathic pain-like behaviour in rats by potentiating seratonergic neurotransmission. International Journal of Integrative Biology. 2007. 3:196-206</ref> Paracetamol is a peripherally acting drug, and hence does not cross the BBB as readily as hydrocodone.

==Indications==
Vicodin, like other [[opioid]] analgesics, is used to manage pain. It is most commonly prescribed for relief of moderate to moderately severe pain of acute, chronic, or post-operative types. It can also be used to treat severe cough.

==Pregnancy==
This drug is classified under pregnancy category C. Although not enough research has been done to deem this drug safe for pregnant women, if the positive effects outweigh the possible negatives, then it can be taken. If taken in the time before delivery, it may give rise to respiratory depression in the baby. Mothers who use any opioids regularly during pregnancy run the risk of their babies being substance dependent and therefore going through withdrawal symptoms after birth. Withdrawal symptoms include: excessive crying, vomiting, irritability, tremors and fever. Nursing mothers should not use this drug as [[paracetamol]] is transferred through breast milk and it is unknown if hydrocodone is. <ref>[http://www.drugs.com/pro/vicodin-hp.html Vicodin] HP Official FDA information, side effects and uses. - Drugs.com</ref>

==Side effects==
[[Image:Side effects of Vicodin.png|thumb|left|280px|Main side effects of Vicodin.<ref>[http://www.drugs.com/vicodin.html Vicodin] Information from Drugs.com</ref>]]

Side effects for Vicodin are most commonly upset stomach, nausea, and altered mental status (eg. dizziness, light headedness). Other more rare side effects include [[allergy|allergic reaction]], [[seizure]]s, clammy skin, hallucinations, severe weakness, [[dizziness]], [[hyperventilation]], [[unconsciousness]], [[jaundice]] (yellowing of eyes or skin), unusual [[fatigue (medical)|fatigue]], [[bleeding]], [[bruise|bruising]], stomach pain<ref>{{cite web
| author=Drugs.com | date=March 24, 2008
| url=http://www.drugs.com/vicodin.html | title=Vicodin
| publisher=Cerner Multum, Inc. | accessdate=2008-06-09 }}</ref>, [[constipation]], [[Xerostomia|dry mouth]], [[Anorexia (symptom)|decreased appetite]], [[Muscle contraction|muscle twitches]], [[Perspiration|sweating]], [[hot flash]]es, [[itch]]ing, [[tinnitus]], [[Hearing impairment|hearing loss]], decreased [[urination]], and altered [[Libido|sex drive]]. Vicodin also has [[depressant]] effects on the [[central nervous system]]. However, some of the less mundane effects can be desirable effects that are sought after by some. Those effects include [[Euphoria (emotion)|euphoria]] and [[Somnolence|drowsiness]], as well as slowing of the pulse. Unlike [[NSAIDs]], [[Paracetamol]] does not cause ulcers. Liver damage can manifest ranging from abdominal pain to outright liver failure, and can necessitate a liver transplant to avoid death. Paracetamol dosages should never exceed 4g a day; this is especially important and may be a smaller number when dealing with mixed drugs like Vicodin. It is imperative that users of this drug follow physician prescribed dosages.

==Behavioral effects==
Tolerance to this drug may develop rapidly, especially if it is misused. This tolerance will usually manifest itself by analgesic effects wearing off faster, and people needing higher dosages to reach the analgesic effects. It is commonly misused or used excessively because people take too much in order to relieve their pain faster. Taking more of the drug does increase its efficacy but it also increases its addictive properties. When tolerance does develop, people are often forced to seek out more and more Vicodin, but as it is a controlled substance, there are regulations on how much can be legally prescribed. This often leads to societal/legal consequences as people will visit many doctors and/or try to buy the drug illegally. The withdrawal effects of Vicodin include things such as insomnia, night sweats, tremors, and agitation.<ref>[http://www.drugabusehelp.com/drugs/vicodin/ Vicodin Information] - Drug Abuse Help</ref> People looking for the secondary effects of the drug often abuse many forms of prescription drugs. Vicodin is a potentially addictive drug, specifically due to the hydrocodone in it. People who are using Vicodin for non-medicinal purposes are typically using it to get the euphoric effects sometimes associated with it. Ten percent of American high school seniors have abused Vicodin; 4.7 percent report abusing Oxycontin in the past year.<ref>[http://www.injuryboard.com/national-news/middle-class-white-teens-abusing-vicodin-and-oxycontin.aspx?googleid=253158 Middle-Class White Teens Abusing Vicodin and OxyContin]</ref> There have been reports of severe hearing loss and deafness associated with the abuse of Vicodin. <ref>Oh, A.K., Ishiyama, A., and Baloh, R.W. Deafness associated with abuse of hydrocodone/acetaminophen. 2000. Neurology. 54:2345-2351</ref> If taken at the normal prescribed dosages, the risk of hearing loss is very minimal. It is interesting to note that in people who use these drugs for recreational purposes there are sex differences. Women tend to feel less "in control on their thoughts" and more report, "feeling bad" more often than men. People given logic examinations while under the influence of this drug showed an increase in incorrect answers, but spent more time on the exams. This suggests that this drug may be aiding in attention. It is again important to note that clinically prescribed dosages do not produce these effects; these effects are related to taking more of the drug than typically prescribed.<ref name="Zacny" />

==Paracetamol/Acetaminophen Deaths==

On Jun 30 2009 an FDA advisory panel recommended that Vicodin and another painkiller, [[Percocet]], be removed from the market because they have allegedly caused over 400 deaths a year. The problem is with Paracetamol overdose and liver damage.<ref>[http://www.cnn.com/2009/HEALTH/06/30/acetaminophen.fda.hearing/index.html] - CNN: "FDA Advisers vote to take Vicodin, Percocet off market</ref>

==References==
{{Reflist|2}}

==External links==
*[http://www.usdoj.gov/dea/pubs/scheduling.html U.S. DEA Drug Schedule]
*[http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm U.S. Federal Regulations]

[[Category:Analgesics]]
{{SIB}}
[[cs:Vicodin]]
[[fr:Vicodin]]
[[nl:Vicodin]]
[[pl:Vicodin]]
[[pt:Vicodin]]
[[ru:Викодин]]
[[sr:Викодин]]
{{WH}}
{{WS}}

File:Side effects of Vicodin.png

2009-07-01T12:59:51Z

LBiller:

Vicodin

2009-07-01T12:58:47Z

LBiller: /* Behavioral effects */

{{Drugbox
| type = combo
| drug_name = Vicodin
| component1 = Hydrocodone
| class1 = [[Opioid|Opioid Analgesic]]
| component2 = Paracetamol
| class2 = [[Anilides|Anilide Analgesic]]
| component3 =
| class3 =
| component4 = 
| class4 = 
| CAS_number = 8055-08-1
| CAS_supplemental =
| ATC_prefix =
| ATC_suffix =
| ATC_supplemental =
| PubChem =
| DrugBank =
| ChemSpiderID =
| licence_EU = 
| licence_US = Vicodin
| pregnancy_AU = 
| pregnancy_US = 
| pregnancy_category= '''C'''
| legal_AU = 
| legal_CA = 
| legal_UK = 
| legal_US = Schedule III
| legal_status =
| dependency_liability =
| routes_of_administration = [[Mouth|Oral]]
}}

''For drug information from the FDA drug label, click'' [[Hydrocodone|here]]

{{SI}}

{{EH}}

==Overview==
[[Image:BrandnameVicodin.jpg|thumb|left|Brand name Vicodin-hydrocodone and acetaminophen (also known as paracetamol or abbreviated as APAP) 5-500 tablets (Abbot Laboratories).]]'''Vicodin''' is a trademarked brand [[narcotic]] [[analgesic]] product containing [[hydrocodone]] and [[paracetamol]] ([[acetaminophen]] or more completely para-acetylaminophenol)]]. It is usually found in tablet form with either the names ''Vicodin'', ''Vicodin ES'', or ''Vicodin HP'' imprinted on one side. Analgesics with the same chemical composition and a similar physical appearance are found under many other [[trade name]]s, including ''Anexsia'', ''Anolor DH5'', ''Bancap HC'', ''Dolacet'', ''Lorcet'', ''Lortab'', and ''Norco''. The [[hydrocodone]]/[[paracetamol]] drug formula is also available under [[Generic drug|generic brands]]. The paracetamol in the formula increases the effects of the hydrocodone. Hydrocodone also comes in a combination with [[ibuprofen]], available under the trade name ''Vicoprofen''.

==Ingredients==
Vicodin is made as a mixture of hydrocodone and paracetamol. Paracetamol, which is also called acetaminophen, acts as an [[analgesic]]/[[antipyretic]]. Hydrocodone is a synthetic mixture of the opiate [[codeine]] modified by an added hydrogen and the opiate alkaloid [[thebaine]]. Codeine acts as an antitussive, antidiarrheal and analgesic, while thebaine is added for its stimulatory effects.
* Vicodin contains 500 mg paracetamol and 5 mg hydrocodone
* Vicodin ES contains 750 mg paracetamol and 7.5 mg hydrocodone
* Vicodin HP contains 660 mg paracetamol and 10 mg hydrocodone
Non-active ingredients included in each pill as well: colloidal silicon dioxide, starch, croscarmellose sodium, dibasic calcium phosphate, magnesium stearate, microcrystalline cellulose, povidone, and stearic acid.<ref>[http://www.rxlist.com/vicodin-drug.htm Vicodin (Hydrocodone Bitartrate and Acetaminophen)] - RxList</ref>

==Regulation and scheduling==
In the [[United States]], Vicodin production is regulated in part by the [[Controlled Substances Act]] of 1970. This guarantees that all manufacturing, importing, possession, and distribution of drugs is to be overseen and regulated by the federal government.

In the U.S. Hydrocodone is a [[List of Schedule III drugs|Schedule III drug]]. Other drugs on this list include [[anabolic steroids]], [[dihydrocodeine]], [[dronabinol]], [[phendimetrazine]], [[ketamine]], [[paregoric]], and [[Xyrem]]; [[codeine]] and [[hydrocodone]] are also Schedule III but only when compounded with [[paracetamol]] or with an [[Non-steroidal anti-inflammatory drug|NSAID]]. Schedule III drugs are classified by the U.S. government as potentially causing moderate or low physical dependence or a high psychological dependence if abused. There is a high inclination for abuse of this drug.

==Manufacture==
The principal constituent of Vicodin, hydrocodone, has the same basic structure as morphine but is metabolized by different enzymes. There are three variations of Vicodin, with different amounts of hydrocodone / paracetamol (acetaminophen) in each. Hydrocodone is a strong drug which has similar effects as morphine, because of this, the pills are made with much less hydrocodone than paracetamol. The theory of using the mix comes from the idea that these drugs alleviate pain using different mechanisms and also that the adverse side effects of each separate drug are reduced by using reduced dosages of both drugs in order to get the same analgesic effect.<ref>Beaver W.T., and McMillan D. Methodological considerations in the evaluation of analgesic combinations: Acetaminophen (paracetamol) and hydrocodone in postpartum pain. ''Br. J. Clin. Pharmac.'' (1980), 10, 215S-223S</ref> Both hydrocodone and acetaminophen are white crystalline powders, which are then manufactured into pill form. There is also a theory that the acetaminophen is added in order to reduce abuse potential, as multiple doses will result in nausea symptoms and stomach complications.
Manufacturers of hydrocodone (generic or otherwise) include Abbott Laboratories (makers of trademark Vicodin), Amerisource Health Services Corp, Cardinal Health, Drx Pharmaceutical Consultants Inc, Eckerd Corp, Hospira Inc, Knoll Laboratories Div Knoll Pharmaceutical Co, Mallinckrodt Pharm. Quality Care, Pdrx Pharmaceuticals Inc, Physicians Total Care Inc, Rx Pak Div of Mckesson Corp, Sandhills Packaging Inc, and Watson Pharmaceuticals.

==Pharmacokinetics==
Besides the activity of hydrocodone and acetaminophen on their own, there is observed a factor of analgesia related to the two substances in tandem which is not altogether understood, but this independent synergy has been observed to be related to the inhibition of prostaglandins. The pharmacokinetics of a mixed drug such as Vicodin depends on the kinetics of the drugs that comprise it. We will look at the two main constituents separately, hydrocodone and paracetamol.
Hydrocodone: acts at mu [[opioid]] receptors.<ref name=Zacny>Zacny, J.P., Gutierrez, S. and Bolbolan, S.A. (2004) Profiling the subjective, psychomotor, and physiological effects of a hydrocodone/acetaminophen product in recreational drug users. Drug and Alcohol Dependence. 78 243-252</ref> Hydrocodone must be metabolized to its active state, [[hydromorphone]]. This metabolism occurs by the activity of cytochrome P450 2D6. Cytochrome 3A4 forms the active substrate norhydrocodone. Cytochromes are haemoprotiens found in the cells of all living organisms and are involved primarily with the electron transport chain producing ATP. Hydrocodone passes through the Blood Brain Barrier because of its modifications, the brain is typically where the analgesic effects are being carried out. Many of the side effects of this drug are caused by the fact that it so readily crosses the BBB. The half-life of hydrocodone is approximately 3.8 hrs. Paracetamol: the major active metabolites are sulphates and glucuronide conjugates. Its main mode of action is to inhibit the activity of the enzyme cyclooxygenase (COX). COX enzymes are necessary for the production of prostaglandins. Prostaglandins are a form of hormone (although rarely classified as such), which are indicated to be mediators of pain, fever and inflammation. The half-life of paracetamol may be measured either by salivary or plasma counts. Both measurements give a varying half-life between 1 and 4 hours.<ref>Lee, H.S., Ti, T.Y., Lye, W.C., Khoo, Y.M., and Tan, C.C. Paracetamol and its metabolites in saliva and plasma in chronic dialysis patients. Br. J. Clin. Pharmacology. 1996. 41: 41-47</ref> Peak levels are reached between 40–60 minutes after ingestion. It has been proposed that paracetamol aids in the reduction of pain by increasing seratonergic neurotransmissions.<ref>Garrone, B., Polenzani L., De Santi, S., Moreci, W., and Guglielmotti, A. Paraccetamol reduces neuropathic pain-like behaviour in rats by potentiating seratonergic neurotransmission. International Journal of Integrative Biology. 2007. 3:196-206</ref> Paracetamol is a peripherally acting drug, and hence does not cross the BBB as readily as hydrocodone.

==Indications==
Vicodin, like other [[opioid]] analgesics, is used to manage pain. It is most commonly prescribed for relief of moderate to moderately severe pain of acute, chronic, or post-operative types. It can also be used to treat severe cough.

==Pregnancy==
This drug is classified under pregnancy category C. Although not enough research has been done to deem this drug safe for pregnant women, if the positive effects outweigh the possible negatives, then it can be taken. If taken in the time before delivery, it may give rise to respiratory depression in the baby. Mothers who use any opioids regularly during pregnancy run the risk of their babies being substance dependent and therefore going through withdrawal symptoms after birth. Withdrawal symptoms include: excessive crying, vomiting, irritability, tremors and fever. Nursing mothers should not use this drug as [[paracetamol]] is transferred through breast milk and it is unknown if hydrocodone is. <ref>[http://www.drugs.com/pro/vicodin-hp.html Vicodin] HP Official FDA information, side effects and uses. - Drugs.com</ref>

==Side effects==
[[Image:Side effects of Vicodin.png|thumb|left|280px|Main side effects of Vicodin.<ref>[http://www.drugs.com/vicodin.html Vicodin] Information from Drugs.com</ref>]]

Side effects for Vicodin are most commonly upset stomach, nausea, and altered mental status (eg. dizziness, light headedness). Other more rare side effects include [[allergy|allergic reaction]], [[seizure]]s, clammy skin, hallucinations, severe weakness, [[dizziness]], [[hyperventilation]], [[unconsciousness]], [[jaundice]] (yellowing of eyes or skin), unusual [[fatigue (medical)|fatigue]], [[bleeding]], [[bruise|bruising]], stomach pain<ref>{{cite web
| author=Drugs.com | date=March 24, 2008
| url=http://www.drugs.com/vicodin.html | title=Vicodin
| publisher=Cerner Multum, Inc. | accessdate=2008-06-09 }}</ref>, [[constipation]], [[Xerostomia|dry mouth]], [[Anorexia (symptom)|decreased appetite]], [[Muscle contraction|muscle twitches]], [[Perspiration|sweating]], [[hot flash]]es, [[itch]]ing, [[tinnitus]], [[Hearing impairment|hearing loss]], decreased [[urination]], and altered [[Libido|sex drive]]. Vicodin also has [[depressant]] effects on the [[central nervous system]]. However, some of the less mundane effects can be desirable effects that are sought after by some. Those effects include [[Euphoria (emotion)|euphoria]] and [[Somnolence|drowsiness]], as well as slowing of the pulse. Unlike [[NSAIDs]], [[Paracetamol]] does not cause ulcers. Liver damage can manifest ranging from abdominal pain to outright liver failure, and can necessitate a liver transplant to avoid death. Paracetamol dosages should never exceed 4g a day; this is especially important and may be a smaller number when dealing with mixed drugs like Vicodin. It is imperative that users of this drug follow physician prescribed dosages.

==Behavioral effects==
Tolerance to this drug may develop rapidly, especially if it is misused. This tolerance will usually manifest itself by analgesic effects wearing off faster, and people needing higher dosages to reach the analgesic effects. It is commonly misused or used excessively because people take too much in order to relieve their pain faster. Taking more of the drug does increase its efficacy but it also increases its addictive properties. When tolerance does develop, people are often forced to seek out more and more Vicodin, but as it is a controlled substance, there are regulations on how much can be legally prescribed. This often leads to societal/legal consequences as people will visit many doctors and/or try to buy the drug illegally. The withdrawal effects of Vicodin include things such as insomnia, night sweats, tremors, and agitation.<ref>[http://www.drugabusehelp.com/drugs/vicodin/ Vicodin Information] - Drug Abuse Help</ref> People looking for the secondary effects of the drug often abuse many forms of prescription drugs. Vicodin is a potentially addictive drug, specifically due to the hydrocodone in it. People who are using Vicodin for non-medicinal purposes are typically using it to get the euphoric effects sometimes associated with it. Ten percent of American high school seniors have abused Vicodin; 4.7 percent report abusing Oxycontin in the past year.<ref>[http://www.injuryboard.com/national-news/middle-class-white-teens-abusing-vicodin-and-oxycontin.aspx?googleid=253158 Middle-Class White Teens Abusing Vicodin and OxyContin]</ref> There have been reports of severe hearing loss and deafness associated with the abuse of Vicodin. <ref>Oh, A.K., Ishiyama, A., and Baloh, R.W. Deafness associated with abuse of hydrocodone/acetaminophen. 2000. Neurology. 54:2345-2351</ref> If taken at the normal prescribed dosages, the risk of hearing loss is very minimal. It is interesting to note that in people who use these drugs for recreational purposes there are sex differences. Women tend to feel less "in control on their thoughts" and more report, "feeling bad" more often than men. People given logic examinations while under the influence of this drug showed an increase in incorrect answers, but spent more time on the exams. This suggests that this drug may be aiding in attention. It is again important to note that clinically prescribed dosages do not produce these effects; these effects are related to taking more of the drug than typically prescribed.<ref name="Zacny" />

==Paracetamol/Acetaminophen Deaths==

On Jun 30 2009 an FDA advisory panel recommended that Vicodin and another painkiller, [[Percocet]], be removed from the market because they have allegedly caused over 400 deaths a year. The problem is with Paracetamol overdose and liver damage.<ref>[http://www.cnn.com/2009/HEALTH/06/30/acetaminophen.fda.hearing/index.html] - CNN: "FDA Advisers vote to take Vicodin, Percocet off market</ref>

==References==
{{Reflist|2}}

==External links==
*[http://www.usdoj.gov/dea/pubs/scheduling.html U.S. DEA Drug Schedule]
*[http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm U.S. Federal Regulations]

[[Category:Analgesics]]
{{SIB}}
[[cs:Vicodin]]
[[fr:Vicodin]]
[[nl:Vicodin]]
[[pl:Vicodin]]
[[pt:Vicodin]]
[[ru:Викодин]]
[[sr:Викодин]]
{{WH}}
{{WS}}

File:BrandnameVicodin.jpg

2009-07-01T12:57:17Z

LBiller:

Vicodin

2009-07-01T12:56:45Z

LBiller:

{{Drugbox
| type = combo
| drug_name = Vicodin
| component1 = Hydrocodone
| class1 = [[Opioid|Opioid Analgesic]]
| component2 = Paracetamol
| class2 = [[Anilides|Anilide Analgesic]]
| component3 =
| class3 =
| component4 = 
| class4 = 
| CAS_number = 8055-08-1
| CAS_supplemental =
| ATC_prefix =
| ATC_suffix =
| ATC_supplemental =
| PubChem =
| DrugBank =
| ChemSpiderID =
| licence_EU = 
| licence_US = Vicodin
| pregnancy_AU = 
| pregnancy_US = 
| pregnancy_category= '''C'''
| legal_AU = 
| legal_CA = 
| legal_UK = 
| legal_US = Schedule III
| legal_status =
| dependency_liability =
| routes_of_administration = [[Mouth|Oral]]
}}

''For drug information from the FDA drug label, click'' [[Hydrocodone|here]]

{{SI}}

{{EH}}

==Overview==
[[Image:BrandnameVicodin.jpg|thumb|left|Brand name Vicodin-hydrocodone and acetaminophen (also known as paracetamol or abbreviated as APAP) 5-500 tablets (Abbot Laboratories).]]'''Vicodin''' is a trademarked brand [[narcotic]] [[analgesic]] product containing [[hydrocodone]] and [[paracetamol]] ([[acetaminophen]] or more completely para-acetylaminophenol)]]. It is usually found in tablet form with either the names ''Vicodin'', ''Vicodin ES'', or ''Vicodin HP'' imprinted on one side. Analgesics with the same chemical composition and a similar physical appearance are found under many other [[trade name]]s, including ''Anexsia'', ''Anolor DH5'', ''Bancap HC'', ''Dolacet'', ''Lorcet'', ''Lortab'', and ''Norco''. The [[hydrocodone]]/[[paracetamol]] drug formula is also available under [[Generic drug|generic brands]]. The paracetamol in the formula increases the effects of the hydrocodone. Hydrocodone also comes in a combination with [[ibuprofen]], available under the trade name ''Vicoprofen''.

==Ingredients==
Vicodin is made as a mixture of hydrocodone and paracetamol. Paracetamol, which is also called acetaminophen, acts as an [[analgesic]]/[[antipyretic]]. Hydrocodone is a synthetic mixture of the opiate [[codeine]] modified by an added hydrogen and the opiate alkaloid [[thebaine]]. Codeine acts as an antitussive, antidiarrheal and analgesic, while thebaine is added for its stimulatory effects.
* Vicodin contains 500 mg paracetamol and 5 mg hydrocodone
* Vicodin ES contains 750 mg paracetamol and 7.5 mg hydrocodone
* Vicodin HP contains 660 mg paracetamol and 10 mg hydrocodone
Non-active ingredients included in each pill as well: colloidal silicon dioxide, starch, croscarmellose sodium, dibasic calcium phosphate, magnesium stearate, microcrystalline cellulose, povidone, and stearic acid.<ref>[http://www.rxlist.com/vicodin-drug.htm Vicodin (Hydrocodone Bitartrate and Acetaminophen)] - RxList</ref>

==Regulation and scheduling==
In the [[United States]], Vicodin production is regulated in part by the [[Controlled Substances Act]] of 1970. This guarantees that all manufacturing, importing, possession, and distribution of drugs is to be overseen and regulated by the federal government.

In the U.S. Hydrocodone is a [[List of Schedule III drugs|Schedule III drug]]. Other drugs on this list include [[anabolic steroids]], [[dihydrocodeine]], [[dronabinol]], [[phendimetrazine]], [[ketamine]], [[paregoric]], and [[Xyrem]]; [[codeine]] and [[hydrocodone]] are also Schedule III but only when compounded with [[paracetamol]] or with an [[Non-steroidal anti-inflammatory drug|NSAID]]. Schedule III drugs are classified by the U.S. government as potentially causing moderate or low physical dependence or a high psychological dependence if abused. There is a high inclination for abuse of this drug.

==Manufacture==
The principal constituent of Vicodin, hydrocodone, has the same basic structure as morphine but is metabolized by different enzymes. There are three variations of Vicodin, with different amounts of hydrocodone / paracetamol (acetaminophen) in each. Hydrocodone is a strong drug which has similar effects as morphine, because of this, the pills are made with much less hydrocodone than paracetamol. The theory of using the mix comes from the idea that these drugs alleviate pain using different mechanisms and also that the adverse side effects of each separate drug are reduced by using reduced dosages of both drugs in order to get the same analgesic effect.<ref>Beaver W.T., and McMillan D. Methodological considerations in the evaluation of analgesic combinations: Acetaminophen (paracetamol) and hydrocodone in postpartum pain. ''Br. J. Clin. Pharmac.'' (1980), 10, 215S-223S</ref> Both hydrocodone and acetaminophen are white crystalline powders, which are then manufactured into pill form. There is also a theory that the acetaminophen is added in order to reduce abuse potential, as multiple doses will result in nausea symptoms and stomach complications.
Manufacturers of hydrocodone (generic or otherwise) include Abbott Laboratories (makers of trademark Vicodin), Amerisource Health Services Corp, Cardinal Health, Drx Pharmaceutical Consultants Inc, Eckerd Corp, Hospira Inc, Knoll Laboratories Div Knoll Pharmaceutical Co, Mallinckrodt Pharm. Quality Care, Pdrx Pharmaceuticals Inc, Physicians Total Care Inc, Rx Pak Div of Mckesson Corp, Sandhills Packaging Inc, and Watson Pharmaceuticals.

==Pharmacokinetics==
Besides the activity of hydrocodone and acetaminophen on their own, there is observed a factor of analgesia related to the two substances in tandem which is not altogether understood, but this independent synergy has been observed to be related to the inhibition of prostaglandins. The pharmacokinetics of a mixed drug such as Vicodin depends on the kinetics of the drugs that comprise it. We will look at the two main constituents separately, hydrocodone and paracetamol.
Hydrocodone: acts at mu [[opioid]] receptors.<ref name=Zacny>Zacny, J.P., Gutierrez, S. and Bolbolan, S.A. (2004) Profiling the subjective, psychomotor, and physiological effects of a hydrocodone/acetaminophen product in recreational drug users. Drug and Alcohol Dependence. 78 243-252</ref> Hydrocodone must be metabolized to its active state, [[hydromorphone]]. This metabolism occurs by the activity of cytochrome P450 2D6. Cytochrome 3A4 forms the active substrate norhydrocodone. Cytochromes are haemoprotiens found in the cells of all living organisms and are involved primarily with the electron transport chain producing ATP. Hydrocodone passes through the Blood Brain Barrier because of its modifications, the brain is typically where the analgesic effects are being carried out. Many of the side effects of this drug are caused by the fact that it so readily crosses the BBB. The half-life of hydrocodone is approximately 3.8 hrs. Paracetamol: the major active metabolites are sulphates and glucuronide conjugates. Its main mode of action is to inhibit the activity of the enzyme cyclooxygenase (COX). COX enzymes are necessary for the production of prostaglandins. Prostaglandins are a form of hormone (although rarely classified as such), which are indicated to be mediators of pain, fever and inflammation. The half-life of paracetamol may be measured either by salivary or plasma counts. Both measurements give a varying half-life between 1 and 4 hours.<ref>Lee, H.S., Ti, T.Y., Lye, W.C., Khoo, Y.M., and Tan, C.C. Paracetamol and its metabolites in saliva and plasma in chronic dialysis patients. Br. J. Clin. Pharmacology. 1996. 41: 41-47</ref> Peak levels are reached between 40–60 minutes after ingestion. It has been proposed that paracetamol aids in the reduction of pain by increasing seratonergic neurotransmissions.<ref>Garrone, B., Polenzani L., De Santi, S., Moreci, W., and Guglielmotti, A. Paraccetamol reduces neuropathic pain-like behaviour in rats by potentiating seratonergic neurotransmission. International Journal of Integrative Biology. 2007. 3:196-206</ref> Paracetamol is a peripherally acting drug, and hence does not cross the BBB as readily as hydrocodone.

==Indications==
Vicodin, like other [[opioid]] analgesics, is used to manage pain. It is most commonly prescribed for relief of moderate to moderately severe pain of acute, chronic, or post-operative types. It can also be used to treat severe cough.

==Pregnancy==
This drug is classified under pregnancy category C. Although not enough research has been done to deem this drug safe for pregnant women, if the positive effects outweigh the possible negatives, then it can be taken. If taken in the time before delivery, it may give rise to respiratory depression in the baby. Mothers who use any opioids regularly during pregnancy run the risk of their babies being substance dependent and therefore going through withdrawal symptoms after birth. Withdrawal symptoms include: excessive crying, vomiting, irritability, tremors and fever. Nursing mothers should not use this drug as [[paracetamol]] is transferred through breast milk and it is unknown if hydrocodone is. <ref>[http://www.drugs.com/pro/vicodin-hp.html Vicodin] HP Official FDA information, side effects and uses. - Drugs.com</ref>

==Side effects==
[[Image:Side effects of Vicodin.png|thumb|left|280px|Main side effects of Vicodin.<ref>[http://www.drugs.com/vicodin.html Vicodin] Information from Drugs.com</ref>]]

Side effects for Vicodin are most commonly upset stomach, nausea, and altered mental status (eg. dizziness, light headedness). Other more rare side effects include [[allergy|allergic reaction]], [[seizure]]s, clammy skin, hallucinations, severe weakness, [[dizziness]], [[hyperventilation]], [[unconsciousness]], [[jaundice]] (yellowing of eyes or skin), unusual [[fatigue (medical)|fatigue]], [[bleeding]], [[bruise|bruising]], stomach pain<ref>{{cite web
| author=Drugs.com | date=March 24, 2008
| url=http://www.drugs.com/vicodin.html | title=Vicodin
| publisher=Cerner Multum, Inc. | accessdate=2008-06-09 }}</ref>, [[constipation]], [[Xerostomia|dry mouth]], [[Anorexia (symptom)|decreased appetite]], [[Muscle contraction|muscle twitches]], [[Perspiration|sweating]], [[hot flash]]es, [[itch]]ing, [[tinnitus]], [[Hearing impairment|hearing loss]], decreased [[urination]], and altered [[Libido|sex drive]]. Vicodin also has [[depressant]] effects on the [[central nervous system]]. However, some of the less mundane effects can be desirable effects that are sought after by some. Those effects include [[Euphoria (emotion)|euphoria]] and [[Somnolence|drowsiness]], as well as slowing of the pulse. Unlike [[NSAIDs]], [[Paracetamol]] does not cause ulcers. Liver damage can manifest ranging from abdominal pain to outright liver failure, and can necessitate a liver transplant to avoid death. Paracetamol dosages should never exceed 4g a day; this is especially important and may be a smaller number when dealing with mixed drugs like Vicodin. It is imperative that users of this drug follow physician prescribed dosages.

==Behavioral effects==
Tolerance to this drug may develop rapidly, especially if it is misused. This tolerance will usually manifest itself by analgesic effects wearing off faster, and people needing higher dosages to reach the analgesic effects. It is commonly misused or used excessively because people take too much in order to relieve their pain faster. Taking more of the drug does increase its efficacy but it also increases its addictive properties. When tolerance does develop, people are often forced to seek out more and more Vicodin, but as it is a [[drug prohibition law|controlled substance]], there are regulations on how much can be legally prescribed. This often leads to societal/legal consequences as people will visit many doctors and/or try to buy the drug illegally. The withdrawal effects of Vicodin include things such as insomnia, night sweats, tremors, and agitation.<ref>[http://www.drugabusehelp.com/drugs/vicodin/ Vicodin Information] - Drug Abuse Help</ref> People looking for the secondary effects of the drug often abuse many forms of prescription drugs. Vicodin is a potentially addictive drug, specifically due to the hydrocodone in it. People who are using Vicodin for non-medicinal purposes are typically using it to get the euphoric effects sometimes associated with it. Ten percent of American high school seniors have abused Vicodin; 4.7 percent report abusing Oxycontin in the past year.<ref>[http://www.injuryboard.com/national-news/middle-class-white-teens-abusing-vicodin-and-oxycontin.aspx?googleid=253158 Middle-Class White Teens Abusing Vicodin and OxyContin]</ref> There have been reports of severe hearing loss and deafness associated with the abuse of Vicodin. <ref>Oh, A.K., Ishiyama, A., and Baloh, R.W. Deafness associated with abuse of hydrocodone/acetaminophen. 2000. Neurology. 54:2345-2351</ref> If taken at the normal prescribed dosages, the risk of hearing loss is very minimal. It is interesting to note that in people who use these drugs for recreational purposes there are sex differences. Women tend to feel less "in control on their thoughts" and more report, "feeling bad" more often than men. People given logic examinations while under the influence of this drug showed an increase in incorrect answers, but spent more time on the exams. This suggests that this drug may be aiding in attention. It is again important to note that clinically prescribed dosages do not produce these effects; these effects are related to taking more of the drug than typically prescribed.<ref name="Zacny" />

==Paracetamol/Acetaminophen Deaths==

On Jun 30 2009 an FDA advisory panel recommended that Vicodin and another painkiller, [[Percocet]], be removed from the market because they have allegedly caused over 400 deaths a year. The problem is with Paracetamol overdose and liver damage.<ref>[http://www.cnn.com/2009/HEALTH/06/30/acetaminophen.fda.hearing/index.html] - CNN: "FDA Advisers vote to take Vicodin, Percocet off market</ref>

==References==
{{Reflist|2}}

==External links==
*[http://www.usdoj.gov/dea/pubs/scheduling.html U.S. DEA Drug Schedule]
*[http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm U.S. Federal Regulations]

[[Category:Analgesics]]
{{SIB}}
[[cs:Vicodin]]
[[fr:Vicodin]]
[[nl:Vicodin]]
[[pl:Vicodin]]
[[pt:Vicodin]]
[[ru:Викодин]]
[[sr:Викодин]]
{{WH}}
{{WS}}

Vicodin

2009-07-01T12:52:43Z

LBiller: /* Overview */

{{Drugbox
| type = combo
| drug_name = Vicodin
| component1 = Hydrocodone
| class1 = [[Opioid|Opioid Analgesic]]
| component2 = Paracetamol
| class2 = [[Anilides|Anilide Analgesic]]
| component3 =
| class3 =
| component4 = 
| class4 = 
| CAS_number = 8055-08-1
| CAS_supplemental =
| ATC_prefix =
| ATC_suffix =
| ATC_supplemental =
| PubChem =
| DrugBank =
| ChemSpiderID =
| licence_EU = 
| licence_US = Vicodin
| pregnancy_AU = 
| pregnancy_US = 
| pregnancy_category= '''C'''
| legal_AU = 
| legal_CA = 
| legal_UK = 
| legal_US = Schedule III
| legal_status =
| dependency_liability =
| routes_of_administration = [[Mouth|Oral]]
}}

{{SI}}

{{EH}}

''For drug information from the FDA drug label, click'' [[Hydrocodone|here]]

==Overview==
[[Image:BrandnameVicodin.jpg|thumb|right|Brand name Vicodin-hydrocodone and acetaminophen (also known as paracetamol or abbreviated as APAP) 5-500 tablets (Abbot Laboratories).]]'''Vicodin''' is a trademarked brand [[narcotic]] [[analgesic]] product containing [[hydrocodone]] and [[paracetamol]] ([[acetaminophen]] or more completely para-acetylaminophenol). It is usually found in tablet form with either the names ''Vicodin'', ''Vicodin ES'', or ''Vicodin HP'' imprinted on one side. Analgesics with the same chemical composition and a similar physical appearance are found under many other [[trade name]]s, including ''Anexsia'', ''Anolor DH5'', ''Bancap HC'', ''Dolacet'', ''Lorcet'', ''Lortab'', and ''Norco''. The [[hydrocodone]]/[[paracetamol]] drug formula is also available under [[Generic drug|generic brands]]. The paracetamol in the formula increases the effects of the hydrocodone. Hydrocodone also comes in a combination with [[ibuprofen]], available under the trade name ''Vicoprofen''.

==Ingredients==
Vicodin is made as a mixture of hydrocodone and paracetamol. Paracetamol, which is also called acetaminophen, acts as an [[analgesic]]/[[antipyretic]]. Hydrocodone is a synthetic mixture of the opiate [[codeine]] modified by an added hydrogen and the opiate alkaloid [[thebaine]]. Codeine acts as an antitussive, antidiarrheal and analgesic, while thebaine is added for its stimulatory effects.
* Vicodin contains 500 mg paracetamol and 5 mg hydrocodone
* Vicodin ES contains 750 mg paracetamol and 7.5 mg hydrocodone
* Vicodin HP contains 660 mg paracetamol and 10 mg hydrocodone
Non-active ingredients included in each pill as well: colloidal silicon dioxide, starch, croscarmellose sodium, dibasic calcium phosphate, magnesium stearate, microcrystalline cellulose, povidone, and stearic acid.<ref>[http://www.rxlist.com/vicodin-drug.htm Vicodin (Hydrocodone Bitartrate and Acetaminophen)] - RxList</ref>

==Regulation and scheduling==
In the [[United States]], Vicodin production is regulated in part by the [[Controlled Substances Act]] of 1970. This guarantees that all manufacturing, importing, possession, and distribution of drugs is to be overseen and regulated by the [[Federal government of the United States|federal government]].

In the U.S. Hydrocodone is a [[List of Schedule III drugs|Schedule III drug]]. Other drugs on this list include [[anabolic steroids]], [[dihydrocodeine]], [[dronabinol]], [[phendimetrazine]], [[ketamine]], [[paregoric]], and [[Xyrem]]; [[codeine]] and [[hydrocodone]] are also Schedule III but only when compounded with [[paracetamol]] or with an [[Non-steroidal anti-inflammatory drug|NSAID]]. Schedule III drugs are classified by the U.S. government as potentially causing moderate or low physical dependence or a high psychological dependence if abused. There is a high inclination for abuse of this drug.

==Manufacture==
The principal constituent of Vicodin, hydrocodone, has the same basic structure as morphine but is metabolized by different enzymes. There are three variations of Vicodin, with different amounts of hydrocodone / paracetamol (acetaminophen) in each. Hydrocodone is a strong drug which has similar effects as morphine, because of this, the pills are made with much less hydrocodone than paracetamol. The theory of using the mix comes from the idea that these drugs alleviate pain using different mechanisms and also that the adverse side effects of each separate drug are reduced by using reduced dosages of both drugs in order to get the same analgesic effect.<ref>Beaver W.T., and McMillan D. Methodological considerations in the evaluation of analgesic combinations: Acetaminophen (paracetamol) and hydrocodone in postpartum pain. ''Br. J. Clin. Pharmac.'' (1980), 10, 215S-223S</ref> Both hydrocodone and acetaminophen are white crystalline powders, which are then manufactured into pill form. There is also a theory{{Fact|date=June 2009}} that the acetaminophen is added in order to reduce abuse potential, as multiple doses will result in nausea symptoms and stomach complications.
Manufacturers of hydrocodone (generic or otherwise) include Abbott Laboratories (makers of trademark Vicodin), Amerisource Health Services Corp, Cardinal Health, Drx Pharmaceutical Consultants Inc, Eckerd Corp, Hospira Inc, Knoll Laboratories Div Knoll Pharmaceutical Co, Mallinckrodt Pharm. Quality Care, Pdrx Pharmaceuticals Inc, Physicians Total Care Inc, Rx Pak Div of Mckesson Corp, Sandhills Packaging Inc, and Watson Pharmaceuticals.

==Pharmacokinetics==
Besides the activity of hydrocodone and acetaminophen on their own, there is observed a factor of analgesia related to the two substances in tandem which is not altogether understood, but this independent synergy has been observed to be related to the inhibition of prostaglandins. The pharmacokinetics of a mixed drug such as Vicodin depends on the kinetics of the drugs that comprise it. We will look at the two main constituents separately, hydrocodone and paracetamol.
Hydrocodone: acts at mu [[opioid]] receptors.<ref name=Zacny>Zacny, J.P., Gutierrez, S. and Bolbolan, S.A. (2004) Profiling the subjective, psychomotor, and physiological effects of a hydrocodone/acetaminophen product in recreational drug users. Drug and Alcohol Dependence. 78 243-252</ref> Hydrocodone must be metabolized to its active state, [[hydromorphone]]. This metabolism occurs by the activity of cytochrome P450 2D6. Cytochrome 3A4 forms the active substrate norhydrocodone. Cytochromes are haemoprotiens found in the cells of all living organisms and are involved primarily with the electron transport chain producing ATP. Hydrocodone passes through the Blood Brain Barrier because of its modifications, the brain is typically where the analgesic effects are being carried out. Many of the side effects of this drug are caused by the fact that it so readily crosses the BBB. The half-life of hydrocodone is approximately 3.8 hrs. Paracetamol: the major active metabolites are sulphates and glucuronide conjugates. Its main mode of action is to inhibit the activity of the enzyme cyclooxygenase (COX). COX enzymes are necessary for the production of prostaglandins. Prostaglandins are a form of hormone (although rarely classified as such), which are indicated to be mediators of pain, fever and inflammation. The half-life of paracetamol may be measured either by salivary or plasma counts. Both measurements give a varying half-life between 1 and 4 hours.<ref>Lee, H.S., Ti, T.Y., Lye, W.C., Khoo, Y.M., and Tan, C.C. Paracetamol and its metabolites in saliva and plasma in chronic dialysis patients. Br. J. Clin. Pharmacology. 1996. 41: 41-47</ref> Peak levels are reached between 40–60 minutes after ingestion. It has been proposed that paracetamol aids in the reduction of pain by increasing seratonergic neurotransmissions.<ref>Garrone, B., Polenzani L., De Santi, S., Moreci, W., and Guglielmotti, A. Paraccetamol reduces neuropathic pain-like behaviour in rats by potentiating seratonergic neurotransmission. International Journal of Integrative Biology. 2007. 3:196-206</ref> Paracetamol is a peripherally acting drug, and hence does not cross the BBB as readily as hydrocodone.{{Fact|date=May 2009}}

==Indications==
Vicodin, like other [[opioid]] analgesics, is used to manage pain. It is most commonly prescribed for relief of moderate to moderately severe pain of acute, chronic, or post-operative types. It can also be used to treat severe cough.

==Pregnancy==
This drug is classified under pregnancy category C. Although not enough research has been done to deem this drug safe for pregnant women, if the positive effects outweigh the possible negatives, then it can be taken. If taken in the time before delivery, it may give rise to respiratory depression in the baby. Mothers who use any opioids regularly during pregnancy run the risk of their babies being substance dependent and therefore going through withdrawal symptoms after birth. Withdrawal symptoms include: excessive crying, vomiting, irritability, tremors and fever. Nursing mothers should not use this drug as [[paracetamol]] is transferred through breast milk and it is unknown if hydrocodone is. <ref>[http://www.drugs.com/pro/vicodin-hp.html Vicodin] HP Official FDA information, side effects and uses. - Drugs.com</ref>

==Side effects==
[[File:Side effects of Vicodin.png|thumb|280px|Main side effects of Vicodin.<ref>[http://www.drugs.com/vicodin.html Vicodin] Information from Drugs.com</ref>]]

Side effects for Vicodin are most commonly upset stomach, nausea, and altered mental status (eg. dizziness, light headedness). Other more rare side effects include [[allergy|allergic reaction]], [[seizure]]s, clammy skin, hallucinations, severe weakness, [[dizziness]], [[hyperventilation]], [[unconsciousness]], [[jaundice]] (yellowing of eyes or skin), unusual [[fatigue (medical)|fatigue]], [[bleeding]], [[bruise|bruising]], stomach pain<ref>{{cite web
| author=Drugs.com | date=[[March 24]], [[2008]]
| url=http://www.drugs.com/vicodin.html | title=Vicodin
| publisher=Cerner Multum, Inc. | accessdate=2008-06-09 }}</ref>, [[constipation]], [[Xerostomia|dry mouth]], [[Anorexia (symptom)|decreased appetite]], [[Muscle contraction|muscle twitches]], [[Perspiration|sweating]], [[hot flash]]es, [[itch]]ing, [[tinnitus]], [[Hearing impairment|hearing loss]], decreased [[urination]], and altered [[Libido|sex drive]]. Vicodin also has [[depressant]] effects on the [[central nervous system]]. However, some of the less mundane effects can be desirable effects that are sought after by some. Those effects include [[Euphoria (emotion)|euphoria]] and [[Somnolence|drowsiness]], as well as slowing of the pulse. Unlike [[NSAIDs]], [[Paracetamol]] does not cause ulcers. Liver damage can manifest ranging from abdominal pain to outright liver failure, and can necessitate a liver transplant to avoid death. Paracetamol dosages should never exceed 4g a day; this is especially important and may be a smaller number when dealing with mixed drugs like Vicodin. It is imperative that users of this drug follow physician prescribed dosages.

==Behavioral effects==
Tolerance to this drug may develop rapidly, especially if it is misused. This tolerance will usually manifest itself by analgesic effects wearing off faster, and people needing higher dosages to reach the analgesic effects. It is commonly misused or used excessively because people take too much in order to relieve their pain faster. Taking more of the drug does increase its efficacy but it also increases its addictive properties. When tolerance does develop, people are often forced to seek out more and more Vicodin, but as it is a [[drug prohibition law|controlled substance]], there are regulations on how much can be legally prescribed. This often leads to societal/legal consequences as people will visit many doctors and/or try to buy the drug illegally. The withdrawal effects of Vicodin include things such as insomnia, night sweats, tremors, and agitation.<ref>[http://www.drugabusehelp.com/drugs/vicodin/ Vicodin Information] - Drug Abuse Help</ref> People looking for the secondary effects of the drug often abuse many forms of prescription drugs. Vicodin is a potentially addictive drug, specifically due to the hydrocodone in it. People who are using Vicodin for non-medicinal purposes are typically using it to get the euphoric effects sometimes associated with it. Ten percent of American high school seniors have abused Vicodin; 4.7 percent report abusing Oxycontin in the past year.<ref>[http://www.injuryboard.com/national-news/middle-class-white-teens-abusing-vicodin-and-oxycontin.aspx?googleid=253158 Middle-Class White Teens Abusing Vicodin and OxyContin]</ref> There have been reports of severe hearing loss and deafness associated with the abuse of Vicodin. <ref>Oh, A.K., Ishiyama, A., and Baloh, R.W. Deafness associated with abuse of hydrocodone/acetaminophen. 2000. Neurology. 54:2345-2351</ref> If taken at the normal prescribed dosages, the risk of hearing loss is very minimal. It is interesting to note that in people who use these drugs for recreational purposes there are sex differences. Women tend to feel less "in control on their thoughts" and more report, "feeling bad" more often than men. People given logic examinations while under the influence of this drug showed an increase in incorrect answers, but spent more time on the exams. This suggests that this drug may be aiding in attention. It is again important to note that clinically prescribed dosages do not produce these effects; these effects are related to taking more of the drug than typically prescribed.<ref name="Zacny" />

==References in pop culture==
*The main character of the TV show ''[[House (TV series)|House]]'', [[Gregory House|Dr. Gregory House]], takes Vicodin habitually to counter the chronic pain in his [[infarction|infarcted]] leg. His [[drug addiction|addiction]] to the drug has been a recurrent [[plot point]] on the show.
*In the Showtime TV Series "[[Nurse Jackie]]", the protagonist is seen sniffing the active ingredients of Vicodin pills in order to experience mild relaxation.
*[[Terra Naomi]] wrote a song about vicodin, called 'the Vicodin Song'.
*[[Eminem]] references his addiction to vicodin in the majority of his songs on his album [[Relapse_(album)|Relapse]], and in Kill You from the [[Marshall Mathers LP]].
*In the [[HBO]] series, [[Six Feet Under (TV series)|Six Feet Under]], the character of Sarah O'Conner struggles with Vicodin addiction.
*The song 'Feel Good Hit of the Summer', by american hard rock band Queens of the Stone Age has a reference to vicodin. The lyrics of this song consist of a list of drugs sung repeatedly: "Nicotin, valium, vicodin, marijuana, ecstasy and alcohol".
*American [[Industrial Metal]] Band '''[[Dope (band)|Dope]]''' made reference to Vicodin in their song "Addiction", from their 2009 Album "[[No Regrets (Dope_album)|No Regrets]]". ''(Repeated throughout the chorus of the song).''

==Paracetamol/Acetaminophen Deaths==

On Jun 30 2009 an FDA advisory panel recommended that Vicodin and another painkiller, [[Percocet]], be removed from the market because they have allegedly caused over 400 deaths a year. The problem is with Paracetamol overdose and liver damage.<ref>[http://www.cnn.com/2009/HEALTH/06/30/acetaminophen.fda.hearing/index.html] - CNN: "FDA Advisers vote to take Vicodin, Percocet off market</ref>

==References==
{{Reflist|2}}

==External links==
*[http://www.usdoj.gov/dea/pubs/scheduling.html U.S. DEA Drug Schedule]
*[http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm U.S. Federal Regulations]

[[Category:Analgesics]]

[[cs:Vicodin]]
[[fr:Vicodin]]
[[nl:Vicodin]]
[[pl:Vicodin]]
[[pt:Vicodin]]
[[ru:Викодин]]
[[sr:Викодин]]

Vicodin

2009-07-01T12:52:17Z

LBiller:

{{Drugbox
| type = combo
| drug_name = Vicodin
| component1 = Hydrocodone
| class1 = [[Opioid|Opioid Analgesic]]
| component2 = Paracetamol
| class2 = [[Anilides|Anilide Analgesic]]
| component3 =
| class3 =
| component4 = 
| class4 = 
| CAS_number = 8055-08-1
| CAS_supplemental =
| ATC_prefix =
| ATC_suffix =
| ATC_supplemental =
| PubChem =
| DrugBank =
| ChemSpiderID =
| licence_EU = 
| licence_US = Vicodin
| pregnancy_AU = 
| pregnancy_US = 
| pregnancy_category= '''C'''
| legal_AU = 
| legal_CA = 
| legal_UK = 
| legal_US = Schedule III
| legal_status =
| dependency_liability =
| routes_of_administration = [[Mouth|Oral]]
}}

{{SI}}

{{EH}}

''For drug information from the FDA drug label, click'' [[Hydrocodone|here]]

==Overview==
[[File:BrandnameVicodin.jpg|thumb|right|Brand name Vicodin-hydrocodone and acetaminophen (also known as paracetamol or abbreviated as APAP) 5-500 tablets (Abbot Laboratories).]]'''Vicodin''' is a trademarked brand [[narcotic]] [[analgesic]] product containing [[hydrocodone]] and [[paracetamol]] ([[acetaminophen]] or more completely para-acetylaminophenol). It is usually found in tablet form with either the names ''Vicodin'', ''Vicodin ES'', or ''Vicodin HP'' imprinted on one side. Analgesics with the same chemical composition and a similar physical appearance are found under many other [[trade name]]s, including ''Anexsia'', ''Anolor DH5'', ''Bancap HC'', ''Dolacet'', ''Lorcet'', ''Lortab'', and ''Norco''. The [[hydrocodone]]/[[paracetamol]] drug formula is also available under [[Generic drug|generic brands]]. The paracetamol in the formula increases the effects of the hydrocodone. Hydrocodone also comes in a combination with [[ibuprofen]], available under the trade name ''Vicoprofen''.

==Ingredients==
Vicodin is made as a mixture of hydrocodone and paracetamol. Paracetamol, which is also called acetaminophen, acts as an [[analgesic]]/[[antipyretic]]. Hydrocodone is a synthetic mixture of the opiate [[codeine]] modified by an added hydrogen and the opiate alkaloid [[thebaine]]. Codeine acts as an antitussive, antidiarrheal and analgesic, while thebaine is added for its stimulatory effects.
* Vicodin contains 500 mg paracetamol and 5 mg hydrocodone
* Vicodin ES contains 750 mg paracetamol and 7.5 mg hydrocodone
* Vicodin HP contains 660 mg paracetamol and 10 mg hydrocodone
Non-active ingredients included in each pill as well: colloidal silicon dioxide, starch, croscarmellose sodium, dibasic calcium phosphate, magnesium stearate, microcrystalline cellulose, povidone, and stearic acid.<ref>[http://www.rxlist.com/vicodin-drug.htm Vicodin (Hydrocodone Bitartrate and Acetaminophen)] - RxList</ref>

==Regulation and scheduling==
In the [[United States]], Vicodin production is regulated in part by the [[Controlled Substances Act]] of 1970. This guarantees that all manufacturing, importing, possession, and distribution of drugs is to be overseen and regulated by the [[Federal government of the United States|federal government]].

In the U.S. Hydrocodone is a [[List of Schedule III drugs|Schedule III drug]]. Other drugs on this list include [[anabolic steroids]], [[dihydrocodeine]], [[dronabinol]], [[phendimetrazine]], [[ketamine]], [[paregoric]], and [[Xyrem]]; [[codeine]] and [[hydrocodone]] are also Schedule III but only when compounded with [[paracetamol]] or with an [[Non-steroidal anti-inflammatory drug|NSAID]]. Schedule III drugs are classified by the U.S. government as potentially causing moderate or low physical dependence or a high psychological dependence if abused. There is a high inclination for abuse of this drug.

==Manufacture==
The principal constituent of Vicodin, hydrocodone, has the same basic structure as morphine but is metabolized by different enzymes. There are three variations of Vicodin, with different amounts of hydrocodone / paracetamol (acetaminophen) in each. Hydrocodone is a strong drug which has similar effects as morphine, because of this, the pills are made with much less hydrocodone than paracetamol. The theory of using the mix comes from the idea that these drugs alleviate pain using different mechanisms and also that the adverse side effects of each separate drug are reduced by using reduced dosages of both drugs in order to get the same analgesic effect.<ref>Beaver W.T., and McMillan D. Methodological considerations in the evaluation of analgesic combinations: Acetaminophen (paracetamol) and hydrocodone in postpartum pain. ''Br. J. Clin. Pharmac.'' (1980), 10, 215S-223S</ref> Both hydrocodone and acetaminophen are white crystalline powders, which are then manufactured into pill form. There is also a theory{{Fact|date=June 2009}} that the acetaminophen is added in order to reduce abuse potential, as multiple doses will result in nausea symptoms and stomach complications.
Manufacturers of hydrocodone (generic or otherwise) include Abbott Laboratories (makers of trademark Vicodin), Amerisource Health Services Corp, Cardinal Health, Drx Pharmaceutical Consultants Inc, Eckerd Corp, Hospira Inc, Knoll Laboratories Div Knoll Pharmaceutical Co, Mallinckrodt Pharm. Quality Care, Pdrx Pharmaceuticals Inc, Physicians Total Care Inc, Rx Pak Div of Mckesson Corp, Sandhills Packaging Inc, and Watson Pharmaceuticals.

==Pharmacokinetics==
Besides the activity of hydrocodone and acetaminophen on their own, there is observed a factor of analgesia related to the two substances in tandem which is not altogether understood, but this independent synergy has been observed to be related to the inhibition of prostaglandins. The pharmacokinetics of a mixed drug such as Vicodin depends on the kinetics of the drugs that comprise it. We will look at the two main constituents separately, hydrocodone and paracetamol.
Hydrocodone: acts at mu [[opioid]] receptors.<ref name=Zacny>Zacny, J.P., Gutierrez, S. and Bolbolan, S.A. (2004) Profiling the subjective, psychomotor, and physiological effects of a hydrocodone/acetaminophen product in recreational drug users. Drug and Alcohol Dependence. 78 243-252</ref> Hydrocodone must be metabolized to its active state, [[hydromorphone]]. This metabolism occurs by the activity of cytochrome P450 2D6. Cytochrome 3A4 forms the active substrate norhydrocodone. Cytochromes are haemoprotiens found in the cells of all living organisms and are involved primarily with the electron transport chain producing ATP. Hydrocodone passes through the Blood Brain Barrier because of its modifications, the brain is typically where the analgesic effects are being carried out. Many of the side effects of this drug are caused by the fact that it so readily crosses the BBB. The half-life of hydrocodone is approximately 3.8 hrs. Paracetamol: the major active metabolites are sulphates and glucuronide conjugates. Its main mode of action is to inhibit the activity of the enzyme cyclooxygenase (COX). COX enzymes are necessary for the production of prostaglandins. Prostaglandins are a form of hormone (although rarely classified as such), which are indicated to be mediators of pain, fever and inflammation. The half-life of paracetamol may be measured either by salivary or plasma counts. Both measurements give a varying half-life between 1 and 4 hours.<ref>Lee, H.S., Ti, T.Y., Lye, W.C., Khoo, Y.M., and Tan, C.C. Paracetamol and its metabolites in saliva and plasma in chronic dialysis patients. Br. J. Clin. Pharmacology. 1996. 41: 41-47</ref> Peak levels are reached between 40–60 minutes after ingestion. It has been proposed that paracetamol aids in the reduction of pain by increasing seratonergic neurotransmissions.<ref>Garrone, B., Polenzani L., De Santi, S., Moreci, W., and Guglielmotti, A. Paraccetamol reduces neuropathic pain-like behaviour in rats by potentiating seratonergic neurotransmission. International Journal of Integrative Biology. 2007. 3:196-206</ref> Paracetamol is a peripherally acting drug, and hence does not cross the BBB as readily as hydrocodone.{{Fact|date=May 2009}}

==Indications==
Vicodin, like other [[opioid]] analgesics, is used to manage pain. It is most commonly prescribed for relief of moderate to moderately severe pain of acute, chronic, or post-operative types. It can also be used to treat severe cough.

==Pregnancy==
This drug is classified under pregnancy category C. Although not enough research has been done to deem this drug safe for pregnant women, if the positive effects outweigh the possible negatives, then it can be taken. If taken in the time before delivery, it may give rise to respiratory depression in the baby. Mothers who use any opioids regularly during pregnancy run the risk of their babies being substance dependent and therefore going through withdrawal symptoms after birth. Withdrawal symptoms include: excessive crying, vomiting, irritability, tremors and fever. Nursing mothers should not use this drug as [[paracetamol]] is transferred through breast milk and it is unknown if hydrocodone is. <ref>[http://www.drugs.com/pro/vicodin-hp.html Vicodin] HP Official FDA information, side effects and uses. - Drugs.com</ref>

==Side effects==
[[File:Side effects of Vicodin.png|thumb|280px|Main side effects of Vicodin.<ref>[http://www.drugs.com/vicodin.html Vicodin] Information from Drugs.com</ref>]]

Side effects for Vicodin are most commonly upset stomach, nausea, and altered mental status (eg. dizziness, light headedness). Other more rare side effects include [[allergy|allergic reaction]], [[seizure]]s, clammy skin, hallucinations, severe weakness, [[dizziness]], [[hyperventilation]], [[unconsciousness]], [[jaundice]] (yellowing of eyes or skin), unusual [[fatigue (medical)|fatigue]], [[bleeding]], [[bruise|bruising]], stomach pain<ref>{{cite web
| author=Drugs.com | date=[[March 24]], [[2008]]
| url=http://www.drugs.com/vicodin.html | title=Vicodin
| publisher=Cerner Multum, Inc. | accessdate=2008-06-09 }}</ref>, [[constipation]], [[Xerostomia|dry mouth]], [[Anorexia (symptom)|decreased appetite]], [[Muscle contraction|muscle twitches]], [[Perspiration|sweating]], [[hot flash]]es, [[itch]]ing, [[tinnitus]], [[Hearing impairment|hearing loss]], decreased [[urination]], and altered [[Libido|sex drive]]. Vicodin also has [[depressant]] effects on the [[central nervous system]]. However, some of the less mundane effects can be desirable effects that are sought after by some. Those effects include [[Euphoria (emotion)|euphoria]] and [[Somnolence|drowsiness]], as well as slowing of the pulse. Unlike [[NSAIDs]], [[Paracetamol]] does not cause ulcers. Liver damage can manifest ranging from abdominal pain to outright liver failure, and can necessitate a liver transplant to avoid death. Paracetamol dosages should never exceed 4g a day; this is especially important and may be a smaller number when dealing with mixed drugs like Vicodin. It is imperative that users of this drug follow physician prescribed dosages.

==Behavioral effects==
Tolerance to this drug may develop rapidly, especially if it is misused. This tolerance will usually manifest itself by analgesic effects wearing off faster, and people needing higher dosages to reach the analgesic effects. It is commonly misused or used excessively because people take too much in order to relieve their pain faster. Taking more of the drug does increase its efficacy but it also increases its addictive properties. When tolerance does develop, people are often forced to seek out more and more Vicodin, but as it is a [[drug prohibition law|controlled substance]], there are regulations on how much can be legally prescribed. This often leads to societal/legal consequences as people will visit many doctors and/or try to buy the drug illegally. The withdrawal effects of Vicodin include things such as insomnia, night sweats, tremors, and agitation.<ref>[http://www.drugabusehelp.com/drugs/vicodin/ Vicodin Information] - Drug Abuse Help</ref> People looking for the secondary effects of the drug often abuse many forms of prescription drugs. Vicodin is a potentially addictive drug, specifically due to the hydrocodone in it. People who are using Vicodin for non-medicinal purposes are typically using it to get the euphoric effects sometimes associated with it. Ten percent of American high school seniors have abused Vicodin; 4.7 percent report abusing Oxycontin in the past year.<ref>[http://www.injuryboard.com/national-news/middle-class-white-teens-abusing-vicodin-and-oxycontin.aspx?googleid=253158 Middle-Class White Teens Abusing Vicodin and OxyContin]</ref> There have been reports of severe hearing loss and deafness associated with the abuse of Vicodin. <ref>Oh, A.K., Ishiyama, A., and Baloh, R.W. Deafness associated with abuse of hydrocodone/acetaminophen. 2000. Neurology. 54:2345-2351</ref> If taken at the normal prescribed dosages, the risk of hearing loss is very minimal. It is interesting to note that in people who use these drugs for recreational purposes there are sex differences. Women tend to feel less "in control on their thoughts" and more report, "feeling bad" more often than men. People given logic examinations while under the influence of this drug showed an increase in incorrect answers, but spent more time on the exams. This suggests that this drug may be aiding in attention. It is again important to note that clinically prescribed dosages do not produce these effects; these effects are related to taking more of the drug than typically prescribed.<ref name="Zacny" />

==References in pop culture==
*The main character of the TV show ''[[House (TV series)|House]]'', [[Gregory House|Dr. Gregory House]], takes Vicodin habitually to counter the chronic pain in his [[infarction|infarcted]] leg. His [[drug addiction|addiction]] to the drug has been a recurrent [[plot point]] on the show.
*In the Showtime TV Series "[[Nurse Jackie]]", the protagonist is seen sniffing the active ingredients of Vicodin pills in order to experience mild relaxation.
*[[Terra Naomi]] wrote a song about vicodin, called 'the Vicodin Song'.
*[[Eminem]] references his addiction to vicodin in the majority of his songs on his album [[Relapse_(album)|Relapse]], and in Kill You from the [[Marshall Mathers LP]].
*In the [[HBO]] series, [[Six Feet Under (TV series)|Six Feet Under]], the character of Sarah O'Conner struggles with Vicodin addiction.
*The song 'Feel Good Hit of the Summer', by american hard rock band Queens of the Stone Age has a reference to vicodin. The lyrics of this song consist of a list of drugs sung repeatedly: "Nicotin, valium, vicodin, marijuana, ecstasy and alcohol".
*American [[Industrial Metal]] Band '''[[Dope (band)|Dope]]''' made reference to Vicodin in their song "Addiction", from their 2009 Album "[[No Regrets (Dope_album)|No Regrets]]". ''(Repeated throughout the chorus of the song).''

==Paracetamol/Acetaminophen Deaths==

On Jun 30 2009 an FDA advisory panel recommended that Vicodin and another painkiller, [[Percocet]], be removed from the market because they have allegedly caused over 400 deaths a year. The problem is with Paracetamol overdose and liver damage.<ref>[http://www.cnn.com/2009/HEALTH/06/30/acetaminophen.fda.hearing/index.html] - CNN: "FDA Advisers vote to take Vicodin, Percocet off market</ref>

==References==
{{Reflist|2}}

==External links==
*[http://www.usdoj.gov/dea/pubs/scheduling.html U.S. DEA Drug Schedule]
*[http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm U.S. Federal Regulations]

[[Category:Analgesics]]

[[cs:Vicodin]]
[[fr:Vicodin]]
[[nl:Vicodin]]
[[pl:Vicodin]]
[[pt:Vicodin]]
[[ru:Викодин]]
[[sr:Викодин]]

Static popular pages list

2009-06-29T14:05:07Z

LBiller:

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#[[National Library of Medicine ‎]]
#[[Neurotoxicity ‎]]
#[[Non coronary interventions in the cardiac catheterization laboratory ‎]]
#[[Olopatadine ‎]]
#[[Ondansetron ‎]]
#[[Lamotrigine ‎]]
#[[List of ICD-9 codes 680-709: Diseases of the skin and subcutaneous tissue ‎]]
#[[Lumbar puncture ‎]]
#[[Indomethacin ‎]]
#[[Infranodal Wenkebach-type block ‎]]
#[[Oppositional defiant disorder ‎]]
#[[Ototoxicity ‎]]
#[[Palatoglossus muscle ‎]]
#[[Pantoprazole (patient information) ‎]]
#[[49 XXXXY syndrome ‎]]
#[[Achilles tendon ‎]]
#[[Ammonium chloride ‎]]
#[[Apomorphine ‎]]
#[[Dimetindene ‎]]
#[[Charcoal ‎]]
#[[Cisplatin ‎]]
#[[Defibrotide ‎]]
#[[Follicular dendritic cells ‎]]
#[[Genital tubercle ‎]]
#[[Glutamate decarboxylase ‎]]
#[[Hepatic vein ‎]]
#[[Prostatectomy ‎]]
#[[Renal lobe ‎]]
#[[Repetitive strain injury ‎]]
#[[ST elevation myocardial infarction gross pathology ‎]]
#[[Pseudohermaphroditism ‎]]
#[[Receptive aphasia ‎]]
#[[Rosalyn Sussman Yalow ‎]]
#[[Hertwig's epithelial root sheath ‎]]
#[[Hounsfield scale ‎]]
#[[Hypothesis ‎]]
#[[Iodoform ‎]]
#[[Kendall tau rank correlation coefficient ‎]]
#[[Semicircular canal ‎]]
#[[Sequela ‎]]
#[[Smith-Lemli-Opitz syndrome ‎]]
#[[Spinous process ‎]]
#[[Teplizumab ‎]]
#[[Tick-borne meningoencephalitis ‎]]
#[[Trichlorfon ‎]]
#[[Leflunomide (patient information) ‎]]
#[[Major calyx ‎]]
#[[Median ‎]]
#[[Biological life cycle ‎]]
#[[Minor calyx ‎]]
#[[Monosaccharide ‎]]
#[[Monosodium glutamate ‎]]
#[[Mylohyoid muscle ‎]]
#[[NMR spectroscopy ‎]]
#[[Nail-patella syndrome ‎]]
#[[Necrobiosis lipoidica ‎]]
#[[Oculomotor nerve palsy ‎]]
#[[Floating rib ‎]]
#[[Fluid ‎]]
#[[Glucosamine ‎]]
#[[Gonadotropin-releasing hormone agonist ‎]]
#[[Hemostatic agent ‎]]
#[[Dental fluorosis ‎]]
#[[Enthesis ‎]]
#[[Eponychium ‎]]
#[[Oxicam ‎]]
#[[Partial anomalous pulmonary venous connection ‎]]
#[[Pedodontics ‎]]
#[[Alloy ‎]]
#[[Apolipoprotein E ‎]]
#[[Coronary artery dissection classification ‎]]
#[[Chemical symbol ‎]]
#[[Cholinesterase enzyme ‎]]
#[[Cytogenetics ‎]]
#[[Biocatalysis ‎]]
#[[Bufotenin ‎]]
#[[Candida (genus) ‎]]
#[[Hydrolase ‎]]
#[[Hypoplasia ‎]]
#[[Inflammatory biomarkers predict short-term mortality in patients with peripheral arterial disease ‎]]
#[[Pulmonary thromboendarterectomy ‎]]
#[[Retroperitoneum ‎]]
#[[Kidney development ‎]]
#[[Legionella ‎]]
#[[Leigh's disease ‎]]
#[[Lumbar plexus ‎]]
#[[Mequitazine ‎]]
#[[Sixth nerve palsy ‎]]
#[[Sunscreen ‎]]
#[[Thoracoacromial artery ‎]]
#[[Vomeronasal organ ‎]]
#[[ATC code A ‎]]
#[[Acrodermatitis enteropathica ‎]]
#[[Algorithm ‎]]
#[[Alopecia totalis ‎]]
#[[Amantadine ‎]]
#[[Ambulatory phlebectomy ‎]]
#[[Dimethyl sulfide ‎]]
#[[Dipole ‎]]
#[[Dyslipidemia ‎]]
#[[Elastic fiber ‎]]
#[[Eli Lilly and Company ‎]]
#[[Femoral vein ‎]]
#[[Methyl salicylate ‎]]
#[[Mixture ‎]]
#[[Molecular modelling ‎]]
#[[Neocortex ‎]]
#[[Nephrogenic diabetes insipidus ‎]]
#[[Neuroleptic malignant syndrome ‎]]
#[[Noma (disease) ‎]]
#[[Gauss–Markov theorem ‎]]
#[[Heart-lung transplant ‎]]
#[[Hematopoiesis ‎]]
#[[Parenchyma ‎]]
#[[Pityriasis alba ‎]]
#[[Povidone-iodine ‎]]
#[[Ovarian ligament ‎]]
#[[Oxoglutarate dehydrogenase ‎]]
#[[Parnaparin ‎]]
#[[Phenylalanine ‎]]
#[[Polyethylene terephthalate ‎]]
#[[Portal vein ‎]]
#[[Stilbene ‎]]
#[[Tactile fremitus ‎]]
#[[Tetracaine ‎]]
#[[Biological system ‎]]
#[[Black eye ‎]]
#[[Cardiolipin ‎]]
#[[Chlamydiae ‎]]
#[[Ciclesonide ‎]]
#[[Daclizumab ‎]]
#[[Wyeth ‎]]
#[[Zwitterion ‎]]
#[[Koch's postulates ‎]]
#[[Laparotomy ‎]]
#[[Lobotomy ‎]]
#[[Lornoxicam ‎]]
#[[Hereditary spastic paraplegia ‎]]
#[[Implantable cardioverter-defibrillator ‎]]
#[[Inclusions ‎]]
#[[Insulin detemir ‎]]
#[[Isoelectric point ‎]]
#[[Renal medulla ‎]]
#[[ST elevation myocardial infarction nitrate therapy ‎]]
#[[Scientist ‎]]
#[[Fragment antigen binding ‎]]
#[[HLA-A66 ‎]]
#[[Hamstring ‎]]
#[[Hemagglutinin ‎]]
#[[Hemoperitoneum ‎]]
#[[Diels-Alder reaction ‎]]
#[[Disulfiram ‎]]
#[[Dyspareunia ‎]]
#[[Vein stripping ‎]]
#[[Viral envelope ‎]]
#[[Abdominal guarding ‎]]
#[[Accessory nerve ‎]]
#[[Acute promyelocytic leukemia ‎]]
#[[Methimazole (patient information) ‎]]
#[[Methoxyphedrine ‎]]
#[[Michael Stuart Brown ‎]]
#[[Musculoskeletal problems of the foot ‎]]
#[[Nanobe ‎]]
#[[Native PAGE ‎]]
#[[Neurotrophin-3 ‎]]
#[[Nicotinic antagonist ‎]]
#[[Obstetrical hemorrhage ‎]]
#[[Microphthalmia ‎]]
#[[Mycobacterium tuberculosis ‎]]
#[[Nicardipine ‎]]
#[[Oblique vein of the left atrium ‎]]
#[[Hyperaemia ‎]]
#[[Hypertensive emergency ‎]]
#[[Binasal hemianopsia ‎]]
#[[Bone morphogenetic protein 2 ‎]]
#[[Osteochondroma ‎]]
#[[Ouabain ‎]]
#[[Pantothenate kinase-associated neurodegeneration ‎]]
#[[Pharmacist ‎]]
#[[Pisiform bone ‎]]
#[[Precordial examination ‎]]
#[[Serous pericardium ‎]]
#[[Serratus anterior muscle ‎]]
#[[Sex cord ‎]]
#[[Stanozolol ‎]]
#[[Stenosing tenosynovitis ‎]]
#[[Susceptibility loci for intracranial aneurysm in European and Japanese populations ‎]]
#[[Synovial sarcoma ‎]]
#[[Lamina of the vertebral arch ‎]]
#[[List of diseases (P) ‎]]
#[[Longitudinal study ‎]]
#[[Caspase ‎]]
#[[Chalcogen ‎]]
#[[Chloride ‎]]
#[[Clorindione ‎]]
#[[Complement deficiency ‎]]
#[[Condensation reaction ‎]]
#[[Cutis laxa ‎]]
#[[Yolk sac ‎]]
#[[Zoonosis ‎]]
#[[1,2-Dichloroethane ‎]]
#[[ATC code B ‎]]
#[[Acamprosate (patient information) ‎]]
#[[Adhesion (medicine) ‎]]
#[[Alprostadil detailed information ‎]]
#[[Depressant ‎]]
#[[Dicloxacillin (patient information) ‎]]
#[[Embryonal carcinoma ‎]]
#[[Equipment used in diagnostic cardiac catheterizaiton ‎]]
#[[Extraglomerular mesangial cell ‎]]
#[[Familial atrial fibrillation ‎]]
#[[Prune belly syndrome ‎]]
#[[Red algae ‎]]
#[[Retroperitoneal fibrosis ‎]]
#[[Heart protection study ‎]]
#[[Hemolytic disease of the newborn (anti-Kell) ‎]]
#[[Torisel ‎]]
#[[United States National Library of Medicine ‎]]
#[[Urinary casts ‎]]
#[[Thiamin ‎]]
#[[Twelve-step program ‎]]
#[[Vaginectomy ‎]]
#[[Virology ‎]]
#[[Virulence ‎]]
#[[Cefprozil ‎]]
#[[Ciliary ganglion ‎]]
#[[DNA glycosylase ‎]]
#[[Asthenopia ‎]]
#[[Hematopathology ‎]]
#[[Proteobacteria ‎]]
#[[Prurigo nodularis ‎]]
#[[Sartorius muscle ‎]]
#[[Saturation (chemistry) ‎]]
#[[Scientific method ‎]]
#[[Palatine bone ‎]]
#[[Pap smear ‎]]
#[[Pennyroyal ‎]]
#[[Pergolide (patient information) ‎]]
#[[Postcentral gyrus ‎]]
#[[Prazosin ‎]]
#[[Asthenopia ‎]]
#[[Bamipine ‎]]
#[[Basic life support ‎]]
#[[Camillo Golgi ‎]]
#[[Stavudine (patient information) ‎]]
#[[T-cell lymphoma ‎]]
#[[Tea tree oil ‎]]
#[[Nicorandil ‎]]
#[[Number needed to treat ‎]]
#[[Diazoxide ‎]]
#[[Dura mater ‎]]
#[[Ergonomics ‎]]
#[[Ethanolamine ‎]]
#[[Euthyroid sick syndrome ‎]]
#[[Extracellular matrix ‎]]
#[[Wilhelm Conrad Röntgen ‎]]
#[[Ileitis ‎]]
#[[Indobufen ‎]]
#[[IntraUterine System ‎]]
#[[Isradipine ‎]]
#[[Joule per mole ‎]]
#[[Thiamin ‎]]
#[[Twelve-step program ‎]]
#[[Vaginectomy ‎]]
#[[Virology ‎]]
#[[Virulence ‎]]
#[[The heart in juvenile rheumatoid arthritis ‎]]
#[[Thyroxine-binding globulin ‎]]
#[[Trepanation ‎]]
#[[Baroreceptor ‎]]
#[[Benzylpiperazine ‎]]
#[[Branched-chain amino acids ‎]]
#[[Branchial arch ‎]]
#[[Bromazepam ‎]]
#[[Acquired cardiac valve disease ‎]]
#[[Activated protein C resistance ‎]]
#[[Alimemazine ‎]]
#[[Alopecia universalis ‎]]
#[[Levetiracetam (patient information) ‎]]
#[[List of diseases (0-9) ‎]]
#[[Lysogenic cycle ‎]]
#[[Marcus Gunn pupil ‎]]
#[[Medullary sponge kidney ‎]]
#[[Chloroplast ‎]]
#[[Cholinergic urticaria ‎]]
#[[Combined immunodeficiencies ‎]]
#[[Congenital cystic adenomatoid malformation ‎]]
#[[Coumatetralyl ‎]]
#[[Periodontology ‎]]
#[[Peripheral vascular examination ‎]]
#[[Picotamide ‎]]
#[[Policosanol ‎]]
#[[Genetic marker ‎]]
#[[Genetic predisposition ‎]]
#[[Guanfacine ‎]]
#[[H5N1 genetic structure ‎]]
#[[Psychoanalysis ‎]]
#[[Right heart ‎]]
#[[Risedronate ‎]]
#[[Ritonavir (patient information) ‎]]
#[[Ruptured spleen ‎]]
#[[Salvador Luria ‎]]
#[[Hertz ‎]]
#[[Hysteresivity ‎]]
#[[Iduronidase ‎]]
#[[Ifosfamide (patient information) ‎]]
#[[Ion transporter ‎]]
#[[Ipilimumab ‎]]
#[[Detergent ‎]]
#[[Diphyllobothrium ‎]]
#[[Doctor of Philosophy ‎]]
#[[Esophoria ‎]]
#[[Ethyl biscoumacetate ‎]]
#[[Eye surgery ‎]]
#[[Factor XIII ‎]]
#[[Sly syndrome ‎]]
#[[Spermatocele ‎]]
#[[Tablet ‎]]
#[[Neuropeptide Y ‎]]
#[[Neurulation ‎]]
#[[Norplant ‎]]
#[[Occipitofrontalis muscle ‎]]
#[[Off-label use ‎]]
#[[News:Elevated Plasma Fibrinogen Levels among Diabetics and Increased BMI are Associated with Reduced Platelet Inhibition with Clopidogrel ‎]]
#[[Willem Einthoven ‎]]
#[[Furazolidone ‎]]
#[[Ganciclovir (patient information) ‎]]
#[[General visceral afferent fibers ‎]]
#[[Hemangioendothelioma ‎]]
#[[ATC code C ‎]]
#[[Adenoid ‎]]
#[[Adherens junction ‎]]
#[[Adrenocortical carcinoma ‎]]
#[[Alveolar duct ‎]]
#[[Amelia (birth defect) ‎]]
#[[Anconeus muscle ‎]]
#[[Transesophageal echocardiography (TEE) ‎]]
#[[Transverse plane ‎]]
#[[Vagotomy ‎]]
#[[Visceral leishmaniasis ‎]]
#[[Axis (anatomy) ‎]]
#[[Bacterial artificial chromosome ‎]]
#[[Bcl-2 ‎]]
#[[Bemiparin ‎]]
#[[Biotin deficiency ‎]]
#[[Optical microscope ‎]]
#[[Organophosphorus ‎]]
#[[Pamidronic acid ‎]]
#[[Parotitis ‎]]
#[[Pentamycin ‎]]
#[[Personality disorder ‎]]
#[[Phenacetin ‎]]
#[[Phosphatase ‎]]
#[[Polarization ‎]]
#[[Preventive medicine ‎]]
#[[List of diseases (U) ‎]]
#[[Chorioretinitis ‎]]
#[[Cochlear nerve ‎]]
#[[Colposcopy ‎]]
#[[Congenital epulis ‎]]
#[[Metenolone enanthate ‎]]
#[[Methcathinone ‎]]
#[[Microalbuminuria ‎]]
#[[Mucolipidosis type IV ‎]]
#[[Myeloperoxidase deficiency ‎]]
#[[Nephrotoxic drugs ‎]]
#[[Drug design ‎]]
#[[Earwax ‎]]
#[[Electrode ‎]]
#[[Enuresis ‎]]
#[[Esophageal stricture ‎]]
#[[Etanercept ‎]]
#[[ST elevation myocardial infarction percutaneous coronary intervention following fibrinolytic administration ‎]]
#[[Sciatic nerve ‎]]
#[[Scrub typhus ‎]]
#[[Intracoronary infusion of selected and unselected mononuclear cells does not lead to significant improvement in cardiac function after sustained ischemia: Results from the REGENT trial ‎]]
#[[Serum sickness ‎]]
#[[Silicone ‎]]
#[[Stomatology ‎]]
#[[Simmonds' disease ‎]]
#[[Somatization disorder ‎]]
#[[Spherocytosis ‎]]
#[[Streptomyces ‎]]
#[[Long-term effects of alcohol ‎]]
#[[Acrolein ‎]]
#[[Aflatoxin ‎]]
#[[Amanita phalloides ‎]]
#[[Zinc sulfate ‎]]
#[[Goldenhar syndrome ‎]]
#[[Hard palate ‎]]
#[[Optic disc drusen ‎]]
#[[Ovalbumin ‎]]
#[[Podiatry ‎]]
#[[Presbyopia ‎]]
#[[The heart in Wegener's granulomatosis ‎]]
#[[Tiratricol ‎]]
#[[Titration ‎]]
#[[Beriberi heart disease ‎]]
#[[Blastocystosis ‎]]
#[[Buspirone ‎]]
#[[Cannizzaro reaction ‎]]
#[[Hinge joint ‎]]
#[[Intervertebral foramina ‎]]
#[[Intussusception ‎]]
#[[Inward-rectifier potassium ion channel ‎]]
#[[Delocalized electron ‎]]
#[[Diaphragmatic hernia ‎]]
#[[Dopaminergic ‎]]
#[[Ductal carcinoma ‎]]
#[[Edward Lawrie Tatum ‎]]
#[[Eosinophilic gastroenteritis ‎]]
#[[Cementoblastoma ‎]]
#[[Coal tar ‎]]
#[[Cumulus oophorus ‎]]
#[[Mesoderm ‎]]
#[[Muscle tone ‎]]
#[[Noscapine ‎]]
#[[Methicillin-resistant Staphylococcus aureus ‎]]
#[[Myositis ossificans ‎]]
#[[Nephritis ‎]]
#[[Nitrosamine ‎]]
#[[Odor ‎]]
#[[Oligosaccharide ‎]]
#[[Thin ascending limb of loop of Henle ‎]]
#[[Transfusion in ACS management ‎]]
#[[Transversus abdominis muscle ‎]]
#[[Triquetral bone ‎]]
#[[ATC code R06 ‎]]
#[[Arcus senilis ‎]]
#[[Social anxiety ‎]]
#[[Spasmodic dysphonia ‎]]
#[[Spore ‎]]
#[[Telogen effluvium ‎]]
#[[Teniposide (patient information) ‎]]
#[[Lacidipine ‎]]
#[[Lidocaine detailed information ‎]]
#[[Membrane transport protein ‎]]
#[[Oxytetracycline ‎]]
#[[Phenazone ‎]]
#[[Posterior superior alveolar artery ‎]]
#[[Yaws ‎]]
#[[Fibrosarcoma ‎]]
#[[Formoterol ‎]]
#[[Great arteries ‎]]
#[[Central chemoreceptors ‎]]
#[[Cholinesterase ‎]]
#[[Circadian rhythm sleep disorder ‎]]
#[[Congenital adrenal hyperplasia due to 3 beta-hydroxysteroid dehydrogenase deficiency ‎]]
#[[DNA extraction ‎]]
#[[Debye ‎]]
#[[Degranulation ‎]]
#[[Dermabrasion ‎]]
#[[Diacetyldihydromorphine ‎]]
#[[Ditazole ‎]]
#[[Executive system ‎]]
#[[Biotechnology ‎]]
#[[Black Death ‎]]
#[[Body fat percentage ‎]]
#[[Capillary leak syndrome ‎]]
#[[Capitate bone ‎]]
#[[Insulin aspart ‎]]
#[[Interleukin 6 ‎]]
#[[Irregular bone ‎]]
#[[Rectus femoris muscle ‎]]
#[[Refractory period ‎]]
#[[Respiratory examination ‎]]
#[[Proctology ‎]]
#[[Protein kinase inhibitor ‎]]
#[[QRS axis and voltage ‎]]
#[[Quinoline ‎]]
#[[ST elevation myocardial infarction oxygen therapy ‎]]
#[[Scalene muscles ‎]]
#[[Sclerodactyly ‎]]
#[[Zones of the lung ‎]]
#[[ATPase ‎]]
#[[Adalimumab ‎]]
#[[Alkylation ‎]]
#[[Anise ‎]]
#[[Apocrine ‎]]
#[[Methane ‎]]
#[[Milrinone ‎]]
#[[Tunica externa (vessels) ‎]]
#[[Urea cycle disorder ‎]]
#[[Veins of the head and neck ‎]]
#[[Oxaceprol ‎]]
#[[Piperacillin ‎]]
#[[Temporalis muscle ‎]]
#[[Tertiary bronchus ‎]]
#[[Howard Florey, Baron Florey ‎]]
#[[Hyperammonemia ‎]]
#[[Intestinal villus ‎]]
#[[Diaphysis ‎]]
#[[Dimethyltubocurarinium ‎]]
#[[Eicosanoid ‎]]
#[[Facial motor nucleus ‎]]
#[[Gefitinib (patient information) ‎]]
#[[Good clinical practice ‎]]
#[[Cherry angioma ‎]]
#[[Clear cell tumor ‎]]
#[[Contractility ‎]]
#[[Costodiaphragmatic recess ‎]]
#[[Decidua ‎]]
#[[Bias of an estimator ‎]]
#[[Bitemporal hemianopsia ‎]]
#[[Bitot's spots ‎]]
#[[Borderline personality disorder ‎]]
#[[Brain herniation ‎]]
#[[Buclizine ‎]]
#[[Butyric acid ‎]]
#[[Cadaver ‎]]
#[[Opium poppy ‎]]
#[[Pepscan ‎]]
#[[Adductor magnus muscle ‎]]
#[[Alternative medicine ‎]]
#[[Pseudomyxoma peritonei ‎]]
#[[Veins of the torso ‎]]
#[[Voltage-gated ion channel ‎]]
#[[Linear discriminant analysis ‎]]
#[[List of diseases (K) ‎]]
#[[Chronic stable angina definition ‎]]
#[[Complement membrane attack complex ‎]]
#[[Comprehensive metabolic panel ‎]]
#[[Cystadenoma ‎]]
#[[Subarachnoid space ‎]]
#[[Taurodontism ‎]]
#[[Hip fracture ‎]]
#[[Hysterectomy ‎]]
#[[ICD-10 Chapter I: Certain infectious and parasitic diseases ‎]]
#[[JNK in the trunk without extra sugar in the tank ‎]]
#[[Jarque-Bera test ‎]]
#[[Fox-Fordyce disease ‎]]
#[[Heart Failure: Acoustic Cardiography Improves Clinicians’ Confidence for Making the Diagnosis when BNP is Ambiguous ‎]]
#[[Thiocolchicoside ‎]]
#[[Tinzaparin ‎]]
#[[Tonsillectomy ‎]]
#[[Triclosan ‎]]
#[[Triflusal ‎]]
#[[Tryptamine ‎]]
#[[United States Adopted Name ‎]]
#[[Vesicoureteral reflux ‎]]
#[[Visual acuity ‎]]
#[[Paracentesis ‎]]
#[[Phenyltoloxamine ‎]]
#[[Pneumonitis ‎]]
#[[Polyphagia ‎]]
#[[Atomoxetine ‎]]
#[[Bence Jones protein ‎]]
#[[Benign ‎]]
#[[Borrelia ‎]]
#[[Xenon ‎]]
#[[Zona reticularis ‎]]
#[[Pseudoxanthoma elasticum ‎]]
#[[Rhinorrhea ‎]]
#[[Metabolic alkalosis ‎]]
#[[Myeloid leukemia ‎]]
#[[Alkane stereochemistry ‎]]
#[[Alkylating antineoplastic agent ‎]]
#[[Alternate hypothesis ‎]]
#[[Anterior horn (spinal cord) ‎]]
#[[Histidinemia ‎]]
#[[Cefixime ‎]]
#[[Chorea ‎]]
#[[Dapoxetine ‎]]
#[[Digitoxin ‎]]
#[[Dorsiflexion ‎]]
#[[Levator scapulae muscle ‎]]
#[[Mediastinal surface of lung ‎]]
#[[Short stature ‎]]
#[[Sickle cell trait ‎]]
#[[Sorbitol ‎]]
#[[Sports medicine ‎]]
#[[Steric effects ‎]]
#[[Streptomycin ‎]]
#[[Testicular artery ‎]]
#[[Skeletal fluorosis ‎]]
#[[Stratified sampling ‎]]
#[[Synovitis ‎]]
#[[TORCH infections ‎]]
#[[Tanner stage ‎]]
#[[Metenolone ‎]]
#[[Mucin ‎]]
#[[Neuroendocrinology ‎]]
#[[Norgestrienone ‎]]
#[[Fibroepithelial neoplasms ‎]]
#[[First pharyngeal arch ‎]]
#[[Gramicidin ‎]]
#[[Heart development ‎]]
#[[Torticollis ‎]]
#[[Trehalose ‎]]
#[[Viral gastroenteritis ‎]]
#[[Pseudopod ‎]]
#[[Race (classification of human beings) ‎]]
#[[Ruffini ending ‎]]
#[[Bleeding gums ‎]]
#[[Blepharophimosis ‎]]
#[[Blood substitutes ‎]]
#[[Bosentan ‎]]
#[[Butorphanol ‎]]
#[[Calcific tendinitis ‎]]
#[[Wikisurgery ‎]]
#[[Liothyronine sodium ‎]]
#[[Medicinal leech ‎]]
#[[Cefalotin ‎]]
#[[Cerebral edema ‎]]
#[[Dead space ‎]]
#[[ATC code S01 ‎]]
#[[Air embolism ‎]]
#[[Alexander Fleming ‎]]
#[[Anodontia ‎]]
#[[Hippocrates ‎]]
#[[HomoloGene ‎]]
#[[Intraglomerular mesangial cell ‎]]
#[[Irinotecan ‎]]
#[[Dopamine reuptake inhibitor ‎]]
#[[Effects of high altitude on humans ‎]]
#[[Diphenadione ‎]]
#[[Blunt trauma ‎]]
#[[Multiple endocrine neoplasia type 1 ‎]]
#[[NMDA receptor ‎]]
#[[Penile prosthesis ‎]]
#[[Peroneus longus ‎]]
#[[Photoreceptor ‎]]
#[[Primary immunodeficiency ‎]]
#[[Serotype ‎]]
#[[Sodium-glucose transport proteins ‎]]
#[[Statins found to be protective against recurrence of atrial fibrillation after cardioversion ‎]]
#[[Technetium ‎]]
#[[Robinow syndrome ‎]]
#[[Rupatadine ‎]]
#[[Thygeson's superficial punctate keratopathy ‎]]
#[[Transmission electron microscopy ‎]]
#[[Transwoman ‎]]
#[[Trendelenburg position ‎]]
#[[Upper respiratory tract ‎]]
#[[Vapor pressure ‎]]
#[[Visual perception ‎]]
#[[ICD-10 Chapter R ‎]]
#[[Impaired glucose tolerance ‎]]
#[[Cholecalciferol ‎]]
#[[Defence mechanism ‎]]
#[[Left main bronchus ‎]]
#[[Lipid raft ‎]]
#[[List of fatty acid metabolism disorders ‎]]
#[[17-Hydroxypregnenolone ‎]]
#[[Activin ‎]]
#[[Amblyopia ‎]]
#[[Antagonist (muscle) ‎]]
#[[Anti-ganglioside antibodies ‎]]
#[[Arcuate vein ‎]]
#[[Arene substitution patterns ‎]]
#[[ATC code H ‎]]
#[[ATC code R01 ‎]]
#[[Abnormalities in erythrocyte morphology ‎]]
#[[Red eye (medicine) ‎]]
#[[Rugae ‎]]
#[[Sanfilippo syndrome ‎]]
#[[Mutarotation ‎]]
#[[Naphazoline ‎]]
#[[Non-gonococcal urethritis ‎]]
#[[Olivary body ‎]]
#[[Dextran ‎]]
#[[Fertility ‎]]
#[[Basolateral membrane ‎]]
#[[Beta-carotene ‎]]
#[[Spondyloepimetaphyseal dysplasia, Strudwick type ‎]]
#[[Stethoscope ‎]]
#[[Sulfasalazine (patient information) ‎]]
#[[Teicoplanin ‎]]
#[[G cell ‎]]
#[[Ganglion cyst ‎]]
#[[Gas constant ‎]]
#[[Otorrhea ‎]]
#[[Paramyxovirus ‎]]
#[[Pentose ‎]]
#[[Perinatal period ‎]]
#[[Periodic acid-Schiff stain ‎]]
#[[Pholcodine ‎]]
#[[Phylogenetic tree ‎]]
#[[Phytochemical ‎]]
#[[Podophyllum peltatum ‎]]
#[[Klebsiella infection ‎]]
#[[Meperidine (patient information) ‎]]
#[[Hydroquinone ‎]]
#[[Zimmerman-Laband syndrome ‎]]
#[[News:Expression of programmed death ligand-1 in donor hearts regulates chronic allograft rejection ‎]]
#[[Thenalidine ‎]]
#[[Tolterodine ‎]]
#[[Trachoma ‎]]
#[[Urinary diversion ‎]]
#[[Vitelliform macular dystrophy ‎]]
#[[Cervical rib ‎]]
#[[Cartesian coordinate system ‎]]
#[[Cementoblast ‎]]
#[[Closing capacity ‎]]
#[[Condyloma ‎]]
#[[Congenital insensitivity to pain with anhidrosis ‎]]
#[[Cuticle ‎]]
#[[Cyanide poisoning ‎]]
#[[DNA repair-deficiency disorder ‎]]
#[[Fiber ‎]]
#[[Genitourinary system ‎]]
#[[Glandular branches of facial artery ‎]]
#[[Guanine ‎]]
#[[Haemophilus ‎]]
#[[Heparan sulfate ‎]]
#[[Midbrain tectum ‎]]
#[[Natural selection ‎]]
#[[Neomycin ‎]]
#[[Normochromic anemia ‎]]
#[[Aniridia ‎]]
#[[Aorticopulmonary septum ‎]]
#[[Pseudocyst ‎]]
#[[Renal corpuscle ‎]]
#[[Reticular fiber ‎]]
#[[Tetrahydrogestrinone ‎]]
#[[Diseases of the myocardium ‎]]
#[[Epididymis ‎]]
#[[Bone pain ‎]]
#[[Boric acid ‎]]
#[[Bromo-DragonFLY ‎]]
#[[Carbamate ‎]]
#[[Tooth gemination ‎]]
#[[Tracheoesophageal septum ‎]]
#[[Human skin color ‎]]
#[[Immunoglobulin D ‎]]
#[[Iron(II) sulfate ‎]]
#[[Jöns Jakob Berzelius ‎]]
#[[Ophthalmic nerve ‎]]
#[[Pelger-Huet anomaly ‎]]
#[[Pindolol ‎]]
#[[Policresulen ‎]]
#[[List of ICD-9 codes 460-519: Diseases of the respiratory system ‎]]
#[[List of diseases (D) ‎]]
#[[List of diseases (N) ‎]]
#[[List of diseases (Q) ‎]]
#[[List of probability topics ‎]]
#[[Wiskott-Aldrich syndrome ‎]]
#[[Zinc pyrithione ‎]]
#[[News:Study demonstrates that non-cardiac cells can help repair a damaged heart; new excitement for existence of cardiac stem cells. August 26, 2007 ‎]]
#[[Wikidoc news template ‎]]
#[[Wilcoxon signed-rank test ‎]]
#[[Discrete probability distribution ‎]]
#[[Dolasetron (patient information) ‎]]
#[[Drug test ‎]]
#[[Epoxy ‎]]
#[[Motor protein ‎]]
#[[National Center for Health Statistics ‎]]
#[[Nonlinear regression ‎]]
#[[Odontoblast ‎]]
#[[Operon ‎]]
#[[Cathine ‎]]
#[[Chilblain ‎]]
#[[Chlorambucil ‎]]
#[[Choana ‎]]
#[[Cinoxacin (patient information) ‎]]
#[[Frederick Sanger ‎]]
#[[Glossodynia ‎]]
#[[Gonadotropin-releasing hormone antagonist ‎]]
#[[Superior cerebellar artery ‎]]
#[[Systematic review ‎]]
#[[Tapentadol ‎]]
#[[Tetrahydrozoline ‎]]
#[[ATC code N02 ‎]]
#[[Pterygomandibular raphe ‎]]
#[[Retroperitoneal hematoma ‎]]
#[[Rimonabant ‎]]
#[[Mean time between failures ‎]]
#[[Hypochromic anemia ‎]]
#[[Influenza vaccine ‎]]
#[[Balloon catheter ‎]]
#[[Benzoyl peroxide ‎]]
#[[Calcaneus ‎]]
#[[Cardiac surgeon ‎]]
#[[United States customary units ‎]]
#[[West syndrome ‎]]
#[[Ottawa Charter for Health Promotion ‎]]
#[[Parapsoriasis ‎]]
#[[Ablation ‎]]
#[[Acronyms of Clinical Trial Terms ‎]]
#[[Aminoglutethimide ‎]]
#[[Anterior commissure of labia ‎]]
#[[Apex of lung ‎]]
#[[Nadolol detailed information ‎]]
#[[Nightmare ‎]]
#[[News:Better to be a pear than an apple: new prospective look at associations between fat distribution and coronary heart disease ‎]]
#[[Dementia with Lewy bodies ‎]]
#[[Designer drug ‎]]
#[[Enkephalin ‎]]
#[[Fallopian tubes ‎]]
#[[Seminiferous tubules ‎]]
#[[T-tubule ‎]]
#[[Terfenadine ‎]]
#[[Cell culture ‎]]
#[[Cinchocaine ‎]]
#[[Coccus ‎]]
#[[Cryoprecipitate ‎]]
#[[Cyclosporine (patient information) ‎]]
#[[Cytochrome c oxidase ‎]]
#[[Decreased bowel sounds ‎]]
#[[Förster resonance energy transfer ‎]]
#[[Generalized anxiety disorder ‎]]
#[[Trench fever ‎]]
#[[Hypothalamic-pituitary-thyroid axis ‎]]
#[[Inguinal ligament ‎]]
#[[Isoelectric focusing ‎]]
#[[Right main bronchus ‎]]
#[[ST elevation myocardial infarction analgesic therapy ‎]]
#[[Sacral nerves ‎]]
#[[Lymphoblast ‎]]
#[[Measuring Fractional Flow Reserve During PCI Improves 1-Year Outcomes ‎]]
#[[Bendroflumethiazide ‎]]
#[[Biceps brachii muscle ‎]]
#[[Biperiden ‎]]
#[[Calcium alginate ‎]]
#[[Carbimazole ‎]]
#[[Chain of survival ‎]]
#[[Clopidogrel resistance ‎]]
#[[Mexiletine ‎]]
#[[Neurotoxin ‎]]
#[[Notochord ‎]]
#[[Obturator internus muscle ‎]]
#[[Octopamine ‎]]
#[[Phlegm ‎]]
#[[Plateletpheresis ‎]]
#[[Acetaminophen (patient information) ‎]]
#[[Acute abdomen ‎]]
#[[Antimicrobial peptides ‎]]
#[[Secretin ‎]]
#[[Shellfish poisoning ‎]]
#[[Social phobia ‎]]
#[[Stratum corneum ‎]]
#[[Tetrazepam ‎]]
#[[Depression (mood) ‎]]
#[[Derivative (chemistry) ‎]]
#[[Duane syndrome ‎]]
#[[Elbow pain ‎]]
#[[Fenoldopam ‎]]
#[[Lateral sulcus ‎]]
#[[Mean corpuscular volume ‎]]
#[[High-molecular-weight kininogen ‎]]
#[[Hydrogen chloride ‎]]
#[[Hydrogen sulfide ‎]]
#[[Ilya Ilyich Mechnikov ‎]]
#[[Influenzavirus B ‎]]
#[[Fibrous protein ‎]]
#[[Frey's procedure ‎]]
#[[Fructose bisphosphatase deficiency ‎]]
#[[Fundus (uterus) ‎]]
#[[Gastrocolic reflex ‎]]
#[[Genu valgum ‎]]
#[[Giant cell tumor of bone ‎]]
#[[The Physical Examination in Cardiovascular Disease:The Heart ‎]]
#[[Thoracic surgery ‎]]
#[[Transmission and infection of H5N1 ‎]]
#[[Transsexualism ‎]]
#[[Visible spectrum ‎]]
#[[Pubococcygeus muscle ‎]]
#[[Santiago Ramón y Cajal ‎]]
#[[Pronator teres muscle ‎]]
#[[Psilocin ‎]]
#[[Renal osteodystrophy ‎]]
#[[Rhomboid major muscle ‎]]
#[[Rhythm method ‎]]
#[[Statistical power ‎]]
#[[Stress fracture ‎]]
#[[Microscopic polyangiitis ‎]]
#[[Misoprostol ‎]]
#[[Myoglobin ‎]]
#[[Nesiritide ‎]]
#[[Odontoma ‎]]
#[[Carotenodermia ‎]]
#[[Cefalexin ‎]]
#[[Cholinergic ‎]]
#[[Cloaca (embryology) ‎]]
#[[ADME ‎]]
#[[ATC code C08 ‎]]
#[[Adhesive capsulitis of shoulder ‎]]
#[[Aquaporin 1 ‎]]
#[[Wisdom teeth ‎]]
#[[Paget's disease ‎]]
#[[Panthenol ‎]]
#[[Phytosterol ‎]]
#[[Transmetalation ‎]]
#[[Independent and identically-distributed random variables ‎]]
#[[Intravenous pyelogram ‎]]
#[[Kernicterus ‎]]
#[[Desensitization (medicine) ‎]]
#[[Lagophthalmos ‎]]
#[[Left heart ‎]]
#[[Left lung ‎]]
#[[Light chain ‎]]
#[[Liquid-liquid extraction ‎]]
#[[Lopinavir ‎]]
#[[Macrocytosis ‎]]
#[[Menarche ‎]]
#[[Gestational diabetes ‎]]
#[[Glycolic acid ‎]]
#[[Halide ‎]]
#[[Generic drug ‎]]
#[[Genus ‎]]
#[[Glycosyl ‎]]
#[[Haptoglobin ‎]]
#[[Helicobacter ‎]]
#[[Hepatic portal system ‎]]
#[[Skin appendage ‎]]
#[[Sodium dodecyl sulfate ‎]]
#[[Spindle apparatus ‎]]
#[[Stabilizing selection ‎]]
#[[Stasis dermatitis ‎]]
#[[Succinic acid ‎]]
#[[Tendinitis ‎]]
#[[Biofilm ‎]]
#[[Bone morphogenetic protein 7 ‎]]
#[[Bretylium ‎]]
#[[Brotizolam ‎]]
#[[Butane ‎]]
#[[Carcinoembryonic antigen ‎]]
#[[Purpura fulminans ‎]]
#[[Pyruvate kinase deficiency ‎]]
#[[Rathke's pouch ‎]]
#[[Renal tubule ‎]]
#[[Rifampicin ‎]]
#[[AFP-L3 ‎]]
#[[ATC code C03 ‎]]
#[[Adenosine diphosphate ‎]]
#[[Alprazolam indications ‎]]
#[[Angiodysplasia ‎]]
#[[Nicotinamide ‎]]
#[[Nosocomial infection ‎]]
#[[Nurse ‎]]
#[[Nurse practitioner ‎]]
#[[Chromosome 17 (human) ‎]]
#[[Clinical psychology ‎]]
#[[Levomethadyl Acetate ‎]]
#[[Linoleic acid ‎]]
#[[Lipofuscin ‎]]
#[[List of diseases (H) ‎]]
#[[List of diseases (Y) ‎]]
#[[Mebeverine ‎]]
#[[Megakaryoblast ‎]]
#[[Hypesthesia ‎]]
#[[Impaction ‎]]
#[[Inhibin ‎]]
#[[Organic redox reaction ‎]]
#[[Outer ear ‎]]
#[[Ovarian hyperstimulation syndrome ‎]]
#[[Persistent genital arousal disorder ‎]]
#[[Phallus ‎]]
#[[Polycyclic compound ‎]]
#[[Toxic multinodular goitre ‎]]
#[[Transfusion reaction ‎]]
#[[Variable ‎]]
#[[Dopamine agonist ‎]]
#[[Dysphasia ‎]]
#[[Descemet's membrane ‎]]
#[[Dexchlorpheniramine ‎]]
#[[Disorders of calcium metabolism ‎]]
#[[Dolly (sheep) ‎]]
#[[Earlobe ‎]]
#[[Emergency contraception ‎]]
#[[Erlotinib (patient information) ‎]]
#[[Esophageal candidiasis ‎]]
#[[Etoricoxib ‎]]
#[[Methdilazine ‎]]
#[[Molsidomine ‎]]
#[[Muehrcke's lines ‎]]
#[[National Institute for Health and Clinical Excellence ‎]]
#[[Nerve growth factor ‎]]
#[[Secondary bronchus ‎]]
#[[Sole (foot) ‎]]
#[[Spastic diplegia ‎]]
#[[Splenic vein ‎]]
#[[Talon cusp ‎]]
#[[News:Unfractionated Heparin and PCI ‎]]
#[[Galactorrhea ‎]]
#[[Gas gangrene ‎]]
#[[Geniohyoid muscle ‎]]
#[[Glycolipid ‎]]
#[[Glycopeptide antibiotic ‎]]
#[[ATC code C02 ‎]]
#[[ATC code D ‎]]
#[[Acipimox ‎]]
#[[Ampicillin ‎]]
#[[Bioremediation ‎]]
#[[Branchial pouch ‎]]
#[[Prodrome ‎]]
#[[Profunda brachii ‎]]
#[[Prosencephalon ‎]]
#[[Pudendal nerve ‎]]
#[[Safe sex ‎]]
#[[Vastus lateralis muscle ‎]]
#[[Verrucous carcinoma ‎]]
#[[Indapamide ‎]]
#[[Insulin analog ‎]]
#[[Irritation ‎]]
#[[Chronic stable angina introduction ‎]]
#[[Colistin ‎]]
#[[Cystathioninuria ‎]]
#[[Darunavir (patient information) ‎]]
#[[Larsen syndrome ‎]]
#[[Lateral cutaneous nerve of thigh ‎]]
#[[Lichen nitidus ‎]]
#[[Lyme disease microbiology ‎]]
#[[Mandibular nerve ‎]]
#[[Manubrium ‎]]
#[[Meckel syndrome ‎]]
#[[Philtrum ‎]]
#[[Oviparity ‎]]
#[[Piriformis muscle ‎]]
#[[Potter syndrome ‎]]
#[[Azatadine ‎]]
#[[Barry Marshall ‎]]
#[[Bitolterol ‎]]
#[[Serotonin antagonist ‎]]
#[[Strontium ranelate ‎]]
#[[Deletion policy ‎]]
#[[Dinoprostone ‎]]
#[[Etofibrate ‎]]
#[[Nefazodone ‎]]
#[[Neutron ‎]]
#[[Ainhum ‎]]
#[[Arterial line ‎]]
#[[News:Thyroid abnormalities affect more than 30% of males on amiodarone ‎]]
#[[Forensic pathology ‎]]
#[[Gartner's duct ‎]]
#[[Glatiramer acetate ‎]]
#[[Glucose-galactose malabsorption ‎]]
#[[Heme ‎]]
#[[Kussmaul's sign ‎]]
#[[Max Theiler ‎]]
#[[Mechanoreceptor ‎]]
#[[Hepatoblastoma ‎]]
#[[Inosine ‎]]
#[[Trousseau sign of malignancy ‎]]
#[[Vasectomy ‎]]
#[[Vitelline arteries ‎]]
#[[Voyeurism ‎]]
#[[Cenani Lenz syndactylism ‎]]
#[[Chitin ‎]]
#[[Chloride channel ‎]]
#[[Chloropyramine ‎]]
#[[Clavicle fracture ‎]]
#[[Clioquinol ‎]]
#[[Clofibride ‎]]
#[[Cutaneous larva migrans ‎]]
#[[Cascade reaction ‎]]
#[[Small cell lymphoma ‎]]
#[[Sorafenib ‎]]
#[[Swiss-Prot ‎]]
#[[Tensor veli palatini muscle ‎]]
#[[Tetramer ‎]]
#[[Plasminogen ‎]]
#[[Primitive ventricle ‎]]
#[[Astemizole ‎]]
#[[Athlete's foot ‎]]
#[[Bacteriostatic agent ‎]]
#[[Beta-Carboline ‎]]
#[[Antinuclear antibodies ‎]]
#[[Aromatase inhibitor ‎]]
#[[Desmoplastic small round cell tumor ‎]]
#[[Migrating motor complex ‎]]
#[[Needle aspiration biopsy ‎]]
#[[Neural network ‎]]
#[[Occipital bone ‎]]
#[[Tioclomarol ‎]]
#[[Tooth enamel ‎]]
#[[Triprolidine ‎]]
#[[Trisomy 22 ‎]]
#[[Vertebra prominens ‎]]
#[[Wheat ‎]]
#[[Klebsiella ‎]]
#[[Labyrinthine artery ‎]]
#[[Lactulose ‎]]
#[[Lambdoid suture ‎]]
#[[Least squares ‎]]
#[[List of diseases (G) ‎]]
#[[List of diseases (L) ‎]]
#[[Medial lemniscus ‎]]
#[[Pulmonary stretch receptors ‎]]
#[[Raphe nuclei ‎]]
#[[Reverse transcription polymerase chain reaction ‎]]
#[[Sample size ‎]]
#[[Saruplase ‎]]
#[[Seckel syndrome ‎]]
#[[Fomite ‎]]
#[[Gram-positive ‎]]
#[[Halothane ‎]]
#[[Hemolytic disease of the newborn (anti-Rhc) ‎]]
#[[Induction (birth) ‎]]
#[[Iridectomy ‎]]
#[[Incus ‎]]
#[[Intracellular ‎]]
#[[Ion exchange resin ‎]]
#[[Depressor anguli oris muscle ‎]]
#[[Epidemiological methods ‎]]
#[[Eye development ‎]]
#[[Tentorium cerebelli ‎]]
#[[News:Abnormal pressure gradient distal to the implanted bare metal stent is associated with the occurrence of in-stent restenosis ‎]]
#[[Cataract surgery ‎]]
#[[Chemical affinity ‎]]
#[[Chondroblast ‎]]
#[[Complex partial seizure ‎]]
#[[Conjugate acid ‎]]
#[[Cyproterone ‎]]
#[[Academic journal ‎]]
#[[Adnexa ‎]]
#[[Anaerobic respiration ‎]]
#[[Optic neuritis ‎]]
#[[Peroxide ‎]]
#[[Poiseuille's law ‎]]
#[[Portal hypertensive gastropathy ‎]]
#[[Aspergillus ‎]]
#[[Atrophic gastritis ‎]]
#[[Binomial distribution ‎]]
#[[Gene therapy ‎]]
#[[Guanidine ‎]]
#[[HU-210 ‎]]
#[[Laser ablation ‎]]
#[[List of ICD-9 codes 280-289: Diseases of the blood and blood-forming organs ‎]]
#[[List of ICD-9 codes 360-389: Diseases of the sense organs ‎]]
#[[List of diseases (J) ‎]]
#[[Longissimus ‎]]
#[[Magnetism ‎]]
#[[Michaelis-Menten kinetics ‎]]
#[[Multifidus muscle ‎]]
#[[Nimodipine ‎]]
#[[Toxic metal ‎]]
#[[Transverse fissure of liver ‎]]
#[[Trypanosome ‎]]
#[[Visceral pleura ‎]]
#[[Vitamin A deficiency ‎]]
#[[Psoralen ‎]]
#[[Pustulosis ‎]]
#[[SARS coronavirus ‎]]
#[[Radioimmunoassay ‎]]
#[[Raloxifene ‎]]
#[[Resonance ‎]]
#[[Retrograde amnesia ‎]]
#[[Organic reaction ‎]]
#[[Percentile ‎]]
#[[Pinguecula ‎]]
#[[Sexual reproduction ‎]]
#[[Simfibrate ‎]]
#[[Sodium polystyrene sulfonate (patient information) ‎]]
#[[Sulfanilamide ‎]]
#[[Systemic inflammatory response syndrome ‎]]
#[[Hypothenar eminence ‎]]
#[[Kauffman-White classification ‎]]
#[[Drug abuse ‎]]
#[[Electrostatics ‎]]
#[[Ergot ‎]]
#[[Errors and residuals in statistics ‎]]
#[[Extracellular ‎]]
#[[Accommodation (eye) ‎]]
#[[Adrenal medulla ‎]]
#[[Aluminium chloride ‎]]
#[[Amorphous solid ‎]]
#[[Arterial tree ‎]]
#[[Colextran ‎]]
#[[Congenital hepatic fibrosis ‎]]
#[[Cox maze procedure ‎]]
#[[Thromboxane ‎]]
#[[Transduction (genetics) ‎]]
#[[Vanillyl mandelic acid ‎]]
#[[Ventral tegmentum ‎]]
#[[Lacrimal canaliculi ‎]]
#[[Linear regression ‎]]
#[[Liposome ‎]]
#[[Machine perfusion ‎]]
#[[Medial circumflex femoral artery ‎]]
#[[Bacterial conjugation ‎]]
#[[Benfluorex ‎]]
#[[CD90 ‎]]
#[[Calcium lactate ‎]]
#[[Canal of the cervix ‎]]
#[[Follicular fluid ‎]]
#[[Glutathione ‎]]
#[[Metipranolol ‎]]
#[[Microvascular disease ‎]]
#[[Mycoplasma ‎]]
#[[Norfloxacin (patient information) ‎]]
#[[Nuclear envelope ‎]]
#[[Olfactory epithelium ‎]]
#[[Neuroepithelial cell ‎]]
#[[Nonketotic hyperosmolar coma ‎]]
#[[Nucleoside ‎]]
#[[7-Dehydrocholesterol ‎]]
#[[American Association for the Advancement of Science ‎]]
#[[Ancrod ‎]]
#[[Sequencing ‎]]
#[[Sternohyoid muscle ‎]]
#[[Pharmacogenetics ‎]]
#[[Polymyxin B ‎]]
#[[Probucol ‎]]
#[[Ectopia ‎]]
#[[Enamel pearl ‎]]
#[[Enzyte ‎]]
#[[Epidemiological transition ‎]]
#[[Histone H1 ‎]]
#[[GM1 gangliosidoses ‎]]
#[[Hemofiltration ‎]]
#[[Kingdom (biology) ‎]]
#[[Lysozyme ‎]]
#[[Chondrodystrophy ‎]]
#[[Combivent ‎]]
#[[Titer ‎]]
#[[Totally Endoscopic Coronary Artery Bypass Surgery (TECAB) ‎]]
#[[Bar (unit) ‎]]
#[[Bromodiphenhydramine ‎]]
#[[Asymptomatic ‎]]
#[[Blastocyst ‎]]
#[[Buffer solution ‎]]
#[[Buphthalmos ‎]]
#[[CHARGE syndrome ‎]]
#[[Capecitabine ‎]]
#[[Carbon group ‎]]
#[[Carcinogenesis ‎]]
#[[Dexbrompheniramine ‎]]
#[[Epidermolysis bullosa ‎]]
#[[Erythema toxicum ‎]]
#[[Euthanasia ‎]]
#[[ATC code G ‎]]
#[[Alloplant ‎]]
#[[Alpers' disease ‎]]
#[[Alstrom syndrome ‎]]
#[[Amobarbital ‎]]
#[[Anandamide ‎]]
#[[Aqueous solution ‎]]
#[[Blastocyst ‎]]
#[[Buffer solution ‎]]
#[[Buphthalmos ‎]]
#[[Capecitabine ‎]]
#[[Carcinogenesis ‎]]
#[[Phentolamine ‎]]
#[[Human iron metabolism ‎]]
#[[List of surgical procedures ‎]]
#[[Lumbar nerves ‎]]
#[[Meclofenamate (patient information) ‎]]
#[[ATC code G ‎]]
#[[Alloplant ‎]]
#[[Alpers' disease ‎]]
#[[Amobarbital ‎]]
#[[Anandamide ‎]]
#[[Ankle pain and swelling ‎]]
#[[Aqueous solution ‎]]
#[[Thyroglossal duct ‎]]
#[[Triosephosphate isomerase deficiency ‎]]
#[[Trochanteric bursitis ‎]]
#[[Weber's syndrome ‎]]
#[[Chromosome 7 (human) ‎]]
#[[Ptosis ‎]]
#[[Pyridinium chlorochromate ‎]]
#[[National Eye Institute ‎]]
#[[Dexbrompheniramine ‎]]
#[[Epidermolysis bullosa ‎]]
#[[Erythema toxicum ‎]]
#[[Euthanasia ‎]]
#[[Fossa of vestibule of vagina ‎]]
#[[Gonadal dysgenesis ‎]]
#[[Gram-negative ‎]]
#[[Guanethidine ‎]]
#[[Hassall's corpuscles ‎]]
#[[Felbinac ‎]]
#[[Ferritin ‎]]
#[[Galactokinase deficiency ‎]]
#[[Gender ‎]]
#[[Genital candidiasis ‎]]
#[[Tobacco ‎]]
#[[Tropomyosin ‎]]
#[[Urachus ‎]]
#[[Olfactory bulb ‎]]
#[[Optics ‎]]
#[[Petrochemical ‎]]
#[[Physostigmine ‎]]
#[[Platysma muscle ‎]]
#[[Salicin ‎]]
#[[C1-inhibitor ‎]]
#[[Carbamazepine ‎]]
#[[Acinetobacter baumanni ‎]]
#[[Hydrochloric acid ‎]]
#[[Intermediate filament ‎]]
#[[Laryngectomy ‎]]
#[[Loop of Henle ‎]]
#[[MEDLINE ‎]]
#[[Diol ‎]]
#[[Dmitri Mendeleev ‎]]
#[[Dysphonia ‎]]
#[[Edman degradation ‎]]
#[[Pyrazolone ‎]]
#[[RAST test ‎]]
#[[Radiological Physics Center ‎]]
#[[Rhabdomyosarcoma ‎]]
#[[Woman ‎]]
#[[Ziprasidone (patient information) ‎]]
#[[Chloroquine ‎]]
#[[Mofebutazone ‎]]
#[[Multicystic dysplastic kidney ‎]]
#[[Nitric oxide synthase ‎]]
#[[Homans' sign ‎]]
#[[ICD-10 Chapter VI: Diseases of the nervous system ‎]]
#[[International Chemical Identifier ‎]]
#[[Intrastromal corneal ring segments ‎]]
#[[Ochronosis ‎]]
#[[Oxiconazole (patient information) ‎]]
#[[Palmoplantar keratoderma ‎]]
#[[Pasteurization ‎]]
#[[Pimozide (patient information) ‎]]
#[[Flexor digitorum superficialis muscle ‎]]
#[[Foot (length) ‎]]
#[[Foramen ovale (heart) ‎]]
#[[Ganglion cell ‎]]
#[[Thallium ‎]]
#[[Transurethral resection of the prostate ‎]]
#[[Vertebral artery ‎]]
#[[4-Methyl-aminorex ‎]]
#[[Alexis Carrel ‎]]
#[[Algae ‎]]
#[[Amnion ‎]]
#[[Anorectal pain ‎]]
#[[Sandbox ‎]]
#[[Spermatic cord ‎]]
#[[Ascending aorta ‎]]
#[[Atonic seizure ‎]]
#[[Cefazolin ‎]]
#[[Colestipol ‎]]
#[[Courvoisier's law ‎]]
#[[Pyridine ‎]]
#[[Retinoblastoma protein ‎]]
#[[Ronifibrate ‎]]
#[[ST elevation myocardial infarction classification ‎]]
#[[Lateral lingual swelling ‎]]
#[[Library (biology) ‎]]
#[[Lipoprotein-associated phospholipase A2 (Lp-PLA2) ‎]]
#[[List of withdrawn drugs ‎]]
#[[Local anesthesia ‎]]
#[[Dens evaginatus ‎]]
#[[Diethylcathinone ‎]]
#[[Duodenal switch ‎]]
#[[Dysthymia ‎]]
#[[Electrophoresis ‎]]
#[[Enterotoxin ‎]]
#[[Endocrine disruptor ‎]]
#[[Endoscopic thoracic sympathectomy ‎]]
#[[Enfuvirtide ‎]]
#[[Enzyme assay ‎]]
#[[Ethmoid bulla ‎]]
#[[Serum amyloid A ‎]]
#[[Shapiro-Wilk test ‎]]
#[[Sigmoid colon ‎]]
#[[Standard deviation ‎]]
#[[Succinic anhydride ‎]]
#[[Suspensory ligament of the ovary ‎]]
#[[Oxoacid ‎]]
#[[Plasminogen activator inhibitor-2 ‎]]
#[[Polyethylene ‎]]
#[[Medigoxin ‎]]
#[[Nalbuphine ‎]]
#[[Nasopalatine nerve ‎]]
#[[Nature (journal) ‎]]
#[[Intracranial aneurysms ‎]]
#[[Antianginal ‎]]
#[[Fatty acid metabolism ‎]]
#[[Frenulum of prepuce of penis ‎]]
#[[Fusafungine ‎]]
#[[H. Robert Horvitz ‎]]
#[[Halachic Organ Donor Society ‎]]
#[[Heat shock protein ‎]]
#[[Tenofovir (patient information) ‎]]
#[[Troleandomycin (patient information) ‎]]
#[[Uveal melanoma ‎]]
#[[Vesalius ‎]]
#[[Leukocyte adhesion deficiency ‎]]
#[[Liquid ‎]]
#[[List of diseases (E) ‎]]
#[[Mebhydrolin ‎]]
#[[Protein S ‎]]
#[[Protein Z ‎]]
#[[Radiofrequency ablation ‎]]
#[[Arytenoid cartilage ‎]]
#[[Carbachol ‎]]
#[[Ceftazidime ‎]]
#[[Chromium ‎]]
#[[Chromosome 2 (human) ‎]]
#[[Colonic polyps ‎]]
#[[Congenital anomalies of the genitalia ‎]]
#[[Crus ‎]]
#[[Carnitine palmitoyltransferase II deficiency ‎]]
#[[Cefradine ‎]]
#[[Chemical pneumonitis ‎]]
#[[Chiral pool synthesis ‎]]
#[[Choanal atresia ‎]]
#[[Coalworker's pneumoconiosis ‎]]
#[[HERG ‎]]
#[[HLA-A2 ‎]]
#[[Occipital artery ‎]]
#[[Outlier ‎]]
#[[Plasma osmolality ‎]]
#[[Plexus ‎]]
#[[Plicamycin (patient information) ‎]]
#[[Delayed sleep phase syndrome ‎]]
#[[Diverticulum ‎]]
#[[Electron shell ‎]]
#[[Ependyma ‎]]
#[[Saethre-Chotzen syndrome ‎]]
#[[Small GTPase ‎]]
#[[Acrivastine ‎]]
#[[Ammonium ‎]]
#[[Anal-oral sex ‎]]
#[[Hemangiopericytoma ‎]]
#[[ISBT 128 ‎]]
#[[Idarubicin (patient information) ‎]]
#[[Iodomethane ‎]]
#[[Bare lymphocyte syndrome ‎]]
#[[Barton's fracture ‎]]
#[[Birdshot chorioretinopathy ‎]]
#[[Bismuth subsalicylate ‎]]
#[[Prothrombin fragment 1.2 (F1.2) ‎]]
#[[Quantitative trait locus ‎]]
#[[Rapid plasma reagent ‎]]
#[[Refractive error ‎]]
#[[Roger Wolcott Sperry ‎]]
#[[Roxithromycin ‎]]
#[[Thoracoscopy ‎]]
#[[Throat ‎]]
#[[Thrombectomy ‎]]
#[[Thrombus precursor protein (TpP) ‎]]
#[[Tongue pain ‎]]
#[[Transcortin ‎]]
#[[Urethral stricture ‎]]
#[[Karl Pearson ‎]]
#[[Kernel density estimation ‎]]
#[[Ketanserin ‎]]
#[[Ketone bodies ‎]]
#[[Köhler disease ‎]]
#[[Leukonychia ‎]]
#[[List of ICD-9 codes 140-239: Neoplasms ‎]]
#[[Long acting beta-adrenoceptor agonist ‎]]
#[[Medial cutaneous nerve of forearm ‎]]
#[[List of diseases (F) ‎]]
#[[Lung buds ‎]]
#[[4-Chloro-2,5-dimethoxyamphetamine ‎]]
#[[Acquired disorder ‎]]
#[[Allergic bronchopulmonary aspergillosis ‎]]
#[[Orosomucoid ‎]]
#[[Osteocalcin ‎]]
#[[Pharyngeal pouch (embryology) ‎]]
#[[Pitch (music) ‎]]
#[[Cerebral hemisphere ‎]]
#[[Cocaine dependence ‎]]
#[[Colles' fracture ‎]]
#[[Common bile duct ‎]]
#[[Community-acquired pneumonia ‎]]
#[[Cubic crystal system ‎]]
#[[Ferromagnetism ‎]]
#[[HLA-A29 ‎]]
#[[Haemopexin ‎]]
#[[Signet ring cell carcinoma ‎]]
#[[Sodium monofluorophosphate ‎]]
#[[Mitotane ‎]]
#[[Mucormycosis ‎]]
#[[National Institute on Aging ‎]]
#[[Natural Killer T cell ‎]]
#[[Dichloromethane ‎]]
#[[Extensor hallucis longus muscle ‎]]
#[[Exudate ‎]]
#[[Failure to thrive ‎]]
#[[Tasosartan ‎]]
#[[Thyroid isthmus ‎]]
#[[Tirofiban and transfer compares favorably to fibrinolysis in STEMI ‎]]
#[[Transitional cell carcinoma ‎]]
#[[Transmembrane protein ‎]]
#[[Trapezium (bone) ‎]]
#[[Unsaturated fat ‎]]
#[[Upper motor neuron ‎]]
#[[Valdecoxib ‎]]
#[[Ventricular system ‎]]
#[[Primer (molecular biology) ‎]]
#[[Propionic acid ‎]]
#[[Heterochromatin ‎]]
#[[Homatropine ‎]]
#[[Infrared spectroscopy ‎]]
#[[Ischiocavernosus muscle ‎]]
#[[Arthropathy ‎]]
#[[Barium ‎]]
#[[Barrel chest ‎]]
#[[Bendamustine ‎]]
#[[Capsid ‎]]
#[[Vivipary ‎]]
#[[Withdrawal ‎]]
#[[Xylometazoline ‎]]
#[[Methanogen ‎]]
#[[Mizolastine ‎]]
#[[Neprilysin ‎]]
#[[Optic radiation ‎]]
#[[Oxaliplatin ‎]]
#[[Paramagnetism ‎]]
#[[Phillip Allen Sharp ‎]]
#[[Mastication ‎]]
#[[McNemar's test ‎]]
#[[Mean squared error ‎]]
#[[Amphiarthrosis ‎]]
#[[Apical membrane ‎]]
#[[Scanning electron microscope ‎]]
#[[Sperm ‎]]
#[[Splenic artery ‎]]
#[[Streptococcus mutans ‎]]
#[[Superficial spreading melanoma ‎]]
#[[Superior rectus muscle ‎]]
#[[Covariance matrix ‎]]
#[[Fenfluramine ‎]]
#[[Glycomics ‎]]
#[[Asherman's syndrome ‎]]
#[[Baeyer-Villiger oxidation ‎]]
#[[Calvaria (skull) ‎]]
#[[Protein nuclear magnetic resonance spectroscopy ‎]]
#[[Proximal phalanges ‎]]
#[[Reoviridae ‎]]
#[[Deciduous teeth ‎]]
#[[Diabetes management ‎]]
#[[Diaphragm (contraceptive) ‎]]
#[[Diarrheal shellfish poisoning ‎]]
#[[Dopexamine ‎]]
#[[EC number ‎]]
#[[Ectoderm ‎]]
#[[Embryonic stem cell ‎]]
#[[Endocytosis ‎]]
#[[Ethambutol ‎]]
#[[Tubal ligation ‎]]
#[[Hypertrophy of the heart ‎]]
#[[ICD-10 Chapter H ‎]]
#[[Immunoproliferative disorders ‎]]
#[[International Classification of Health Interventions ‎]]
#[[Janus kinase ‎]]
#[[Homocysteine ‎]]
#[[Homologous series ‎]]
#[[ICD-10 Chapter K ‎]]
#[[Cementum ‎]]
#[[Chronic stable angina historical perspective ‎]]
#[[Cluster of differentiation ‎]]
#[[Computational learning theory ‎]]
#[[Coxsackie B ‎]]
#[[Cryosurgery ‎]]
#[[Pharyngeal recess ‎]]
#[[Wheatgrass ‎]]
#[[Xanthine oxidase ‎]]
#[[Mefenamic acid ‎]]
#[[Morvan's syndrome ‎]]
#[[Nickel(II) chloride ‎]]
#[[Non-rapid eye movement sleep ‎]]
#[[Septum secundum ‎]]
#[[1,3-Bisphosphoglycerate ‎]]
#[[AKT ‎]]
#[[ATC code P ‎]]
#[[Albrecht Kossel ‎]]
#[[Areola ‎]]
#[[Toluene ‎]]
#[[Tubocurarine ‎]]
#[[Variegate porphyria ‎]]
#[[Potassium perchlorate ‎]]
#[[Protic solvent ‎]]
#[[Gigantism ‎]]
#[[Baclofen ‎]]
#[[Bazin disease ‎]]
#[[Benzonatate (patient information) ‎]]
#[[Bone morphogenetic protein ‎]]
#[[Bronchial challenge test ‎]]
#[[Carbonate ‎]]
#[[Deptropine ‎]]
#[[Desoxymethyltestosterone ‎]]
#[[Ehrlichiosis (canine) ‎]]
#[[Electrophysiologic study ‎]]
#[[Ethinylestradiol ‎]]
#[[Endometrioid tumor ‎]]
#[[Eye bank ‎]]
#[[Spasticity ‎]]
#[[Olfactory receptor neuron ‎]]
#[[Orientia ‎]]
#[[PDE5 inhibitor ‎]]
#[[Pericardiacophrenic artery ‎]]
#[[Pimethixene ‎]]
#[[ICF syndrome ‎]]
#[[Immunocompetence ‎]]
#[[Intraosseous infusion ‎]]
#[[NFPA 704 ‎]]
#[[National Human Genome Research Institute ‎]]
#[[Karl Landsteiner ‎]]
#[[Laryngomalacia ‎]]
#[[Lateral circumflex femoral artery ‎]]
#[[List of diseases (X) ‎]]
#[[List of medical abbreviations ‎]]
#[[Malleus ‎]]
#[[Meckel's cartilage ‎]]
#[[Avidin ‎]]
#[[Bismuth ‎]]
#[[Bloating ‎]]
#[[C-peptide ‎]]
#[[Carbamoyl phosphate synthetase I deficiency ‎]]
#[[Pseudo-Hurler polydystrophy ‎]]
#[[Aerobic exercise ‎]]
#[[Anastrozole ‎]]
#[[Androstadienone ‎]]
#[[Anti-p62 antibodies ‎]]
#[[Fibrin degradation product ‎]]
#[[Fluphenazine ‎]]
#[[Fissured tongue ‎]]
#[[Fluid statics ‎]]
#[[Gatifloxacin ‎]]
#[[Mefloquine (patient information) ‎]]
#[[Microfilament ‎]]
#[[Mini-mental state examination ‎]]
#[[Seafood ‎]]
#[[Eosinophilic fasciitis ‎]]
#[[Chondroblastoma ‎]]
#[[Competitive inhibition ‎]]
#[[Cytochrome ‎]]
#[[P53 (protein) ‎]]
#[[Vitelline duct ‎]]
#[[2,5-Dimethoxy-4-bromoamphetamine ‎]]
#[[ATC code C09 ‎]]
#[[Acephaly (medicine) ‎]]
#[[Acetohexamide (patient information) ‎]]
#[[Angular incisure ‎]]
#[[Anti-transglutaminase antibodies ‎]]
#[[B-cell prolymphocytic leukemia ‎]]
#[[Bone marrow suppression ‎]]
#[[Byssinosis ‎]]
#[[Material safety data sheet ‎]]
#[[Root sheath ‎]]
#[[Organic synthesis ‎]]
#[[Periaqueductal gray ‎]]
#[[Smoking cessation ‎]]
#[[Gastric antral vascular ectasia ‎]]
#[[Nasopharynx ‎]]
#[[Nimetazepam ‎]]
#[[Cataplexy ‎]]
#[[Chemiosmosis ‎]]
#[[Chronic stable angina recognition of clinical subsets ‎]]
#[[Cortical dysplasia ‎]]
#[[Dapsone ‎]]
#[[Horizontal gene transfer ‎]]
#[[Humoral immune deficiency ‎]]
#[[Hypoglossal nerve ‎]]
#[[Idose ‎]]
#[[Diphenylpyraline ‎]]
#[[Essential tremor ‎]]
#[[Leukapheresis ‎]]
#[[Lysosomal storage disease ‎]]
#[[AS ‎]]
#[[Akaike information criterion ‎]]
#[[Alveolar gland ‎]]
#[[Anaphylatoxin ‎]]
#[[Thiamine pyrophosphate ‎]]
#[[Tobramycin ‎]]
#[[Traction alopecia ‎]]
#[[Trophoblast ‎]]
#[[Truncus arteriosus ‎]]
#[[Turners hypoplasia ‎]]
#[[Veins of the lower extremity ‎]]
#[[Articular processes ‎]]
#[[Bruch's membrane ‎]]
#[[Calcium phosphate ‎]]
#[[Atypical pneumonia ‎]]
#[[Human mortality from H5N1 ‎]]
#[[ICD-10 Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings ‎]]
#[[Isoquinoline ‎]]
#[[Protionamide ‎]]
#[[Psychogenic polydipsia ‎]]
#[[Respiration (physiology) ‎]]
#[[Osteosclerosis ‎]]
#[[Phytic acid ‎]]
#[[Plica fimbriata ‎]]
#[[Chromosome 9 (human) ‎]]
#[[Compendium of Chemical Terminology ‎]]
#[[Complication (medicine) ‎]]
#[[Gastrointestinal hormone ‎]]
#[[Glomerular basement membrane ‎]]
#[[The safety of thiazolidinediones in older diabetics ‎]]
#[[Tolbutamide ‎]]
#[[Trenbolone ‎]]
#[[Vaginismus ‎]]
#[[Kt/V ‎]]
#[[Lung allocation score ‎]]
#[[Dorland's Medical Dictionary ‎]]
#[[Facial artery ‎]]
#[[Adenomatoid odontogenic tumor ‎]]
#[[Antifibrinolytic ‎]]
#[[AM404 ‎]]
#[[Alpha motor neuron ‎]]
#[[Amylin ‎]]
#[[Central core disease ‎]]
#[[Charge transfer complex ‎]]
#[[Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency ‎]]
#[[Helicase ‎]]
#[[Herbicide ‎]]
#[[Impossible syndrome ‎]]
#[[Indometacin ‎]]
#[[Saxagliptin ‎]]
#[[Short bone ‎]]
#[[Supinator muscle ‎]]
#[[Attrition (dental) ‎]]
#[[Basilic vein ‎]]
#[[Body of vertebra ‎]]
#[[Bronchiolitis obliterans organizing pneumonia ‎]]
#[[Peyer's patches ‎]]
#[[Retroverted uterus ‎]]
#[[Minimaze procedure ‎]]
#[[Mitotic inhibitor ‎]]
#[[Noncompaction cardiomyopathy ‎]]
#[[Dental pathology ‎]]
#[[Descriptive statistics ‎]]
#[[Elimination reaction ‎]]
#[[European Society of Cardiology ‎]]
#[[Turpentine ‎]]
#[[Weekly EP & ECG rounds at the BIDMC (Archive) ‎]]
#[[Yellow nail syndrome ‎]]
#[[Yunis-Varon syndrome ‎]]
#[[Follicular phase ‎]]
#[[Gardnerella ‎]]
#[[Lacrimal bone ‎]]
#[[Life ‎]]
#[[Marburg virus ‎]]
#[[Juvenile dermatomyositis ‎]]
#[[Lateral plate mesoderm ‎]]
#[[List of diseases (O) ‎]]
#[[List of organic reactions ‎]]
#[[Lymphangiosarcoma ‎]]
#[[Probability ‎]]
#[[Pulse pressure ‎]]
#[[Short bone ‎]]
#[[Smoking cessation ‎]]
#[[Splanchnic nerves ‎]]
#[[Xerophthalmia ‎]]
#[[Yellow nail syndrome ‎]]
#[[Central core disease ‎]]
#[[Charge transfer complex ‎]]
#[[Chloral Hydrate (patient information) ‎]]
#[[Clenbuterol ‎]]
#[[Crypts of Lieberkühn ‎]]
#[[Dermal denticle ‎]]
#[[European Society of Cardiology ‎]]
#[[Thymosin ‎]]
#[[Tonsilitis ‎]]
#[[Kt/V ‎]]
#[[List of diseases (O) ‎]]
#[[List of organic reactions ‎]]
#[[Lymphangiosarcoma ‎]]
#[[Ketosis ‎]]
#[[Lateral plate mesoderm ‎]]
#[[Levonorgestrel ‎]]
#[[Melioidosis ‎]]
#[[Menadione ‎]]
#[[Selman Waksman ‎]]
#[[Intelligence ‎]]
#[[Isotropy ‎]]
#[[Micelle ‎]]
#[[Propranolol drug interactions ‎]]
#[[Regioselectivity ‎]]
#[[ST elevation myocardial infarction thienopyridine therapy ‎]]
#[[Ayurveda ‎]]
#[[Oxatomide ‎]]
#[[Peanut ‎]]
#[[Penis removal ‎]]
#[[Periorbital edema ‎]]
#[[Phalanx bones ‎]]
#[[Poliovirus ‎]]
#[[Abductor pollicis longus muscle ‎]]
#[[Aceruloplasminemia ‎]]
#[[Adenoid cystic carcinoma ‎]]
#[[Agnatha ‎]]
#[[Thoracic splanchnic nerves ‎]]
#[[Transgender ‎]]
#[[Demeclocycline ‎]]
#[[Expected value ‎]]
#[[Extensor carpi radialis longus muscle ‎]]
#[[Yale School of Medicine ‎]]
#[[Colesevelam ‎]]
#[[Gene gun ‎]]
#[[Geographic tongue ‎]]
#[[Gestodene ‎]]
#[[Granule cell ‎]]
#[[Five prime untranslated region ‎]]
#[[Fungicide ‎]]
#[[Gilman reagent ‎]]
#[[Haversian canals ‎]]
#[[Health informatics ‎]]
#[[Pectoralis minor muscle ‎]]
#[[Phenazopyridine ‎]]
#[[Pramipexole (patient information) ‎]]
#[[Hypochondroplasia ‎]]
#[[Inferior alveolar nerve ‎]]
#[[Interlobar arteries ‎]]
#[[Internal iliac vein ‎]]
#[[Lercanidipine ‎]]
#[[Mecamylamine ‎]]
#[[Melancholia ‎]]
#[[Selectable marker ‎]]
#[[Starch ‎]]
#[[Subatomic particle ‎]]
#[[Sulfadiazine (patient information) ‎]]
#[[Automated external defibrillator ‎]]
#[[Benzyl benzoate ‎]]
#[[Bioinorganic chemistry ‎]]
#[[Calcium pangamate ‎]]
#[[Camptothecin ‎]]
#[[Quality Assurance Review Center ‎]]
#[[Reflux nephropathy ‎]]
#[[Reslizumab ‎]]
#[[Rifaximin ‎]]
#[[Schlemm's canal ‎]]
#[[Central retinal artery ‎]]
#[[Cysteine ‎]]
#[[Delusional disorder ‎]]
#[[Dickey-Fuller test ‎]]
#[[Diradical ‎]]
#[[Epirubicin ‎]]
#[[Ferredoxin ‎]]
#[[Acute chest syndrome ‎]]
#[[Adductor longus muscle ‎]]
#[[Anti-thrombin antibodies ‎]]
#[[Viroid ‎]]
#[[Werner syndrome ‎]]
#[[X-linked ichthyosis ‎]]
#[[Zaleplon (patient information) ‎]]
#[[Azole ‎]]
#[[Barotrauma ‎]]
#[[CX717 ‎]]
#[[Hydroxyethylpromethazine ‎]]
#[[Ibopamine ‎]]
#[[Kennedy disease ‎]]
#[[Flexor carpi ulnaris muscle ‎]]
#[[Glass ‎]]
#[[Glottis ‎]]
#[[HLA-A10 ‎]]
#[[Peter Medawar ‎]]
#[[Phenindamine ‎]]
#[[Phenolphthalein ‎]]
#[[Photorefractive keratectomy ‎]]
#[[Prepatellar bursitis ‎]]
#[[Primaquine (patient information) ‎]]
#[[Septum transversum ‎]]
#[[Silent mutation ‎]]
#[[Sphincter ani internus muscle ‎]]
#[[Tannin ‎]]
#[[Temazepam detailed information ‎]]
#[[MicroRNA ‎]]
#[[Model organism ‎]]
#[[Natalizumab ‎]]
#[[Newton's laws of motion ‎]]
#[[Nortriptyline (patient information) ‎]]
#[[Lobo's disease ‎]]
#[[Tinea capitis ‎]]
#[[Titanium dioxide ‎]]
#[[Tixocortol ‎]]
#[[Treatment of Crohn's disease ‎]]
#[[Dimercaptosuccinic acid ‎]]
#[[Docetaxel ‎]]
#[[Dofetilide ‎]]
#[[Environmental sensitivity ‎]]
#[[Extensor digitorum muscle ‎]]
#[[Propensity score ‎]]
#[[Prostaglandin D2 ‎]]
#[[Rethinking a “healthy weight”: New study finds that being overweight is not associated with increased mortality from cardiovascular causes ‎]]
#[[Reviparin ‎]]
#[[Cellular pathology ‎]]
#[[Cerebral venous sinus thrombosis ‎]]
#[[Chlorothiazide ‎]]
#[[Chorea (disease) ‎]]
#[[Chronic stable angina secondary prevention ‎]]
#[[Ciliary body ‎]]
#[[2-Arachidonoylglycerol ‎]]
#[[Alemtuzumab ‎]]
#[[Alexithymia ‎]]
#[[Antimicrosomal antibody ‎]]
#[[Aortography ‎]]
#[[Apoplexy ‎]]
#[[Appendicular skeleton ‎]]
#[[Arbidol ‎]]
#[[Albuterol (patient information) ‎]]
#[[Alcoholics Anonymous ‎]]
#[[Amputee Care Center ‎]]
#[[Anorectic ‎]]
#[[N-Formylmethionine ‎]]
#[[Histapyrrodine ‎]]
#[[Hormonal therapy (oncology) ‎]]
#[[Infraspinatus muscle ‎]]
#[[Ionizing radiation ‎]]
#[[Atovaquone ‎]]
#[[Bayer ‎]]
#[[Bendazac ‎]]
#[[Broad-spectrum antibiotic ‎]]
#[[Calcidiol ‎]]
#[[Semantic pragmatic disorder ‎]]
#[[Short posterior ciliary arteries ‎]]
#[[Sodium fluoride ‎]]
#[[Spindle neuron ‎]]
#[[Standard Anticoagulation Regimen compared to Absence of Anticoagulation for Elective Percutaneous Coronary Intervention: Results from the CIAO Study ‎]]
#[[Superior thyroid artery ‎]]
#[[Flexor hallucis brevis muscle ‎]]
#[[Fluticasone/salmeterol ‎]]
#[[Foot-and-mouth disease ‎]]
#[[Foramen ‎]]
#[[HLA-A69 ‎]]
#[[Orbicularis oculi muscle ‎]]
#[[Outbreak ‎]]
#[[Pachyonychia congenita ‎]]
#[[Pharmacotherapy to Support PCI ‎]]
#[[Praziquantel ‎]]
#[[Characteristic function (probability theory) ‎]]
#[[Chromosome 15 (human) ‎]]
#[[Clonitazene ‎]]
#[[Confidence interval ‎]]
#[[Dysesthesia ‎]]
#[[Enterohepatic circulation ‎]]
#[[Exogenous ‎]]
#[[Ketotifen ‎]]
#[[KvLQT1 ‎]]
#[[Levator ani ‎]]
#[[List of diseases (M) ‎]]
#[[Lone pair ‎]]
#[[Lucid dream ‎]]
#[[Masseter muscle ‎]]
#[[Maximum likelihood ‎]]
#[[Thenar eminence ‎]]
#[[Thyroarytenoid muscle ‎]]
#[[Tocainide ‎]]
#[[Trichloroethylene ‎]]
#[[Variance ‎]]
#[[Protein Z-related protease inhibitor ‎]]
#[[Schwann cell ‎]]
#[[Religion ‎]]
#[[Rutin ‎]]
#[[Food and Agriculture Organization ‎]]
#[[G-test ‎]]
#[[Gait (human) ‎]]
#[[Metatarsalgia ‎]]
#[[Microstomia ‎]]
#[[Miliary tuberculosis ‎]]
#[[Milk of Magnesia ‎]]
#[[Moxonidine ‎]]
#[[Mushroom ‎]]
#[[Nephrotome ‎]]
#[[Non-invasive (medical) ‎]]
#[[Octreotide ‎]]
#[[Oncotic pressure ‎]]
#[[AIDS dementia complex ‎]]
#[[ATC code L04 ‎]]
#[[ATC code N05 ‎]]
#[[Abdominal wall defect ‎]]
#[[Adenosine deaminase ‎]]
#[[Animal virology ‎]]
#[[Anti-apolipoprotein antibodies ‎]]
#[[Aquaporin 2 ‎]]
#[[Shear stress ‎]]
#[[Spinal cord compression ‎]]
#[[Superficial fibular nerve ‎]]
#[[Heptaminol ‎]]
#[[Herbivory ‎]]
#[[Interleukin 1 ‎]]
#[[Intrinsic immunity ‎]]
#[[Body cavity ‎]]
#[[Brachioradialis ‎]]
#[[Cabergoline ‎]]
#[[Calix diverticulum ‎]]
#[[Thonzylamine ‎]]
#[[Tinea versicolor ‎]]
#[[Udenafil ‎]]
#[[Ultraviolet-visible spectroscopy ‎]]
#[[Urachal cyst ‎]]
#[[Ureteroscopy ‎]]
#[[Distal splenorenal shunt procedure ‎]]
#[[Dorsal spinocerebellar tract ‎]]
#[[Endothelin receptor antagonist ‎]]
#[[Enoximone ‎]]
#[[Episiotomy ‎]]
#[[Erector spinae ‎]]
#[[Esmolol ‎]]
#[[FITkit ‎]]
#[[Fahrenheit ‎]]
#[[Felbamate (patient information) ‎]]
#[[Paraventricular nucleus of hypothalamus ‎]]
#[[Perforin ‎]]
#[[Pimecrolimus ‎]]
#[[Polyneuropathy ‎]]
#[[Cervical sinus ‎]]
#[[Chromosome 21 (human) ‎]]
#[[Cigarette ‎]]
#[[Counterimmunoelectrophoresis ‎]]
#[[Cycloalkane ‎]]
#[[Lacteal ‎]]
#[[Lateral horn ‎]]
#[[Leydig cell ‎]]
#[[Lipotropin ‎]]
#[[List of diseases (S) ‎]]
#[[Lithotriptor ‎]]
#[[Medial nasal prominence ‎]]
#[[Lacuna (histology) ‎]]
#[[Mammography ‎]]
#[[Manganese ‎]]
#[[Mannan-binding lectin pathway ‎]]
#[[Mastitis ‎]]
#[[Mebendazole ‎]]
#[[Medulla of ovary ‎]]
#[[Melkersson-Rosenthal syndrome ‎]]
#[[Holoprosencephaly ‎]]
#[[Homeobox ‎]]
#[[Induration ‎]]
#[[Frostbite ‎]]
#[[Genotype ‎]]
#[[Gluteus medius muscle ‎]]
#[[Gravitation ‎]]
#[[HMG-CoA reductase ‎]]
#[[Health insurance ‎]]
#[[Protein in nutrition ‎]]
#[[RNA interference ‎]]
#[[Sphenopalatine artery ‎]]
#[[Submandibular duct ‎]]
#[[Suppository ‎]]
#[[Teres major muscle ‎]]
#[[Tetanic contraction ‎]]
#[[Acrania ‎]]
#[[Anethole ‎]]
#[[Chyluria ‎]]
#[[Clotrimazole ‎]]
#[[Cortisone ‎]]
#[[Crohn's Disease Activity Index ‎]]
#[[Cuboid bone ‎]]
#[[Cutis (anatomy) ‎]]
#[[Degenerative disease ‎]]
#[[Dialysis adequacy ‎]]
#[[Diosmectite ‎]]
#[[Directional selection ‎]]
#[[EcoRI ‎]]
#[[Ectropion ‎]]
#[[Electrophoretic mobility shift assay ‎]]
#[[Ergoline ‎]]
#[[F-test ‎]]
#[[Azo compound ‎]]
#[[Time to Abandon Facilitated PCI: Results from the FINESSE trial ‎]]
#[[Vegetable ‎]]
#[[Ovoviviparity ‎]]
#[[Pachygyria ‎]]
#[[Periodic paralysis ‎]]
#[[Phosphate binders ‎]]
#[[Pityriasis ‎]]
#[[Poisson distribution ‎]]
#[[Polyhistidine-tag ‎]]
#[[Pancreatic veins ‎]]
#[[Pentosan polysulfate ‎]]
#[[Peripherally inserted central catheter ‎]]
#[[Pharyngeal groove ‎]]
#[[Phosphodiester bond ‎]]
#[[Poppy tea ‎]]
#[[Sodium selenite ‎]]
#[[Stroop effect ‎]]
#[[Succinimide ‎]]
#[[Supraspinatus muscle ‎]]
#[[Sydenham's chorea ‎]]
#[[Hydrochloride ‎]]
#[[ICD-10 Chapter XV: Pregnancy, childbirth and the puerperium ‎]]
#[[Keratosis pilaris ‎]]
#[[Klebsiella pneumoniae ‎]]
#[[Saquinavir (patient information) ‎]]
#[[Mold ‎]]
#[[Molybdenum ‎]]
#[[Myristic acid ‎]]
#[[Nasal bone ‎]]
#[[National Center for Research Resources ‎]]
#[[Norfenefrine ‎]]
#[[Occipitalis muscle ‎]]
#[[Omenn syndrome ‎]]
#[[Flumazenil ‎]]
#[[Foam cells ‎]]
#[[Food additive ‎]]
#[[Fosamprenavir (patient information) ‎]]
#[[Fullerene ‎]]
#[[Fusion protein ‎]]
#[[Glasses ‎]]
#[[Gonadotropin ‎]]
#[[Gravidity ‎]]
#[[HLA-A34 ‎]]
#[[Heat map ‎]]
#[[The heart in essential mixed cryoglobulinemia ‎]]
#[[Tinea pedis ‎]]
#[[Triple test ‎]]
#[[Visual impairment ‎]]
#[[WikiDoc News: Acute Coronary Syndromes ‎]]
#[[Efficacy ‎]]
#[[Enhancer (genetics) ‎]]
#[[Eprosartan ‎]]
#[[Ergotamine ‎]]
#[[Extraction (dental) ‎]]
#[[Acheiropodia ‎]]
#[[Alkyne ‎]]
#[[Amplified fragment length polymorphism ‎]]
#[[Carolus Linnaeus ‎]]
#[[Central venous catheter ‎]]
#[[Cobalt ‎]]
#[[Cymarin ‎]]
#[[Cytokines and their receptors ‎]]
#[[Cytopathology ‎]]
#[[Bloodletting ‎]]
#[[Board review draft ‎]]
#[[Baruch Samuel Blumberg ‎]]
#[[Basic metabolic panel ‎]]
#[[Brodmann area 25 ‎]]
#[[Cardinal veins ‎]]
#[[Caries ‎]]
#[[Micromastia ‎]]
#[[National Institute on Alcohol Abuse and Alcoholism ‎]]
#[[Neonatal jaundice ‎]]
#[[Sedation ‎]]
#[[Sever's disease ‎]]
#[[Skull fracture ‎]]
#[[Steatosis ‎]]
#[[Taq polymerase ‎]]
#[[Organic acid ‎]]
#[[Papaverine ‎]]
#[[Persistent fetal circulation ‎]]
#[[Phenmetrazine ‎]]
#[[Phosphate homeostasis ‎]]
#[[Piroxicam ‎]]
#[[Plantar fasciitis ‎]]
#[[Pleural empyema ‎]]
#[[Polynucleotide ‎]]
#[[Posterior cutaneous nerve of forearm ‎]]
#[[Postmature birth ‎]]
#[[Protein tag ‎]]
#[[Randomization ‎]]
#[[Retrognathism ‎]]
#[[Revascularization in the "No Option" patient ‎]]
#[[Rhabdomyoma ‎]]
#[[Rodney Robert Porter ‎]]
#[[Scandinavian Simvastatin Survival Study ‎]]
#[[Scrofula ‎]]
#[[Icosahedron ‎]]
#[[Ileocolic artery ‎]]
#[[Inferior temporal gyrus ‎]]
#[[Limb-girdle muscular dystrophy ‎]]
#[[List of ICD-9 codes 320-359: Diseases of the nervous system ‎]]
#[[Lymphangioleiomyomatosis ‎]]
#[[Cefepime ‎]]
#[[Choroideremia ‎]]
#[[Cryptobiosis ‎]]
#[[Doxepin ‎]]
#[[Electrical network ‎]]
#[[Enoxolone ‎]]
#[[Entacapone (patient information) ‎]]
#[[Esophageal motility disorder ‎]]
#[[Fibular artery ‎]]
#[[Foreign body ‎]]
#[[Francis Peyton Rous ‎]]
#[[Glucuronosyltransferase ‎]]
#[[HLA-A1 ‎]]
#[[HLA-A26 ‎]]
#[[Thoracic nerves ‎]]
#[[Toxicogenomics ‎]]
#[[Abductor hallucis muscle ‎]]
#[[Aniseikonia ‎]]
#[[Anterior communicating artery ‎]]
#[[Anti-actin antibodies ‎]]
#[[Acalculia ‎]]
#[[Altrose ‎]]
#[[Hot flash ‎]]
#[[Hydrogen cyanide ‎]]
#[[Hyperchloremic acidosis ‎]]
#[[Hypertriglyceridemia ‎]]
#[[Idursulfase ‎]]
#[[International unit ‎]]
#[[James W. Black ‎]]
#[[Joint Commission ‎]]
#[[Metalloproteinase ‎]]
#[[Miller-Dieker syndrome ‎]]
#[[Monosomy ‎]]
#[[Nedocromil ‎]]
#[[Nucleolus ‎]]
#[[Zonule of Zinn ‎]]
#[[Asexual reproduction ‎]]
#[[Bartonella ‎]]
#[[Blister agent ‎]]
#[[Bromide ‎]]
#[[Cadherin ‎]]
#[[Psychiatrist ‎]]
#[[Side chain ‎]]
#[[Sitaxsentan ‎]]
#[[Somatic cell ‎]]
#[[Sucralfate ‎]]
#[[Systems biology ‎]]
#[[Taxane ‎]]
#[[Optic disc ‎]]
#[[Oxandrolone ‎]]
#[[Poison ivy ‎]]
#[[Polycystic liver disease ‎]]
#[[Pristinamycin ‎]]
#[[Probit ‎]]
#[[The Lancet ‎]]
#[[Thioridazine (patient information) ‎]]
#[[Trichomonas vaginalis ‎]]
#[[Doxacurium chloride ‎]]
#[[Erythroleukemia ‎]]
#[[Leukotriene antagonist ‎]]
#[[Mahalanobis distance ‎]]
#[[Chemostat ‎]]
#[[Clodronate ‎]]
#[[Codon usage bias ‎]]
#[[Cost effectiveness in cardiovascular disease ‎]]
#[[Fibromatosis ‎]]
#[[Glucocorticoids ‎]]
#[[HLA-B46 ‎]]
#[[HOMO/LUMO ‎]]
#[[Food chemistry ‎]]
#[[Fragment crystallizable region ‎]]
#[[Germline ‎]]
#[[HLA-B5 ‎]]
#[[Healing ‎]]
#[[Heart attack care center ‎]]
#[[Hepatitis B virus ‎]]
#[[Septum intermedium ‎]]
#[[Small saphenous vein ‎]]
#[[Syncytium ‎]]
#[[Metamorphosis ‎]]
#[[Methapyrilene ‎]]
#[[Methoxypropane ‎]]
#[[Metropolis-Hastings algorithm ‎]]
#[[Middle pharyngeal constrictor muscle ‎]]
#[[Ménétrier's disease ‎]]
#[[NHS and Community Care Act (1990) ‎]]
#[[Naphthoquinone ‎]]
#[[Olfactory receptor ‎]]
#[[Middle pharyngeal constrictor muscle ‎]]
#[[Ménétrier's disease ‎]]
#[[NHS and Community Care Act (1990) ‎]]
#[[Naphthoquinone ‎]]
#[[Olfactory receptor ‎]]
#[[Paleopolyploidy ‎]]
#[[Pegaspargase (patient information) ‎]]
#[[Pericardial friction rub ‎]]
#[[Pharmacodynamics ‎]]
#[[Posterior auricular artery ‎]]
#[[Posterior segment ‎]]
#[[Dermatophyte ‎]]
#[[Edmonton protocol ‎]]
#[[Food chemistry ‎]]
#[[Fragment crystallizable region ‎]]
#[[Germline ‎]]
#[[HLA-B5 ‎]]
#[[Healing ‎]]
#[[Heart attack care center ‎]]
#[[Hepatitis B virus ‎]]
#[[News:Clinical data support the non-inferiority of continuous chest compressions compared with conventional cardiopulmonary resuscitation ‎]]
#[[Lumiracoxib ‎]]
#[[Pulpitis ‎]]
#[[Pyonephrosis ‎]]
#[[Rhythm and other relevant findings answer (July 2008) ‎]]
#[[Chlortalidone ‎]]
#[[Corpus spongiosum penis ‎]]
#[[Costamere ‎]]
#[[Daptomycin ‎]]
#[[Data ‎]]
#[[University of Kansas ‎]]
#[[Vitrectomy ‎]]
#[[Warkany syndrome 2 ‎]]
#[[Asthenia ‎]]
#[[Asymmetric synthesis ‎]]
#[[Atrial canal ‎]]
#[[Auxology ‎]]
#[[Biological database ‎]]
#[[Bisacodyl ‎]]
#[[Carnitine palmitoyltransferase I deficiency ‎]]
#[[Septum intermedium ‎]]
#[[Small saphenous vein ‎]]
#[[Syncytium ‎]]
#[[Skin appendages ‎]]
#[[Solifenacin ‎]]
#[[Wikipedia:External links ‎]]
#[[Zori Stalker Williams syndrome ‎]]
#[[Metalloproteinases (MMPs) ‎]]
#[[Mixed disorder of acid-base balance ‎]]
#[[National Institute of Biomedical Imaging and Bioengineering ‎]]
#[[Nephropexy ‎]]
#[[Nested case-control study ‎]]
#[[Nitrite ‎]]
#[[Nucleoporin 210kDa ‎]]
#[[Olecranon bursitis ‎]]
#[[Abu al-Qasim al-Zahrawi ‎]]
#[[Almond ‎]]
#[[Arbutamine ‎]]
#[[Hydrogenation ‎]]
#[[Hyperemesis gravidarum ‎]]
#[[Intein ‎]]
#[[Fraser syndrome ‎]]
#[[Gastric chief cell ‎]]
#[[Gregor Mendel ‎]]
#[[HLA-A68 ‎]]
#[[HLA-DQ2 ‎]]
#[[Paravertebral ganglia ‎]]
#[[Platelet-derived growth factor ‎]]
#[[Deltoid muscle ‎]]
#[[Electromagnetism ‎]]
#[[Epistasis ‎]]
#[[Ethylene oxide ‎]]
#[[Eugenol ‎]]
#[[Extensor digitorum brevis muscle ‎]]
#[[External jugular vein ‎]]
#[[Basal ganglia ‎]]
#[[Bloody show ‎]]
#[[Brimonidine ‎]]
#[[Calcipotriol ‎]]
#[[Cardiovascular Anatomy ‎]]
#[[Chaperone (protein) ‎]]
#[[Chloromethane ‎]]
#[[Citric acid ‎]]
#[[Conradi-Hünermann syndrome ‎]]
#[[Renal fascia ‎]]
#[[Renal papilla ‎]]
#[[Renal pelvis ‎]]
#[[Sagittal plane ‎]]
#[[Tick ‎]]
#[[Trichromacy ‎]]
#[[Ventral root ‎]]
#[[Opisthotonus ‎]]
#[[Otic ganglion ‎]]
#[[Pancreatic duct ‎]]
#[[Pathogenesis ‎]]
#[[Pinta (disease) ‎]]
#[[Pneumococcal polysaccharide vaccine (patient information) ‎]]
#[[Portable Document Format ‎]]
#[[Premarin ‎]]
#[[Metabolite ‎]]
#[[Methocarbamol ‎]]
#[[Methysergide ‎]]
#[[Mixed gonadal dysgenesis ‎]]
#[[National Institute on Drug Abuse ‎]]
#[[New study uses gene variants to predict cardiovascular risk ‎]]
#[[Sponge ‎]]
#[[Surgical oncology ‎]]
#[[Fludarabine ‎]]
#[[Formate ‎]]
#[[Gammaproteobacteria ‎]]
#[[Gerty Cori ‎]]
#[[Gonadotropins ‎]]
#[[HLA-A23 ‎]]
#[[Acarbose ‎]]
#[[Adrenalone ‎]]
#[[Alpha 1-antichymotrypsin ‎]]
#[[Aponeurosis ‎]]
#[[Holocrine ‎]]
#[[Holter monitor ‎]]
#[[Human Tissue Authority ‎]]
#[[Hyper IgM syndrome ‎]]
#[[Ibandronic acid ‎]]
#[[Jejunum ‎]]
#[[Receptor theory ‎]]
#[[Renal clearance ratio ‎]]
#[[Reptile ‎]]
#[[Rhinophyma ‎]]
#[[Bacillary angiomatosis ‎]]
#[[Bevirimat ‎]]
#[[Bronchiolitis obliterans ‎]]
#[[Budesonide/formoterol ‎]]
#[[C3 (complement) ‎]]
#[[Calcium lactate gluconate ‎]]
#[[Kumada coupling ‎]]
#[[Lipase ‎]]
#[[Macrocephaly ‎]]
#[[Downregulation ‎]]
#[[Esophagectomy ‎]]
#[[Exenatide ‎]]
#[[Center for Scientific Review ‎]]
#[[Christiaan Barnard ‎]]
#[[Clitoris enlargement ‎]]
#[[Cloricromen ‎]]
#[[Contingency table ‎]]
#[[Curare ‎]]
#[[Cycloserine ‎]]
#[[DNA-DNA hybridization ‎]]
#[[Cerebellar tonsil ‎]]
#[[Chlorcyclizine ‎]]
#[[Conalbumin ‎]]
#[[Costal cartilages ‎]]
#[[Aldol reaction ‎]]
#[[Allantois ‎]]
#[[Arcuate arteries of the kidney ‎]]
#[[Arrectores pilorum ‎]]
#[[Oxybuprocaine ‎]]
#[[Oxybutynin ‎]]
#[[Pectus carinatum ‎]]
#[[Pneumococcal conjugate vaccine ‎]]
#[[Posterior border of lung ‎]]
#[[Probability mass function ‎]]
#[[Tiadenol ‎]]
#[[Tooth loss ‎]]
#[[Triage ‎]]
#[[University of California, Davis ‎]]
#[[Flurbiprofen ‎]]
#[[Glanders ‎]]
#[[Gubernaculum ‎]]
#[[HLA-A36 ‎]]
#[[Helen B. Taussig ‎]]
#[[Mevalonate kinase ‎]]
#[[Momentum ‎]]
#[[Myotome ‎]]
#[[Nefopam ‎]]
#[[Number needed to harm ‎]]
#[[Self-esteem ‎]]
#[[Sensory Integration Dysfunction ‎]]
#[[Sodium iodide ‎]]
#[[Sprengel's deformity ‎]]
#[[Taxonomic rank ‎]]
#[[Diagnostic immunology ‎]]
#[[Diaper rash ‎]]
#[[Distal phalanges ‎]]
#[[Dorsal interossei of the foot ‎]]
#[[Dorsal nasal artery ‎]]
#[[Enteroglucagon ‎]]
#[[Bacilli ‎]]
#[[Bioethics ‎]]
#[[Bradykinesia ‎]]
#[[Bulbospongiosus muscle ‎]]
#[[Carbasalate calcium ‎]]
#[[Hexylresorcinol ‎]]
#[[Histocompatibility ‎]]
#[[Hysterotomy ‎]]
#[[Insemination ‎]]
#[[Intercalated disc ‎]]
#[[Intracranial berry aneurysm ‎]]
#[[Intramolecular ‎]]
#[[Kerley lines ‎]]
#[[Pseudogene ‎]]
#[[Purinergic receptor ‎]]
#[[Relative risk reduction ‎]]
#[[Renal compensation ‎]]
#[[Risk assessment ‎]]
#[[Sample (statistics) ‎]]
#[[Sarcoma botryoides ‎]]
#[[Lapatinib ‎]]
#[[Latanoprost ‎]]
#[[Linagliptin ‎]]
#[[Measure (mathematics) ‎]]
#[[Lorcainide ‎]]
#[[Malachite green ‎]]
#[[Microsatellite ‎]]
#[[Mineral oil ‎]]
#[[Moment (mathematics) ‎]]
#[[National Institute for Occupational Safety and Health ‎]]
#[[Oncolytic virus ‎]]
#[[Abiogenesis ‎]]
#[[Acetyldigoxin ‎]]
#[[Alfuzosin ‎]]
#[[All signs and symptoms ‎]]
#[[Anisometropia ‎]]
#[[Anti-glycoprotein-210 antibodies ‎]]
#[[Antivenom ‎]]
#[[Aprindine ‎]]
#[[Arsenic trioxide ‎]]
#[[Caroli's disease ‎]]
#[[Cefditoren ‎]]
#[[Clofezone ‎]]
#[[Forest plot ‎]]
#[[Gastrula ‎]]
#[[Gluteus minimus muscle ‎]]
#[[Goserelin ‎]]
#[[Gray ramus communicans ‎]]
#[[Gyrus ‎]]
#[[HLA-A19 ‎]]
#[[HLA-A3 ‎]]
#[[Haplotype ‎]]
#[[Oxidative phosphorylation ‎]]
#[[Plasma (physics) ‎]]
#[[Posterior probability ‎]]
#[[Precordial thump ‎]]
#[[Primitive palate ‎]]
#[[Tositumomab ‎]]
#[[Troponin I ‎]]
#[[Ureterocele ‎]]
#[[Rabson-Mendenhall syndrome ‎]]
#[[Regulation of gene expression ‎]]
#[[Rhizotomy ‎]]
#[[Schizencephaly ‎]]
#[[Aspergillosis ‎]]
#[[Baldness treatments ‎]]
#[[Basement membrane ‎]]
#[[Beilstein database ‎]]
#[[Biological hazard ‎]]
#[[Calcium in biology ‎]]
#[[Carbon-carbon bond ‎]]
#[[Spinal analgesia ‎]]
#[[Substituent ‎]]
#[[Talastine ‎]]
#[[Disability-adjusted life years ‎]]
#[[Dural venous sinuses ‎]]
#[[Eparterial bronchus ‎]]
#[[Humphry Davy ‎]]
#[[Immunohaematology ‎]]
#[[Iliacus muscle ‎]]
#[[Immunogenetics ‎]]
#[[Insulin-like growth factor 1 ‎]]
#[[Intensive insulinotherapy (patient information) ‎]]
#[[Oxygen saturation ‎]]
#[[PCI Complications: "No-Reflow" ‎]]
#[[Pandemic Severity Index ‎]]
#[[Pot-in-pot refrigerator ‎]]
#[[Primary amoebic meningoencephalitis ‎]]
#[[Micro- ‎]]
#[[Midclavicular line ‎]]
#[[Motor nerve ‎]]
#[[Obstructive uropathy ‎]]
#[[Klatskin tumor ‎]]
#[[Lathyrism ‎]]
#[[List of diseases (R) ‎]]
#[[Locked-In syndrome ‎]]
#[[Magnesium carbonate ‎]]
#[[Magnetic resonance molecular imaging ‎]]
#[[Mating ‎]]
#[[Mauveine ‎]]
#[[Mediastinoscopy ‎]]
#[[Yersinia pestis ‎]]
#[[Zalcitabine (patient information) ‎]]
#[[Fibular veins ‎]]
#[[Free nerve ending ‎]]
#[[Greater occipital nerve ‎]]
#[[H5N3 ‎]]
#[[HLA-A31 ‎]]
#[[HLA-A9 ‎]]
#[[HLA-B47 ‎]]
#[[HLA-B53 ‎]]
#[[2C-B-BZP ‎]]
#[[ATC code N07 ‎]]
#[[Amoebozoa ‎]]
#[[Amrinone ‎]]
#[[Anterior tongue ‎]]
#[[Anthraquinone ‎]]
#[[Chlortetracycline ‎]]
#[[Dendritic spine ‎]]
#[[Diallyllysergamide ‎]]
#[[Diflunisal ‎]]
#[[Dimethylethanolamine ‎]]
#[[Drunkenness ‎]]
#[[Encephalitis lethargica ‎]]
#[[Epinastine ‎]]
#[[Estazolam ‎]]
#[[Family (biology) ‎]]
#[[Atenolol (patient information) ‎]]
#[[Atomic number ‎]]
#[[Base of lung ‎]]
#[[Benzyl ‎]]
#[[Biogenic amine ‎]]
#[[Bk-MBDB ‎]]
#[[Boron group ‎]]
#[[Brodmann area 5 ‎]]
#[[Cardioversion ‎]]
#[[Topiramate ‎]]
#[[Trandolapril ‎]]
#[[Truncus arteriosus (embryology) ‎]]
#[[Tumor lysis syndrome ‎]]
#[[Urea cycle ‎]]
#[[Uterine horns ‎]]
#[[Pseudobulbar palsy ‎]]
#[[Pyruvate dehydrogenase ‎]]
#[[SN2 reaction ‎]]
#[[Saccharomyces boulardii ‎]]
#[[Serotonin receptor agonist ‎]]
#[[Small bowel bacterial overgrowth syndrome ‎]]
#[[Sudden infant death syndrome ‎]]
#[[TRANSCEND Study suggests that telmisartan reduces cardiovascular events ‎]]
#[[Sodium acetate ‎]]
#[[Sodium citrate ‎]]
#[[Stereocilia ‎]]
#[[Sulfa drug ‎]]
#[[Synchondrosis ‎]]
#[[Taurine ‎]]
#[[ATC code C07 ‎]]
#[[Acetylene ‎]]
#[[Alcohol withdrawal ‎]]
#[[Aldehyde dehydrogenase ‎]]
#[[Ampulla of uterine tube ‎]]
#[[Aniracetam ‎]]
#[[Antisense ‎]]
#[[Antithrombin Therapy to Support PCI (patient information) ‎]]
#[[Antithyroid microsomal antibodies ‎]]
#[[Metanephric blastema ‎]]
#[[Metaraminol ‎]]
#[[Morula ‎]]
#[[National Institute of Environmental Health Sciences ‎]]
#[[Neurosis ‎]]
#[[Ibutilide ‎]]
#[[Pentane ‎]]
#[[Phase (matter) ‎]]
#[[Posterior commissure of labia ‎]]
#[[Flammability ‎]]
#[[Flexor digitorum longus muscle ‎]]
#[[GUS reporter system ‎]]
#[[Gibbs free energy ‎]]
#[[Glands of Moll ‎]]
#[[Goose bumps ‎]]
#[[Gracilis muscle ‎]]
#[[Greater curvature of the stomach ‎]]
#[[H3N2 ‎]]
#[[HLA-A74 ‎]]
#[[Kidney abscess ‎]]
#[[Kleptomania ‎]]
#[[Labiaplasty ‎]]
#[[Levator labii superioris ‎]]
#[[Levator veli palatini ‎]]
#[[Medical prefixes, suffixes, and combining forms ‎]]
#[[Membrane ‎]]
#[[Williams syndrome ‎]]
#[[Progestogen only pill ‎]]
#[[Recurrent laryngeal nerve ‎]]
#[[Regression analysis ‎]]
#[[Respiratory tract infection ‎]]
#[[Rhesus Macaque ‎]]
#[[Baritosis ‎]]
#[[Biomaterial ‎]]
#[[Butalbital ‎]]
#[[Calcium fluoride ‎]]
#[[Cardiac index ‎]]
#[[Cardiac notch of left lung ‎]]
#[[Cefaclor ‎]]
#[[Cefdinir ‎]]
#[[Chiral ligand ‎]]
#[[Chromosome 11 (human) ‎]]
#[[Chronic stable angina rehabilitation ‎]]
#[[Condensation ‎]]
#[[Cysteamine ‎]]
#[[Dacarbazine ‎]]
#[[Deep fibular nerve ‎]]
#[[DermAtlas ‎]]
#[[Drug development ‎]]
#[[Dwarfism ‎]]
#[[Tolmetin ‎]]
#[[Tolperisone ‎]]
#[[United Network for Organ Sharing ‎]]
#[[Uterine transplant ‎]]
#[[Ventriculostomy ‎]]
#[[Triazolam ‎]]
#[[Vertebrobasilar insufficiency ‎]]
#[[White sponge nevus ‎]]
#[[Kleihauer-Betke test ‎]]
#[[Left lobe of liver ‎]]
#[[Left marginal artery ‎]]
#[[List of autoimmune diseases ‎]]
#[[Logrank test ‎]]
#[[Macula densa ‎]]
#[[Mescaline ‎]]
#[[Mother ‎]]
#[[Nav1.7 ‎]]
#[[NeuroNames ‎]]
#[[Spinocerebellar ataxia ‎]]
#[[Stress ‎]]
#[[Strongyloidiasis ‎]]
#[[Supination ‎]]
#[[TRPA (channel) ‎]]
#[[Terlipressin ‎]]
#[[ATC code M01 ‎]]
#[[Androgen receptor ‎]]
#[[Anterior border of lung ‎]]
#[[Antoine Lavoisier ‎]]
#[[Filtration ‎]]
#[[Foramen cecum (tongue) ‎]]
#[[Framingham Heart Study ‎]]
#[[Fugue state ‎]]
#[[Glucocerebroside ‎]]
#[[Gomphosis ‎]]
#[[HELLP syndrome ‎]]
#[[Hospital medicine ‎]]
#[[Hypoplastic right heart syndrome ‎]]
#[[Joseph L. Goldstein ‎]]
#[[Optic atrophy ‎]]
#[[PDE3 inhibitor ‎]]
#[[Parietal pleura ‎]]
#[[Pemetrexed ‎]]
#[[Pentose phosphate pathway ‎]]
#[[Perimetrium ‎]]
#[[Perioral dermatitis ‎]]
#[[Platinum ‎]]
#[[Pridinol ‎]]
#[[Detrusor urinae muscle ‎]]
#[[Dopamine receptor ‎]]
#[[Ephedra ‎]]
#[[Erythromelalgia ‎]]
#[[C5a ‎]]
#[[CD4 ‎]]
#[[Canaliculus (bone) ‎]]
#[[Canrenone ‎]]
#[[Young's modulus ‎]]
#[[Zeolite ‎]]
#[[Protamine sulfate ‎]]
#[[Purine nucleoside phosphorylase deficiency ‎]]
#[[Pyrrobutamine ‎]]
#[[Radiopharmacology ‎]]
#[[Rho(D) Immune Globulin ‎]]
#[[Root of the hair ‎]]
#[[Clostebol ‎]]
#[[Combat Methamphetamine Epidemic Act of 2005 ‎]]
#[[Cutis marmorata telangiectatica congenita ‎]]
#[[Cytolysin ‎]]
#[[Decompressive craniectomy ‎]]
#[[Chromalveolate ‎]]
#[[Chromosome 5 (human) ‎]]
#[[Cladistics ‎]]
#[[Cloxazolam ‎]]
#[[Cobamamide ‎]]
#[[Correlation does not imply causation ‎]]
#[[Crown (dentistry) ‎]]
#[[DNA-DNA reassociation ‎]]
#[[DNA vaccination ‎]]
#[[Hypnosis ‎]]
#[[Idiotype ‎]]
#[[Insect ‎]]
#[[Interferon beta-1b ‎]]
#[[Internal pudendal artery ‎]]
#[[International Standard Serial Number ‎]]
#[[Ionic compound ‎]]
#[[Iron(III) chloride ‎]]
#[[Irritable hip ‎]]
#[[Kell antigen system ‎]]
#[[Methaemoglobin ‎]]
#[[National Institute of Dental and Craniofacial Research ‎]]
#[[Neurinoma ‎]]
#[[Niels Ryberg Finsen ‎]]
#[[Olaflur ‎]]
#[[Tic ‎]]
#[[Trabecular meshwork ‎]]
#[[Tracheal rings ‎]]
#[[Troxerutin ‎]]
#[[Lower motor neuron ‎]]
#[[Lymphocytic choriomeningitis ‎]]
#[[Fourth nerve palsy ‎]]
#[[Hypnosis ‎]]
#[[Idiotype ‎]]
#[[Insect ‎]]
#[[Interferon beta-1b ‎]]
#[[Internal pudendal artery ‎]]
#[[International Standard Serial Number ‎]]
#[[Ionic compound ‎]]
#[[Iron(III) chloride ‎]]
#[[Irritable hip ‎]]
#[[Kell antigen system ‎]]
#[[Skewness ‎]]
#[[Sodium carbonate ‎]]
#[[Spiro Nikolouzos ‎]]
#[[Structural genomics ‎]]
#[[Superior cervical ganglion ‎]]
#[[Tachykinin peptides ‎]]
#[[Chromalveolate ‎]]
#[[Chromosome 5 (human) ‎]]
#[[Cladistics ‎]]
#[[Cloxazolam ‎]]
#[[Cobamamide ‎]]
#[[Correlation does not imply causation ‎]]
#[[Crown (dentistry) ‎]]
#[[DNA-DNA reassociation ‎]]
#[[DNA vaccination ‎]]
#[[Optic vesicles ‎]]
#[[Penile agenesis ‎]]
#[[Psychological abuse ‎]]
#[[Psychologist ‎]]
#[[Pulmonary angiography ‎]]
#[[Rauwolfia ‎]]
#[[Reproductive endocrinology and infertility ‎]]
#[[Fourth nerve palsy ‎]]
#[[Glycogen phosphorylase ‎]]
#[[HLA-B*83 ‎]]
#[[Har Gobind Khorana ‎]]
#[[Hay-Wells syndrome ‎]]
#[[Hemispherectomy ‎]]
#[[Flexor retinaculum of the hand ‎]]
#[[HLA-A11 ‎]]
#[[HLA-A32 ‎]]
#[[HLA-A33 ‎]]
#[[HLA-DP ‎]]
#[[Kurtosis ‎]]
#[[Medial pectoral nerve ‎]]
#[[Melitracen ‎]]
#[[United States National Academy of Sciences ‎]]
#[[Vasogenic edema ‎]]
#[[Dimetofrine ‎]]
#[[Disorganized schizophrenia ‎]]
#[[Duct of Bellini ‎]]
#[[Merkel nerve ending ‎]]
#[[Mesosalpinx ‎]]
#[[Neck pain ‎]]
#[[Nested polymerase chain reaction ‎]]
#[[Nizatidine (patient information) ‎]]
#[[NuvaRing ‎]]
#[[Oblique fissure ‎]]
#[[2-Phenylphenol ‎]]
#[[2008 bird flu outbreak in West Bengal ‎]]
#[[5-Methoxy-diisopropyltryptamine ‎]]
#[[ATC code M02 ‎]]
#[[Accessory breast ‎]]
#[[American College of Cardiology ‎]]
#[[Andrology ‎]]
#[[Asymmetric crying facies ‎]]
#[[Behavioural sciences ‎]]
#[[Biodegradation ‎]]
#[[Bird flu in India ‎]]
#[[Calorie restriction ‎]]
#[[Wright's stain ‎]]
#[[Pulmonary aspiration ‎]]
#[[Quadratus femoris muscle ‎]]
#[[Quality of life ‎]]
#[[Rilmenidine ‎]]
#[[Royal jelly ‎]]
#[[Schizoaffective disorder ‎]]
#[[Cochran's theorem ‎]]
#[[Commensalism ‎]]
#[[Cystadenocarcinoma ‎]]
#[[Cytomegalic Inclusion Body Disease ‎]]
#[[Hepatology ‎]]
#[[Johnson & Johnson ‎]]
#[[Social sciences ‎]]
#[[Sodium nitrite ‎]]
#[[Surgical pathology ‎]]
#[[Sympathetic ganglion ‎]]
#[[Tabun (nerve agent) ‎]]
#[[PEGylation ‎]]
#[[Peruvoside ‎]]
#[[Pleocytosis ‎]]
#[[Porin (protein) ‎]]
#[[Primary care ‎]]
#[[Principal components analysis ‎]]
#[[Pathophysiology ‎]]
#[[Plasmacytoma ‎]]
#[[Polycyclic aromatic hydrocarbon ‎]]
#[[Processus vaginalis ‎]]
#[[Bernoulli distribution ‎]]
#[[Biceps femoris muscle ‎]]
#[[Body water ‎]]
#[[Theodrenaline ‎]]
#[[Tramazoline ‎]]
#[[Vertebral notch ‎]]
#[[Vesical tenesmus ‎]]
#[[Visual field ‎]]
#[[Wide pulse pressure ‎]]
#[[Firmicutes ‎]]
#[[Framycetin ‎]]
#[[Fulvestrant ‎]]
#[[Furazabol ‎]]
#[[George Davis Snell ‎]]
#[[Germinal epithelium (female) ‎]]
#[[Gerontology ‎]]
#[[Granuloma faciale ‎]]
#[[HLA-B60 ‎]]
#[[Laryngotracheal groove ‎]]
#[[Mephentermine ‎]]
#[[ATC code V03 ‎]]
#[[Abnormal basal metabolic rate ‎]]
#[[Accessory meningeal artery ‎]]
#[[Advanced trauma life support ‎]]
#[[Allvar Gullstrand ‎]]
#[[Alminoprofen ‎]]
#[[Aprotinin ‎]]
#[[Dipivefrine ‎]]
#[[Dissociative drug ‎]]
#[[Dream ‎]]
#[[Emedastine ‎]]
#[[Enterogastrone ‎]]
#[[Extrafusal muscle fiber ‎]]
#[[Fetal hemoglobin ‎]]
#[[Monoterpene ‎]]
#[[Multipotency ‎]]
#[[Multivariate normal distribution ‎]]
#[[New drug application ‎]]
#[[Nilotinib ‎]]
#[[Sermorelin ‎]]
#[[Smallpox vaccine ‎]]
#[[Solid ‎]]
#[[TRPV1 ‎]]
#[[Compliance (medicine) ‎]]
#[[Cronkhite–Canada disease ‎]]
#[[Dartos ‎]]
#[[Γδ T cells ‎]]
#[[Puestow procedure ‎]]
#[[Pyramidalis muscle ‎]]
#[[Quinethazone ‎]]
#[[Regional odontodysplasia ‎]]
#[[Resection ‎]]
#[[Rhizaria ‎]]
#[[Hyaline cartilage ‎]]
#[[Hypokalemic periodic paralysis ‎]]
#[[Intestinal juice ‎]]
#[[Intoxication ‎]]
#[[Hermansky-Pudlak syndrome ‎]]
#[[Hyoglossus ‎]]
#[[Influenza treatment ‎]]
#[[Informed consent ‎]]
#[[Inion ‎]]
#[[Interlabial sulci ‎]]
#[[Isosthenuria ‎]]
#[[Distillation ‎]]
#[[Drotaverine ‎]]
#[[ESR ‎]]
#[[Epiblast ‎]]
#[[Eye movement ‎]]
#[[F-distribution ‎]]
#[[Vaginoplasty ‎]]
#[[Pancreatectomy ‎]]
#[[Panitumumab ‎]]
#[[Parasympathomimetics ‎]]
#[[Parathyroid chief cell ‎]]
#[[Parts-per notation ‎]]
#[[Potassium canrenoate ‎]]
#[[Aspartame ‎]]
#[[Biomedical tissue ‎]]
#[[CD117 ‎]]
#[[Cafedrine ‎]]
#[[1,3-Butadiene ‎]]
#[[4-HO-MiPT ‎]]
#[[Acemetacin ‎]]
#[[Advanced practice nurse ‎]]
#[[Alfred Hershey ‎]]
#[[Amniocentesis ‎]]
#[[Anterior cingulate cortex ‎]]
#[[Forearm ‎]]
#[[GABAA receptor ‎]]
#[[HLA-B41 ‎]]
#[[Helium ‎]]
#[[Kleine-Levin syndrome ‎]]
#[[Linea negra ‎]]
#[[Pseudocyesis ‎]]
#[[Q-Q plot ‎]]
#[[Reflex arc ‎]]
#[[Resistivity ‎]]
#[[ST elevation myocardial infarction glycoprotein IIbIIIa inhibition ‎]]
#[[Chronic stable angina prognosis ‎]]
#[[Co-dydramol ‎]]
#[[Cochlear nuclei ‎]]
#[[Conduct disorder ‎]]
#[[Craniotomy ‎]]
#[[Data mining ‎]]
#[[Monoamine neurotransmitter ‎]]
#[[Moricizine ‎]]
#[[Nemaline myopathy ‎]]
#[[Odds ‎]]
#[[Self-expandable metallic stent ‎]]
#[[Shigella ‎]]
#[[Superoxide ‎]]
#[[TPAP ‎]]
#[[Teres minor muscle ‎]]
#[[Z-factor ‎]]
#[[Zinc gluconate ‎]]
#[[Flat bone ‎]]
#[[The Physical Examination in Cardiovascular Disease: The Extremities ‎]]
#[[Thumbprint sign ‎]]
#[[Tonicity ‎]]
#[[Triazole ‎]]
#[[Unequal leg length ‎]]
#[[Vesicointestinal fistula ‎]]
#[[Her 3 ‎]]
#[[Hypnagogia ‎]]
#[[Id, ego, and super-ego ‎]]
#[[Imiquimod ‎]]
#[[Indoramin ‎]]
#[[Iron supplements ‎]]
#[[Dequalinium ‎]]
#[[Disruptive selection ‎]]
#[[ELISPOT ‎]]
#[[Eosinophilic ‎]]
#[[Fatty streak ‎]]
#[[Acronyms of Clinical Trial Names ‎]]
#[[Adderall drug interactions ‎]]
#[[Alloimmunity ‎]]
#[[Allotransplantation ‎]]
#[[Alveolate ‎]]
#[[Aminolevulinic acid synthase ‎]]
#[[Organic Syntheses ‎]]
#[[Oxaprozin ‎]]
#[[Pars intermedia ‎]]
#[[Posaconazole (patient information) ‎]]
#[[Bicalutamide ‎]]
#[[Blepharoplasty ‎]]
#[[CMR image acquisition protocols ‎]]
#[[Campylobacter ‎]]
#[[TNF inhibitor ‎]]
#[[Cerebellar vermis ‎]]
#[[Choroid plexus tumor ‎]]
#[[Chromium deficiency ‎]]
#[[Cicletanine ‎]]
#[[Cleavage (embryo) ‎]]
#[[Click chemistry ‎]]
#[[Cortical lobule ‎]]
#[[Deep dorsal vein of the penis ‎]]
#[[Deflazacort ‎]]
#[[Levamisole ‎]]
#[[Mathematical modelling in epidemiology ‎]]
#[[Mayer-Rokitansky-Hauser syndrome ‎]]
#[[Progestin ‎]]
#[[Retinitis ‎]]
#[[Methylation ‎]]
#[[National Institute of General Medical Sciences ‎]]
#[[Muromonab-CD3 ‎]]
#[[Oligoastrocytoma ‎]]
#[[Pasteurella multocida ‎]]
#[[Thioxanthene ‎]]
#[[Thomas Bayes ‎]]
#[[Torsten Wiesel ‎]]
#[[Virus classification ‎]]
#[[Zafirlukast ‎]]
#[[Gene copy number ‎]]
#[[Gluteal muscles ‎]]
#[[Golfer's elbow ‎]]
#[[Hair removal ‎]]
#[[2C-I ‎]]
#[[Adrenalectomy ‎]]
#[[Aluminium nicotinate ‎]]
#[[Amantadine (patient information) ‎]]
#[[Amyloid beta ‎]]
#[[Antisocial personality disorder ‎]]
#[[Hydrophobic effect ‎]]
#[[Iliac crest ‎]]
#[[Immunoglobulin M deficiency ‎]]
#[[Integral membrane protein ‎]]
#[[Kerosene ‎]]
#[[Dentin ‎]]
#[[Dolichocephaly ‎]]
#[[Earl Wilbur Sutherland Jr. ‎]]
#[[Enoxacin (patient information) ‎]]
#[[Enterobacter ‎]]
#[[Enterocolitis ‎]]
#[[Enterovirus ‎]]
#[[Erythema elevatum diutinum ‎]]
#[[Propylthiouracil (patient information) ‎]]
#[[Pulmonary ligament ‎]]
#[[Pulsed field gel electrophoresis ‎]]
#[[Pyuria ‎]]
#[[Quorum sensing ‎]]
#[[Receiver operating characteristic ‎]]
#[[Red nucleus ‎]]
#[[Renal column ‎]]
#[[Ronald Ross ‎]]
#[[SERCA ‎]]
#[[ST elevation myocardial infarction management of patients who were not reperfused ‎]]
#[[Saccade ‎]]
#[[Catenation ‎]]
#[[Chin ‎]]
#[[Chronic stable angina diagnosis ‎]]
#[[Cleveland Clinic ‎]]
#[[Clorazepate ‎]]
#[[Cochlear implant ‎]]
#[[Corneal limbus ‎]]
#[[Corpus cavernosum ‎]]
#[[Cross-validation ‎]]
#[[Cycloguanil ‎]]
#[[Baylis-Hillman reaction ‎]]
#[[Benorylate ‎]]
#[[Bufexamac ‎]]
#[[Sociology ‎]]
#[[Sodium selenate ‎]]
#[[Sodoku ‎]]
#[[Spiro compound ‎]]
#[[Lanreotide ‎]]
#[[List of United States foodborne illness outbreaks ‎]]
#[[Lydia Fairchild ‎]]
#[[M2 protein ‎]]
#[[MacConkey agar ‎]]
#[[Mange ‎]]
#[[Maxwell's equations ‎]]
#[[Lead time bias ‎]]
#[[Lipopolysaccharide ‎]]
#[[Magnesium pidolate ‎]]
#[[Malassezia ‎]]
#[[Meglutol ‎]]
#[[ICD-10 Chapter D ‎]]
#[[Inhalant ‎]]
#[[Insecticide ‎]]
#[[Intraoperative blood salvage ‎]]
#[[Tick paralysis ‎]]
#[[Trisodium phosphate ‎]]
#[[Trovafloxacin ‎]]
#[[Ultrafiltration (renal) ‎]]
#[[Vertebral arch ‎]]
#[[Metizoline ‎]]
#[[Molecular genetics ‎]]
#[[Morphogenesis ‎]]
#[[National Institute of Nursing Research ‎]]
#[[Non-heart beating donation ‎]]
#[[Ocular hypertension ‎]]
#[[Oral rehydration therapy ‎]]
#[[Paraphyly ‎]]
#[[Parvovirus B19 ‎]]
#[[Posterior inferior cerebellar artery ‎]]
#[[Pramocaine ‎]]
#[[Prenalterol ‎]]
#[[Prenylation ‎]]
#[[Abbott Laboratories ‎]]
#[[Alar plate ‎]]
#[[WikiDoc Scholars ‎]]
#[[Zonisamide (patient information) ‎]]
#[[Friedrich August Kekulé von Stradonitz ‎]]
#[[Gastrectomy ‎]]
#[[Gill ‎]]
#[[HLA-A25 ‎]]
#[[Hans Adolf Krebs ‎]]
#[[Hemotoxin ‎]]
#[[Shampoo ‎]]
#[[Short tandem repeat ‎]]
#[[Subclavian steal syndrome ‎]]
#[[Superficial iliac circumflex artery ‎]]
#[[Synesthesia ‎]]
#[[Tetra-ethyl lead ‎]]
#[[Tetrachloroethylene ‎]]
#[[Catechol-O-methyl transferase ‎]]
#[[Chromosome 15q partial deletion ‎]]
#[[Clavulanic acid ‎]]
#[[Collaborative Hypertext of Radiology ‎]]
#[[Cuneiform (anatomy) ‎]]
#[[Dacryocystitis ‎]]
#[[Disease burden ‎]]
#[[Dracunculiasis ‎]]
#[[Enantiomeric excess ‎]]
#[[Endovascular surgery ‎]]
#[[Enzyme engineering ‎]]
#[[Estrogen receptor ‎]]
#[[Extensor pollicis brevis muscle ‎]]
#[[Eye color ‎]]
#[[Fertilizer ‎]]
#[[Pyridoxine deficiency ‎]]
#[[Renin inhibitor ‎]]
#[[Restriction fragment length polymorphism ‎]]
#[[Rodenticide ‎]]
#[[ST elevation myocardial infarction assessing success of reperfusion ‎]]
#[[Schering ‎]]
#[[Scrotal masses ‎]]
#[[Benign lymphoepithelial lesion ‎]]
#[[CA-19-9 ‎]]
#[[Cardiofaciocutaneous syndrome ‎]]
#[[Atypical AVNRT ‎]]
#[[Avanafil ‎]]
#[[Balkan nephropathy ‎]]
#[[Bile duct cyst ‎]]
#[[Bucladesine ‎]]
#[[Caenorhabditis elegans ‎]]
#[[Calcarine fissure ‎]]
#[[Carcinosarcoma ‎]]
#[[Xamoterol ‎]]
#[[Thermography ‎]]
#[[Trichotillomania ‎]]
#[[Wavelength ‎]]
#[[Lateral cutaneous nerve of forearm ‎]]
#[[Lecithin cholesterol acyltransferase deficiency ‎]]
#[[Lipofection ‎]]
#[[Long thoracic nerve ‎]]
#[[Lumbricals of the hand ‎]]
#[[MALT lymphoma ‎]]
#[[Mannich base ‎]]
#[[Medical education ‎]]
#[[Medical procedure ‎]]
#[[Hydranencephaly ‎]]
#[[Hypoprothrombinemia ‎]]
#[[Immersion foot ‎]]
#[[Impaired fasting glycaemia ‎]]
#[[John James Richard Macleod ‎]]
#[[Julius Wagner-Jauregg ‎]]
#[[1p36 deletion syndrome ‎]]
#[[Abdominal enlargement ‎]]
#[[Alpha-Methyltryptamine ‎]]
#[[Alpha subunit of glycoprotein hormones ‎]]
#[[Andrew Huxley ‎]]
#[[Anterior intercostal branches of internal thoracic artery ‎]]
#[[Mitoxantrone ‎]]
#[[Multicollinearity ‎]]
#[[Mysophobia ‎]]
#[[National Institute of Arthritis and Musculoskeletal and Skin Diseases ‎]]
#[[Nitrosourea ‎]]
#[[Nuchal lines ‎]]
#[[Optic tract ‎]]
#[[Panaeolus subbalteatus ‎]]
#[[Pancreatic bud ‎]]
#[[Pancreatic juice ‎]]
#[[Parotid duct ‎]]
#[[Pathogenicity ‎]]
#[[Posterior horn ‎]]
#[[Prefrontal cortex ‎]]
#[[Pregabalin (patient information) ‎]]
#[[Rate equation ‎]]
#[[Retinal pigment epithelium ‎]]
#[[Rickettsialpox ‎]]
#[[Chemogenomics ‎]]
#[[Corpus hemorrhagicum ‎]]
#[[DNA polymerase ‎]]
#[[Gastric juice ‎]]
#[[Gene duplication ‎]]
#[[Genzyme ‎]]
#[[Gestation ‎]]
#[[HLA-A80 ‎]]
#[[HLA-B67 ‎]]
#[[Hangman's fracture ‎]]
#[[Hemispatial neglect ‎]]
#[[Sharpey's fibres ‎]]
#[[Spice ‎]]
#[[Suprascapular artery ‎]]
#[[Deoxycorticosterone ‎]]
#[[Dichromacy ‎]]
#[[Entheogen ‎]]
#[[Enzyme induction and inhibition ‎]]
#[[Eukaryotic translation ‎]]
#[[FLAG-tag ‎]]
#[[Fenoprofen ‎]]
#[[Diffuse panbronchiolitis ‎]]
#[[Dose-response relationship ‎]]
#[[Dry eyes ‎]]
#[[Excision ‎]]
#[[Mixed connective tissue disease ‎]]
#[[Molecular pathology ‎]]
#[[Monorchism ‎]]
#[[Mosquito ‎]]
#[[Mouse Genome Informatics ‎]]
#[[Omphalitis ‎]]
#[[Thiomersal controversy ‎]]
#[[Thylakoid ‎]]
#[[Tizanidine ‎]]
#[[Twin study ‎]]
#[[Urea nitrate ‎]]
#[[Blastula ‎]]
#[[Bupivacaine ‎]]
#[[Caduceus ‎]]
#[[ATC code B02 ‎]]
#[[ATC code D10 ‎]]
#[[ATC code N06 ‎]]
#[[Alpha-glucosidase inhibitor ‎]]
#[[Lady Windermere syndrome ‎]]
#[[Leber's congenital amaurosis ‎]]
#[[Little finger ‎]]
#[[Malignant fibrous histiocytoma ‎]]
#[[Marsupial ‎]]
#[[Hydroxy ‎]]
#[[Inferior ganglion of glossopharyngeal nerve ‎]]
#[[Culdocentesis ‎]]
#[[Database ‎]]
#[[ATC code B02 ‎]]
#[[ATC code N06 ‎]]
#[[Alpha-glucosidase inhibitor ‎]]
#[[Scott's Pi ‎]]
#[[Selenium sulfide ‎]]
#[[Statistical population ‎]]
#[[Sulfonamide ‎]]
#[[Suprachiasmatic nucleus ‎]]
#[[PCI in the patient in cardiogenic shock ‎]]
#[[PCNA ‎]]
#[[Palmitoylation ‎]]
#[[Pharmacogenomics ‎]]
#[[Phosphoinositide 3-kinase ‎]]
#[[Polyamine ‎]]
#[[Popliteal pterygium syndrome ‎]]
#[[Popliteus muscle ‎]]
#[[Keratoglobus ‎]]
#[[Leber's congenital amaurosis ‎]]
#[[Listeria monocytogenes ‎]]
#[[Little finger ‎]]
#[[Magnesium lactate ‎]]
#[[Malignant fibrous histiocytoma ‎]]
#[[Marsupial ‎]]
#[[Thiomersal controversy ‎]]
#[[Thylakoid ‎]]
#[[Tizanidine ‎]]
#[[Twin study ‎]]
#[[Urban-Rogers-Meyer syndrome ‎]]
#[[Urea nitrate ‎]]
#[[August Krogh ‎]]
#[[Brazilian purpuric fever ‎]]
#[[Bupivacaine ‎]]
#[[Dose-response relationship ‎]]
#[[Dry eyes ‎]]
#[[Eugenics ‎]]
#[[Excision ‎]]
#[[Fludrocortisone ‎]]
#[[Hydroxy ‎]]
#[[Inferior ganglion of glossopharyngeal nerve ‎]]
#[[Molecular pathology ‎]]
#[[Mosquito ‎]]
#[[Mouse Genome Informatics ‎]]
#[[Median sacral artery ‎]]
#[[Mesalazine ‎]]
#[[Methylenedioxybenzylpiperazine ‎]]
#[[N-Methyl-3-piperidyl benzilate ‎]]
#[[Niceritrol ‎]]
#[[Ketose ‎]]
#[[Magnesium citrate ‎]]
#[[2,4-Dichlorobenzyl alcohol ‎]]
#[[ATC code D06 ‎]]
#[[Abdominal aortic aneurysm screening ‎]]
#[[Acetamide ‎]]
#[[Acridine ‎]]
#[[Active site ‎]]
#[[Alfentanil ‎]]
#[[Anaplastic large cell lymphoma ‎]]
#[[Anterior pituitary acidophil ‎]]
#[[Antimony ‎]]
#[[Aphonia ‎]]
#[[Pound (mass) ‎]]
#[[Prajmaline ‎]]
#[[Prochlorperazine ‎]]
#[[Questionnaire ‎]]
#[[Renin: who needs it, anyway? ‎]]
#[[Resampling (statistics) ‎]]
#[[Reverse genetics ‎]]
#[[Ribavirin ‎]]
#[[Root of the lung ‎]]
#[[Rubinstein-Taybi syndrome ‎]]
#[[Cementoma ‎]]
#[[Chlamydia (bacterium) ‎]]
#[[Chlorquinaldol ‎]]
#[[Chronic stable angina epidemiology ‎]]
#[[Complementarity (molecular biology) ‎]]
#[[Congenital myopathy ‎]]
#[[Pheniramine ‎]]
#[[Sarcopenia ‎]]
#[[Serine protease ‎]]
#[[Sexual orientation ‎]]
#[[Small interfering RNA ‎]]
#[[Sulfite ‎]]
#[[White matter ‎]]
#[[Heteroscedasticity ‎]]
#[[Huxley's layer ‎]]
#[[Hydrazine ‎]]
#[[Incidence ‎]]
#[[Interstitial ‎]]
#[[Intrauterine growth retardation ‎]]
#[[Jervell and Lange-Nielsen syndrome ‎]]
#[[Diaphragmatic elevation ‎]]
#[[Diet and heart disease ‎]]
#[[Docosanol ‎]]
#[[Dorsal scapular nerve ‎]]
#[[Enterochromaffin cell ‎]]
#[[Erosion (dental) ‎]]
#[[Ethisterone ‎]]
#[[Thermophile ‎]]
#[[Troponin T ‎]]
#[[Ureteric bud ‎]]
#[[Vaccine Adverse Event Reporting System ‎]]
#[[Vecuronium ‎]]
#[[Ventricular remodeling ‎]]
#[[Breast pain and discharge ‎]]
#[[Carboxyglutamate ‎]]
#[[Cardinal ligament ‎]]
#[[Flexor digitorum brevis muscle ‎]]
#[[Folding (chemistry) ‎]]
#[[Galen ‎]]
#[[Gene nomenclature ‎]]
#[[Geniculate ganglion ‎]]
#[[Great auricular nerve ‎]]
#[[Guidelines for echocardiography ‎]]
#[[HLA-B*82 ‎]]
#[[HLA-B73 ‎]]
#[[Hand surgery ‎]]
#[[Health care industry ‎]]
#[[Federal Food, Drug, and Cosmetic Act ‎]]
#[[Focal seizures ‎]]
#[[Fosmid ‎]]
#[[Gantenerumab ‎]]
#[[Georges J. F. Köhler ‎]]
#[[Glomerulosclerosis ‎]]
#[[Glycogen debranching enzyme ‎]]
#[[Gonadoblastoma ‎]]
#[[HIV test ‎]]
#[[HLA-B78 ‎]]
#[[Sphincter of Oddi ‎]]
#[[State University of New York ‎]]
#[[Subscapularis muscle ‎]]
#[[Achilles tendinitis ‎]]
#[[Acute stress reaction ‎]]
#[[Acyl chloride ‎]]
#[[Midgut ‎]]
#[[Mitogen ‎]]
#[[Neurochemistry ‎]]
#[[Ketobemidone ‎]]
#[[Laryngocele ‎]]
#[[Levosalbutamol ‎]]
#[[Life support ‎]]
#[[MEDEVAC ‎]]
#[[MMRV vaccine ‎]]
#[[Oral contraceptive ‎]]
#[[Oxprenolol ‎]]
#[[Permanent teeth ‎]]
#[[Peroneus tertius ‎]]
#[[Phototoxicity ‎]]
#[[Posterior cutaneous nerve of arm ‎]]
#[[Radium ‎]]
#[[Reactive oxygen species ‎]]
#[[Repressor ‎]]
#[[Rizatriptan (patient information) ‎]]
#[[S cell ‎]]
#[[Chemical decomposition ‎]]
#[[Chloroethane ‎]]
#[[Chlorpropamide ‎]]
#[[Chronic mountain sickness ‎]]
#[[Coefficient of thermal expansion ‎]]
#[[Congenital syphilis ‎]]
#[[Contraction (childbirth) ‎]]
#[[Controlled substance ‎]]
#[[Ascomycota ‎]]
#[[Balanitis circinata ‎]]
#[[CD20 ‎]]
#[[CD40 (protein) ‎]]
#[[Deliriant ‎]]
#[[Diphallia ‎]]
#[[Dubowitz syndrome ‎]]
#[[Encainide ‎]]
#[[Facioscapulohumeral muscular dystrophy ‎]]
#[[Failure rate ‎]]
#[[Vytorin detailed information ‎]]
#[[Zinc deficiency ‎]]
#[[Hemolytic disease of the newborn (anti-RhE) ‎]]
#[[Interlobar veins ‎]]
#[[Iridocorneal endothelial syndrome ‎]]
#[[Isoflurane ‎]]
#[[Ivermectin ‎]]
#[[Jones fracture ‎]]
#[[Tetracene ‎]]
#[[Therapeutic index ‎]]
#[[Tolpropamine ‎]]
#[[Trisomy 16 ‎]]
#[[Validity (statistics) ‎]]
#[[Thymectomy ‎]]
#[[Tiludronate ‎]]
#[[Timothy syndrome ‎]]
#[[Tincture ‎]]
#[[Togaviridae ‎]]
#[[Trauma surgery ‎]]
#[[Varices ‎]]
#[[Veins of the upper extremity ‎]]
#[[Pseudounipolar neuron ‎]]
#[[Racetam ‎]]
#[[Refractive index ‎]]
#[[Regression toward the mean ‎]]
#[[Retrotransposon ‎]]
#[[1-(3-Chlorophenyl)piperazine ‎]]
#[[4-HO-DiPT ‎]]
#[[Anatomical snuff box ‎]]
#[[Anterior compartment of leg ‎]]
#[[Aortopulmonary window ‎]]
#[[Appetite ‎]]
#[[First-line treatment ‎]]
#[[Fluorescein ‎]]
#[[Friedrich Wöhler ‎]]
#[[Fundic glands ‎]]
#[[HLA-A30 ‎]]
#[[Habitat ‎]]
#[[Sexual arousal ‎]]
#[[Statistical independence ‎]]
#[[Steeple sign ‎]]
#[[Sulfamethoxazole ‎]]
#[[Sultiame ‎]]
#[[Olfactory nerve ‎]]
#[[Oxaloacetic acid ‎]]
#[[Pancreatic polypeptide ‎]]
#[[Mesterolone ‎]]
#[[Minimum-variance unbiased estimator ‎]]
#[[Monoclonal antibody therapy ‎]]
#[[Myotonia ‎]]
#[[Negative selection ‎]]
#[[Nephrostomy ‎]]
#[[Neuropathology ‎]]
#[[Nicofuranose ‎]]
#[[Norepinephrine reuptake inhibitor ‎]]
#[[Nuclear pore ‎]]
#[[Kidd antigen system ‎]]
#[[Lambda phage ‎]]
#[[Large cell ‎]]
#[[Levomepromazine ‎]]
#[[Lipid pneumonia ‎]]
#[[List of infectious diseases ‎]]
#[[Malignant rhabdoid tumour ‎]]
#[[Indinavir (patient information) ‎]]
#[[Inferior olivary nucleus ‎]]
#[[Inguinal canal ‎]]
#[[Intrafusal muscle fiber ‎]]
#[[Deuterium ‎]]
#[[Doxazosin drug interactions ‎]]
#[[Dysopia ‎]]
#[[Endotoxin ‎]]
#[[Ensembl ‎]]
#[[Factor analysis ‎]]
#[[Cavity of the body of the uterus ‎]]
#[[Chloracne ‎]]
#[[Choroid plexus cyst ‎]]
#[[Clostridium perfringens ‎]]
#[[Concrescence ‎]]
#[[Cone dystrophy ‎]]
#[[Cyclopia ‎]]
#[[Avogadro's law ‎]]
#[[Azoospermia ‎]]
#[[Backhousia citriodora ‎]]
#[[Balancing selection ‎]]
#[[Behaviorism ‎]]
#[[Benactyzine ‎]]
#[[Beta-2 adrenergic receptor ‎]]
#[[Body of sternum ‎]]
#[[Body piercing ‎]]
#[[Bradykinin ‎]]
#[[Artery to the ductus deferens ‎]]
#[[B. F. Skinner ‎]]
#[[Baltimore classification ‎]]
#[[Bicarbonate buffering system ‎]]
#[[Mucous gland ‎]]
#[[Nicotinyl alcohol ‎]]
#[[ATC code M03 ‎]]
#[[Anergy ‎]]
#[[Arndt-Eistert synthesis ‎]]
#[[Aromatase ‎]]
#[[Tar ‎]]
#[[Technetium-99m ‎]]
#[[The heart in psoriasis ‎]]
#[[Tibial nerve ‎]]
#[[Tocilizumab ‎]]
#[[Type I hypersensitivity ‎]]
#[[Valence electron ‎]]
#[[Prediabetes ‎]]
#[[Pyrimidine metabolism ‎]]
#[[Quazepam ‎]]
#[[Ramogen ‎]]
#[[Omega-6 fatty acid ‎]]
#[[PCI in the bifurcation lesion ‎]]
#[[Paraldehyde ‎]]
#[[Parathyroidectomy ‎]]
#[[Parvalbumin ‎]]
#[[Pesticide poisoning ‎]]
#[[Plasticity ‎]]
#[[Polymyxin ‎]]
#[[Flexor pollicis brevis muscle ‎]]
#[[Focal adhesion ‎]]
#[[George Wald ‎]]
#[[Gunther disease ‎]]
#[[Gustatory system ‎]]
#[[Healthy diet ‎]]
#[[Science (journal) ‎]]
#[[Skin whitening ‎]]
#[[Cefpodoxime ‎]]
#[[Censoring (statistics) ‎]]
#[[Costal pleura ‎]]
#[[Diethylpropion (patient information) ‎]]
#[[Dorsal nerve of the penis ‎]]
#[[Echinococcus ‎]]
#[[Endoneurium ‎]]
#[[Ethylestrenol ‎]]
#[[Euchromatin ‎]]
#[[Family medicine ‎]]
#[[Kinesiology ‎]]
#[[Labioscrotal folds ‎]]
#[[Lactalbumin ‎]]
#[[Leukodystrophy ‎]]
#[[Lisp ‎]]
#[[Luxating patella ‎]]
#[[Maspin ‎]]
#[[Hepatitis B vaccine ‎]]
#[[Human development ‎]]
#[[Hygiene ‎]]
#[[Infundibulum of uterine tube ‎]]
#[[Interaction ‎]]
#[[Intrauterine hypoxia ‎]]
#[[Ionization ‎]]
#[[Isothermal process ‎]]
#[[Helix ‎]]
#[[Hh antigen system ‎]]
#[[Hyperactivity ‎]]
#[[Ice cream ‎]]
#[[In situ ‎]]
#[[Intravenous drug use ‎]]
#[[Islamic medicine ‎]]
#[[First rib ‎]]
#[[Folliculogenesis ‎]]
#[[Glucose-6-phosphate dehydrogenase ‎]]
#[[Hallux varus ‎]]
#[[5-alpha reductase ‎]]
#[[Adductor pollicis muscle ‎]]
#[[Alcohol abuse ‎]]
#[[Allylamine ‎]]
#[[Analysis of covariance ‎]]
#[[Arylsulfatase B ‎]]
#[[Aspartic acid ‎]]
#[[Bauxite fibrosis ‎]]
#[[Bioaccumulation ‎]]
#[[Bioartificial liver device ‎]]
#[[Borax ‎]]
#[[Calcium glucoheptonate ‎]]
#[[Membranous urethra ‎]]
#[[Monte Carlo method ‎]]
#[[NMDA ‎]]
#[[National Institute of Diabetes and Digestive and Kidney Diseases ‎]]
#[[Nephrologist ‎]]
#[[Nissl body ‎]]
#[[Oligodendrocyte ‎]]
#[[Organic peroxide ‎]]
#[[Organogenesis ‎]]
#[[Orientations of Proteins in Membranes database ‎]]
#[[Perineal nerve ‎]]
#[[Phosphatidylinositol (4,5)-bisphosphate ‎]]
#[[Positive predictive value ‎]]
#[[Tetrachlorodecaoxide ‎]]
#[[Tissue factor pathway inhibitor ‎]]
#[[Tuberculous meningitis ‎]]
#[[Tymazoline ‎]]
#[[Ullmann reaction ‎]]
#[[Ulnar nerve ‎]]
#[[Urethral syndrome ‎]]
#[[Urinary urgency ‎]]
#[[Veganism ‎]]
#[[Posterior intercostal arteries ‎]]
#[[Potassium cyanide ‎]]
#[[Pyrazole ‎]]
#[[Left gastro-omental artery ‎]]
#[[Leg swelling ‎]]
#[[Lichen planopilaris ‎]]
#[[Male genital examination ‎]]
#[[Maturity onset diabetes of the young ‎]]
#[[Decanoic acid ‎]]
#[[Demyelinating disease ‎]]
#[[Earth's atmosphere ‎]]
#[[Electroconvulsive therapy ‎]]
#[[Endoderm ‎]]
#[[Ethacridine lactate ‎]]
#[[Scattering ‎]]
#[[Siderosis ‎]]
#[[Somite ‎]]
#[[Spirulina (dietary supplement) ‎]]
#[[Stachyose ‎]]
#[[Striated muscle ‎]]
#[[Subclavian artery disease ‎]]
#[[Sushruta ‎]]
#[[Celiac ganglia ‎]]
#[[Chaos theory ‎]]
#[[Chemotype ‎]]
#[[Chromosome 16 (human) ‎]]
#[[Congenital anomalies of the coronary circulation ‎]]
#[[Contraceptive patch ‎]]
#[[Creatine ‎]]
#[[Yoga ‎]]
#[[Zona pellucida ‎]]
#[[Vinegar ‎]]
#[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure ‎]]
#[[Ticarcillin ‎]]
#[[Tubulointerstitial diseases of the kidney ‎]]
#[[3-Methylfentanyl ‎]]
#[[4-Fluoroamphetamine ‎]]
#[[ATC code N03 ‎]]
#[[Ablepharon macrostomia syndrome ‎]]
#[[Acanthocyte ‎]]
#[[Acral lentiginous melanoma ‎]]
#[[Adolphe Quetelet ‎]]
#[[Aluminium sulfate ‎]]
#[[Anorexia (symptom) ‎]]
#[[Antibiotic sensitivity ‎]]
#[[Heritability ‎]]
#[[Hexosaminidase ‎]]
#[[Insular cortex ‎]]
#[[Internal pudendal veins ‎]]
#[[Intravenous fluids ‎]]
#[[Femoral nerve ‎]]
#[[Flurazepam ‎]]
#[[Follicular lymphoma ‎]]
#[[Fosfomycin ‎]]
#[[Fuchs' dystrophy ‎]]
#[[Gardner's syndrome ‎]]
#[[Ginseng ‎]]
#[[HLA-A28 ‎]]
#[[HLA-Cw*16 ‎]]
#[[HLA-DQ5 ‎]]
#[[Otelixizumab ‎]]
#[[Oxidoreductase ‎]]
#[[Percoll ‎]]
#[[Pica (disorder) ‎]]
#[[Autonomic ganglion ‎]]
#[[Brønsted-Lowry acid-base theory ‎]]
#[[Busulfan ‎]]
#[[Campylobacteriosis ‎]]
#[[Mediastinal mass ‎]]
#[[Mediastinal pleura ‎]]
#[[Meprobamate ‎]]
#[[Merocrine ‎]]
#[[Mesenchyme ‎]]
#[[Mobilome ‎]]
#[[N-Ethyl-3-piperidyl benzilate ‎]]
#[[National Marrow Donor Program ‎]]
#[[Non-coding RNA ‎]]
#[[Carmine ‎]]
#[[Carnegie stages ‎]]
#[[Cavernous sinus ‎]]
#[[Cediranib ‎]]
#[[Center for Information Technology ‎]]
#[[Chemist ‎]]
#[[Chromate ‎]]
#[[Circumflex scapular artery ‎]]
#[[Cyanocobalamin Injection (patient information) ‎]]
#[[Cyclic vomiting syndrome ‎]]
#[[Dacryoadenitis ‎]]
#[[Decrease of urinary stream ‎]]
#[[Dientamoebiasis ‎]]
#[[Dimension ‎]]
#[[Echo in tetralogy of fallot ‎]]
#[[Egg activation ‎]]
#[[Equilibrioception ‎]]
#[[European Heart Journal Announces Articles to be Available in Open Source Format ‎]]
#[[Facial pain ‎]]
#[[Primase ‎]]
#[[Probability theory ‎]]
#[[Procyclidine (patient information) ‎]]
#[[Proportional hazards models ‎]]
#[[Pulp (tooth) ‎]]
#[[R-type calcium channel ‎]]
#[[Ragnar Granit ‎]]
#[[Rubrospinal tract ‎]]
#[[Kruskal-Wallis one-way analysis of variance ‎]]
#[[Lateral nasal cartilage ‎]]
#[[Lead(II) acetate ‎]]
#[[Levosimendan ‎]]
#[[Ligase ‎]]
#[[Likelihood function ‎]]
#[[Loxoprofen ‎]]
#[[Mayo Clinic ‎]]
#[[Mazindol ‎]]
#[[Streptococcus viridans ‎]]
#[[Sulfacetamide ‎]]
#[[Superior mesenteric artery ‎]]
#[[Suspensory muscle of the duodenum ‎]]
#[[TRPV ‎]]
#[[Seyferth-Gilbert homologation ‎]]
#[[Skin changes ‎]]
#[[Spirapril ‎]]
#[[Sterol ‎]]
#[[Substitution (chemistry) ‎]]
#[[Superior gemellus muscle ‎]]
#[[Bedwetting ‎]]
#[[Biological activity ‎]]
#[[Bromfenac ‎]]
#[[Acetylsalicylic acid (patient information) ‎]]
#[[Acromion ‎]]
#[[Adapalene ‎]]
#[[Bedwetting ‎]]
#[[Biological activity ‎]]
#[[Bromfenac ‎]]
#[[Carob tree ‎]]
#[[Wikipedia:Manual of Style (mathematics) ‎]]
#[[Lactated Ringer's solution ‎]]
#[[Lanatoside C ‎]]
#[[Lesser cornu ‎]]
#[[Levine's sign ‎]]
#[[List of inorganic compounds ‎]]
#[[Maximum a posteriori ‎]]
#[[Medullary cystic kidney disease ‎]]
#[[Menstrual cup ‎]]
#[[Deodorant ‎]]
#[[Deoxycytidine triphosphate ‎]]
#[[Diltiazem drug interactions ‎]]
#[[Diosmin ‎]]
#[[Diphenyl oxalate ‎]]
#[[Echo in tetralogy of fallot ‎]]
#[[Efferent ducts ‎]]
#[[Epigallocatechin gallate ‎]]
#[[Eukaryotic initiation factor ‎]]
#[[Factor analysis ‎]]
#[[Cavernous sinus ‎]]
#[[Chernoff's inequality ‎]]
#[[Choriocapillaris ‎]]
#[[Chromosome 3 (human) ‎]]
#[[Clobetasol (patient information) ‎]]
#[[Cochran-Armitage test for trend ‎]]
#[[Convergent evolution ‎]]
#[[Cyanocobalamin Injection (patient information) ‎]]
#[[Decompression sickness ‎]]
#[[Ablepharon macrostomia syndrome ‎]]
#[[Acetylsalicylic acid (patient information) ‎]]
#[[Acral lentiginous melanoma ‎]]
#[[Acromion ‎]]
#[[Adapalene ‎]]
#[[Airway obstruction ‎]]
#[[Aminomethylbenzoic acid ‎]]
#[[Anemia of chronic disease ‎]]
#[[Antiviral ‎]]
#[[Otelixizumab ‎]]
#[[Patchouli ‎]]
#[[Peroneus brevis ‎]]
#[[Pica (disorder) ‎]]
#[[Primase ‎]]
#[[Pterygopalatine ganglion ‎]]
#[[Respiratory tract ‎]]
#[[Radial neuropathy ‎]]
#[[Respiratory splinting ‎]]
#[[Rifamycin ‎]]
#[[Rilonacept ‎]]
#[[Scale (zoology) ‎]]
#[[Wikipedia:Accessibility ‎]]
#[[Methoxamine ‎]]
#[[Microbial biodegradation ‎]]
#[[Microvillous inclusion disease ‎]]
#[[Mixed Mullerian tumor ‎]]
#[[Multiple system atrophy ‎]]
#[[NANOG (medicine) ‎]]
#[[Nav1.4 ‎]]
#[[Neural tube ‎]]
#[[Nicomorphine ‎]]
#[[Nocebo ‎]]
#[[Occam's razor ‎]]
#[[Selective mutism ‎]]
#[[Semitendinosus muscle ‎]]
#[[Sphygmomanometer ‎]]
#[[Sterol ‎]]
#[[Hispanic Paradox ‎]]
#[[Hymenorrhaphy ‎]]
#[[Hypha ‎]]
#[[Hypoblast ‎]]
#[[Hypodermic needle ‎]]
#[[Infection control ‎]]
#[[Infratemporal fossa ‎]]
#[[Intermediate mesoderm ‎]]
#[[Intravenous fluids ‎]]
#[[Karyorrhexis ‎]]
#[[Kava ‎]]
#[[Kelvin ‎]]
#[[Aselizumab ‎]]
#[[Autism therapies ‎]]
#[[Bareback (sex) ‎]]
#[[Benign familial neonatal convulsions ‎]]
#[[Biliary atresia ‎]]
#[[Bipolar cell ‎]]
#[[Birth trauma ‎]]
#[[Blastomycosis ‎]]
#[[CPR mask ‎]]
#[[Calamine ‎]]
#[[Carnosinemia ‎]]
#[[Gerald Edelman ‎]]
#[[Grief ‎]]
#[[Gynecological surgery ‎]]
#[[HLA-B59 ‎]]
#[[The GRACE risk score ‎]]
#[[Thiazole ‎]]
#[[Thymopoietin ‎]]
#[[Tinea ‎]]
#[[Travoprost ‎]]
#[[Trifluoperazine ‎]]
#[[Trigeminal nerve nuclei ‎]]
#[[Trimipramine (patient information) ‎]]
#[[Triosephosphate isomerase ‎]]
#[[Tropicamide ‎]]
#[[Tuaminoheptane ‎]]
#[[Two-pore channel ‎]]
#[[Ulf von Euler ‎]]
#[[Urethral cancer ‎]]
#[[Osmotic diuresis ‎]]
#[[Ovarian artery ‎]]
#[[Oxiracetam ‎]]
#[[Pentamidine ‎]]
#[[Plasmolysis ‎]]
#[[Polyomavirus ‎]]
#[[Posterior compartment of leg ‎]]
#[[Cediranib ‎]]
#[[Central tolerance ‎]]
#[[Chlamydophila ‎]]
#[[Cloning vector ‎]]
#[[Cross-link ‎]]
#[[DNA sequencer ‎]]
#[[Dasatinib ‎]]
#[[Ketoacidosis ‎]]
#[[Lymphokine-activated killer cell ‎]]
#[[Diamagnetism ‎]]
#[[Dimercaprol ‎]]
#[[Efficiency (statistics) ‎]]
#[[Egg activation ‎]]
#[[European Heart Journal Announces Articles to be Available in Open Source Format ‎]]
#[[Extracorporeal ‎]]
#[[FSH-receptor ‎]]
#[[5-Methyltetrahydrofolate-homocysteine methyltransferase ‎]]
#[[Alefacept ‎]]
#[[Amniotic cavity ‎]]
#[[Anileridine ‎]]
#[[ADHD predominantly inattentive ‎]]
#[[ATC code A11 ‎]]
#[[Actinobacillus ‎]]
#[[Adenosine monophosphate ‎]]
#[[Adrenergic ‎]]
#[[Affymetrix ‎]]
#[[Allergic conjunctivitis ‎]]
#[[Anopsia ‎]]
#[[Ansa cervicalis ‎]]
#[[Antithrombotic therapy ‎]]
#[[Fibrinolysin ‎]]
#[[Foot drop ‎]]
#[[Genotoxicity ‎]]
#[[Glycoside hydrolase ‎]]
#[[HLA-B48 ‎]]
#[[Health care systems ‎]]
#[[Heavy chain disease ‎]]
#[[Hepatic cysts ‎]]
#[[Neurofibrosarcoma ‎]]
#[[Nicotine poisoning ‎]]
#[[Nitrile ‎]]
#[[Nitro compound ‎]]
#[[Protonation ‎]]
#[[R-factor ‎]]
#[[René Favaloro ‎]]
#[[Reproductive health ‎]]
#[[Respiratory compensation ‎]]
#[[Ritiometan ‎]]
#[[Salicylamide ‎]]
#[[Articaine ‎]]
#[[Asparagus ‎]]
#[[Atelosteogenesis, type II ‎]]
#[[Axillary artery ‎]]
#[[Basiliximab ‎]]
#[[Bazedoxifene ‎]]
#[[Benzenediol ‎]]
#[[Benzoxonium chloride ‎]]
#[[Bias ‎]]
#[[Blink ‎]]
#[[Borax ‎]]
#[[Brodmann area ‎]]
#[[Bronchial veins ‎]]
#[[Calcium metabolism ‎]]
#[[Streptococcus viridans ‎]]
#[[Subcostal nerve ‎]]
#[[Sunitinib ‎]]
#[[Superior labial artery ‎]]
#[[Superior vesical artery ‎]]
#[[Sydney Brenner ‎]]
#[[Teva Pharmaceutical Industries ‎]]
#[[Hepatoerythropoietic porphyria ‎]]
#[[Hormone replacement therapy (menopause) ‎]]
#[[Human artificial chromosome ‎]]
#[[Hydrophthalmos ‎]]
#[[Hydroxide ‎]]
#[[Inferior labial artery ‎]]
#[[Initiation factor ‎]]
#[[Insulin-like growth factor 2 ‎]]
#[[Interleukin 10 ‎]]
#[[Deslanoside ‎]]
#[[Diagnosis and mechanism of this bradyarrhythmia answer (July 2008) ‎]]
#[[Dilaceration ‎]]
#[[Epikeratophakia ‎]]
#[[Exocrine pancreatic insufficiency ‎]]
#[[Cholesterylester transfer protein ‎]]
#[[Convergence insufficiency ‎]]
#[[Cross-reactivity ‎]]
#[[Curve fitting ‎]]
#[[Cutaneous leishmaniasis ‎]]
#[[Tinidazole ‎]]
#[[Tongue swelling ‎]]
#[[Toxocariasis ‎]]
#[[Venous ulcer ‎]]
#[[Pancreatic fistula ‎]]
#[[Pathogenicity island ‎]]
#[[Perioperative mortality ‎]]
#[[Phantom limb ‎]]
#[[Phosphatidylserine ‎]]
#[[Probability density function ‎]]
#[[Kevin Trudeau ‎]]
#[[Lentinan ‎]]
#[[Meglitinide ‎]]
#[[Keutel syndrome ‎]]
#[[Lacrimal lake ‎]]
#[[Magnesium pyridoxal 5-phosphate glutamate ‎]]
#[[Mast cell stabilizer ‎]]
#[[Megestrol ‎]]
#[[Self-injury ‎]]
#[[Silver sulfadiazine ‎]]
#[[Sodium salicylate ‎]]
#[[Spotted fever ‎]]
#[[Substantia nigra ‎]]
#[[Synovial fluid ‎]]
#[[Table of standard reduction potentials for half-reactions important in biochemistry ‎]]
#[[Tendon reflex ‎]]
#[[Flexor hallucis longus muscle ‎]]
#[[Glycerate 3-phosphate ‎]]
#[[H10N7 ‎]]
#[[HLA-DQ1 ‎]]
#[[APACHE II ‎]]
#[[ATC code S02 ‎]]
#[[Acetoacetic acid ‎]]
#[[Adefovir ‎]]
#[[Wishart distribution ‎]]
#[[Wrist and hand pain ‎]]
#[[Atrial branches of coronary arteries ‎]]
#[[Auriculares muscles ‎]]
#[[Autocorrelation ‎]]
#[[Bambuterol ‎]]
#[[Bertilimumab ‎]]
#[[Carl Jung ‎]]
#[[Milk allergy ‎]]
#[[Models of nucleotide substitution ‎]]
#[[Newborn screening ‎]]
#[[Non ST Elevation Myocardial Infarction: Diagnosis ‎]]
#[[Null cell ‎]]
#[[Psyllium (patient information) ‎]]
#[[Reaction intermediate ‎]]
#[[Oxametacin ‎]]
#[[Peritoneal disease ‎]]
#[[Population genetics ‎]]
#[[Prevertebral ganglia ‎]]
#[[Probenecid ‎]]
#[[Prochiral ‎]]
#[[Carotid sinus ‎]]
#[[Caudate lobe of liver ‎]]
#[[Central pontine myelinolysis ‎]]
#[[Cervical pleura ‎]]
#[[Charles Louis Alphonse Laveran ‎]]
#[[Chemical classification ‎]]
#[[Chorionic villus sampling ‎]]
#[[Coitus interruptus ‎]]
#[[Cold-blooded ‎]]
#[[Cryptosporidium ‎]]
#[[Cuneate nucleus ‎]]
#[[César Milstein ‎]]
#[[Deep circumflex iliac artery ‎]]
#[[Histamine receptor ‎]]
#[[ICD-10 Chapter G ‎]]
#[[Immunophilin ‎]]
#[[Indoprofen ‎]]
#[[International Conference on Emerging Infectious Diseases ‎]]
#[[Japanese Honeysuckle ‎]]
#[[Dermatofibrosarcoma ‎]]
#[[Dielectric constant ‎]]
#[[Dimethyl ether ‎]]
#[[Drosophila melanogaster ‎]]
#[[Dysphoria ‎]]
#[[Electrofuge ‎]]
#[[Emtricitabine (patient information) ‎]]
#[[Eosinophilia-myalgia syndrome ‎]]
#[[Epidemic model ‎]]
#[[Ergosterol ‎]]
#[[Etidronic acid ‎]]
#[[Faropenem ‎]]
#[[Female condom ‎]]
#[[Tilidine ‎]]
#[[Triphenylmethane ‎]]
#[[Tubulin ‎]]
#[[Vascular access steal syndrome ‎]]
#[[Vesicular and bullous lesions ‎]]
#[[Theca externa ‎]]
#[[Thermoreceptor ‎]]
#[[Thyrohyoid muscle ‎]]
#[[Titermax ‎]]
#[[Totipotency ‎]]
#[[Twelfth rib ‎]]
#[[Typical antipsychotic ‎]]
#[[Ultimobranchial body ‎]]
#[[Uroscopy ‎]]
#[[Mineral ascorbates ‎]]
#[[Molecular evolution ‎]]
#[[Monotreme ‎]]
#[[Myc ‎]]
#[[Ofloxacin ‎]]
#[[Flavin ‎]]
#[[Flosequinan ‎]]
#[[Flu season ‎]]
#[[Fluoride poisoning ‎]]
#[[Fusion gene ‎]]
#[[General surgery ‎]]
#[[Golimumab ‎]]
#[[H7N2 ‎]]
#[[HLA-A43 ‎]]
#[[HLA-DQ8 ‎]]
#[[Headgear ‎]]
#[[Health Impact Assessment ‎]]
#[[Heat shock protein 47 ‎]]
#[[Liver dialysis ‎]]
#[[MMR vaccine controversy ‎]]
#[[Managed care ‎]]
#[[Medical abortion ‎]]
#[[Medullary cavity ‎]]
#[[Medullary interstitium ‎]]
#[[Spleen transplantation ‎]]
#[[Stimulus (physiology) ‎]]
#[[Substance abuse ‎]]
#[[TRPP ‎]]
#[[Tajima's D ‎]]
#[[Aziridine ‎]]
#[[Base excess ‎]]
#[[Behaviour therapy ‎]]
#[[Bilaminar disc ‎]]
#[[Bile canaliculus ‎]]
#[[Bronchial artery ‎]]
#[[Butene ‎]]
#[[Cancer immunotherapy ‎]]
#[[Abderhalden-Kaufmann-Lignac syndrome ‎]]
#[[Alveolus ‎]]
#[[Amino sugar ‎]]
#[[Apudoma ‎]]
#[[Aromatic compound ‎]]
#[[Ylide ‎]]
#[[Zanamivir ‎]]
#[[Desmin ‎]]
#[[Efflux (microbiology) ‎]]
#[[Elastic cartilage ‎]]
#[[Epidemiological study ‎]]
#[[Febarbamate ‎]]
#[[Chromosome 8 (human) ‎]]
#[[Clopidogrel (patient information) ‎]]
#[[Combat stress reaction ‎]]
#[[Cranial cavity ‎]]
#[[Cumulative incidence ‎]]
#[[Cyclopentamine ‎]]
#[[Pronephros ‎]]
#[[Prontosil ‎]]
#[[Quantitative genetics ‎]]
#[[RNA editing ‎]]
#[[RNA polymerase ‎]]
#[[Renal glucose reabsorption ‎]]
#[[Right lobe of liver ‎]]
#[[Root mean square ‎]]
#[[Rothmund-Thomson syndrome ‎]]
#[[Otto Loewi ‎]]
#[[Parasomnia ‎]]
#[[Plagiocephaly ‎]]
#[[Hydride ‎]]
#[[Hydrophilic interaction liquid chromatography ‎]]
#[[Hyperkalemic periodic paralysis ‎]]
#[[Immunologic adjuvant ‎]]
#[[Influenzavirus C ‎]]
#[[International Medical Commission on Bhopal ‎]]
#[[International Nucleotide Sequence Database Collaboration ‎]]
#[[Heteroatom ‎]]
#[[Horizontal cell ‎]]
#[[House Mouse ‎]]
#[[ICAM-1 ‎]]
#[[Isocarboxazid (patient information) ‎]]
#[[Jacques Monod ‎]]
#[[1,3-dipole ‎]]
#[[ATC code A01 ‎]]
#[[ATC code A14 ‎]]
#[[ATC code D04 ‎]]
#[[Abarelix ‎]]
#[[Abatacept ‎]]
#[[Acetaminophen and Hydrocodone (patient information) ‎]]
#[[Adductor brevis muscle ‎]]
#[[Aleglitazar ‎]]
#[[Anterior arch of the atlas ‎]]
#[[Applied behavior analysis ‎]]
#[[Artery of the pterygoid canal ‎]]
#[[Gamma Knife ‎]]
#[[Gliquidone ‎]]
#[[Glycoprotein IIb/IIIa ‎]]
#[[HLA-B61 ‎]]
#[[Transition metal ‎]]
#[[Trismus ‎]]
#[[Trochlear nerve ‎]]
#[[Tyrothricin ‎]]
#[[United States Department of Agriculture ‎]]
#[[Vellus hair ‎]]
#[[Vesicular breathing ‎]]
#[[Vocal cord paresis ‎]]
#[[Metaplasia ‎]]
#[[Methylcobalamin ‎]]
#[[Articular disk ‎]]
#[[Blood-borne disease ‎]]
#[[Breech birth ‎]]
#[[Carbocation ‎]]
#[[KvLQT2 ‎]]
#[[Leuprolide ‎]]
#[[Mass ‎]]
#[[Median eminence ‎]]
#[[Selection bias ‎]]
#[[Somatoform disorder ‎]]
#[[Stanley B. Prusiner ‎]]
#[[Stomodeum ‎]]
#[[Tensor fasciae latae ‎]]
#[[Overeaters Anonymous ‎]]
#[[Papain ‎]]
#[[Parasympathomimetic drug ‎]]
#[[Paroöphoron ‎]]
#[[Pasteurellosis ‎]]
#[[Peginterferon alfa-2a ‎]]
#[[Pentazocine ‎]]
#[[Pethidine ‎]]
#[[Phenylbutazone ‎]]
#[[Pivot joint ‎]]
#[[Polyembryoma ‎]]
#[[Posterior cutaneous nerve of thigh ‎]]
#[[Posterior tibial artery ‎]]
#[[Posterior vein of the left ventricle ‎]]
#[[Pressure ‎]]
#[[Cholesterol side-chain cleavage enzyme ‎]]
#[[Colorado tick fever ‎]]
#[[Cosmid ‎]]
#[[Cronbach's alpha ‎]]
#[[DNase footprinting assay ‎]]
#[[Woodhouse-Sakati syndrome ‎]]
#[[Dipeptidyl peptidase-4 inhibitors ‎]]
#[[Dorsal mesentery ‎]]
#[[Drospirenone ‎]]
#[[Ecology ‎]]
#[[Endocrine gland neoplasm ‎]]
#[[Endolymphatic sac ‎]]
#[[Ergonovine ‎]]
#[[Etizolam ‎]]
#[[Etofenamate ‎]]
#[[Psoas minor muscle ‎]]
#[[Psychosomatic medicine ‎]]
#[[Pyramid of thyroid ‎]]
#[[Refeeding syndrome ‎]]
#[[Schedule IV ‎]]
#[[Proscillaridin ‎]]
#[[Protein kinase C ‎]]
#[[Psicose ‎]]
#[[Pulmonary capillary wedge pressure ‎]]
#[[Quadratus plantae muscle ‎]]
#[[Rate-determining step ‎]]
#[[Repugnant market ‎]]
#[[Rescinnamine ‎]]
#[[Respiratory burst ‎]]
#[[Rimantadine ‎]]
#[[Scid mouse ‎]]
#[[Kombucha ‎]]
#[[Lacrimal papilla ‎]]
#[[Letrozole ‎]]
#[[Lincosamides ‎]]
#[[Lipoid congenital adrenal hyperplasia ‎]]
#[[Logit ‎]]
#[[Macrobiotic diet ‎]]
#[[Markers of Developing Metabolic Syndrome ‎]]
#[[Maternal death ‎]]
#[[Max Delbrück ‎]]
#[[Mechanism of action ‎]]
#[[Hierarchical linear modeling ‎]]
#[[Human genome ‎]]
#[[IL-2 receptor ‎]]
#[[Immunoconjugate ‎]]
#[[Inhalational anaesthetic ‎]]
#[[Irradiation ‎]]
#[[Ambulatory blood pressure ‎]]
#[[Ankyrins ‎]]
#[[Balsalazide ‎]]
#[[Bartholin's ducts ‎]]
#[[Benfotiamine ‎]]
#[[Bezoar ‎]]
#[[Bietti's crystalline dystrophy ‎]]
#[[Blastocoele ‎]]
#[[Brachialis muscle ‎]]
#[[Calgranulin ‎]]
#[[Carnitine-acylcarnitine translocase deficiency ‎]]
#[[Ferid Murad ‎]]
#[[Flexor pollicis longus muscle ‎]]
#[[HLA-DQ3 ‎]]
#[[HLA-DQ6 ‎]]
#[[Zinc acetate ‎]]
#[[Kombucha ‎]]
#[[Lacrimal papilla ‎]]
#[[Letrozole ‎]]
#[[Lilliefors test ‎]]
#[[Lipoid congenital adrenal hyperplasia ‎]]
#[[Lytic cycle ‎]]
#[[Macrobiotic diet ‎]]
#[[Markers of Developing Metabolic Syndrome ‎]]
#[[Maternal death ‎]]
#[[Max Delbrück ‎]]
#[[Mechanism of action ‎]]
#[[Posterior interosseous nerve ‎]]
#[[Premature ejaculation ‎]]
#[[Proscillaridin ‎]]
#[[Protein kinase C ‎]]
#[[Psicose ‎]]
#[[Pulmonary capillary wedge pressure ‎]]
#[[Quadratus plantae muscle ‎]]
#[[Rate-determining step ‎]]
#[[Repugnant market ‎]]
#[[Rescinnamine ‎]]
#[[Respiratory burst ‎]]
#[[Rimantadine ‎]]
#[[Aicardi syndrome ‎]]
#[[Ambulatory blood pressure ‎]]
#[[Ankyrins ‎]]
#[[IL-2 receptor ‎]]
#[[Imipenem ‎]]
#[[Immunoconjugate ‎]]
#[[Immunoglobulin allotype ‎]]
#[[Inferior orbital fissure ‎]]
#[[Inhalational anaesthetic ‎]]
#[[Monobenzone ‎]]
#[[Mycoplasma pneumoniae ‎]]
#[[Myocardial ischemia ‎]]
#[[N-Bromosuccinimide ‎]]
#[[National Institute on Deafness and Other Communication Disorders ‎]]
#[[Natural reservoir ‎]]
#[[Nd:YAG laser ‎]]
#[[Non-Kekulé molecule ‎]]
#[[Obturator hernia ‎]]
#[[Pathogenic bacteria ‎]]
#[[Peroxisome ‎]]
#[[Placental abruption ‎]]
#[[Population ‎]]
#[[Scid mouse ‎]]
#[[Slit lamp ‎]]
#[[Stable isotope ‎]]
#[[Staphylococcus epidermidis ‎]]
#[[Stroma of iris ‎]]
#[[TLR 2 ‎]]
#[[Carnitine-acylcarnitine translocase deficiency ‎]]
#[[Castor oil ‎]]
#[[Center for Drug Evaluation and Research ‎]]
#[[Cholesteatoma ‎]]
#[[Chromosome 10 (human) ‎]]
#[[Cord blood ‎]]
#[[Cyclin ‎]]
#[[Cytotrophoblast ‎]]
#[[Dacryocystorhinostomy ‎]]
#[[Datura ‎]]
#[[Carfentanil ‎]]
#[[Cefotaxime ‎]]
#[[Coiled coil ‎]]
#[[Collagenous colitis ‎]]
#[[Color vision ‎]]
#[[Potato ‎]]
#[[Praseodymium ‎]]
#[[Psilocybe cubensis ‎]]
#[[Psychedelic plants ‎]]
#[[Pyramidal cell ‎]]
#[[Quadratus lumborum muscle ‎]]
#[[ROMK ‎]]
#[[Racemic ‎]]
#[[Replacement joint ‎]]
#[[Richard Axel ‎]]
#[[Robust statistics ‎]]
#[[Rotation ‎]]
#[[Decitabine ‎]]
#[[Diacerein ‎]]
#[[Dimethyltryptamine ‎]]
#[[Ethanol fuel ‎]]
#[[Ethidium bromide ‎]]
#[[Thyroid function tests ‎]]
#[[Tigecycline ‎]]
#[[Toremifene ‎]]
#[[Transcellular fluid ‎]]
#[[Trioxsalen ‎]]
#[[Troglitazone ‎]]
#[[Vestibular nuclei ‎]]
#[[Barbital ‎]]
#[[Belatacept ‎]]
#[[Bimatoprost ‎]]
#[[Biochip ‎]]
#[[Biologist ‎]]
#[[British National Formulary ‎]]
#[[Buccal artery ‎]]
#[[CX546 ‎]]
#[[Lactation ‎]]
#[[Lactose ‎]]
#[[Liver tumor ‎]]
#[[Loeys-Dietz syndrome ‎]]
#[[Lutheran antigen system ‎]]
#[[Maternal age effect ‎]]
#[[Fritz Albert Lipmann ‎]]
#[[Haemorrhagic disease of the newborn ‎]]
#[[Vinorelbine ‎]]
#[[Visilizumab ‎]]
#[[Walter Gilbert ‎]]
#[[Saddle joint ‎]]
#[[Somatic ‎]]
#[[Statins (patient information) ‎]]
#[[Strong acid ‎]]
#[[Methazolamide ‎]]
#[[Methorphan ‎]]
#[[Mosapride ‎]]
#[[N-type calcium channel ‎]]
#[[Nerve block ‎]]
#[[Nervous system neoplasm ‎]]
#[[Netilmicin ‎]]
#[[Neurofibrillary tangle ‎]]
#[[Norbolethone ‎]]
#[[ATC code A07 ‎]]
#[[ATC code C05 ‎]]
#[[Actinomycetales ‎]]
#[[American English ‎]]
#[[Amiodarone Oral (patient information) ‎]]
#[[Androgyny ‎]]
#[[Anterior interosseous artery ‎]]
#[[Hemiacetal ‎]]
#[[Homogenization ‎]]
#[[Inferior gemellus muscle ‎]]
#[[Inferior thyroid artery ‎]]
#[[Intraembryonic coelom ‎]]
#[[Ixodes ‎]]
#[[Jules Bordet ‎]]
#[[Obturator externus muscle ‎]]
#[[Oxycephaly ‎]]
#[[Oxyphenbutazone ‎]]
#[[Palatoglossal arch ‎]]
#[[Paramyotonia congenita ‎]]
#[[Pectineus muscle ‎]]
#[[Pentavalent antimonial ‎]]
#[[Peptide synthesis ‎]]
#[[Physics ‎]]
#[[Plasmodium falciparum ‎]]
#[[Ozonolysis ‎]]
#[[Persistent pupillary membrane ‎]]
#[[Pneumocyte ‎]]
#[[Fumaric acid ‎]]
#[[Genitofemoral nerve ‎]]
#[[Greater cornu ‎]]
#[[H3N8 ‎]]
#[[HLA-B81 ‎]]
#[[Haber process ‎]]
#[[Deep inguinal ring ‎]]
#[[Dentin dysplasia ‎]]
#[[Dissociation (chemistry) ‎]]
#[[ERMAP ‎]]
#[[Elevation (kinesiology) ‎]]
#[[Environmental chemistry ‎]]
#[[Ethmoid sinus ‎]]
#[[Extensor digiti minimi muscle ‎]]
#[[Eye disease ‎]]
#[[Causes of autism ‎]]
#[[Cheilitis ‎]]
#[[Chlamydophila psittaci ‎]]
#[[Christiane Nüsslein-Volhard ‎]]
#[[Chromosome 12 (human) ‎]]
#[[Cochrane Collaboration ‎]]
#[[Corpus albicans ‎]]
#[[Romano-Ward syndrome ‎]]
#[[Ropinirole ‎]]
#[[Lateral thoracic artery ‎]]
#[[Transdermal patch ‎]]
#[[Tuberculum impar ‎]]
#[[Ventromedial nucleus ‎]]
#[[Arthrosis ‎]]
#[[Artificial extracorporeal liver support ‎]]
#[[Atkins Nutritional Approach ‎]]
#[[BK channel ‎]]
#[[Benazepril (patient information) ‎]]
#[[Bleach ‎]]
#[[Bronchoconstriction ‎]]
#[[Hepadnaviridae ‎]]
#[[Herpetic whitlow ‎]]
#[[Hypertension in the elderly ‎]]
#[[Immune disorder ‎]]
#[[Involuntary muscle ‎]]
#[[John Franklin Enders ‎]]
#[[Methyprylon ‎]]
#[[Misuse of Drugs Act 1971 ‎]]
#[[Mycoremediation ‎]]
#[[Nadifloxacin ‎]]
#[[Necrobiosis ‎]]
#[[Niflumic acid ‎]]
#[[Wikipedia:Template limits ‎]]
#[[Scaphocephaly ‎]]
#[[Schilder's disease ‎]]
#[[Sievert ‎]]
#[[Stent thrombosis incidence in drug eluting stents ‎]]
#[[Superficial epigastric artery ‎]]
#[[T-Lymphocytopenia ‎]]
#[[Acetylation ‎]]
#[[Adenomyosis ‎]]
#[[Anterior ciliary arteries ‎]]
#[[Arrestin ‎]]
#[[2C-T-7 ‎]]
#[[ATC code A04 ‎]]
#[[ATC code C10 ‎]]
#[[ATC code M05 ‎]]
#[[Acidifier ‎]]
#[[Amacrine cell ‎]]
#[[Anterior segment ‎]]
#[[Apraclonidine ‎]]
#[[Tenoxicam ‎]]
#[[The Living Guidelines: Chronic Stable Angina Pectoris ‎]]
#[[Tiaprofenic acid ‎]]
#[[Trimer (biochemistry) ‎]]
#[[Vici syndrome ‎]]
#[[Delta method ‎]]
#[[Diffusion MRI ‎]]
#[[Drostanolone propionate ‎]]
#[[EIF-2 ‎]]
#[[Encephalomyelitis ‎]]
#[[Enflurane ‎]]
#[[Enrofloxacin ‎]]
#[[Estimation ‎]]
#[[Etorphine ‎]]
#[[Excitatory postsynaptic potential ‎]]
#[[Exercise intolerance ‎]]
#[[External resorption ‎]]
#[[Oguchi disease ‎]]
#[[One and a half syndrome ‎]]
#[[Otto Heinrich Warburg ‎]]
#[[Overnutrition ‎]]
#[[Pascolizumab ‎]]
#[[Paternal age effect ‎]]
#[[Percutaneous transhepatic cholangiography ‎]]
#[[Point prevalence ‎]]
#[[Post cardiac arrest syndrome ‎]]
#[[Firocoxib ‎]]
#[[Fixation (histology) ‎]]
#[[Frozen shoulder ‎]]
#[[Gamma motoneuron ‎]]
#[[Glutamate receptor ‎]]
#[[H5N2 ‎]]
#[[H7N4 ‎]]
#[[HLA-DR1 ‎]]
#[[Laminar flow ‎]]
#[[Large intestine ‎]]
#[[Lentiform nucleus ‎]]
#[[Lymphomatoid papulosis ‎]]
#[[Lyxose ‎]]
#[[Maternal health ‎]]
#[[Central venous pressure ‎]]
#[[Clomiphene (patient information) ‎]]
#[[Co-receptor ‎]]
#[[Cogan syndrome ‎]]
#[[DSM-IV Codes ‎]]
#[[Potassium citrate ‎]]
#[[Pulmonary alveolar proteinosis ‎]]
#[[Pyrazinamide ‎]]
#[[Pyrethrum ‎]]
#[[Royal College of Physicians ‎]]
#[[Serine ‎]]
#[[Sociological and cultural aspects of autism ‎]]
#[[Standardized Kt/V ‎]]
#[[Superficial perineal pouch ‎]]
#[[Suprofen ‎]]
#[[Survival analysis ‎]]
#[[Metathesis reaction ‎]]
#[[Michael reaction ‎]]
#[[Natural science ‎]]
#[[Noncentral chi-square distribution ‎]]
#[[Numbering aberrant rhythms ‎]]
#[[Band keratopathy ‎]]
#[[Batrachotoxin ‎]]
#[[Body modification ‎]]
#[[Bunaftine ‎]]
#[[Calcium hexamine thiocyanate ‎]]
#[[Carbetocin ‎]]
#[[Hell-Volhard-Zelinsky halogenation ‎]]
#[[Histogram ‎]]
#[[History of medicine ‎]]
#[[Voltage-gated potassium channel ‎]]
#[[XK (protein) ‎]]
#[[Yersinia enterocolitica ‎]]
#[[Charles Darwin ‎]]
#[[Chromosome 13 (human) ‎]]
#[[Chromosome 4 (human) ‎]]
#[[Ciliary processes ‎]]
#[[Clobenzorex ‎]]
#[[Conducting zone ‎]]
#[[Congenital anorchia ‎]]
#[[Deep cervical artery ‎]]
#[[Delorazepam ‎]]
#[[Diego antigen system ‎]]
#[[Erythrulose ‎]]
#[[49, XXXXX ‎]]
#[[8-Chlorotheophylline ‎]]
#[[Adenitis ‎]]
#[[Adrafinil ‎]]
#[[Terminal bronchiole ‎]]
#[[The Physical Examination in Cardiovascular Disease:The Neck ‎]]
#[[Thyroid ima artery ‎]]
#[[Treatment of paroxysmal nocturnal hemoglobinuria with the anti-complement antibody eculizumab helps prevent thromboembolism ‎]]
#[[Triphenylphosphine ‎]]
#[[Tris ‎]]
#[[Tylenol ‎]]
#[[Unsaturated compound ‎]]
#[[Lateral nasal branch of facial artery ‎]]
#[[Lateral sacral artery ‎]]
#[[Law of large numbers ‎]]
#[[Liquorice ‎]]
#[[Lisfranc fracture ‎]]
#[[Lumiliximab ‎]]
#[[Malignant hypertension ‎]]
#[[Orphan drug ‎]]
#[[Orthopedic cast ‎]]
#[[Oxazepam ‎]]
#[[Pickwickian syndrome ‎]]
#[[Feminization (biology) ‎]]
#[[Fischer-Tropsch process ‎]]
#[[Food ‎]]
#[[Freeze drying ‎]]
#[[Friedman test ‎]]
#[[Frontotemporal dementia ‎]]
#[[H7N7 ‎]]
#[[Hypochondrogenesis ‎]]
#[[Ibogaine ‎]]
#[[Ibuproxam ‎]]
#[[Impurity ‎]]
#[[Inferior salivatory nucleus ‎]]
#[[Journal of the American Medical Association ‎]]
#[[Mepartricin ‎]]
#[[Metrazol ‎]]
#[[Murashige and Skoog medium ‎]]
#[[Musculocutaneous nerve ‎]]
#[[Nasal placode ‎]]
#[[Natamycin ‎]]
#[[Protein metabolism ‎]]
#[[Prozone ‎]]
#[[Robert W. Holley ‎]]
#[[Röntgen equivalent man ‎]]
#[[SUMO protein ‎]]
#[[Seropositivity ‎]]
#[[Structural biology ‎]]
#[[Superior rectal vein ‎]]
#[[Synarthrosis ‎]]
#[[Aztreonam ‎]]
#[[Bat ‎]]
#[[Bejel ‎]]
#[[Blackwater fever ‎]]
#[[Breast cyst ‎]]
#[[Bulimia ‎]]
#[[CDB-4124 ‎]]
#[[Atorvastatin (patient information) ‎]]
#[[Bernardo Houssay ‎]]
#[[Beryllium ‎]]
#[[Bisulfite sequencing ‎]]
#[[Bromocriptine ‎]]
#[[Bronchogenic cyst ‎]]
#[[Buserelin ‎]]
#[[Calcium acetate ‎]]
#[[Calcium silicate ‎]]
#[[Observational study ‎]]
#[[Optic stalk ‎]]
#[[Oral hygiene ‎]]
#[[Oxide ‎]]
#[[P-rep ‎]]
#[[P2Y12 ‎]]
#[[Periplasmic space ‎]]
#[[Periventricular leukomalacia ‎]]
#[[Phosphorus pentoxide ‎]]
#[[Pia mater ‎]]
#[[Dental plaque ‎]]
#[[Depressor labii inferioris muscle ‎]]
#[[Deviance (statistics) ‎]]
#[[Doripenem ‎]]
#[[Double helix ‎]]
#[[Dysfunctional uterine bleeding ‎]]
#[[E. Donnall Thomas ‎]]
#[[Ego-dystonic sexual orientation ‎]]
#[[Endothermic ‎]]
#[[Enteropathy ‎]]
#[[Excited state ‎]]
#[[Eye pain ‎]]
#[[Fasciolosis ‎]]
#[[Carnitine O-palmitoyltransferase ‎]]
#[[Case study ‎]]
#[[Cefoperazone ‎]]
#[[Cerebral crus ‎]]
#[[Certolizumab pegol ‎]]
#[[Computational genomics ‎]]
#[[Cricoid ‎]]
#[[Daniel Nathans ‎]]
#[[Kegel exercise ‎]]
#[[Keto acid ‎]]
#[[Leonardo da Vinci ‎]]
#[[Lipodystrophy ‎]]
#[[List of distinct cell types in the adult human body ‎]]
#[[Lynestrenol ‎]]
#[[ACHE ‎]]
#[[AMPA receptor ‎]]
#[[Arachidonic acid ‎]]
#[[Tacrine ‎]]
#[[The On-Time 2 trial Suggests Benefit with Early Administration of Tirofiban in the Ambulance following Acute Myocardial Infarction. ‎]]
#[[Thrombin-activatable fibrinolysis inhibitor ‎]]
#[[Transpyloric plane ‎]]
#[[Transversus thoracis muscle ‎]]
#[[Tyramine ‎]]
#[[Unterberger test ‎]]
#[[Seed ‎]]
#[[Social medicine ‎]]
#[[Stigmine ‎]]
#[[Stunned myocardium ‎]]
#[[Superacid ‎]]
#[[Syncytiotrophoblast ‎]]
#[[TGN1412 ‎]]
#[[TNM ‎]]
#[[Medial longitudinal fissure ‎]]
#[[Mesovarium ‎]]
#[[Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes ‎]]
#[[N-Methyl-N-isopropyltryptamine ‎]]
#[[Nalorphine ‎]]
#[[Nanobacterium ‎]]
#[[Nav1.9 ‎]]
#[[Nucleoplasm ‎]]
#[[Fenbufen ‎]]
#[[Fencamfamine ‎]]
#[[Flunoxaprofen ‎]]
#[[Fly ‎]]
#[[Garlic ‎]]
#[[HLA-B42 ‎]]
#[[HLA-DQ9 ‎]]
#[[Hearing loss with craniofacial syndromes ‎]]
#[[Hematologic disease ‎]]
#[[Heparin cofactor II ‎]]
#[[Hepatic artery proper ‎]]
#[[History of biochemistry ‎]]
#[[Hyperostosis ‎]]
#[[Inferior phrenic vein ‎]]
#[[Injury prevention ‎]]
#[[Inner ear ‎]]
#[[Intermediate density lipoprotein ‎]]
#[[Isomerisation ‎]]
#[[John Carew Eccles ‎]]
#[[Proglumetacin ‎]]
#[[Posterior spinal artery ‎]]
#[[Precursor mRNA ‎]]
#[[Quantitative polymerase chain reaction ‎]]
#[[RNA dependent RNA polymerase ‎]]
#[[Rifapentin ‎]]
#[[Rocuronium ‎]]
#[[Romanowsky stain ‎]]
#[[Agoraphobia ‎]]
#[[Alveolitis ‎]]
#[[Amalgam ‎]]
#[[American Medical Association ‎]]
#[[Aminobenzoic acid ‎]]
#[[Aminotransferases ‎]]
#[[Argon ‎]]
#[[Oligoclonal band ‎]]
#[[Osteopenia ‎]]
#[[PDD not otherwise specified ‎]]
#[[Pedigree chart ‎]]
#[[Plantar arch ‎]]
#[[Porencephaly ‎]]
#[[Xeroderma ‎]]
#[[Attributable risk ‎]]
#[[Benzopyrene ‎]]
#[[Bite ‎]]
#[[COX-inhibiting nitric oxide donator ‎]]
#[[Calvin cycle ‎]]
#[[Carbanion ‎]]
#[[Kebuzone ‎]]
#[[Kugelberg-Welander disease ‎]]
#[[Lactone ‎]]
#[[Light-dependent reaction ‎]]
#[[List of clinically important bacteria ‎]]
#[[Magnetofection ‎]]
#[[Matrix (biology) ‎]]
#[[Desogestrel ‎]]
#[[Dihydropyridine ‎]]
#[[Disaccharide ‎]]
#[[Drug Enforcement Administration ‎]]
#[[Eclampsia ‎]]
#[[Eutectic point ‎]]
#[[Extensor carpi ulnaris muscle ‎]]
#[[Extensor pollicis longus muscle ‎]]
#[[Extreme value ‎]]
#[[Fair coin ‎]]
#[[Chalicosis ‎]]
#[[Charles Robert Richet ‎]]

{{WH}}
{{WS}}

Static popular pages list

2009-06-29T13:58:55Z

LBiller:

----
Here is a partial list of popular pages that need to get cleaned up. Please remove pages from the list before you begin to clean it.
----

#[[Frederick Banting ‎]]
#[[List of diseases (T) ‎]]
#[[Ras ‎]]
#[[Renal glycosuria ‎]]
#[[Respiratory alkalosis ‎]]
#[[2,5-Dimethoxy-4-methylamphetamine ‎]]
#[[Acral necrosis ‎]]
#[[Acupuncture ‎]]
#[[Ajmaline ‎]]
#[[Amelogenesis imperfecta ‎]]
#[[Anistreplase ‎]]
#[[Eugen Bleuler ‎]]
#[[Topoisomerase inhibitor ‎]]
#[[Trisomy 9 ‎]]
#[[Ulna ‎]]
#[[Ureaplasma urealyticum ‎]]
#[[Ventricle ‎]]
#[[Fimbria (female reproductive system) ‎]]
#[[Frontal bone ‎]]
#[[Gamma-amino-beta-hydroxybutyric acid ‎]]
#[[Glycine ‎]]
#[[Grading (tumors) ‎]]
#[[HER2/neu ‎]]
#[[Ascorbic Acid (patient information) ‎]]
#[[Atlas (anatomy) ‎]]
#[[Avascular necrosis ‎]]
#[[Bacitracin ‎]]
#[[Beckwith-Wiedemann syndrome ‎]]
#[[Blood flow ‎]]
#[[Breast examination ‎]]
#[[Bulbus cordis ‎]]
#[[CA 19-9 ‎]]
#[[Athetosis ‎]]
#[[Bacterial disease ‎]]
#[[Betaxolol ‎]]
#[[Biliary dyskinesia ‎]]
#[[Bioenergetics ‎]]
#[[Boldenone ‎]]
#[[Calmodulin ‎]]
#[[Methaqualone ‎]]
#[[Metolazone ‎]]
#[[Null hypothesis ‎]]
#[[Onychomycosis ‎]]
#[[Spectroscopy ‎]]
#[[Spermatid ‎]]
#[[Sphingolipidoses ‎]]
#[[Splenius capitis muscle ‎]]
#[[Superoxide dismutase ‎]]
#[[Thanatophoric dysplasia ‎]]
#[[Human height ‎]]
#[[Parkinsonism ‎]]
#[[Phrenic nerve ‎]]
#[[Potassium hydroxide ‎]]
#[[Krukenberg tumor ‎]]
#[[Lamina propria ‎]]
#[[Lancet Editor Forsees Wikis as the Future for Medical Journals ‎]]
#[[Limbic system ‎]]
#[[Magnesium chloride ‎]]
#[[Making the most of cardiac resynchronization therapy : remotely monitoring patients ‎]]
#[[Xerosis ‎]]
#[[Circle of Willis ‎]]
#[[Common iliac artery ‎]]
#[[Cyclohexane ‎]]
#[[Dabigatran ‎]]
#[[David Baltimore ‎]]
#[[Fluoride ‎]]
#[[Fucosidosis ‎]]
#[[General anaesthetic ‎]]
#[[Gross examination ‎]]
#[[Hematological malignancy ‎]]
#[[Dess-Martin periodinane ‎]]
#[[Diatomic molecule ‎]]
#[[Endothelin ‎]]
#[[Enucleation ‎]]
#[[Epoophoron ‎]]
#[[Equipment used in percutaneous coronary intervention ‎]]
#[[Eyelash ‎]]
#[[Proxibarbital ‎]]
#[[Pterion ‎]]
#[[Pterygium (conjunctiva) ‎]]
#[[Radial artery ‎]]
#[[SDS-PAGE ‎]]
#[[Scotoma ‎]]
#[[A-a gradient ‎]]
#[[ATC code R ‎]]
#[[Aloxiprin ‎]]
#[[Aluminium clofibrate ‎]]
#[[Alveolar-capillary barrier ‎]]
#[[Antazoline ‎]]
#[[Anterior chamber ‎]]
#[[Antimicrobial ‎]]
#[[Arteries of the lower limbs ‎]]
#[[Thumb ‎]]
#[[Tooth fusion ‎]]
#[[Ventricular reduction ‎]]
#[[Therapeutic embolization ‎]]
#[[Thomas Huckle Weller ‎]]
#[[Tracheomalacia ‎]]
#[[Tumor necrosis factors ‎]]
#[[Uvulopalatopharyngoplasty ‎]]
#[[ZAP70 deficiency ‎]]
#[[Septum primum ‎]]
#[[Serotonin-norepinephrine reuptake inhibitor ‎]]
#[[Skeletal formula ‎]]
#[[Sulcus (anatomy) ‎]]
#[[Terazosin ‎]]
#[[Assay ‎]]
#[[Axial skeleton ‎]]
#[[Bromine ‎]]
#[[Brucella ‎]]
#[[Cancer research ‎]]
#[[Mesenchymal stem cell ‎]]
#[[Mevalonate pathway ‎]]
#[[Midodrine ‎]]
#[[Milk ‎]]
#[[National Library of Medicine ‎]]
#[[Neurotoxicity ‎]]
#[[Non coronary interventions in the cardiac catheterization laboratory ‎]]
#[[Olopatadine ‎]]
#[[Ondansetron ‎]]
#[[Lamotrigine ‎]]
#[[List of ICD-9 codes 680-709: Diseases of the skin and subcutaneous tissue ‎]]
#[[Lumbar puncture ‎]]
#[[Indomethacin ‎]]
#[[Infranodal Wenkebach-type block ‎]]
#[[Oppositional defiant disorder ‎]]
#[[Ototoxicity ‎]]
#[[Palatoglossus muscle ‎]]
#[[Pantoprazole (patient information) ‎]]
#[[49 XXXXY syndrome ‎]]
#[[Achilles tendon ‎]]
#[[Ammonium chloride ‎]]
#[[Apomorphine ‎]]
#[[Dimetindene ‎]]
#[[Charcoal ‎]]
#[[Cisplatin ‎]]
#[[Defibrotide ‎]]
#[[Follicular dendritic cells ‎]]
#[[Genital tubercle ‎]]
#[[Glutamate decarboxylase ‎]]
#[[Hepatic vein ‎]]
#[[Prostatectomy ‎]]
#[[Renal lobe ‎]]
#[[Repetitive strain injury ‎]]
#[[ST elevation myocardial infarction gross pathology ‎]]
#[[Pseudohermaphroditism ‎]]
#[[Receptive aphasia ‎]]
#[[Rosalyn Sussman Yalow ‎]]
#[[Hertwig's epithelial root sheath ‎]]
#[[Hounsfield scale ‎]]
#[[Hypothesis ‎]]
#[[Iodoform ‎]]
#[[Kendall tau rank correlation coefficient ‎]]
#[[Semicircular canal ‎]]
#[[Sequela ‎]]
#[[Smith-Lemli-Opitz syndrome ‎]]
#[[Spinous process ‎]]
#[[Teplizumab ‎]]
#[[Tick-borne meningoencephalitis ‎]]
#[[Trichlorfon ‎]]
#[[Leflunomide (patient information) ‎]]
#[[Major calyx ‎]]
#[[Median ‎]]
#[[Biological life cycle ‎]]
#[[Minor calyx ‎]]
#[[Monosaccharide ‎]]
#[[Monosodium glutamate ‎]]
#[[Mylohyoid muscle ‎]]
#[[NMR spectroscopy ‎]]
#[[Nail-patella syndrome ‎]]
#[[Necrobiosis lipoidica ‎]]
#[[Oculomotor nerve palsy ‎]]
#[[Floating rib ‎]]
#[[Fluid ‎]]
#[[Glucosamine ‎]]
#[[Gonadotropin-releasing hormone agonist ‎]]
#[[Hemostatic agent ‎]]
#[[Dental fluorosis ‎]]
#[[Enthesis ‎]]
#[[Eponychium ‎]]
#[[Oxicam ‎]]
#[[Partial anomalous pulmonary venous connection ‎]]
#[[Pedodontics ‎]]
#[[Alloy ‎]]
#[[Apolipoprotein E ‎]]
#[[Coronary artery dissection classification ‎]]
#[[Chemical symbol ‎]]
#[[Cholinesterase enzyme ‎]]
#[[Cytogenetics ‎]]
#[[Biocatalysis ‎]]
#[[Bufotenin ‎]]
#[[Candida (genus) ‎]]
#[[Hydrolase ‎]]
#[[Hypoplasia ‎]]
#[[Inflammatory biomarkers predict short-term mortality in patients with peripheral arterial disease ‎]]
#[[Pulmonary thromboendarterectomy ‎]]
#[[Retroperitoneum ‎]]
#[[Kidney development ‎]]
#[[Legionella ‎]]
#[[Leigh's disease ‎]]
#[[Lumbar plexus ‎]]
#[[Mequitazine ‎]]
#[[Sixth nerve palsy ‎]]
#[[Sunscreen ‎]]
#[[Thoracoacromial artery ‎]]
#[[Vomeronasal organ ‎]]
#[[ATC code A ‎]]
#[[Acrodermatitis enteropathica ‎]]
#[[Algorithm ‎]]
#[[Alopecia totalis ‎]]
#[[Amantadine ‎]]
#[[Ambulatory phlebectomy ‎]]
#[[Dimethyl sulfide ‎]]
#[[Dipole ‎]]
#[[Dyslipidemia ‎]]
#[[Elastic fiber ‎]]
#[[Eli Lilly and Company ‎]]
#[[Femoral vein ‎]]
#[[Methyl salicylate ‎]]
#[[Mixture ‎]]
#[[Molecular modelling ‎]]
#[[Neocortex ‎]]
#[[Nephrogenic diabetes insipidus ‎]]
#[[Neuroleptic malignant syndrome ‎]]
#[[Noma (disease) ‎]]
#[[Gauss–Markov theorem ‎]]
#[[Heart-lung transplant ‎]]
#[[Hematopoiesis ‎]]
#[[Parenchyma ‎]]
#[[Pityriasis alba ‎]]
#[[Povidone-iodine ‎]]
#[[Ovarian ligament ‎]]
#[[Oxoglutarate dehydrogenase ‎]]
#[[Parnaparin ‎]]
#[[Phenylalanine ‎]]
#[[Polyethylene terephthalate ‎]]
#[[Portal vein ‎]]
#[[Stilbene ‎]]
#[[Tactile fremitus ‎]]
#[[Tetracaine ‎]]
#[[Biological system ‎]]
#[[Black eye ‎]]
#[[Cardiolipin ‎]]
#[[Chlamydiae ‎]]
#[[Ciclesonide ‎]]
#[[Daclizumab ‎]]
#[[Wyeth ‎]]
#[[Zwitterion ‎]]
#[[Koch's postulates ‎]]
#[[Laparotomy ‎]]
#[[Lobotomy ‎]]
#[[Lornoxicam ‎]]
#[[Hereditary spastic paraplegia ‎]]
#[[Implantable cardioverter-defibrillator ‎]]
#[[Inclusions ‎]]
#[[Insulin detemir ‎]]
#[[Isoelectric point ‎]]
#[[Renal medulla ‎]]
#[[ST elevation myocardial infarction nitrate therapy ‎]]
#[[Scientist ‎]]
#[[Fragment antigen binding ‎]]
#[[HLA-A66 ‎]]
#[[Hamstring ‎]]
#[[Hemagglutinin ‎]]
#[[Hemoperitoneum ‎]]
#[[Diels-Alder reaction ‎]]
#[[Disulfiram ‎]]
#[[Dyspareunia ‎]]
#[[Vein stripping ‎]]
#[[Viral envelope ‎]]
#[[Abdominal guarding ‎]]
#[[Accessory nerve ‎]]
#[[Acute promyelocytic leukemia ‎]]
#[[Methimazole (patient information) ‎]]
#[[Methoxyphedrine ‎]]
#[[Michael Stuart Brown ‎]]
#[[Musculoskeletal problems of the foot ‎]]
#[[Nanobe ‎]]
#[[Native PAGE ‎]]
#[[Neurotrophin-3 ‎]]
#[[Nicotinic antagonist ‎]]
#[[Obstetrical hemorrhage ‎]]
#[[Microphthalmia ‎]]
#[[Mycobacterium tuberculosis ‎]]
#[[Nicardipine ‎]]
#[[Oblique vein of the left atrium ‎]]
#[[Hyperaemia ‎]]
#[[Hypertensive emergency ‎]]
#[[Binasal hemianopsia ‎]]
#[[Bone morphogenetic protein 2 ‎]]
#[[Osteochondroma ‎]]
#[[Ouabain ‎]]
#[[Pantothenate kinase-associated neurodegeneration ‎]]
#[[Pharmacist ‎]]
#[[Pisiform bone ‎]]
#[[Precordial examination ‎]]
#[[Serous pericardium ‎]]
#[[Serratus anterior muscle ‎]]
#[[Sex cord ‎]]
#[[Stanozolol ‎]]
#[[Stenosing tenosynovitis ‎]]
#[[Susceptibility loci for intracranial aneurysm in European and Japanese populations ‎]]
#[[Synovial sarcoma ‎]]
#[[Lamina of the vertebral arch ‎]]
#[[List of diseases (P) ‎]]
#[[Longitudinal study ‎]]
#[[Caspase ‎]]
#[[Chalcogen ‎]]
#[[Chloride ‎]]
#[[Clorindione ‎]]
#[[Complement deficiency ‎]]
#[[Condensation reaction ‎]]
#[[Cutis laxa ‎]]
#[[Yolk sac ‎]]
#[[Zoonosis ‎]]
#[[1,2-Dichloroethane ‎]]
#[[ATC code B ‎]]
#[[Acamprosate (patient information) ‎]]
#[[Adhesion (medicine) ‎]]
#[[Alprostadil detailed information ‎]]
#[[Depressant ‎]]
#[[Dicloxacillin (patient information) ‎]]
#[[Embryonal carcinoma ‎]]
#[[Equipment used in diagnostic cardiac catheterizaiton ‎]]
#[[Extraglomerular mesangial cell ‎]]
#[[Familial atrial fibrillation ‎]]
#[[Prune belly syndrome ‎]]
#[[Red algae ‎]]
#[[Retroperitoneal fibrosis ‎]]
#[[Heart protection study ‎]]
#[[Hemolytic disease of the newborn (anti-Kell) ‎]]
#[[Torisel ‎]]
#[[United States National Library of Medicine ‎]]
#[[Urinary casts ‎]]
#[[Thiamin ‎]]
#[[Twelve-step program ‎]]
#[[Vaginectomy ‎]]
#[[Virology ‎]]
#[[Virulence ‎]]
#[[Cefprozil ‎]]
#[[Ciliary ganglion ‎]]
#[[DNA glycosylase ‎]]
#[[Asthenopia ‎]]
#[[Hematopathology ‎]]
#[[Proteobacteria ‎]]
#[[Prurigo nodularis ‎]]
#[[Sartorius muscle ‎]]
#[[Saturation (chemistry) ‎]]
#[[Scientific method ‎]]
#[[Palatine bone ‎]]
#[[Pap smear ‎]]
#[[Pennyroyal ‎]]
#[[Pergolide (patient information) ‎]]
#[[Postcentral gyrus ‎]]
#[[Prazosin ‎]]
#[[Asthenopia ‎]]
#[[Bamipine ‎]]
#[[Basic life support ‎]]
#[[Camillo Golgi ‎]]
#[[Stavudine (patient information) ‎]]
#[[T-cell lymphoma ‎]]
#[[Tea tree oil ‎]]
#[[Nicorandil ‎]]
#[[Number needed to treat ‎]]
#[[Diazoxide ‎]]
#[[Dura mater ‎]]
#[[Ergonomics ‎]]
#[[Ethanolamine ‎]]
#[[Euthyroid sick syndrome ‎]]
#[[Extracellular matrix ‎]]
#[[Wilhelm Conrad Röntgen ‎]]
#[[Ileitis ‎]]
#[[Indobufen ‎]]
#[[IntraUterine System ‎]]
#[[Isradipine ‎]]
#[[Joule per mole ‎]]
#[[Thiamin ‎]]
#[[Twelve-step program ‎]]
#[[Vaginectomy ‎]]
#[[Virology ‎]]
#[[Virulence ‎]]
#[[The heart in juvenile rheumatoid arthritis ‎]]
#[[Thyroxine-binding globulin ‎]]
#[[Trepanation ‎]]
#[[Baroreceptor ‎]]
#[[Benzylpiperazine ‎]]
#[[Branched-chain amino acids ‎]]
#[[Branchial arch ‎]]
#[[Bromazepam ‎]]
#[[Acquired cardiac valve disease ‎]]
#[[Activated protein C resistance ‎]]
#[[Alimemazine ‎]]
#[[Alopecia universalis ‎]]
#[[Levetiracetam (patient information) ‎]]
#[[List of diseases (0-9) ‎]]
#[[Lysogenic cycle ‎]]
#[[Marcus Gunn pupil ‎]]
#[[Medullary sponge kidney ‎]]
#[[Chloroplast ‎]]
#[[Cholinergic urticaria ‎]]
#[[Combined immunodeficiencies ‎]]
#[[Congenital cystic adenomatoid malformation ‎]]
#[[Coumatetralyl ‎]]
#[[Periodontology ‎]]
#[[Peripheral vascular examination ‎]]
#[[Picotamide ‎]]
#[[Policosanol ‎]]
#[[Genetic marker ‎]]
#[[Genetic predisposition ‎]]
#[[Guanfacine ‎]]
#[[H5N1 genetic structure ‎]]
#[[Psychoanalysis ‎]]
#[[Right heart ‎]]
#[[Risedronate ‎]]
#[[Ritonavir (patient information) ‎]]
#[[Ruptured spleen ‎]]
#[[Salvador Luria ‎]]
#[[Hertz ‎]]
#[[Hysteresivity ‎]]
#[[Iduronidase ‎]]
#[[Ifosfamide (patient information) ‎]]
#[[Ion transporter ‎]]
#[[Ipilimumab ‎]]
#[[Detergent ‎]]
#[[Diphyllobothrium ‎]]
#[[Doctor of Philosophy ‎]]
#[[Esophoria ‎]]
#[[Ethyl biscoumacetate ‎]]
#[[Eye surgery ‎]]
#[[Factor XIII ‎]]
#[[Sly syndrome ‎]]
#[[Spermatocele ‎]]
#[[Tablet ‎]]
#[[Neuropeptide Y ‎]]
#[[Neurulation ‎]]
#[[Norplant ‎]]
#[[Occipitofrontalis muscle ‎]]
#[[Off-label use ‎]]
#[[News:Elevated Plasma Fibrinogen Levels among Diabetics and Increased BMI are Associated with Reduced Platelet Inhibition with Clopidogrel ‎]]
#[[Willem Einthoven ‎]]
#[[Furazolidone ‎]]
#[[Ganciclovir (patient information) ‎]]
#[[General visceral afferent fibers ‎]]
#[[Hemangioendothelioma ‎]]
#[[ATC code C ‎]]
#[[Adenoid ‎]]
#[[Adherens junction ‎]]
#[[Adrenocortical carcinoma ‎]]
#[[Alveolar duct ‎]]
#[[Amelia (birth defect) ‎]]
#[[Anconeus muscle ‎]]
#[[Transesophageal echocardiography (TEE) ‎]]
#[[Transverse plane ‎]]
#[[Vagotomy ‎]]
#[[Visceral leishmaniasis ‎]]
#[[Axis (anatomy) ‎]]
#[[Bacterial artificial chromosome ‎]]
#[[Bcl-2 ‎]]
#[[Bemiparin ‎]]
#[[Biotin deficiency ‎]]
#[[Optical microscope ‎]]
#[[Organophosphorus ‎]]
#[[Pamidronic acid ‎]]
#[[Parotitis ‎]]
#[[Pentamycin ‎]]
#[[Personality disorder ‎]]
#[[Phenacetin ‎]]
#[[Phosphatase ‎]]
#[[Polarization ‎]]
#[[Preventive medicine ‎]]
#[[List of diseases (U) ‎]]
#[[Chorioretinitis ‎]]
#[[Cochlear nerve ‎]]
#[[Colposcopy ‎]]
#[[Congenital epulis ‎]]
#[[Metenolone enanthate ‎]]
#[[Methcathinone ‎]]
#[[Microalbuminuria ‎]]
#[[Mucolipidosis type IV ‎]]
#[[Myeloperoxidase deficiency ‎]]
#[[Nephrotoxic drugs ‎]]
#[[Drug design ‎]]
#[[Earwax ‎]]
#[[Electrode ‎]]
#[[Enuresis ‎]]
#[[Esophageal stricture ‎]]
#[[Etanercept ‎]]
#[[ST elevation myocardial infarction percutaneous coronary intervention following fibrinolytic administration ‎]]
#[[Sciatic nerve ‎]]
#[[Scrub typhus ‎]]
#[[Intracoronary infusion of selected and unselected mononuclear cells does not lead to significant improvement in cardiac function after sustained ischemia: Results from the REGENT trial ‎]]
#[[Serum sickness ‎]]
#[[Silicone ‎]]
#[[Stomatology ‎]]
#[[Simmonds' disease ‎]]
#[[Somatization disorder ‎]]
#[[Spherocytosis ‎]]
#[[Streptomyces ‎]]
#[[Long-term effects of alcohol ‎]]
#[[Acrolein ‎]]
#[[Aflatoxin ‎]]
#[[Amanita phalloides ‎]]
#[[Zinc sulfate ‎]]
#[[Goldenhar syndrome ‎]]
#[[Hard palate ‎]]
#[[Optic disc drusen ‎]]
#[[Ovalbumin ‎]]
#[[Podiatry ‎]]
#[[Presbyopia ‎]]
#[[The heart in Wegener's granulomatosis ‎]]
#[[Tiratricol ‎]]
#[[Titration ‎]]
#[[Beriberi heart disease ‎]]
#[[Blastocystosis ‎]]
#[[Buspirone ‎]]
#[[Cannizzaro reaction ‎]]
#[[Hinge joint ‎]]
#[[Intervertebral foramina ‎]]
#[[Intussusception ‎]]
#[[Inward-rectifier potassium ion channel ‎]]
#[[Delocalized electron ‎]]
#[[Diaphragmatic hernia ‎]]
#[[Dopaminergic ‎]]
#[[Ductal carcinoma ‎]]
#[[Edward Lawrie Tatum ‎]]
#[[Eosinophilic gastroenteritis ‎]]
#[[Cementoblastoma ‎]]
#[[Coal tar ‎]]
#[[Cumulus oophorus ‎]]
#[[Mesoderm ‎]]
#[[Muscle tone ‎]]
#[[Noscapine ‎]]
#[[Methicillin-resistant Staphylococcus aureus ‎]]
#[[Myositis ossificans ‎]]
#[[Nephritis ‎]]
#[[Nitrosamine ‎]]
#[[Odor ‎]]
#[[Oligosaccharide ‎]]
#[[Thin ascending limb of loop of Henle ‎]]
#[[Transfusion in ACS management ‎]]
#[[Transversus abdominis muscle ‎]]
#[[Triquetral bone ‎]]
#[[ATC code R06 ‎]]
#[[Arcus senilis ‎]]
#[[Social anxiety ‎]]
#[[Spasmodic dysphonia ‎]]
#[[Spore ‎]]
#[[Telogen effluvium ‎]]
#[[Teniposide (patient information) ‎]]
#[[Lacidipine ‎]]
#[[Lidocaine detailed information ‎]]
#[[Membrane transport protein ‎]]
#[[Oxytetracycline ‎]]
#[[Phenazone ‎]]
#[[Posterior superior alveolar artery ‎]]
#[[Yaws ‎]]
#[[Fibrosarcoma ‎]]
#[[Formoterol ‎]]
#[[Great arteries ‎]]
#[[Central chemoreceptors ‎]]
#[[Cholinesterase ‎]]
#[[Circadian rhythm sleep disorder ‎]]
#[[Congenital adrenal hyperplasia due to 3 beta-hydroxysteroid dehydrogenase deficiency ‎]]
#[[DNA extraction ‎]]
#[[Debye ‎]]
#[[Degranulation ‎]]
#[[Dermabrasion ‎]]
#[[Diacetyldihydromorphine ‎]]
#[[Ditazole ‎]]
#[[Executive system ‎]]
#[[Biotechnology ‎]]
#[[Black Death ‎]]
#[[Body fat percentage ‎]]
#[[Capillary leak syndrome ‎]]
#[[Capitate bone ‎]]
#[[Insulin aspart ‎]]
#[[Interleukin 6 ‎]]
#[[Irregular bone ‎]]
#[[Rectus femoris muscle ‎]]
#[[Refractory period ‎]]
#[[Respiratory examination ‎]]
#[[Proctology ‎]]
#[[Protein kinase inhibitor ‎]]
#[[QRS axis and voltage ‎]]
#[[Quinoline ‎]]
#[[ST elevation myocardial infarction oxygen therapy ‎]]
#[[Scalene muscles ‎]]
#[[Sclerodactyly ‎]]
#[[Zones of the lung ‎]]
#[[ATPase ‎]]
#[[Adalimumab ‎]]
#[[Alkylation ‎]]
#[[Anise ‎]]
#[[Apocrine ‎]]
#[[Methane ‎]]
#[[Milrinone ‎]]
#[[Tunica externa (vessels) ‎]]
#[[Urea cycle disorder ‎]]
#[[Veins of the head and neck ‎]]
#[[Oxaceprol ‎]]
#[[Piperacillin ‎]]
#[[Temporalis muscle ‎]]
#[[Tertiary bronchus ‎]]
#[[Howard Florey, Baron Florey ‎]]
#[[Hyperammonemia ‎]]
#[[Intestinal villus ‎]]
#[[Diaphysis ‎]]
#[[Dimethyltubocurarinium ‎]]
#[[Eicosanoid ‎]]
#[[Facial motor nucleus ‎]]
#[[Gefitinib (patient information) ‎]]
#[[Good clinical practice ‎]]
#[[Cherry angioma ‎]]
#[[Clear cell tumor ‎]]
#[[Contractility ‎]]
#[[Costodiaphragmatic recess ‎]]
#[[Decidua ‎]]
#[[Bias of an estimator ‎]]
#[[Bitemporal hemianopsia ‎]]
#[[Bitot's spots ‎]]
#[[Borderline personality disorder ‎]]
#[[Brain herniation ‎]]
#[[Buclizine ‎]]
#[[Butyric acid ‎]]
#[[Cadaver ‎]]
#[[Opium poppy ‎]]
#[[Pepscan ‎]]
#[[Adductor magnus muscle ‎]]
#[[Alternative medicine ‎]]
#[[Pseudomyxoma peritonei ‎]]
#[[Veins of the torso ‎]]
#[[Voltage-gated ion channel ‎]]
#[[Linear discriminant analysis ‎]]
#[[List of diseases (K) ‎]]
#[[Chronic stable angina definition ‎]]
#[[Complement membrane attack complex ‎]]
#[[Comprehensive metabolic panel ‎]]
#[[Cystadenoma ‎]]
#[[Subarachnoid space ‎]]
#[[Taurodontism ‎]]
#[[Hip fracture ‎]]
#[[Hysterectomy ‎]]
#[[ICD-10 Chapter I: Certain infectious and parasitic diseases ‎]]
#[[JNK in the trunk without extra sugar in the tank ‎]]
#[[Jarque-Bera test ‎]]
#[[Fox-Fordyce disease ‎]]
#[[Heart Failure: Acoustic Cardiography Improves Clinicians’ Confidence for Making the Diagnosis when BNP is Ambiguous ‎]]
#[[Thiocolchicoside ‎]]
#[[Tinzaparin ‎]]
#[[Tonsillectomy ‎]]
#[[Triclosan ‎]]
#[[Triflusal ‎]]
#[[Tryptamine ‎]]
#[[United States Adopted Name ‎]]
#[[Vesicoureteral reflux ‎]]
#[[Visual acuity ‎]]
#[[Paracentesis ‎]]
#[[Phenyltoloxamine ‎]]
#[[Pneumonitis ‎]]
#[[Polyphagia ‎]]
#[[Atomoxetine ‎]]
#[[Bence Jones protein ‎]]
#[[Benign ‎]]
#[[Borrelia ‎]]
#[[Xenon ‎]]
#[[Zona reticularis ‎]]
#[[Pseudoxanthoma elasticum ‎]]
#[[Rhinorrhea ‎]]
#[[Metabolic alkalosis ‎]]
#[[Myeloid leukemia ‎]]
#[[Alkane stereochemistry ‎]]
#[[Alkylating antineoplastic agent ‎]]
#[[Alternate hypothesis ‎]]
#[[Anterior horn (spinal cord) ‎]]
#[[Histidinemia ‎]]
#[[Cefixime ‎]]
#[[Chorea ‎]]
#[[Dapoxetine ‎]]
#[[Digitoxin ‎]]
#[[Dorsiflexion ‎]]
#[[Levator scapulae muscle ‎]]
#[[Mediastinal surface of lung ‎]]
#[[Short stature ‎]]
#[[Sickle cell trait ‎]]
#[[Sorbitol ‎]]
#[[Sports medicine ‎]]
#[[Steric effects ‎]]
#[[Streptomycin ‎]]
#[[Testicular artery ‎]]
#[[Skeletal fluorosis ‎]]
#[[Stratified sampling ‎]]
#[[Synovitis ‎]]
#[[TORCH infections ‎]]
#[[Tanner stage ‎]]
#[[Metenolone ‎]]
#[[Mucin ‎]]
#[[Neuroendocrinology ‎]]
#[[Norgestrienone ‎]]
#[[Fibroepithelial neoplasms ‎]]
#[[First pharyngeal arch ‎]]
#[[Gramicidin ‎]]
#[[Heart development ‎]]
#[[Torticollis ‎]]
#[[Trehalose ‎]]
#[[Viral gastroenteritis ‎]]
#[[Pseudopod ‎]]
#[[Race (classification of human beings) ‎]]
#[[Ruffini ending ‎]]
#[[Bleeding gums ‎]]
#[[Blepharophimosis ‎]]
#[[Blood substitutes ‎]]
#[[Bosentan ‎]]
#[[Butorphanol ‎]]
#[[Calcific tendinitis ‎]]
#[[Wikisurgery ‎]]
#[[Liothyronine sodium ‎]]
#[[Medicinal leech ‎]]
#[[Cefalotin ‎]]
#[[Cerebral edema ‎]]
#[[Dead space ‎]]
#[[ATC code S01 ‎]]
#[[Air embolism ‎]]
#[[Alexander Fleming ‎]]
#[[Anodontia ‎]]
#[[Hippocrates ‎]]
#[[HomoloGene ‎]]
#[[Intraglomerular mesangial cell ‎]]
#[[Irinotecan ‎]]
#[[Dopamine reuptake inhibitor ‎]]
#[[Effects of high altitude on humans ‎]]
#[[Diphenadione ‎]]
#[[Blunt trauma ‎]]
#[[Multiple endocrine neoplasia type 1 ‎]]
#[[NMDA receptor ‎]]
#[[Penile prosthesis ‎]]
#[[Peroneus longus ‎]]
#[[Photoreceptor ‎]]
#[[Primary immunodeficiency ‎]]
#[[Serotype ‎]]
#[[Sodium-glucose transport proteins ‎]]
#[[Statins found to be protective against recurrence of atrial fibrillation after cardioversion ‎]]
#[[Technetium ‎]]
#[[Robinow syndrome ‎]]
#[[Rupatadine ‎]]
#[[Thygeson's superficial punctate keratopathy ‎]]
#[[Transmission electron microscopy ‎]]
#[[Transwoman ‎]]
#[[Trendelenburg position ‎]]
#[[Upper respiratory tract ‎]]
#[[Vapor pressure ‎]]
#[[Visual perception ‎]]
#[[ICD-10 Chapter R ‎]]
#[[Impaired glucose tolerance ‎]]
#[[Cholecalciferol ‎]]
#[[Defence mechanism ‎]]
#[[Left main bronchus ‎]]
#[[Lipid raft ‎]]
#[[List of fatty acid metabolism disorders ‎]]
#[[17-Hydroxypregnenolone ‎]]
#[[Activin ‎]]
#[[Amblyopia ‎]]
#[[Antagonist (muscle) ‎]]
#[[Anti-ganglioside antibodies ‎]]
#[[Arcuate vein ‎]]
#[[Arene substitution patterns ‎]]
#[[ATC code H ‎]]
#[[ATC code R01 ‎]]
#[[Abnormalities in erythrocyte morphology ‎]]
#[[Red eye (medicine) ‎]]
#[[Rugae ‎]]
#[[Sanfilippo syndrome ‎]]
#[[Mutarotation ‎]]
#[[Naphazoline ‎]]
#[[Non-gonococcal urethritis ‎]]
#[[Olivary body ‎]]
#[[Dextran ‎]]
#[[Fertility ‎]]
#[[Basolateral membrane ‎]]
#[[Beta-carotene ‎]]
#[[Spondyloepimetaphyseal dysplasia, Strudwick type ‎]]
#[[Stethoscope ‎]]
#[[Sulfasalazine (patient information) ‎]]
#[[Teicoplanin ‎]]
#[[G cell ‎]]
#[[Ganglion cyst ‎]]
#[[Gas constant ‎]]
#[[Otorrhea ‎]]
#[[Paramyxovirus ‎]]
#[[Pentose ‎]]
#[[Perinatal period ‎]]
#[[Periodic acid-Schiff stain ‎]]
#[[Pholcodine ‎]]
#[[Phylogenetic tree ‎]]
#[[Phytochemical ‎]]
#[[Podophyllum peltatum ‎]]
#[[Klebsiella infection ‎]]
#[[Meperidine (patient information) ‎]]
#[[Hydroquinone ‎]]
#[[Zimmerman-Laband syndrome ‎]]
#[[News:Expression of programmed death ligand-1 in donor hearts regulates chronic allograft rejection ‎]]
#[[Thenalidine ‎]]
#[[Tolterodine ‎]]
#[[Trachoma ‎]]
#[[Urinary diversion ‎]]
#[[Vitelliform macular dystrophy ‎]]
#[[Cervical rib ‎]]
#[[Cartesian coordinate system ‎]]
#[[Cementoblast ‎]]
#[[Closing capacity ‎]]
#[[Condyloma ‎]]
#[[Congenital insensitivity to pain with anhidrosis ‎]]
#[[Cuticle ‎]]
#[[Cyanide poisoning ‎]]
#[[DNA repair-deficiency disorder ‎]]
#[[Fiber ‎]]
#[[Genitourinary system ‎]]
#[[Glandular branches of facial artery ‎]]
#[[Guanine ‎]]
#[[Haemophilus ‎]]
#[[Heparan sulfate ‎]]
#[[Midbrain tectum ‎]]
#[[Natural selection ‎]]
#[[Neomycin ‎]]
#[[Normochromic anemia ‎]]
#[[Aniridia ‎]]
#[[Aorticopulmonary septum ‎]]
#[[Pseudocyst ‎]]
#[[Renal corpuscle ‎]]
#[[Reticular fiber ‎]]
#[[Tetrahydrogestrinone ‎]]
#[[Diseases of the myocardium ‎]]
#[[Epididymis ‎]]
#[[Bone pain ‎]]
#[[Boric acid ‎]]
#[[Bromo-DragonFLY ‎]]
#[[Carbamate ‎]]
#[[Tooth gemination ‎]]
#[[Tracheoesophageal septum ‎]]
#[[Human skin color ‎]]
#[[Immunoglobulin D ‎]]
#[[Iron(II) sulfate ‎]]
#[[Jöns Jakob Berzelius ‎]]
#[[Ophthalmic nerve ‎]]
#[[Pelger-Huet anomaly ‎]]
#[[Pindolol ‎]]
#[[Policresulen ‎]]
#[[List of ICD-9 codes 460-519: Diseases of the respiratory system ‎]]
#[[List of diseases (D) ‎]]
#[[List of diseases (N) ‎]]
#[[List of diseases (Q) ‎]]
#[[List of probability topics ‎]]
#[[Wiskott-Aldrich syndrome ‎]]
#[[Zinc pyrithione ‎]]
#[[News:Study demonstrates that non-cardiac cells can help repair a damaged heart; new excitement for existence of cardiac stem cells. August 26, 2007 ‎]]
#[[Wikidoc news template ‎]]
#[[Wilcoxon signed-rank test ‎]]
#[[Discrete probability distribution ‎]]
#[[Dolasetron (patient information) ‎]]
#[[Drug test ‎]]
#[[Epoxy ‎]]
#[[Motor protein ‎]]
#[[National Center for Health Statistics ‎]]
#[[Nonlinear regression ‎]]
#[[Odontoblast ‎]]
#[[Operon ‎]]
#[[Cathine ‎]]
#[[Chilblain ‎]]
#[[Chlorambucil ‎]]
#[[Choana ‎]]
#[[Cinoxacin (patient information) ‎]]
#[[Frederick Sanger ‎]]
#[[Glossodynia ‎]]
#[[Gonadotropin-releasing hormone antagonist ‎]]
#[[Superior cerebellar artery ‎]]
#[[Systematic review ‎]]
#[[Tapentadol ‎]]
#[[Tetrahydrozoline ‎]]
#[[ATC code N02 ‎]]
#[[Pterygomandibular raphe ‎]]
#[[Retroperitoneal hematoma ‎]]
#[[Rimonabant ‎]]
#[[Mean time between failures ‎]]
#[[Hypochromic anemia ‎]]
#[[Influenza vaccine ‎]]
#[[Balloon catheter ‎]]
#[[Benzoyl peroxide ‎]]
#[[Calcaneus ‎]]
#[[Cardiac surgeon ‎]]
#[[United States customary units ‎]]
#[[West syndrome ‎]]
#[[Ottawa Charter for Health Promotion ‎]]
#[[Parapsoriasis ‎]]
#[[Ablation ‎]]
#[[Acronyms of Clinical Trial Terms ‎]]
#[[Aminoglutethimide ‎]]
#[[Anterior commissure of labia ‎]]
#[[Apex of lung ‎]]
#[[Nadolol detailed information ‎]]
#[[Nightmare ‎]]
#[[News:Better to be a pear than an apple: new prospective look at associations between fat distribution and coronary heart disease ‎]]
#[[Dementia with Lewy bodies ‎]]
#[[Designer drug ‎]]
#[[Enkephalin ‎]]
#[[Fallopian tubes ‎]]
#[[Seminiferous tubules ‎]]
#[[T-tubule ‎]]
#[[Terfenadine ‎]]
#[[Cell culture ‎]]
#[[Cinchocaine ‎]]
#[[Coccus ‎]]
#[[Cryoprecipitate ‎]]
#[[Cyclosporine (patient information) ‎]]
#[[Cytochrome c oxidase ‎]]
#[[Decreased bowel sounds ‎]]
#[[Förster resonance energy transfer ‎]]
#[[Generalized anxiety disorder ‎]]
#[[Trench fever ‎]]
#[[Hypothalamic-pituitary-thyroid axis ‎]]
#[[Inguinal ligament ‎]]
#[[Isoelectric focusing ‎]]
#[[Right main bronchus ‎]]
#[[ST elevation myocardial infarction analgesic therapy ‎]]
#[[Sacral nerves ‎]]
#[[Lymphoblast ‎]]
#[[Measuring Fractional Flow Reserve During PCI Improves 1-Year Outcomes ‎]]
#[[Bendroflumethiazide ‎]]
#[[Biceps brachii muscle ‎]]
#[[Biperiden ‎]]
#[[Calcium alginate ‎]]
#[[Carbimazole ‎]]
#[[Chain of survival ‎]]
#[[Clopidogrel resistance ‎]]
#[[Mexiletine ‎]]
#[[Neurotoxin ‎]]
#[[Notochord ‎]]
#[[Obturator internus muscle ‎]]
#[[Octopamine ‎]]
#[[Phlegm ‎]]
#[[Plateletpheresis ‎]]
#[[Acetaminophen (patient information) ‎]]
#[[Acute abdomen ‎]]
#[[Antimicrobial peptides ‎]]
#[[Secretin ‎]]
#[[Shellfish poisoning ‎]]
#[[Social phobia ‎]]
#[[Stratum corneum ‎]]
#[[Tetrazepam ‎]]
#[[Depression (mood) ‎]]
#[[Derivative (chemistry) ‎]]
#[[Duane syndrome ‎]]
#[[Elbow pain ‎]]
#[[Fenoldopam ‎]]
#[[Lateral sulcus ‎]]
#[[Mean corpuscular volume ‎]]
#[[High-molecular-weight kininogen ‎]]
#[[Hydrogen chloride ‎]]
#[[Hydrogen sulfide ‎]]
#[[Ilya Ilyich Mechnikov ‎]]
#[[Influenzavirus B ‎]]
#[[Fibrous protein ‎]]
#[[Frey's procedure ‎]]
#[[Fructose bisphosphatase deficiency ‎]]
#[[Fundus (uterus) ‎]]
#[[Gastrocolic reflex ‎]]
#[[Genu valgum ‎]]
#[[Giant cell tumor of bone ‎]]
#[[The Physical Examination in Cardiovascular Disease:The Heart ‎]]
#[[Thoracic surgery ‎]]
#[[Transmission and infection of H5N1 ‎]]
#[[Transsexualism ‎]]
#[[Visible spectrum ‎]]
#[[Pubococcygeus muscle ‎]]
#[[Santiago Ramón y Cajal ‎]]
#[[Pronator teres muscle ‎]]
#[[Psilocin ‎]]
#[[Renal osteodystrophy ‎]]
#[[Rhomboid major muscle ‎]]
#[[Rhythm method ‎]]
#[[Statistical power ‎]]
#[[Stress fracture ‎]]
#[[Microscopic polyangiitis ‎]]
#[[Misoprostol ‎]]
#[[Myoglobin ‎]]
#[[Nesiritide ‎]]
#[[Odontoma ‎]]
#[[Carotenodermia ‎]]
#[[Cefalexin ‎]]
#[[Cholinergic ‎]]
#[[Cloaca (embryology) ‎]]
#[[ADME ‎]]
#[[ATC code C08 ‎]]
#[[Adhesive capsulitis of shoulder ‎]]
#[[Aquaporin 1 ‎]]
#[[Wisdom teeth ‎]]
#[[Paget's disease ‎]]
#[[Panthenol ‎]]
#[[Phytosterol ‎]]
#[[Transmetalation ‎]]
#[[Independent and identically-distributed random variables ‎]]
#[[Intravenous pyelogram ‎]]
#[[Kernicterus ‎]]
#[[Desensitization (medicine) ‎]]
#[[Lagophthalmos ‎]]
#[[Left heart ‎]]
#[[Left lung ‎]]
#[[Light chain ‎]]
#[[Liquid-liquid extraction ‎]]
#[[Lopinavir ‎]]
#[[Macrocytosis ‎]]
#[[Menarche ‎]]
#[[Gestational diabetes ‎]]
#[[Glycolic acid ‎]]
#[[Halide ‎]]
#[[Generic drug ‎]]
#[[Genus ‎]]
#[[Glycosyl ‎]]
#[[Haptoglobin ‎]]
#[[Helicobacter ‎]]
#[[Hepatic portal system ‎]]
#[[Skin appendage ‎]]
#[[Sodium dodecyl sulfate ‎]]
#[[Spindle apparatus ‎]]
#[[Stabilizing selection ‎]]
#[[Stasis dermatitis ‎]]
#[[Succinic acid ‎]]
#[[Tendinitis ‎]]
#[[Biofilm ‎]]
#[[Bone morphogenetic protein 7 ‎]]
#[[Bretylium ‎]]
#[[Brotizolam ‎]]
#[[Butane ‎]]
#[[Carcinoembryonic antigen ‎]]
#[[Purpura fulminans ‎]]
#[[Pyruvate kinase deficiency ‎]]
#[[Rathke's pouch ‎]]
#[[Renal tubule ‎]]
#[[Rifampicin ‎]]
#[[AFP-L3 ‎]]
#[[ATC code C03 ‎]]
#[[Adenosine diphosphate ‎]]
#[[Alprazolam indications ‎]]
#[[Angiodysplasia ‎]]
#[[Nicotinamide ‎]]
#[[Nosocomial infection ‎]]
#[[Nurse ‎]]
#[[Nurse practitioner ‎]]
#[[Chromosome 17 (human) ‎]]
#[[Clinical psychology ‎]]
#[[Levomethadyl Acetate ‎]]
#[[Linoleic acid ‎]]
#[[Lipofuscin ‎]]
#[[List of diseases (H) ‎]]
#[[List of diseases (Y) ‎]]
#[[Mebeverine ‎]]
#[[Megakaryoblast ‎]]
#[[Hypesthesia ‎]]
#[[Impaction ‎]]
#[[Inhibin ‎]]
#[[Organic redox reaction ‎]]
#[[Outer ear ‎]]
#[[Ovarian hyperstimulation syndrome ‎]]
#[[Persistent genital arousal disorder ‎]]
#[[Phallus ‎]]
#[[Polycyclic compound ‎]]
#[[Toxic multinodular goitre ‎]]
#[[Transfusion reaction ‎]]
#[[Variable ‎]]
#[[Dopamine agonist ‎]]
#[[Dysphasia ‎]]
#[[Descemet's membrane ‎]]
#[[Dexchlorpheniramine ‎]]
#[[Disorders of calcium metabolism ‎]]
#[[Dolly (sheep) ‎]]
#[[Earlobe ‎]]
#[[Emergency contraception ‎]]
#[[Erlotinib (patient information) ‎]]
#[[Esophageal candidiasis ‎]]
#[[Etoricoxib ‎]]
#[[Methdilazine ‎]]
#[[Molsidomine ‎]]
#[[Muehrcke's lines ‎]]
#[[National Institute for Health and Clinical Excellence ‎]]
#[[Nerve growth factor ‎]]
#[[Secondary bronchus ‎]]
#[[Sole (foot) ‎]]
#[[Spastic diplegia ‎]]
#[[Splenic vein ‎]]
#[[Talon cusp ‎]]
#[[News:Unfractionated Heparin and PCI ‎]]
#[[Galactorrhea ‎]]
#[[Gas gangrene ‎]]
#[[Geniohyoid muscle ‎]]
#[[Glycolipid ‎]]
#[[Glycopeptide antibiotic ‎]]
#[[ATC code C02 ‎]]
#[[ATC code D ‎]]
#[[Acipimox ‎]]
#[[Ampicillin ‎]]
#[[Bioremediation ‎]]
#[[Branchial pouch ‎]]
#[[Prodrome ‎]]
#[[Profunda brachii ‎]]
#[[Prosencephalon ‎]]
#[[Pudendal nerve ‎]]
#[[Safe sex ‎]]
#[[Vastus lateralis muscle ‎]]
#[[Verrucous carcinoma ‎]]
#[[Indapamide ‎]]
#[[Insulin analog ‎]]
#[[Irritation ‎]]
#[[Chronic stable angina introduction ‎]]
#[[Colistin ‎]]
#[[Cystathioninuria ‎]]
#[[Darunavir (patient information) ‎]]
#[[Larsen syndrome ‎]]
#[[Lateral cutaneous nerve of thigh ‎]]
#[[Lichen nitidus ‎]]
#[[Lyme disease microbiology ‎]]
#[[Mandibular nerve ‎]]
#[[Manubrium ‎]]
#[[Meckel syndrome ‎]]
#[[Philtrum ‎]]
#[[Oviparity ‎]]
#[[Piriformis muscle ‎]]
#[[Potter syndrome ‎]]
#[[Azatadine ‎]]
#[[Barry Marshall ‎]]
#[[Bitolterol ‎]]
#[[Serotonin antagonist ‎]]
#[[Strontium ranelate ‎]]
#[[Deletion policy ‎]]
#[[Dinoprostone ‎]]
#[[Etofibrate ‎]]
#[[Nefazodone ‎]]
#[[Neutron ‎]]
#[[Ainhum ‎]]
#[[Arterial line ‎]]
#[[News:Thyroid abnormalities affect more than 30% of males on amiodarone ‎]]
#[[Forensic pathology ‎]]
#[[Gartner's duct ‎]]
#[[Glatiramer acetate ‎]]
#[[Glucose-galactose malabsorption ‎]]
#[[Heme ‎]]
#[[Kussmaul's sign ‎]]
#[[Max Theiler ‎]]
#[[Mechanoreceptor ‎]]
#[[Hepatoblastoma ‎]]
#[[Inosine ‎]]
#[[Trousseau sign of malignancy ‎]]
#[[Vasectomy ‎]]
#[[Vitelline arteries ‎]]
#[[Voyeurism ‎]]
#[[Cenani Lenz syndactylism ‎]]
#[[Chitin ‎]]
#[[Chloride channel ‎]]
#[[Chloropyramine ‎]]
#[[Clavicle fracture ‎]]
#[[Clioquinol ‎]]
#[[Clofibride ‎]]
#[[Cutaneous larva migrans ‎]]
#[[Cascade reaction ‎]]
#[[Small cell lymphoma ‎]]
#[[Sorafenib ‎]]
#[[Swiss-Prot ‎]]
#[[Tensor veli palatini muscle ‎]]
#[[Tetramer ‎]]
#[[Plasminogen ‎]]
#[[Primitive ventricle ‎]]
#[[Astemizole ‎]]
#[[Athlete's foot ‎]]
#[[Bacteriostatic agent ‎]]
#[[Beta-Carboline ‎]]
#[[Antinuclear antibodies ‎]]
#[[Aromatase inhibitor ‎]]
#[[Desmoplastic small round cell tumor ‎]]
#[[Migrating motor complex ‎]]
#[[Needle aspiration biopsy ‎]]
#[[Neural network ‎]]
#[[Occipital bone ‎]]
#[[Tioclomarol ‎]]
#[[Tooth enamel ‎]]
#[[Triprolidine ‎]]
#[[Trisomy 22 ‎]]
#[[Vertebra prominens ‎]]
#[[Wheat ‎]]
#[[Klebsiella ‎]]
#[[Labyrinthine artery ‎]]
#[[Lactulose ‎]]
#[[Lambdoid suture ‎]]
#[[Least squares ‎]]
#[[List of diseases (G) ‎]]
#[[List of diseases (L) ‎]]
#[[Medial lemniscus ‎]]
#[[Pulmonary stretch receptors ‎]]
#[[Raphe nuclei ‎]]
#[[Reverse transcription polymerase chain reaction ‎]]
#[[Sample size ‎]]
#[[Saruplase ‎]]
#[[Seckel syndrome ‎]]
#[[Fomite ‎]]
#[[Gram-positive ‎]]
#[[Halothane ‎]]
#[[Hemolytic disease of the newborn (anti-Rhc) ‎]]
#[[Induction (birth) ‎]]
#[[Iridectomy ‎]]
#[[Incus ‎]]
#[[Intracellular ‎]]
#[[Ion exchange resin ‎]]
#[[Depressor anguli oris muscle ‎]]
#[[Epidemiological methods ‎]]
#[[Eye development ‎]]
#[[Tentorium cerebelli ‎]]
#[[News:Abnormal pressure gradient distal to the implanted bare metal stent is associated with the occurrence of in-stent restenosis ‎]]
#[[Cataract surgery ‎]]
#[[Chemical affinity ‎]]
#[[Chondroblast ‎]]
#[[Complex partial seizure ‎]]
#[[Conjugate acid ‎]]
#[[Cyproterone ‎]]
#[[Academic journal ‎]]
#[[Adnexa ‎]]
#[[Anaerobic respiration ‎]]
#[[Optic neuritis ‎]]
#[[Peroxide ‎]]
#[[Poiseuille's law ‎]]
#[[Portal hypertensive gastropathy ‎]]
#[[Aspergillus ‎]]
#[[Atrophic gastritis ‎]]
#[[Binomial distribution ‎]]
#[[Gene therapy ‎]]
#[[Guanidine ‎]]
#[[HU-210 ‎]]
#[[Laser ablation ‎]]
#[[List of ICD-9 codes 280-289: Diseases of the blood and blood-forming organs ‎]]
#[[List of ICD-9 codes 360-389: Diseases of the sense organs ‎]]
#[[List of diseases (J) ‎]]
#[[Longissimus ‎]]
#[[Magnetism ‎]]
#[[Michaelis-Menten kinetics ‎]]
#[[Multifidus muscle ‎]]
#[[Nimodipine ‎]]
#[[Toxic metal ‎]]
#[[Transverse fissure of liver ‎]]
#[[Trypanosome ‎]]
#[[Visceral pleura ‎]]
#[[Vitamin A deficiency ‎]]
#[[Psoralen ‎]]
#[[Pustulosis ‎]]
#[[SARS coronavirus ‎]]
#[[Radioimmunoassay ‎]]
#[[Raloxifene ‎]]
#[[Resonance ‎]]
#[[Retrograde amnesia ‎]]
#[[Organic reaction ‎]]
#[[Percentile ‎]]
#[[Pinguecula ‎]]
#[[Sexual reproduction ‎]]
#[[Simfibrate ‎]]
#[[Sodium polystyrene sulfonate (patient information) ‎]]
#[[Sulfanilamide ‎]]
#[[Systemic inflammatory response syndrome ‎]]
#[[Hypothenar eminence ‎]]
#[[Kauffman-White classification ‎]]
#[[Drug abuse ‎]]
#[[Electrostatics ‎]]
#[[Ergot ‎]]
#[[Errors and residuals in statistics ‎]]
#[[Extracellular ‎]]
#[[Accommodation (eye) ‎]]
#[[Adrenal medulla ‎]]
#[[Aluminium chloride ‎]]
#[[Amorphous solid ‎]]
#[[Arterial tree ‎]]
#[[Colextran ‎]]
#[[Congenital hepatic fibrosis ‎]]
#[[Cox maze procedure ‎]]
#[[Thromboxane ‎]]
#[[Transduction (genetics) ‎]]
#[[Vanillyl mandelic acid ‎]]
#[[Ventral tegmentum ‎]]
#[[Lacrimal canaliculi ‎]]
#[[Linear regression ‎]]
#[[Liposome ‎]]
#[[Machine perfusion ‎]]
#[[Medial circumflex femoral artery ‎]]
#[[Bacterial conjugation ‎]]
#[[Benfluorex ‎]]
#[[CD90 ‎]]
#[[Calcium lactate ‎]]
#[[Canal of the cervix ‎]]
#[[Follicular fluid ‎]]
#[[Glutathione ‎]]
#[[Metipranolol ‎]]
#[[Microvascular disease ‎]]
#[[Mycoplasma ‎]]
#[[Norfloxacin (patient information) ‎]]
#[[Nuclear envelope ‎]]
#[[Olfactory epithelium ‎]]
#[[Neuroepithelial cell ‎]]
#[[Nonketotic hyperosmolar coma ‎]]
#[[Nucleoside ‎]]
#[[7-Dehydrocholesterol ‎]]
#[[American Association for the Advancement of Science ‎]]
#[[Ancrod ‎]]
#[[Sequencing ‎]]
#[[Sternohyoid muscle ‎]]
#[[Pharmacogenetics ‎]]
#[[Polymyxin B ‎]]
#[[Probucol ‎]]
#[[Ectopia ‎]]
#[[Enamel pearl ‎]]
#[[Enzyte ‎]]
#[[Epidemiological transition ‎]]
#[[Histone H1 ‎]]
#[[GM1 gangliosidoses ‎]]
#[[Hemofiltration ‎]]
#[[Kingdom (biology) ‎]]
#[[Lysozyme ‎]]
#[[Chondrodystrophy ‎]]
#[[Combivent ‎]]
#[[Titer ‎]]
#[[Totally Endoscopic Coronary Artery Bypass Surgery (TECAB) ‎]]
#[[Bar (unit) ‎]]
#[[Bromodiphenhydramine ‎]]
#[[Asymptomatic ‎]]
#[[Blastocyst ‎]]
#[[Buffer solution ‎]]
#[[Buphthalmos ‎]]
#[[CHARGE syndrome ‎]]
#[[Capecitabine ‎]]
#[[Carbon group ‎]]
#[[Carcinogenesis ‎]]
#[[Dexbrompheniramine ‎]]
#[[Epidermolysis bullosa ‎]]
#[[Erythema toxicum ‎]]
#[[Euthanasia ‎]]
#[[ATC code G ‎]]
#[[Alloplant ‎]]
#[[Alpers' disease ‎]]
#[[Alstrom syndrome ‎]]
#[[Amobarbital ‎]]
#[[Anandamide ‎]]
#[[Aqueous solution ‎]]
#[[Blastocyst ‎]]
#[[Buffer solution ‎]]
#[[Buphthalmos ‎]]
#[[Capecitabine ‎]]
#[[Carcinogenesis ‎]]
#[[Phentolamine ‎]]
#[[Human iron metabolism ‎]]
#[[List of surgical procedures ‎]]
#[[Lumbar nerves ‎]]
#[[Meclofenamate (patient information) ‎]]
#[[ATC code G ‎]]
#[[Alloplant ‎]]
#[[Alpers' disease ‎]]
#[[Amobarbital ‎]]
#[[Anandamide ‎]]
#[[Ankle pain and swelling ‎]]
#[[Aqueous solution ‎]]
#[[Thyroglossal duct ‎]]
#[[Triosephosphate isomerase deficiency ‎]]
#[[Trochanteric bursitis ‎]]
#[[Weber's syndrome ‎]]
#[[Chromosome 7 (human) ‎]]
#[[Ptosis ‎]]
#[[Pyridinium chlorochromate ‎]]
#[[National Eye Institute ‎]]
#[[Dexbrompheniramine ‎]]
#[[Epidermolysis bullosa ‎]]
#[[Erythema toxicum ‎]]
#[[Euthanasia ‎]]
#[[Fossa of vestibule of vagina ‎]]
#[[Gonadal dysgenesis ‎]]
#[[Gram-negative ‎]]
#[[Guanethidine ‎]]
#[[Hassall's corpuscles ‎]]
#[[Felbinac ‎]]
#[[Ferritin ‎]]
#[[Galactokinase deficiency ‎]]
#[[Gender ‎]]
#[[Genital candidiasis ‎]]
#[[Tobacco ‎]]
#[[Tropomyosin ‎]]
#[[Urachus ‎]]
#[[Olfactory bulb ‎]]
#[[Optics ‎]]
#[[Petrochemical ‎]]
#[[Physostigmine ‎]]
#[[Platysma muscle ‎]]
#[[Salicin ‎]]
#[[C1-inhibitor ‎]]
#[[Carbamazepine ‎]]
#[[Acinetobacter baumanni ‎]]
#[[Hydrochloric acid ‎]]
#[[Intermediate filament ‎]]
#[[Laryngectomy ‎]]
#[[Loop of Henle ‎]]
#[[MEDLINE ‎]]
#[[Diol ‎]]
#[[Dmitri Mendeleev ‎]]
#[[Dysphonia ‎]]
#[[Edman degradation ‎]]
#[[Pyrazolone ‎]]
#[[RAST test ‎]]
#[[Radiological Physics Center ‎]]
#[[Rhabdomyosarcoma ‎]]
#[[Woman ‎]]
#[[Ziprasidone (patient information) ‎]]
#[[Chloroquine ‎]]
#[[Mofebutazone ‎]]
#[[Multicystic dysplastic kidney ‎]]
#[[Nitric oxide synthase ‎]]
#[[Homans' sign ‎]]
#[[ICD-10 Chapter VI: Diseases of the nervous system ‎]]
#[[International Chemical Identifier ‎]]
#[[Intrastromal corneal ring segments ‎]]
#[[Ochronosis ‎]]
#[[Oxiconazole (patient information) ‎]]
#[[Palmoplantar keratoderma ‎]]
#[[Pasteurization ‎]]
#[[Pimozide (patient information) ‎]]
#[[Flexor digitorum superficialis muscle ‎]]
#[[Foot (length) ‎]]
#[[Foramen ovale (heart) ‎]]
#[[Ganglion cell ‎]]
#[[Thallium ‎]]
#[[Transurethral resection of the prostate ‎]]
#[[Vertebral artery ‎]]
#[[4-Methyl-aminorex ‎]]
#[[Alexis Carrel ‎]]
#[[Algae ‎]]
#[[Amnion ‎]]
#[[Anorectal pain ‎]]
#[[Sandbox ‎]]
#[[Spermatic cord ‎]]
#[[Ascending aorta ‎]]
#[[Atonic seizure ‎]]
#[[Cefazolin ‎]]
#[[Colestipol ‎]]
#[[Courvoisier's law ‎]]
#[[Pyridine ‎]]
#[[Retinoblastoma protein ‎]]
#[[Ronifibrate ‎]]
#[[ST elevation myocardial infarction classification ‎]]
#[[Lateral lingual swelling ‎]]
#[[Library (biology) ‎]]
#[[Lipoprotein-associated phospholipase A2 (Lp-PLA2) ‎]]
#[[List of withdrawn drugs ‎]]
#[[Local anesthesia ‎]]
#[[Dens evaginatus ‎]]
#[[Diethylcathinone ‎]]
#[[Duodenal switch ‎]]
#[[Dysthymia ‎]]
#[[Electrophoresis ‎]]
#[[Enterotoxin ‎]]
#[[Endocrine disruptor ‎]]
#[[Endoscopic thoracic sympathectomy ‎]]
#[[Enfuvirtide ‎]]
#[[Enzyme assay ‎]]
#[[Ethmoid bulla ‎]]
#[[Serum amyloid A ‎]]
#[[Shapiro-Wilk test ‎]]
#[[Sigmoid colon ‎]]
#[[Standard deviation ‎]]
#[[Succinic anhydride ‎]]
#[[Suspensory ligament of the ovary ‎]]
#[[Oxoacid ‎]]
#[[Plasminogen activator inhibitor-2 ‎]]
#[[Polyethylene ‎]]
#[[Medigoxin ‎]]
#[[Nalbuphine ‎]]
#[[Nasopalatine nerve ‎]]
#[[Nature (journal) ‎]]
#[[Intracranial aneurysms ‎]]
#[[Antianginal ‎]]
#[[Fatty acid metabolism ‎]]
#[[Frenulum of prepuce of penis ‎]]
#[[Fusafungine ‎]]
#[[H. Robert Horvitz ‎]]
#[[Halachic Organ Donor Society ‎]]
#[[Heat shock protein ‎]]
#[[Tenofovir (patient information) ‎]]
#[[Troleandomycin (patient information) ‎]]
#[[Uveal melanoma ‎]]
#[[Vesalius ‎]]
#[[Leukocyte adhesion deficiency ‎]]
#[[Liquid ‎]]
#[[List of diseases (E) ‎]]
#[[Mebhydrolin ‎]]
#[[Protein S ‎]]
#[[Protein Z ‎]]
#[[Radiofrequency ablation ‎]]
#[[Arytenoid cartilage ‎]]
#[[Carbachol ‎]]
#[[Ceftazidime ‎]]
#[[Chromium ‎]]
#[[Chromosome 2 (human) ‎]]
#[[Colonic polyps ‎]]
#[[Congenital anomalies of the genitalia ‎]]
#[[Crus ‎]]
#[[Carnitine palmitoyltransferase II deficiency ‎]]
#[[Cefradine ‎]]
#[[Chemical pneumonitis ‎]]
#[[Chiral pool synthesis ‎]]
#[[Choanal atresia ‎]]
#[[Coalworker's pneumoconiosis ‎]]
#[[HERG ‎]]
#[[HLA-A2 ‎]]
#[[Occipital artery ‎]]
#[[Outlier ‎]]
#[[Plasma osmolality ‎]]
#[[Plexus ‎]]
#[[Plicamycin (patient information) ‎]]
#[[Delayed sleep phase syndrome ‎]]
#[[Diverticulum ‎]]
#[[Electron shell ‎]]
#[[Ependyma ‎]]
#[[Saethre-Chotzen syndrome ‎]]
#[[Small GTPase ‎]]
#[[Acrivastine ‎]]
#[[Ammonium ‎]]
#[[Anal-oral sex ‎]]
#[[Hemangiopericytoma ‎]]
#[[ISBT 128 ‎]]
#[[Idarubicin (patient information) ‎]]
#[[Iodomethane ‎]]
#[[Bare lymphocyte syndrome ‎]]
#[[Barton's fracture ‎]]
#[[Birdshot chorioretinopathy ‎]]
#[[Bismuth subsalicylate ‎]]
#[[Prothrombin fragment 1.2 (F1.2) ‎]]
#[[Quantitative trait locus ‎]]
#[[Rapid plasma reagent ‎]]
#[[Refractive error ‎]]
#[[Roger Wolcott Sperry ‎]]
#[[Roxithromycin ‎]]
#[[Thoracoscopy ‎]]
#[[Throat ‎]]
#[[Thrombectomy ‎]]
#[[Thrombus precursor protein (TpP) ‎]]
#[[Tongue pain ‎]]
#[[Transcortin ‎]]
#[[Urethral stricture ‎]]
#[[Karl Pearson ‎]]
#[[Kernel density estimation ‎]]
#[[Ketanserin ‎]]
#[[Ketone bodies ‎]]
#[[Köhler disease ‎]]
#[[Leukonychia ‎]]
#[[List of ICD-9 codes 140-239: Neoplasms ‎]]
#[[Long acting beta-adrenoceptor agonist ‎]]
#[[Medial cutaneous nerve of forearm ‎]]
#[[List of diseases (F) ‎]]
#[[Lung buds ‎]]
#[[4-Chloro-2,5-dimethoxyamphetamine ‎]]
#[[Acquired disorder ‎]]
#[[Allergic bronchopulmonary aspergillosis ‎]]
#[[Orosomucoid ‎]]
#[[Osteocalcin ‎]]
#[[Pharyngeal pouch (embryology) ‎]]
#[[Pitch (music) ‎]]
#[[Cerebral hemisphere ‎]]
#[[Cocaine dependence ‎]]
#[[Colles' fracture ‎]]
#[[Common bile duct ‎]]
#[[Community-acquired pneumonia ‎]]
#[[Cubic crystal system ‎]]
#[[Ferromagnetism ‎]]
#[[HLA-A29 ‎]]
#[[Haemopexin ‎]]
#[[Signet ring cell carcinoma ‎]]
#[[Sodium monofluorophosphate ‎]]
#[[Mitotane ‎]]
#[[Mucormycosis ‎]]
#[[National Institute on Aging ‎]]
#[[Natural Killer T cell ‎]]
#[[Dichloromethane ‎]]
#[[Extensor hallucis longus muscle ‎]]
#[[Exudate ‎]]
#[[Failure to thrive ‎]]
#[[Tasosartan ‎]]
#[[Thyroid isthmus ‎]]
#[[Tirofiban and transfer compares favorably to fibrinolysis in STEMI ‎]]
#[[Transitional cell carcinoma ‎]]
#[[Transmembrane protein ‎]]
#[[Trapezium (bone) ‎]]
#[[Unsaturated fat ‎]]
#[[Upper motor neuron ‎]]
#[[Valdecoxib ‎]]
#[[Ventricular system ‎]]
#[[Primer (molecular biology) ‎]]
#[[Propionic acid ‎]]
#[[Heterochromatin ‎]]
#[[Homatropine ‎]]
#[[Infrared spectroscopy ‎]]
#[[Ischiocavernosus muscle ‎]]
#[[Arthropathy ‎]]
#[[Barium ‎]]
#[[Barrel chest ‎]]
#[[Bendamustine ‎]]
#[[Capsid ‎]]
#[[Vivipary ‎]]
#[[Withdrawal ‎]]
#[[Xylometazoline ‎]]
#[[Methanogen ‎]]
#[[Mizolastine ‎]]
#[[Neprilysin ‎]]
#[[Optic radiation ‎]]
#[[Oxaliplatin ‎]]
#[[Paramagnetism ‎]]
#[[Phillip Allen Sharp ‎]]
#[[Mastication ‎]]
#[[McNemar's test ‎]]
#[[Mean squared error ‎]]
#[[Amphiarthrosis ‎]]
#[[Apical membrane ‎]]
#[[Scanning electron microscope ‎]]
#[[Sperm ‎]]
#[[Splenic artery ‎]]
#[[Streptococcus mutans ‎]]
#[[Superficial spreading melanoma ‎]]
#[[Superior rectus muscle ‎]]
#[[Covariance matrix ‎]]
#[[Fenfluramine ‎]]
#[[Glycomics ‎]]
#[[Asherman's syndrome ‎]]
#[[Baeyer-Villiger oxidation ‎]]
#[[Calvaria (skull) ‎]]
#[[Protein nuclear magnetic resonance spectroscopy ‎]]
#[[Proximal phalanges ‎]]
#[[Reoviridae ‎]]
#[[Deciduous teeth ‎]]
#[[Diabetes management ‎]]
#[[Diaphragm (contraceptive) ‎]]
#[[Diarrheal shellfish poisoning ‎]]
#[[Dopexamine ‎]]
#[[EC number ‎]]
#[[Ectoderm ‎]]
#[[Embryonic stem cell ‎]]
#[[Endocytosis ‎]]
#[[Ethambutol ‎]]
#[[Tubal ligation ‎]]
#[[Hypertrophy of the heart ‎]]
#[[ICD-10 Chapter H ‎]]
#[[Immunoproliferative disorders ‎]]
#[[International Classification of Health Interventions ‎]]
#[[Janus kinase ‎]]
#[[Homocysteine ‎]]
#[[Homologous series ‎]]
#[[ICD-10 Chapter K ‎]]
#[[Cementum ‎]]
#[[Chronic stable angina historical perspective ‎]]
#[[Cluster of differentiation ‎]]
#[[Computational learning theory ‎]]
#[[Coxsackie B ‎]]
#[[Cryosurgery ‎]]
#[[Pharyngeal recess ‎]]
#[[Wheatgrass ‎]]
#[[Xanthine oxidase ‎]]
#[[Mefenamic acid ‎]]
#[[Morvan's syndrome ‎]]
#[[Nickel(II) chloride ‎]]
#[[Non-rapid eye movement sleep ‎]]
#[[Septum secundum ‎]]
#[[1,3-Bisphosphoglycerate ‎]]
#[[AKT ‎]]
#[[ATC code P ‎]]
#[[Albrecht Kossel ‎]]
#[[Areola ‎]]
#[[Toluene ‎]]
#[[Tubocurarine ‎]]
#[[Variegate porphyria ‎]]
#[[Potassium perchlorate ‎]]
#[[Protic solvent ‎]]
#[[Gigantism ‎]]
#[[Baclofen ‎]]
#[[Bazin disease ‎]]
#[[Benzonatate (patient information) ‎]]
#[[Bone morphogenetic protein ‎]]
#[[Bronchial challenge test ‎]]
#[[Carbonate ‎]]
#[[Deptropine ‎]]
#[[Desoxymethyltestosterone ‎]]
#[[Ehrlichiosis (canine) ‎]]
#[[Electrophysiologic study ‎]]
#[[Ethinylestradiol ‎]]
#[[Endometrioid tumor ‎]]
#[[Eye bank ‎]]
#[[Spasticity ‎]]
#[[Olfactory receptor neuron ‎]]
#[[Orientia ‎]]
#[[PDE5 inhibitor ‎]]
#[[Pericardiacophrenic artery ‎]]
#[[Pimethixene ‎]]
#[[ICF syndrome ‎]]
#[[Immunocompetence ‎]]
#[[Intraosseous infusion ‎]]
#[[NFPA 704 ‎]]
#[[National Human Genome Research Institute ‎]]
#[[Karl Landsteiner ‎]]
#[[Laryngomalacia ‎]]
#[[Lateral circumflex femoral artery ‎]]
#[[List of diseases (X) ‎]]
#[[List of medical abbreviations ‎]]
#[[Malleus ‎]]
#[[Meckel's cartilage ‎]]
#[[Avidin ‎]]
#[[Bismuth ‎]]
#[[Bloating ‎]]
#[[C-peptide ‎]]
#[[Carbamoyl phosphate synthetase I deficiency ‎]]
#[[Pseudo-Hurler polydystrophy ‎]]
#[[Aerobic exercise ‎]]
#[[Anastrozole ‎]]
#[[Androstadienone ‎]]
#[[Anti-p62 antibodies ‎]]
#[[Fibrin degradation product ‎]]
#[[Fluphenazine ‎]]
#[[Fissured tongue ‎]]
#[[Fluid statics ‎]]
#[[Gatifloxacin ‎]]
#[[Mefloquine (patient information) ‎]]
#[[Microfilament ‎]]
#[[Mini-mental state examination ‎]]
#[[Seafood ‎]]
#[[Eosinophilic fasciitis ‎]]
#[[Chondroblastoma ‎]]
#[[Competitive inhibition ‎]]
#[[Cytochrome ‎]]
#[[P53 (protein) ‎]]
#[[Vitelline duct ‎]]
#[[2,5-Dimethoxy-4-bromoamphetamine ‎]]
#[[ATC code C09 ‎]]
#[[Acephaly (medicine) ‎]]
#[[Acetohexamide (patient information) ‎]]
#[[Angular incisure ‎]]
#[[Anti-transglutaminase antibodies ‎]]
#[[B-cell prolymphocytic leukemia ‎]]
#[[Bone marrow suppression ‎]]
#[[Byssinosis ‎]]
#[[Material safety data sheet ‎]]
#[[Root sheath ‎]]
#[[Organic synthesis ‎]]
#[[Periaqueductal gray ‎]]
#[[Smoking cessation ‎]]
#[[Gastric antral vascular ectasia ‎]]
#[[Nasopharynx ‎]]
#[[Nimetazepam ‎]]
#[[Cataplexy ‎]]
#[[Chemiosmosis ‎]]
#[[Chronic stable angina recognition of clinical subsets ‎]]
#[[Cortical dysplasia ‎]]
#[[Dapsone ‎]]
#[[Horizontal gene transfer ‎]]
#[[Humoral immune deficiency ‎]]
#[[Hypoglossal nerve ‎]]
#[[Idose ‎]]
#[[Diphenylpyraline ‎]]
#[[Essential tremor ‎]]
#[[Leukapheresis ‎]]
#[[Lysosomal storage disease ‎]]
#[[AS ‎]]
#[[Akaike information criterion ‎]]
#[[Alveolar gland ‎]]
#[[Anaphylatoxin ‎]]
#[[Thiamine pyrophosphate ‎]]
#[[Tobramycin ‎]]
#[[Traction alopecia ‎]]
#[[Trophoblast ‎]]
#[[Truncus arteriosus ‎]]
#[[Turners hypoplasia ‎]]
#[[Veins of the lower extremity ‎]]
#[[Articular processes ‎]]
#[[Bruch's membrane ‎]]
#[[Calcium phosphate ‎]]
#[[Atypical pneumonia ‎]]
#[[Human mortality from H5N1 ‎]]
#[[ICD-10 Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings ‎]]
#[[Isoquinoline ‎]]
#[[Protionamide ‎]]
#[[Psychogenic polydipsia ‎]]
#[[Respiration (physiology) ‎]]
#[[Osteosclerosis ‎]]
#[[Phytic acid ‎]]
#[[Plica fimbriata ‎]]
#[[Chromosome 9 (human) ‎]]
#[[Compendium of Chemical Terminology ‎]]
#[[Complication (medicine) ‎]]
#[[Gastrointestinal hormone ‎]]
#[[Glomerular basement membrane ‎]]
#[[The safety of thiazolidinediones in older diabetics ‎]]
#[[Tolbutamide ‎]]
#[[Trenbolone ‎]]
#[[Vaginismus ‎]]
#[[Kt/V ‎]]
#[[Lung allocation score ‎]]
#[[Dorland's Medical Dictionary ‎]]
#[[Facial artery ‎]]
#[[Adenomatoid odontogenic tumor ‎]]
#[[Antifibrinolytic ‎]]
#[[AM404 ‎]]
#[[Alpha motor neuron ‎]]
#[[Amylin ‎]]
#[[Central core disease ‎]]
#[[Charge transfer complex ‎]]
#[[Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency ‎]]
#[[Helicase ‎]]
#[[Herbicide ‎]]
#[[Impossible syndrome ‎]]
#[[Indometacin ‎]]
#[[Saxagliptin ‎]]
#[[Short bone ‎]]
#[[Supinator muscle ‎]]
#[[Attrition (dental) ‎]]
#[[Basilic vein ‎]]
#[[Body of vertebra ‎]]
#[[Bronchiolitis obliterans organizing pneumonia ‎]]
#[[Peyer's patches ‎]]
#[[Retroverted uterus ‎]]
#[[Minimaze procedure ‎]]
#[[Mitotic inhibitor ‎]]
#[[Noncompaction cardiomyopathy ‎]]
#[[Dental pathology ‎]]
#[[Descriptive statistics ‎]]
#[[Elimination reaction ‎]]
#[[European Society of Cardiology ‎]]
#[[Turpentine ‎]]
#[[Weekly EP & ECG rounds at the BIDMC (Archive) ‎]]
#[[Yellow nail syndrome ‎]]
#[[Yunis-Varon syndrome ‎]]
#[[Follicular phase ‎]]
#[[Gardnerella ‎]]
#[[Lacrimal bone ‎]]
#[[Life ‎]]
#[[Marburg virus ‎]]
#[[Juvenile dermatomyositis ‎]]
#[[Lateral plate mesoderm ‎]]
#[[List of diseases (O) ‎]]
#[[List of organic reactions ‎]]
#[[Lymphangiosarcoma ‎]]
#[[Probability ‎]]
#[[Pulse pressure ‎]]
#[[Short bone ‎]]
#[[Smoking cessation ‎]]
#[[Splanchnic nerves ‎]]
#[[Xerophthalmia ‎]]
#[[Yellow nail syndrome ‎]]
#[[Central core disease ‎]]
#[[Charge transfer complex ‎]]
#[[Chloral Hydrate (patient information) ‎]]
#[[Clenbuterol ‎]]
#[[Crypts of Lieberkühn ‎]]
#[[Dermal denticle ‎]]
#[[European Society of Cardiology ‎]]
#[[Thymosin ‎]]
#[[Tonsilitis ‎]]
#[[Kt/V ‎]]
#[[List of diseases (O) ‎]]
#[[List of organic reactions ‎]]
#[[Lymphangiosarcoma ‎]]
#[[Ketosis ‎]]
#[[Lateral plate mesoderm ‎]]
#[[Levonorgestrel ‎]]
#[[Melioidosis ‎]]
#[[Menadione ‎]]
#[[Selman Waksman ‎]]
#[[Intelligence ‎]]
#[[Isotropy ‎]]
#[[Micelle ‎]]
#[[Propranolol drug interactions ‎]]
#[[Regioselectivity ‎]]
#[[ST elevation myocardial infarction thienopyridine therapy ‎]]
#[[Ayurveda ‎]]
#[[Oxatomide ‎]]
#[[Peanut ‎]]
#[[Penis removal ‎]]
#[[Periorbital edema ‎]]
#[[Phalanx bones ‎]]
#[[Poliovirus ‎]]
#[[Abductor pollicis longus muscle ‎]]
#[[Aceruloplasminemia ‎]]
#[[Adenoid cystic carcinoma ‎]]
#[[Agnatha ‎]]
#[[Thoracic splanchnic nerves ‎]]
#[[Transgender ‎]]
#[[Demeclocycline ‎]]
#[[Expected value ‎]]
#[[Extensor carpi radialis longus muscle ‎]]
#[[Yale School of Medicine ‎]]
#[[Colesevelam ‎]]
#[[Gene gun ‎]]
#[[Geographic tongue ‎]]
#[[Gestodene ‎]]
#[[Granule cell ‎]]
#[[Five prime untranslated region ‎]]
#[[Fungicide ‎]]
#[[Gilman reagent ‎]]
#[[Haversian canals ‎]]
#[[Health informatics ‎]]
#[[Pectoralis minor muscle ‎]]
#[[Phenazopyridine ‎]]
#[[Pramipexole (patient information) ‎]]
#[[Hypochondroplasia ‎]]
#[[Inferior alveolar nerve ‎]]
#[[Interlobar arteries ‎]]
#[[Internal iliac vein ‎]]
#[[Lercanidipine ‎]]
#[[Mecamylamine ‎]]
#[[Melancholia ‎]]
#[[Selectable marker ‎]]
#[[Starch ‎]]
#[[Subatomic particle ‎]]
#[[Sulfadiazine (patient information) ‎]]
#[[Automated external defibrillator ‎]]
#[[Benzyl benzoate ‎]]
#[[Bioinorganic chemistry ‎]]
#[[Calcium pangamate ‎]]
#[[Camptothecin ‎]]
#[[Quality Assurance Review Center ‎]]
#[[Reflux nephropathy ‎]]
#[[Reslizumab ‎]]
#[[Rifaximin ‎]]
#[[Schlemm's canal ‎]]
#[[Central retinal artery ‎]]
#[[Cysteine ‎]]
#[[Delusional disorder ‎]]
#[[Dickey-Fuller test ‎]]
#[[Diradical ‎]]
#[[Epirubicin ‎]]
#[[Ferredoxin ‎]]
#[[Acute chest syndrome ‎]]
#[[Adductor longus muscle ‎]]
#[[Anti-thrombin antibodies ‎]]
#[[Viroid ‎]]
#[[Werner syndrome ‎]]
#[[X-linked ichthyosis ‎]]
#[[Zaleplon (patient information) ‎]]
#[[Azole ‎]]
#[[Barotrauma ‎]]
#[[CX717 ‎]]
#[[Hydroxyethylpromethazine ‎]]
#[[Ibopamine ‎]]
#[[Kennedy disease ‎]]
#[[Flexor carpi ulnaris muscle ‎]]
#[[Glass ‎]]
#[[Glottis ‎]]
#[[HLA-A10 ‎]]
#[[Peter Medawar ‎]]
#[[Phenindamine ‎]]
#[[Phenolphthalein ‎]]
#[[Photorefractive keratectomy ‎]]
#[[Prepatellar bursitis ‎]]
#[[Primaquine (patient information) ‎]]
#[[Septum transversum ‎]]
#[[Silent mutation ‎]]
#[[Sphincter ani internus muscle ‎]]
#[[Tannin ‎]]
#[[Temazepam detailed information ‎]]
#[[MicroRNA ‎]]
#[[Model organism ‎]]
#[[Natalizumab ‎]]
#[[Newton's laws of motion ‎]]
#[[Nortriptyline (patient information) ‎]]
#[[Lobo's disease ‎]]
#[[Tinea capitis ‎]]
#[[Titanium dioxide ‎]]
#[[Tixocortol ‎]]
#[[Treatment of Crohn's disease ‎]]
#[[Dimercaptosuccinic acid ‎]]
#[[Docetaxel ‎]]
#[[Dofetilide ‎]]
#[[Environmental sensitivity ‎]]
#[[Extensor digitorum muscle ‎]]
#[[Propensity score ‎]]
#[[Prostaglandin D2 ‎]]
#[[Rethinking a “healthy weight”: New study finds that being overweight is not associated with increased mortality from cardiovascular causes ‎]]
#[[Reviparin ‎]]
#[[Cellular pathology ‎]]
#[[Cerebral venous sinus thrombosis ‎]]
#[[Chlorothiazide ‎]]
#[[Chorea (disease) ‎]]
#[[Chronic stable angina secondary prevention ‎]]
#[[Ciliary body ‎]]
#[[2-Arachidonoylglycerol ‎]]
#[[Alemtuzumab ‎]]
#[[Alexithymia ‎]]
#[[Antimicrosomal antibody ‎]]
#[[Aortography ‎]]
#[[Apoplexy ‎]]
#[[Appendicular skeleton ‎]]
#[[Arbidol ‎]]
#[[Albuterol (patient information) ‎]]
#[[Alcoholics Anonymous ‎]]
#[[Amputee Care Center ‎]]
#[[Anorectic ‎]]
#[[N-Formylmethionine ‎]]
#[[Histapyrrodine ‎]]
#[[Hormonal therapy (oncology) ‎]]
#[[Infraspinatus muscle ‎]]
#[[Ionizing radiation ‎]]
#[[Atovaquone ‎]]
#[[Bayer ‎]]
#[[Bendazac ‎]]
#[[Broad-spectrum antibiotic ‎]]
#[[Calcidiol ‎]]
#[[Semantic pragmatic disorder ‎]]
#[[Short posterior ciliary arteries ‎]]
#[[Sodium fluoride ‎]]
#[[Spindle neuron ‎]]
#[[Standard Anticoagulation Regimen compared to Absence of Anticoagulation for Elective Percutaneous Coronary Intervention: Results from the CIAO Study ‎]]
#[[Superior thyroid artery ‎]]
#[[Flexor hallucis brevis muscle ‎]]
#[[Fluticasone/salmeterol ‎]]
#[[Foot-and-mouth disease ‎]]
#[[Foramen ‎]]
#[[HLA-A69 ‎]]
#[[Orbicularis oculi muscle ‎]]
#[[Outbreak ‎]]
#[[Pachyonychia congenita ‎]]
#[[Pharmacotherapy to Support PCI ‎]]
#[[Praziquantel ‎]]
#[[Characteristic function (probability theory) ‎]]
#[[Chromosome 15 (human) ‎]]
#[[Clonitazene ‎]]
#[[Confidence interval ‎]]
#[[Dysesthesia ‎]]
#[[Enterohepatic circulation ‎]]
#[[Exogenous ‎]]
#[[Ketotifen ‎]]
#[[KvLQT1 ‎]]
#[[Levator ani ‎]]
#[[List of diseases (M) ‎]]
#[[Lone pair ‎]]
#[[Lucid dream ‎]]
#[[Masseter muscle ‎]]
#[[Maximum likelihood ‎]]
#[[Thenar eminence ‎]]
#[[Thyroarytenoid muscle ‎]]
#[[Tocainide ‎]]
#[[Trichloroethylene ‎]]
#[[Variance ‎]]
#[[Protein Z-related protease inhibitor ‎]]
#[[Schwann cell ‎]]
#[[Religion ‎]]
#[[Rutin ‎]]
#[[Food and Agriculture Organization ‎]]
#[[G-test ‎]]
#[[Gait (human) ‎]]
#[[Metatarsalgia ‎]]
#[[Microstomia ‎]]
#[[Miliary tuberculosis ‎]]
#[[Milk of Magnesia ‎]]
#[[Moxonidine ‎]]
#[[Mushroom ‎]]
#[[Nephrotome ‎]]
#[[Non-invasive (medical) ‎]]
#[[Octreotide ‎]]
#[[Oncotic pressure ‎]]
#[[AIDS dementia complex ‎]]
#[[ATC code L04 ‎]]
#[[ATC code N05 ‎]]
#[[Abdominal wall defect ‎]]
#[[Adenosine deaminase ‎]]
#[[Animal virology ‎]]
#[[Anti-apolipoprotein antibodies ‎]]
#[[Aquaporin 2 ‎]]
#[[Shear stress ‎]]
#[[Spinal cord compression ‎]]
#[[Superficial fibular nerve ‎]]
#[[Heptaminol ‎]]
#[[Herbivory ‎]]
#[[Interleukin 1 ‎]]
#[[Intrinsic immunity ‎]]
#[[Body cavity ‎]]
#[[Brachioradialis ‎]]
#[[Cabergoline ‎]]
#[[Calix diverticulum ‎]]
#[[Thonzylamine ‎]]
#[[Tinea versicolor ‎]]
#[[Udenafil ‎]]
#[[Ultraviolet-visible spectroscopy ‎]]
#[[Urachal cyst ‎]]
#[[Ureteroscopy ‎]]
#[[Distal splenorenal shunt procedure ‎]]
#[[Dorsal spinocerebellar tract ‎]]
#[[Endothelin receptor antagonist ‎]]
#[[Enoximone ‎]]
#[[Episiotomy ‎]]
#[[Erector spinae ‎]]
#[[Esmolol ‎]]
#[[FITkit ‎]]
#[[Fahrenheit ‎]]
#[[Felbamate (patient information) ‎]]
#[[Paraventricular nucleus of hypothalamus ‎]]
#[[Perforin ‎]]
#[[Pimecrolimus ‎]]
#[[Polyneuropathy ‎]]
#[[Cervical sinus ‎]]
#[[Chromosome 21 (human) ‎]]
#[[Cigarette ‎]]
#[[Counterimmunoelectrophoresis ‎]]
#[[Cycloalkane ‎]]
#[[Lacteal ‎]]
#[[Lateral horn ‎]]
#[[Leydig cell ‎]]
#[[Lipotropin ‎]]
#[[List of diseases (S) ‎]]
#[[Lithotriptor ‎]]
#[[Medial nasal prominence ‎]]
#[[Lacuna (histology) ‎]]
#[[Mammography ‎]]
#[[Manganese ‎]]
#[[Mannan-binding lectin pathway ‎]]
#[[Mastitis ‎]]
#[[Mebendazole ‎]]
#[[Medulla of ovary ‎]]
#[[Melkersson-Rosenthal syndrome ‎]]
#[[Holoprosencephaly ‎]]
#[[Homeobox ‎]]
#[[Induration ‎]]
#[[Frostbite ‎]]
#[[Genotype ‎]]
#[[Gluteus medius muscle ‎]]
#[[Gravitation ‎]]
#[[HMG-CoA reductase ‎]]
#[[Health insurance ‎]]
#[[Protein in nutrition ‎]]
#[[RNA interference ‎]]
#[[Sphenopalatine artery ‎]]
#[[Submandibular duct ‎]]
#[[Suppository ‎]]
#[[Teres major muscle ‎]]
#[[Tetanic contraction ‎]]
#[[Acrania ‎]]
#[[Anethole ‎]]
#[[Chyluria ‎]]
#[[Clotrimazole ‎]]
#[[Cortisone ‎]]
#[[Crohn's Disease Activity Index ‎]]
#[[Cuboid bone ‎]]
#[[Cutis (anatomy) ‎]]
#[[Degenerative disease ‎]]
#[[Dialysis adequacy ‎]]
#[[Diosmectite ‎]]
#[[Directional selection ‎]]
#[[EcoRI ‎]]
#[[Ectropion ‎]]
#[[Electrophoretic mobility shift assay ‎]]
#[[Ergoline ‎]]
#[[F-test ‎]]
#[[Azo compound ‎]]
#[[Time to Abandon Facilitated PCI: Results from the FINESSE trial ‎]]
#[[Vegetable ‎]]
#[[Ovoviviparity ‎]]
#[[Pachygyria ‎]]
#[[Periodic paralysis ‎]]
#[[Phosphate binders ‎]]
#[[Pityriasis ‎]]
#[[Poisson distribution ‎]]
#[[Polyhistidine-tag ‎]]
#[[Pancreatic veins ‎]]
#[[Pentosan polysulfate ‎]]
#[[Peripherally inserted central catheter ‎]]
#[[Pharyngeal groove ‎]]
#[[Phosphodiester bond ‎]]
#[[Poppy tea ‎]]
#[[Sodium selenite ‎]]
#[[Stroop effect ‎]]
#[[Succinimide ‎]]
#[[Supraspinatus muscle ‎]]
#[[Sydenham's chorea ‎]]
#[[Hydrochloride ‎]]
#[[ICD-10 Chapter XV: Pregnancy, childbirth and the puerperium ‎]]
#[[Keratosis pilaris ‎]]
#[[Klebsiella pneumoniae ‎]]
#[[Saquinavir (patient information) ‎]]
#[[Mold ‎]]
#[[Molybdenum ‎]]
#[[Myristic acid ‎]]
#[[Nasal bone ‎]]
#[[National Center for Research Resources ‎]]
#[[Norfenefrine ‎]]
#[[Occipitalis muscle ‎]]
#[[Omenn syndrome ‎]]
#[[Flumazenil ‎]]
#[[Foam cells ‎]]
#[[Food additive ‎]]
#[[Fosamprenavir (patient information) ‎]]
#[[Fullerene ‎]]
#[[Fusion protein ‎]]
#[[Glasses ‎]]
#[[Gonadotropin ‎]]
#[[Gravidity ‎]]
#[[HLA-A34 ‎]]
#[[Heat map ‎]]
#[[The heart in essential mixed cryoglobulinemia ‎]]
#[[Tinea pedis ‎]]
#[[Triple test ‎]]
#[[Visual impairment ‎]]
#[[WikiDoc News: Acute Coronary Syndromes ‎]]
#[[Efficacy ‎]]
#[[Enhancer (genetics) ‎]]
#[[Eprosartan ‎]]
#[[Ergotamine ‎]]
#[[Extraction (dental) ‎]]
#[[Acheiropodia ‎]]
#[[Alkyne ‎]]
#[[Amplified fragment length polymorphism ‎]]
#[[Carolus Linnaeus ‎]]
#[[Central venous catheter ‎]]
#[[Cobalt ‎]]
#[[Cymarin ‎]]
#[[Cytokines and their receptors ‎]]
#[[Cytopathology ‎]]
#[[Bloodletting ‎]]
#[[Board review draft ‎]]
#[[Baruch Samuel Blumberg ‎]]
#[[Basic metabolic panel ‎]]
#[[Brodmann area 25 ‎]]
#[[Cardinal veins ‎]]
#[[Caries ‎]]
#[[Micromastia ‎]]
#[[National Institute on Alcohol Abuse and Alcoholism ‎]]
#[[Neonatal jaundice ‎]]
#[[Sedation ‎]]
#[[Sever's disease ‎]]
#[[Skull fracture ‎]]
#[[Steatosis ‎]]
#[[Taq polymerase ‎]]
#[[Organic acid ‎]]
#[[Papaverine ‎]]
#[[Persistent fetal circulation ‎]]
#[[Phenmetrazine ‎]]
#[[Phosphate homeostasis ‎]]
#[[Piroxicam ‎]]
#[[Plantar fasciitis ‎]]
#[[Pleural empyema ‎]]
#[[Polynucleotide ‎]]
#[[Posterior cutaneous nerve of forearm ‎]]
#[[Postmature birth ‎]]
#[[Protein tag ‎]]
#[[Randomization ‎]]
#[[Retrognathism ‎]]
#[[Revascularization in the "No Option" patient ‎]]
#[[Rhabdomyoma ‎]]
#[[Rodney Robert Porter ‎]]
#[[Scandinavian Simvastatin Survival Study ‎]]
#[[Scrofula ‎]]
#[[Icosahedron ‎]]
#[[Ileocolic artery ‎]]
#[[Inferior temporal gyrus ‎]]
#[[Limb-girdle muscular dystrophy ‎]]
#[[List of ICD-9 codes 320-359: Diseases of the nervous system ‎]]
#[[Lymphangioleiomyomatosis ‎]]
#[[Cefepime ‎]]
#[[Choroideremia ‎]]
#[[Cryptobiosis ‎]]
#[[Doxepin ‎]]
#[[Electrical network ‎]]
#[[Enoxolone ‎]]
#[[Entacapone (patient information) ‎]]
#[[Esophageal motility disorder ‎]]
#[[Fibular artery ‎]]
#[[Foreign body ‎]]
#[[Francis Peyton Rous ‎]]
#[[Glucuronosyltransferase ‎]]
#[[HLA-A1 ‎]]
#[[HLA-A26 ‎]]
#[[Thoracic nerves ‎]]
#[[Toxicogenomics ‎]]
#[[Abductor hallucis muscle ‎]]
#[[Aniseikonia ‎]]
#[[Anterior communicating artery ‎]]
#[[Anti-actin antibodies ‎]]
#[[Acalculia ‎]]
#[[Altrose ‎]]
#[[Hot flash ‎]]
#[[Hydrogen cyanide ‎]]
#[[Hyperchloremic acidosis ‎]]
#[[Hypertriglyceridemia ‎]]
#[[Idursulfase ‎]]
#[[International unit ‎]]
#[[James W. Black ‎]]
#[[Joint Commission ‎]]
#[[Metalloproteinase ‎]]
#[[Miller-Dieker syndrome ‎]]
#[[Monosomy ‎]]
#[[Nedocromil ‎]]
#[[Nucleolus ‎]]
#[[Zonule of Zinn ‎]]
#[[Asexual reproduction ‎]]
#[[Bartonella ‎]]
#[[Blister agent ‎]]
#[[Bromide ‎]]
#[[Cadherin ‎]]
#[[Psychiatrist ‎]]
#[[Side chain ‎]]
#[[Sitaxsentan ‎]]
#[[Somatic cell ‎]]
#[[Sucralfate ‎]]
#[[Systems biology ‎]]
#[[Taxane ‎]]
#[[Optic disc ‎]]
#[[Oxandrolone ‎]]
#[[Poison ivy ‎]]
#[[Polycystic liver disease ‎]]
#[[Pristinamycin ‎]]
#[[Probit ‎]]
#[[The Lancet ‎]]
#[[Thioridazine (patient information) ‎]]
#[[Trichomonas vaginalis ‎]]
#[[Doxacurium chloride ‎]]
#[[Erythroleukemia ‎]]
#[[Leukotriene antagonist ‎]]
#[[Mahalanobis distance ‎]]
#[[Chemostat ‎]]
#[[Clodronate ‎]]
#[[Codon usage bias ‎]]
#[[Cost effectiveness in cardiovascular disease ‎]]
#[[Fibromatosis ‎]]
#[[Glucocorticoids ‎]]
#[[HLA-B46 ‎]]
#[[HOMO/LUMO ‎]]
#[[Food chemistry ‎]]
#[[Fragment crystallizable region ‎]]
#[[Germline ‎]]
#[[HLA-B5 ‎]]
#[[Healing ‎]]
#[[Heart attack care center ‎]]
#[[Hepatitis B virus ‎]]
#[[Septum intermedium ‎]]
#[[Small saphenous vein ‎]]
#[[Syncytium ‎]]
#[[Metamorphosis ‎]]
#[[Methapyrilene ‎]]
#[[Methoxypropane ‎]]
#[[Metropolis-Hastings algorithm ‎]]
#[[Middle pharyngeal constrictor muscle ‎]]
#[[Ménétrier's disease ‎]]
#[[NHS and Community Care Act (1990) ‎]]
#[[Naphthoquinone ‎]]
#[[Olfactory receptor ‎]]
#[[Middle pharyngeal constrictor muscle ‎]]
#[[Ménétrier's disease ‎]]
#[[NHS and Community Care Act (1990) ‎]]
#[[Naphthoquinone ‎]]
#[[Olfactory receptor ‎]]
#[[Paleopolyploidy ‎]]
#[[Pegaspargase (patient information) ‎]]
#[[Pericardial friction rub ‎]]
#[[Pharmacodynamics ‎]]
#[[Posterior auricular artery ‎]]
#[[Posterior segment ‎]]
#[[Dermatophyte ‎]]
#[[Edmonton protocol ‎]]
#[[Food chemistry ‎]]
#[[Fragment crystallizable region ‎]]
#[[Germline ‎]]
#[[HLA-B5 ‎]]
#[[Healing ‎]]
#[[Heart attack care center ‎]]
#[[Hepatitis B virus ‎]]
#[[News:Clinical data support the non-inferiority of continuous chest compressions compared with conventional cardiopulmonary resuscitation ‎]]
#[[Lumiracoxib ‎]]
#[[Pulpitis ‎]]
#[[Pyonephrosis ‎]]
#[[Rhythm and other relevant findings answer (July 2008) ‎]]
#[[Chlortalidone ‎]]
#[[Corpus spongiosum penis ‎]]
#[[Costamere ‎]]
#[[Daptomycin ‎]]
#[[Data ‎]]
#[[University of Kansas ‎]]
#[[Vitrectomy ‎]]
#[[Warkany syndrome 2 ‎]]
#[[Asthenia ‎]]
#[[Asymmetric synthesis ‎]]
#[[Atrial canal ‎]]
#[[Auxology ‎]]
#[[Biological database ‎]]
#[[Bisacodyl ‎]]
#[[Carnitine palmitoyltransferase I deficiency ‎]]
#[[Septum intermedium ‎]]
#[[Small saphenous vein ‎]]
#[[Syncytium ‎]]
#[[Skin appendages ‎]]
#[[Solifenacin ‎]]
#[[Wikipedia:External links ‎]]
#[[Zori Stalker Williams syndrome ‎]]
#[[Metalloproteinases (MMPs) ‎]]
#[[Mixed disorder of acid-base balance ‎]]
#[[National Institute of Biomedical Imaging and Bioengineering ‎]]
#[[Nephropexy ‎]]
#[[Nested case-control study ‎]]
#[[Nitrite ‎]]
#[[Nucleoporin 210kDa ‎]]
#[[Olecranon bursitis ‎]]
#[[Abu al-Qasim al-Zahrawi ‎]]
#[[Almond ‎]]
#[[Arbutamine ‎]]
#[[Hydrogenation ‎]]
#[[Hyperemesis gravidarum ‎]]
#[[Intein ‎]]
#[[Fraser syndrome ‎]]
#[[Gastric chief cell ‎]]
#[[Gregor Mendel ‎]]
#[[HLA-A68 ‎]]
#[[HLA-DQ2 ‎]]
#[[Paravertebral ganglia ‎]]
#[[Platelet-derived growth factor ‎]]
#[[Deltoid muscle ‎]]
#[[Electromagnetism ‎]]
#[[Epistasis ‎]]
#[[Ethylene oxide ‎]]
#[[Eugenol ‎]]
#[[Extensor digitorum brevis muscle ‎]]
#[[External jugular vein ‎]]
#[[Basal ganglia ‎]]
#[[Bloody show ‎]]
#[[Brimonidine ‎]]
#[[Calcipotriol ‎]]
#[[Cardiovascular Anatomy ‎]]
#[[Chaperone (protein) ‎]]
#[[Chloromethane ‎]]
#[[Citric acid ‎]]
#[[Conradi-Hünermann syndrome ‎]]
#[[Renal fascia ‎]]
#[[Renal papilla ‎]]
#[[Renal pelvis ‎]]
#[[Sagittal plane ‎]]
#[[Tick ‎]]
#[[Trichromacy ‎]]
#[[Ventral root ‎]]
#[[Opisthotonus ‎]]
#[[Otic ganglion ‎]]
#[[Pancreatic duct ‎]]
#[[Pathogenesis ‎]]
#[[Pinta (disease) ‎]]
#[[Pneumococcal polysaccharide vaccine (patient information) ‎]]
#[[Portable Document Format ‎]]
#[[Premarin ‎]]
#[[Metabolite ‎]]
#[[Methocarbamol ‎]]
#[[Methysergide ‎]]
#[[Mixed gonadal dysgenesis ‎]]
#[[National Institute on Drug Abuse ‎]]
#[[New study uses gene variants to predict cardiovascular risk ‎]]
#[[Sponge ‎]]
#[[Surgical oncology ‎]]
#[[Fludarabine ‎]]
#[[Formate ‎]]
#[[Gammaproteobacteria ‎]]
#[[Gerty Cori ‎]]
#[[Gonadotropins ‎]]
#[[HLA-A23 ‎]]
#[[Acarbose ‎]]
#[[Adrenalone ‎]]
#[[Alpha 1-antichymotrypsin ‎]]
#[[Aponeurosis ‎]]
#[[Holocrine ‎]]
#[[Holter monitor ‎]]
#[[Human Tissue Authority ‎]]
#[[Hyper IgM syndrome ‎]]
#[[Ibandronic acid ‎]]
#[[Jejunum ‎]]
#[[Receptor theory ‎]]
#[[Renal clearance ratio ‎]]
#[[Reptile ‎]]
#[[Rhinophyma ‎]]
#[[Bacillary angiomatosis ‎]]
#[[Bevirimat ‎]]
#[[Bronchiolitis obliterans ‎]]
#[[Budesonide/formoterol ‎]]
#[[C3 (complement) ‎]]
#[[Calcium lactate gluconate ‎]]
#[[Kumada coupling ‎]]
#[[Lipase ‎]]
#[[Macrocephaly ‎]]
#[[Downregulation ‎]]
#[[Esophagectomy ‎]]
#[[Exenatide ‎]]
#[[Center for Scientific Review ‎]]
#[[Christiaan Barnard ‎]]
#[[Clitoris enlargement ‎]]
#[[Cloricromen ‎]]
#[[Contingency table ‎]]
#[[Curare ‎]]
#[[Cycloserine ‎]]
#[[DNA-DNA hybridization ‎]]
#[[Cerebellar tonsil ‎]]
#[[Chlorcyclizine ‎]]
#[[Conalbumin ‎]]
#[[Costal cartilages ‎]]
#[[Aldol reaction ‎]]
#[[Allantois ‎]]
#[[Arcuate arteries of the kidney ‎]]
#[[Arrectores pilorum ‎]]
#[[Oxybuprocaine ‎]]
#[[Oxybutynin ‎]]
#[[Pectus carinatum ‎]]
#[[Pneumococcal conjugate vaccine ‎]]
#[[Posterior border of lung ‎]]
#[[Probability mass function ‎]]
#[[Tiadenol ‎]]
#[[Tooth loss ‎]]
#[[Triage ‎]]
#[[University of California, Davis ‎]]
#[[Flurbiprofen ‎]]
#[[Glanders ‎]]
#[[Gubernaculum ‎]]
#[[HLA-A36 ‎]]
#[[Helen B. Taussig ‎]]
#[[Mevalonate kinase ‎]]
#[[Momentum ‎]]
#[[Myotome ‎]]
#[[Nefopam ‎]]
#[[Number needed to harm ‎]]
#[[Self-esteem ‎]]
#[[Sensory Integration Dysfunction ‎]]
#[[Sodium iodide ‎]]
#[[Sprengel's deformity ‎]]
#[[Taxonomic rank ‎]]
#[[Diagnostic immunology ‎]]
#[[Diaper rash ‎]]
#[[Distal phalanges ‎]]
#[[Dorsal interossei of the foot ‎]]
#[[Dorsal nasal artery ‎]]
#[[Enteroglucagon ‎]]
#[[Bacilli ‎]]
#[[Bioethics ‎]]
#[[Bradykinesia ‎]]
#[[Bulbospongiosus muscle ‎]]
#[[Carbasalate calcium ‎]]
#[[Hexylresorcinol ‎]]
#[[Histocompatibility ‎]]
#[[Hysterotomy ‎]]
#[[Insemination ‎]]
#[[Intercalated disc ‎]]
#[[Intracranial berry aneurysm ‎]]
#[[Intramolecular ‎]]
#[[Kerley lines ‎]]
#[[Pseudogene ‎]]
#[[Purinergic receptor ‎]]
#[[Relative risk reduction ‎]]
#[[Renal compensation ‎]]
#[[Risk assessment ‎]]
#[[Sample (statistics) ‎]]
#[[Sarcoma botryoides ‎]]
#[[Lapatinib ‎]]
#[[Latanoprost ‎]]
#[[Linagliptin ‎]]
#[[Measure (mathematics) ‎]]
#[[Lorcainide ‎]]
#[[Malachite green ‎]]
#[[Microsatellite ‎]]
#[[Mineral oil ‎]]
#[[Moment (mathematics) ‎]]
#[[National Institute for Occupational Safety and Health ‎]]
#[[Oncolytic virus ‎]]
#[[Abiogenesis ‎]]
#[[Acetyldigoxin ‎]]
#[[Alfuzosin ‎]]
#[[All signs and symptoms ‎]]
#[[Anisometropia ‎]]
#[[Anti-glycoprotein-210 antibodies ‎]]
#[[Antivenom ‎]]
#[[Aprindine ‎]]
#[[Arsenic trioxide ‎]]
#[[Caroli's disease ‎]]
#[[Cefditoren ‎]]
#[[Clofezone ‎]]
#[[Forest plot ‎]]
#[[Gastrula ‎]]
#[[Gluteus minimus muscle ‎]]
#[[Goserelin ‎]]
#[[Gray ramus communicans ‎]]
#[[Gyrus ‎]]
#[[HLA-A19 ‎]]
#[[HLA-A3 ‎]]
#[[Haplotype ‎]]
#[[Oxidative phosphorylation ‎]]
#[[Plasma (physics) ‎]]
#[[Posterior probability ‎]]
#[[Precordial thump ‎]]
#[[Primitive palate ‎]]
#[[Tositumomab ‎]]
#[[Troponin I ‎]]
#[[Ureterocele ‎]]
#[[Rabson-Mendenhall syndrome ‎]]
#[[Regulation of gene expression ‎]]
#[[Rhizotomy ‎]]
#[[Schizencephaly ‎]]
#[[Aspergillosis ‎]]
#[[Baldness treatments ‎]]
#[[Basement membrane ‎]]
#[[Beilstein database ‎]]
#[[Biological hazard ‎]]
#[[Calcium in biology ‎]]
#[[Carbon-carbon bond ‎]]
#[[Spinal analgesia ‎]]
#[[Substituent ‎]]
#[[Talastine ‎]]
#[[Disability-adjusted life years ‎]]
#[[Dural venous sinuses ‎]]
#[[Eparterial bronchus ‎]]
#[[Humphry Davy ‎]]
#[[Immunohaematology ‎]]
#[[Iliacus muscle ‎]]
#[[Immunogenetics ‎]]
#[[Insulin-like growth factor 1 ‎]]
#[[Intensive insulinotherapy (patient information) ‎]]
#[[Oxygen saturation ‎]]
#[[PCI Complications: "No-Reflow" ‎]]
#[[Pandemic Severity Index ‎]]
#[[Pot-in-pot refrigerator ‎]]
#[[Primary amoebic meningoencephalitis ‎]]
#[[Micro- ‎]]
#[[Midclavicular line ‎]]
#[[Motor nerve ‎]]
#[[Obstructive uropathy ‎]]
#[[Klatskin tumor ‎]]
#[[Lathyrism ‎]]
#[[List of diseases (R) ‎]]
#[[Locked-In syndrome ‎]]
#[[Magnesium carbonate ‎]]
#[[Magnetic resonance molecular imaging ‎]]
#[[Mating ‎]]
#[[Mauveine ‎]]
#[[Mediastinoscopy ‎]]
#[[Yersinia pestis ‎]]
#[[Zalcitabine (patient information) ‎]]
#[[Fibular veins ‎]]
#[[Free nerve ending ‎]]
#[[Greater occipital nerve ‎]]
#[[H5N3 ‎]]
#[[HLA-A31 ‎]]
#[[HLA-A9 ‎]]
#[[HLA-B47 ‎]]
#[[HLA-B53 ‎]]
#[[2C-B-BZP ‎]]
#[[ATC code N07 ‎]]
#[[Amoebozoa ‎]]
#[[Amrinone ‎]]
#[[Anterior tongue ‎]]
#[[Anthraquinone ‎]]
#[[Chlortetracycline ‎]]
#[[Dendritic spine ‎]]
#[[Diallyllysergamide ‎]]
#[[Diflunisal ‎]]
#[[Dimethylethanolamine ‎]]
#[[Drunkenness ‎]]
#[[Encephalitis lethargica ‎]]
#[[Epinastine ‎]]
#[[Estazolam ‎]]
#[[Family (biology) ‎]]
#[[Atenolol (patient information) ‎]]
#[[Atomic number ‎]]
#[[Base of lung ‎]]
#[[Benzyl ‎]]
#[[Biogenic amine ‎]]
#[[Bk-MBDB ‎]]
#[[Boron group ‎]]
#[[Brodmann area 5 ‎]]
#[[Cardioversion ‎]]
#[[Topiramate ‎]]
#[[Trandolapril ‎]]
#[[Truncus arteriosus (embryology) ‎]]
#[[Tumor lysis syndrome ‎]]
#[[Urea cycle ‎]]
#[[Uterine horns ‎]]
#[[Pseudobulbar palsy ‎]]
#[[Pyruvate dehydrogenase ‎]]
#[[SN2 reaction ‎]]
#[[Saccharomyces boulardii ‎]]
#[[Serotonin receptor agonist ‎]]
#[[Small bowel bacterial overgrowth syndrome ‎]]
#[[Sudden infant death syndrome ‎]]
#[[TRANSCEND Study suggests that telmisartan reduces cardiovascular events ‎]]
#[[Sodium acetate ‎]]
#[[Sodium citrate ‎]]
#[[Stereocilia ‎]]
#[[Sulfa drug ‎]]
#[[Synchondrosis ‎]]
#[[Taurine ‎]]
#[[ATC code C07 ‎]]
#[[Acetylene ‎]]
#[[Alcohol withdrawal ‎]]
#[[Aldehyde dehydrogenase ‎]]
#[[Ampulla of uterine tube ‎]]
#[[Aniracetam ‎]]
#[[Antisense ‎]]
#[[Antithrombin Therapy to Support PCI (patient information) ‎]]
#[[Antithyroid microsomal antibodies ‎]]
#[[Metanephric blastema ‎]]
#[[Metaraminol ‎]]
#[[Morula ‎]]
#[[National Institute of Environmental Health Sciences ‎]]
#[[Neurosis ‎]]
#[[Ibutilide ‎]]
#[[Pentane ‎]]
#[[Phase (matter) ‎]]
#[[Posterior commissure of labia ‎]]
#[[Flammability ‎]]
#[[Flexor digitorum longus muscle ‎]]
#[[GUS reporter system ‎]]
#[[Gibbs free energy ‎]]
#[[Glands of Moll ‎]]
#[[Goose bumps ‎]]
#[[Gracilis muscle ‎]]
#[[Greater curvature of the stomach ‎]]
#[[H3N2 ‎]]
#[[HLA-A74 ‎]]
#[[Kidney abscess ‎]]
#[[Kleptomania ‎]]
#[[Labiaplasty ‎]]
#[[Levator labii superioris ‎]]
#[[Levator veli palatini ‎]]
#[[Medical prefixes, suffixes, and combining forms ‎]]
#[[Membrane ‎]]
#[[Williams syndrome ‎]]
#[[Progestogen only pill ‎]]
#[[Recurrent laryngeal nerve ‎]]
#[[Regression analysis ‎]]
#[[Respiratory tract infection ‎]]
#[[Rhesus Macaque ‎]]
#[[Baritosis ‎]]
#[[Biomaterial ‎]]
#[[Butalbital ‎]]
#[[Calcium fluoride ‎]]
#[[Cardiac index ‎]]
#[[Cardiac notch of left lung ‎]]
#[[Cefaclor ‎]]
#[[Cefdinir ‎]]
#[[Chiral ligand ‎]]
#[[Chromosome 11 (human) ‎]]
#[[Chronic stable angina rehabilitation ‎]]
#[[Condensation ‎]]
#[[Cysteamine ‎]]
#[[Dacarbazine ‎]]
#[[Deep fibular nerve ‎]]
#[[DermAtlas ‎]]
#[[Drug development ‎]]
#[[Dwarfism ‎]]
#[[Tolmetin ‎]]
#[[Tolperisone ‎]]
#[[United Network for Organ Sharing ‎]]
#[[Uterine transplant ‎]]
#[[Ventriculostomy ‎]]
#[[Triazolam ‎]]
#[[Vertebrobasilar insufficiency ‎]]
#[[White sponge nevus ‎]]
#[[Kleihauer-Betke test ‎]]
#[[Left lobe of liver ‎]]
#[[Left marginal artery ‎]]
#[[List of autoimmune diseases ‎]]
#[[Logrank test ‎]]
#[[Macula densa ‎]]
#[[Mescaline ‎]]
#[[Mother ‎]]
#[[Nav1.7 ‎]]
#[[NeuroNames ‎]]
#[[Spinocerebellar ataxia ‎]]
#[[Stress ‎]]
#[[Strongyloidiasis ‎]]
#[[Supination ‎]]
#[[TRPA (channel) ‎]]
#[[Terlipressin ‎]]
#[[ATC code M01 ‎]]
#[[Androgen receptor ‎]]
#[[Anterior border of lung ‎]]
#[[Antoine Lavoisier ‎]]
#[[Filtration ‎]]
#[[Foramen cecum (tongue) ‎]]
#[[Framingham Heart Study ‎]]
#[[Fugue state ‎]]
#[[Glucocerebroside ‎]]
#[[Gomphosis ‎]]
#[[HELLP syndrome ‎]]
#[[Hospital medicine ‎]]
#[[Hypoplastic right heart syndrome ‎]]
#[[Joseph L. Goldstein ‎]]
#[[Optic atrophy ‎]]
#[[PDE3 inhibitor ‎]]
#[[Parietal pleura ‎]]
#[[Pemetrexed ‎]]
#[[Pentose phosphate pathway ‎]]
#[[Perimetrium ‎]]
#[[Perioral dermatitis ‎]]
#[[Platinum ‎]]
#[[Pridinol ‎]]
#[[Detrusor urinae muscle ‎]]
#[[Dopamine receptor ‎]]
#[[Ephedra ‎]]
#[[Erythromelalgia ‎]]
#[[C5a ‎]]
#[[CD4 ‎]]
#[[Canaliculus (bone) ‎]]
#[[Canrenone ‎]]
#[[Young's modulus ‎]]
#[[Zeolite ‎]]
#[[Protamine sulfate ‎]]
#[[Purine nucleoside phosphorylase deficiency ‎]]
#[[Pyrrobutamine ‎]]
#[[Radiopharmacology ‎]]
#[[Rho(D) Immune Globulin ‎]]
#[[Root of the hair ‎]]
#[[Clostebol ‎]]
#[[Combat Methamphetamine Epidemic Act of 2005 ‎]]
#[[Cutis marmorata telangiectatica congenita ‎]]
#[[Cytolysin ‎]]
#[[Decompressive craniectomy ‎]]
#[[Chromalveolate ‎]]
#[[Chromosome 5 (human) ‎]]
#[[Cladistics ‎]]
#[[Cloxazolam ‎]]
#[[Cobamamide ‎]]
#[[Correlation does not imply causation ‎]]
#[[Crown (dentistry) ‎]]
#[[DNA-DNA reassociation ‎]]
#[[DNA vaccination ‎]]
#[[Hypnosis ‎]]
#[[Idiotype ‎]]
#[[Insect ‎]]
#[[Interferon beta-1b ‎]]
#[[Internal pudendal artery ‎]]
#[[International Standard Serial Number ‎]]
#[[Ionic compound ‎]]
#[[Iron(III) chloride ‎]]
#[[Irritable hip ‎]]
#[[Kell antigen system ‎]]
#[[Methaemoglobin ‎]]
#[[National Institute of Dental and Craniofacial Research ‎]]
#[[Neurinoma ‎]]
#[[Niels Ryberg Finsen ‎]]
#[[Olaflur ‎]]
#[[Tic ‎]]
#[[Trabecular meshwork ‎]]
#[[Tracheal rings ‎]]
#[[Troxerutin ‎]]
#[[Lower motor neuron ‎]]
#[[Lymphocytic choriomeningitis ‎]]
#[[Fourth nerve palsy ‎]]
#[[Hypnosis ‎]]
#[[Idiotype ‎]]
#[[Insect ‎]]
#[[Interferon beta-1b ‎]]
#[[Internal pudendal artery ‎]]
#[[International Standard Serial Number ‎]]
#[[Ionic compound ‎]]
#[[Iron(III) chloride ‎]]
#[[Irritable hip ‎]]
#[[Kell antigen system ‎]]
#[[Skewness ‎]]
#[[Sodium carbonate ‎]]
#[[Spiro Nikolouzos ‎]]
#[[Structural genomics ‎]]
#[[Superior cervical ganglion ‎]]
#[[Tachykinin peptides ‎]]
#[[Chromalveolate ‎]]
#[[Chromosome 5 (human) ‎]]
#[[Cladistics ‎]]
#[[Cloxazolam ‎]]
#[[Cobamamide ‎]]
#[[Correlation does not imply causation ‎]]
#[[Crown (dentistry) ‎]]
#[[DNA-DNA reassociation ‎]]
#[[DNA vaccination ‎]]
#[[Optic vesicles ‎]]
#[[Penile agenesis ‎]]
#[[Psychological abuse ‎]]
#[[Psychologist ‎]]
#[[Pulmonary angiography ‎]]
#[[Rauwolfia ‎]]
#[[Reproductive endocrinology and infertility ‎]]
#[[Fourth nerve palsy ‎]]
#[[Glycogen phosphorylase ‎]]
#[[HLA-B*83 ‎]]
#[[Har Gobind Khorana ‎]]
#[[Hay-Wells syndrome ‎]]
#[[Hemispherectomy ‎]]
#[[Flexor retinaculum of the hand ‎]]
#[[HLA-A11 ‎]]
#[[HLA-A32 ‎]]
#[[HLA-A33 ‎]]
#[[HLA-DP ‎]]
#[[Kurtosis ‎]]
#[[Medial pectoral nerve ‎]]
#[[Melitracen ‎]]
#[[United States National Academy of Sciences ‎]]
#[[Vasogenic edema ‎]]
#[[Dimetofrine ‎]]
#[[Disorganized schizophrenia ‎]]
#[[Duct of Bellini ‎]]
#[[Merkel nerve ending ‎]]
#[[Mesosalpinx ‎]]
#[[Neck pain ‎]]
#[[Nested polymerase chain reaction ‎]]
#[[Nizatidine (patient information) ‎]]
#[[NuvaRing ‎]]
#[[Oblique fissure ‎]]
#[[2-Phenylphenol ‎]]
#[[2008 bird flu outbreak in West Bengal ‎]]
#[[5-Methoxy-diisopropyltryptamine ‎]]
#[[ATC code M02 ‎]]
#[[Accessory breast ‎]]
#[[American College of Cardiology ‎]]
#[[Andrology ‎]]
#[[Asymmetric crying facies ‎]]
#[[Behavioural sciences ‎]]
#[[Biodegradation ‎]]
#[[Bird flu in India ‎]]
#[[Calorie restriction ‎]]
#[[Wright's stain ‎]]
#[[Pulmonary aspiration ‎]]
#[[Quadratus femoris muscle ‎]]
#[[Quality of life ‎]]
#[[Rilmenidine ‎]]
#[[Royal jelly ‎]]
#[[Schizoaffective disorder ‎]]
#[[Cochran's theorem ‎]]
#[[Commensalism ‎]]
#[[Cystadenocarcinoma ‎]]
#[[Cytomegalic Inclusion Body Disease ‎]]
#[[Hepatology ‎]]
#[[Johnson & Johnson ‎]]
#[[Social sciences ‎]]
#[[Sodium nitrite ‎]]
#[[Surgical pathology ‎]]
#[[Sympathetic ganglion ‎]]
#[[Tabun (nerve agent) ‎]]
#[[PEGylation ‎]]
#[[Peruvoside ‎]]
#[[Pleocytosis ‎]]
#[[Porin (protein) ‎]]
#[[Primary care ‎]]
#[[Principal components analysis ‎]]
#[[Pathophysiology ‎]]
#[[Plasmacytoma ‎]]
#[[Polycyclic aromatic hydrocarbon ‎]]
#[[Processus vaginalis ‎]]
#[[Bernoulli distribution ‎]]
#[[Biceps femoris muscle ‎]]
#[[Body water ‎]]
#[[Theodrenaline ‎]]
#[[Tramazoline ‎]]
#[[Vertebral notch ‎]]
#[[Vesical tenesmus ‎]]
#[[Visual field ‎]]
#[[Wide pulse pressure ‎]]
#[[Firmicutes ‎]]
#[[Framycetin ‎]]
#[[Fulvestrant ‎]]
#[[Furazabol ‎]]
#[[George Davis Snell ‎]]
#[[Germinal epithelium (female) ‎]]
#[[Gerontology ‎]]
#[[Granuloma faciale ‎]]
#[[HLA-B60 ‎]]
#[[Laryngotracheal groove ‎]]
#[[Mephentermine ‎]]
#[[ATC code V03 ‎]]
#[[Abnormal basal metabolic rate ‎]]
#[[Accessory meningeal artery ‎]]
#[[Advanced trauma life support ‎]]
#[[Allvar Gullstrand ‎]]
#[[Alminoprofen ‎]]
#[[Aprotinin ‎]]
#[[Dipivefrine ‎]]
#[[Dissociative drug ‎]]
#[[Dream ‎]]
#[[Emedastine ‎]]
#[[Enterogastrone ‎]]
#[[Extrafusal muscle fiber ‎]]
#[[Fetal hemoglobin ‎]]
#[[Monoterpene ‎]]
#[[Multipotency ‎]]
#[[Multivariate normal distribution ‎]]
#[[New drug application ‎]]
#[[Nilotinib ‎]]
#[[Sermorelin ‎]]
#[[Smallpox vaccine ‎]]
#[[Solid ‎]]
#[[TRPV1 ‎]]
#[[Compliance (medicine) ‎]]
#[[Cronkhite–Canada disease ‎]]
#[[Dartos ‎]]
#[[Γδ T cells ‎]]
#[[Puestow procedure ‎]]
#[[Pyramidalis muscle ‎]]
#[[Quinethazone ‎]]
#[[Regional odontodysplasia ‎]]
#[[Resection ‎]]
#[[Rhizaria ‎]]
#[[Hyaline cartilage ‎]]
#[[Hypokalemic periodic paralysis ‎]]
#[[Intestinal juice ‎]]
#[[Intoxication ‎]]
#[[Hermansky-Pudlak syndrome ‎]]
#[[Hyoglossus ‎]]
#[[Influenza treatment ‎]]
#[[Informed consent ‎]]
#[[Inion ‎]]
#[[Interlabial sulci ‎]]
#[[Isosthenuria ‎]]
#[[Distillation ‎]]
#[[Drotaverine ‎]]
#[[ESR ‎]]
#[[Epiblast ‎]]
#[[Eye movement ‎]]
#[[F-distribution ‎]]
#[[Vaginoplasty ‎]]
#[[Pancreatectomy ‎]]
#[[Panitumumab ‎]]
#[[Parasympathomimetics ‎]]
#[[Parathyroid chief cell ‎]]
#[[Parts-per notation ‎]]
#[[Potassium canrenoate ‎]]
#[[Aspartame ‎]]
#[[Biomedical tissue ‎]]
#[[CD117 ‎]]
#[[Cafedrine ‎]]
#[[1,3-Butadiene ‎]]
#[[4-HO-MiPT ‎]]
#[[Acemetacin ‎]]
#[[Advanced practice nurse ‎]]
#[[Alfred Hershey ‎]]
#[[Amniocentesis ‎]]
#[[Anterior cingulate cortex ‎]]
#[[Forearm ‎]]
#[[GABAA receptor ‎]]
#[[HLA-B41 ‎]]
#[[Helium ‎]]
#[[Kleine-Levin syndrome ‎]]
#[[Linea negra ‎]]
#[[Pseudocyesis ‎]]
#[[Q-Q plot ‎]]
#[[Reflex arc ‎]]
#[[Resistivity ‎]]
#[[ST elevation myocardial infarction glycoprotein IIbIIIa inhibition ‎]]
#[[Chronic stable angina prognosis ‎]]
#[[Co-dydramol ‎]]
#[[Cochlear nuclei ‎]]
#[[Conduct disorder ‎]]
#[[Craniotomy ‎]]
#[[Data mining ‎]]
#[[Monoamine neurotransmitter ‎]]
#[[Moricizine ‎]]
#[[Nemaline myopathy ‎]]
#[[Odds ‎]]
#[[Self-expandable metallic stent ‎]]
#[[Shigella ‎]]
#[[Superoxide ‎]]
#[[TPAP ‎]]
#[[Teres minor muscle ‎]]
#[[Z-factor ‎]]
#[[Zinc gluconate ‎]]
#[[Flat bone ‎]]
#[[The Physical Examination in Cardiovascular Disease: The Extremities ‎]]
#[[Thumbprint sign ‎]]
#[[Tonicity ‎]]
#[[Triazole ‎]]
#[[Unequal leg length ‎]]
#[[Vesicointestinal fistula ‎]]
#[[Her 3 ‎]]
#[[Hypnagogia ‎]]
#[[Id, ego, and super-ego ‎]]
#[[Imiquimod ‎]]
#[[Indoramin ‎]]
#[[Iron supplements ‎]]
#[[Dequalinium ‎]]
#[[Disruptive selection ‎]]
#[[ELISPOT ‎]]
#[[Eosinophilic ‎]]
#[[Fatty streak ‎]]
#[[Acronyms of Clinical Trial Names ‎]]
#[[Adderall drug interactions ‎]]
#[[Alloimmunity ‎]]
#[[Allotransplantation ‎]]
#[[Alveolate ‎]]
#[[Aminolevulinic acid synthase ‎]]
#[[Organic Syntheses ‎]]
#[[Oxaprozin ‎]]
#[[Pars intermedia ‎]]
#[[Posaconazole (patient information) ‎]]
#[[Bicalutamide ‎]]
#[[Blepharoplasty ‎]]
#[[CMR image acquisition protocols ‎]]
#[[Campylobacter ‎]]
#[[TNF inhibitor ‎]]
#[[Cerebellar vermis ‎]]
#[[Choroid plexus tumor ‎]]
#[[Chromium deficiency ‎]]
#[[Cicletanine ‎]]
#[[Cleavage (embryo) ‎]]
#[[Click chemistry ‎]]
#[[Cortical lobule ‎]]
#[[Deep dorsal vein of the penis ‎]]
#[[Deflazacort ‎]]
#[[Levamisole ‎]]
#[[Mathematical modelling in epidemiology ‎]]
#[[Mayer-Rokitansky-Hauser syndrome ‎]]
#[[Progestin ‎]]
#[[Retinitis ‎]]
#[[Methylation ‎]]
#[[National Institute of General Medical Sciences ‎]]
#[[Muromonab-CD3 ‎]]
#[[Oligoastrocytoma ‎]]
#[[Pasteurella multocida ‎]]
#[[Thioxanthene ‎]]
#[[Thomas Bayes ‎]]
#[[Torsten Wiesel ‎]]
#[[Virus classification ‎]]
#[[Zafirlukast ‎]]
#[[Gene copy number ‎]]
#[[Gluteal muscles ‎]]
#[[Golfer's elbow ‎]]
#[[Hair removal ‎]]
#[[2C-I ‎]]
#[[Adrenalectomy ‎]]
#[[Aluminium nicotinate ‎]]
#[[Amantadine (patient information) ‎]]
#[[Amyloid beta ‎]]
#[[Antisocial personality disorder ‎]]
#[[Hydrophobic effect ‎]]
#[[Iliac crest ‎]]
#[[Immunoglobulin M deficiency ‎]]
#[[Integral membrane protein ‎]]
#[[Kerosene ‎]]
#[[Dentin ‎]]
#[[Dolichocephaly ‎]]
#[[Earl Wilbur Sutherland Jr. ‎]]
#[[Enoxacin (patient information) ‎]]
#[[Enterobacter ‎]]
#[[Enterocolitis ‎]]
#[[Enterovirus ‎]]
#[[Erythema elevatum diutinum ‎]]
#[[Propylthiouracil (patient information) ‎]]
#[[Pulmonary ligament ‎]]
#[[Pulsed field gel electrophoresis ‎]]
#[[Pyuria ‎]]
#[[Quorum sensing ‎]]
#[[Receiver operating characteristic ‎]]
#[[Red nucleus ‎]]
#[[Renal column ‎]]
#[[Ronald Ross ‎]]
#[[SERCA ‎]]
#[[ST elevation myocardial infarction management of patients who were not reperfused ‎]]
#[[Saccade ‎]]
#[[Catenation ‎]]
#[[Chin ‎]]
#[[Chronic stable angina diagnosis ‎]]
#[[Cleveland Clinic ‎]]
#[[Clorazepate ‎]]
#[[Cochlear implant ‎]]
#[[Corneal limbus ‎]]
#[[Corpus cavernosum ‎]]
#[[Cross-validation ‎]]
#[[Cycloguanil ‎]]
#[[Baylis-Hillman reaction ‎]]
#[[Benorylate ‎]]
#[[Bufexamac ‎]]
#[[Sociology ‎]]
#[[Sodium selenate ‎]]
#[[Sodoku ‎]]
#[[Spiro compound ‎]]
#[[Lanreotide ‎]]
#[[List of United States foodborne illness outbreaks ‎]]
#[[Lydia Fairchild ‎]]
#[[M2 protein ‎]]
#[[MacConkey agar ‎]]
#[[Mange ‎]]
#[[Maxwell's equations ‎]]
#[[Lead time bias ‎]]
#[[Lipopolysaccharide ‎]]
#[[Magnesium pidolate ‎]]
#[[Malassezia ‎]]
#[[Meglutol ‎]]
#[[ICD-10 Chapter D ‎]]
#[[Inhalant ‎]]
#[[Insecticide ‎]]
#[[Intraoperative blood salvage ‎]]
#[[Tick paralysis ‎]]
#[[Trisodium phosphate ‎]]
#[[Trovafloxacin ‎]]
#[[Ultrafiltration (renal) ‎]]
#[[Vertebral arch ‎]]
#[[Metizoline ‎]]
#[[Molecular genetics ‎]]
#[[Morphogenesis ‎]]
#[[National Institute of Nursing Research ‎]]
#[[Non-heart beating donation ‎]]
#[[Ocular hypertension ‎]]
#[[Oral rehydration therapy ‎]]
#[[Paraphyly ‎]]
#[[Parvovirus B19 ‎]]
#[[Posterior inferior cerebellar artery ‎]]
#[[Pramocaine ‎]]
#[[Prenalterol ‎]]
#[[Prenylation ‎]]
#[[Abbott Laboratories ‎]]
#[[Alar plate ‎]]
#[[WikiDoc Scholars ‎]]
#[[Zonisamide (patient information) ‎]]
#[[Friedrich August Kekulé von Stradonitz ‎]]
#[[Gastrectomy ‎]]
#[[Gill ‎]]
#[[HLA-A25 ‎]]
#[[Hans Adolf Krebs ‎]]
#[[Hemotoxin ‎]]
#[[Shampoo ‎]]
#[[Short tandem repeat ‎]]
#[[Subclavian steal syndrome ‎]]
#[[Superficial iliac circumflex artery ‎]]
#[[Synesthesia ‎]]
#[[Tetra-ethyl lead ‎]]
#[[Tetrachloroethylene ‎]]
#[[Catechol-O-methyl transferase ‎]]
#[[Chromosome 15q partial deletion ‎]]
#[[Clavulanic acid ‎]]
#[[Collaborative Hypertext of Radiology ‎]]
#[[Cuneiform (anatomy) ‎]]
#[[Dacryocystitis ‎]]
#[[Disease burden ‎]]
#[[Dracunculiasis ‎]]
#[[Enantiomeric excess ‎]]
#[[Endovascular surgery ‎]]
#[[Enzyme engineering ‎]]
#[[Estrogen receptor ‎]]
#[[Extensor pollicis brevis muscle ‎]]
#[[Eye color ‎]]
#[[Fertilizer ‎]]
#[[Pyridoxine deficiency ‎]]
#[[Renin inhibitor ‎]]
#[[Restriction fragment length polymorphism ‎]]
#[[Rodenticide ‎]]
#[[ST elevation myocardial infarction assessing success of reperfusion ‎]]
#[[Schering ‎]]
#[[Scrotal masses ‎]]
#[[Benign lymphoepithelial lesion ‎]]
#[[CA-19-9 ‎]]
#[[Cardiofaciocutaneous syndrome ‎]]
#[[Atypical AVNRT ‎]]
#[[Avanafil ‎]]
#[[Balkan nephropathy ‎]]
#[[Bile duct cyst ‎]]
#[[Bucladesine ‎]]
#[[Caenorhabditis elegans ‎]]
#[[Calcarine fissure ‎]]
#[[Carcinosarcoma ‎]]
#[[Xamoterol ‎]]
#[[Thermography ‎]]
#[[Trichotillomania ‎]]
#[[Wavelength ‎]]
#[[Lateral cutaneous nerve of forearm ‎]]
#[[Lecithin cholesterol acyltransferase deficiency ‎]]
#[[Lipofection ‎]]
#[[Long thoracic nerve ‎]]
#[[Lumbricals of the hand ‎]]
#[[MALT lymphoma ‎]]
#[[Mannich base ‎]]
#[[Medical education ‎]]
#[[Medical procedure ‎]]
#[[Hydranencephaly ‎]]
#[[Hypoprothrombinemia ‎]]
#[[Immersion foot ‎]]
#[[Impaired fasting glycaemia ‎]]
#[[John James Richard Macleod ‎]]
#[[Julius Wagner-Jauregg ‎]]
#[[1p36 deletion syndrome ‎]]
#[[Abdominal enlargement ‎]]
#[[Alpha-Methyltryptamine ‎]]
#[[Alpha subunit of glycoprotein hormones ‎]]
#[[Andrew Huxley ‎]]
#[[Anterior intercostal branches of internal thoracic artery ‎]]
#[[Mitoxantrone ‎]]
#[[Multicollinearity ‎]]
#[[Mysophobia ‎]]
#[[National Institute of Arthritis and Musculoskeletal and Skin Diseases ‎]]
#[[Nitrosourea ‎]]
#[[Nuchal lines ‎]]
#[[Optic tract ‎]]
#[[Panaeolus subbalteatus ‎]]
#[[Pancreatic bud ‎]]
#[[Pancreatic juice ‎]]
#[[Parotid duct ‎]]
#[[Pathogenicity ‎]]
#[[Posterior horn ‎]]
#[[Prefrontal cortex ‎]]
#[[Pregabalin (patient information) ‎]]
#[[Rate equation ‎]]
#[[Retinal pigment epithelium ‎]]
#[[Rickettsialpox ‎]]
#[[Chemogenomics ‎]]
#[[Corpus hemorrhagicum ‎]]
#[[DNA polymerase ‎]]
#[[Gastric juice ‎]]
#[[Gene duplication ‎]]
#[[Genzyme ‎]]
#[[Gestation ‎]]
#[[HLA-A80 ‎]]
#[[HLA-B67 ‎]]
#[[Hangman's fracture ‎]]
#[[Hemispatial neglect ‎]]
#[[Sharpey's fibres ‎]]
#[[Spice ‎]]
#[[Suprascapular artery ‎]]
#[[Deoxycorticosterone ‎]]
#[[Dichromacy ‎]]
#[[Entheogen ‎]]
#[[Enzyme induction and inhibition ‎]]
#[[Eukaryotic translation ‎]]
#[[FLAG-tag ‎]]
#[[Fenoprofen ‎]]
#[[Diffuse panbronchiolitis ‎]]
#[[Dose-response relationship ‎]]
#[[Dry eyes ‎]]
#[[Excision ‎]]
#[[Mixed connective tissue disease ‎]]
#[[Molecular pathology ‎]]
#[[Monorchism ‎]]
#[[Mosquito ‎]]
#[[Mouse Genome Informatics ‎]]
#[[Omphalitis ‎]]
#[[Thiomersal controversy ‎]]
#[[Thylakoid ‎]]
#[[Tizanidine ‎]]
#[[Twin study ‎]]
#[[Urea nitrate ‎]]
#[[Blastula ‎]]
#[[Bupivacaine ‎]]
#[[Caduceus ‎]]
#[[ATC code B02 ‎]]
#[[ATC code D10 ‎]]
#[[ATC code N06 ‎]]
#[[Alpha-glucosidase inhibitor ‎]]
#[[Lady Windermere syndrome ‎]]
#[[Leber's congenital amaurosis ‎]]
#[[Little finger ‎]]
#[[Malignant fibrous histiocytoma ‎]]
#[[Marsupial ‎]]
#[[Hydroxy ‎]]
#[[Inferior ganglion of glossopharyngeal nerve ‎]]
#[[Culdocentesis ‎]]
#[[Database ‎]]
#[[ATC code B02 ‎]]
#[[ATC code N06 ‎]]
#[[Alpha-glucosidase inhibitor ‎]]
#[[Scott's Pi ‎]]
#[[Selenium sulfide ‎]]
#[[Statistical population ‎]]
#[[Sulfonamide ‎]]
#[[Suprachiasmatic nucleus ‎]]
#[[PCI in the patient in cardiogenic shock ‎]]
#[[PCNA ‎]]
#[[Palmitoylation ‎]]
#[[Pharmacogenomics ‎]]
#[[Phosphoinositide 3-kinase ‎]]
#[[Polyamine ‎]]
#[[Popliteal pterygium syndrome ‎]]
#[[Popliteus muscle ‎]]
#[[Keratoglobus ‎]]
#[[Leber's congenital amaurosis ‎]]
#[[Listeria monocytogenes ‎]]
#[[Little finger ‎]]
#[[Magnesium lactate ‎]]
#[[Malignant fibrous histiocytoma ‎]]
#[[Marsupial ‎]]
#[[Thiomersal controversy ‎]]
#[[Thylakoid ‎]]
#[[Tizanidine ‎]]
#[[Twin study ‎]]
#[[Urban-Rogers-Meyer syndrome ‎]]
#[[Urea nitrate ‎]]
#[[August Krogh ‎]]
#[[Brazilian purpuric fever ‎]]
#[[Bupivacaine ‎]]
#[[Dose-response relationship ‎]]
#[[Dry eyes ‎]]
#[[Eugenics ‎]]
#[[Excision ‎]]
#[[Fludrocortisone ‎]]
#[[Hydroxy ‎]]
#[[Inferior ganglion of glossopharyngeal nerve ‎]]
#[[Molecular pathology ‎]]
#[[Mosquito ‎]]
#[[Mouse Genome Informatics ‎]]
#[[Median sacral artery ‎]]
#[[Mesalazine ‎]]
#[[Methylenedioxybenzylpiperazine ‎]]
#[[N-Methyl-3-piperidyl benzilate ‎]]
#[[Niceritrol ‎]]
#[[Ketose ‎]]
#[[Magnesium citrate ‎]]
#[[2,4-Dichlorobenzyl alcohol ‎]]
#[[ATC code D06 ‎]]
#[[Abdominal aortic aneurysm screening ‎]]
#[[Acetamide ‎]]
#[[Acridine ‎]]
#[[Active site ‎]]
#[[Alfentanil ‎]]
#[[Anaplastic large cell lymphoma ‎]]
#[[Anterior pituitary acidophil ‎]]
#[[Antimony ‎]]
#[[Aphonia ‎]]
#[[Pound (mass) ‎]]
#[[Prajmaline ‎]]
#[[Prochlorperazine ‎]]
#[[Questionnaire ‎]]
#[[Renin: who needs it, anyway? ‎]]
#[[Resampling (statistics) ‎]]
#[[Reverse genetics ‎]]
#[[Ribavirin ‎]]
#[[Root of the lung ‎]]
#[[Rubinstein-Taybi syndrome ‎]]
#[[Cementoma ‎]]
#[[Chlamydia (bacterium) ‎]]
#[[Chlorquinaldol ‎]]
#[[Chronic stable angina epidemiology ‎]]
#[[Complementarity (molecular biology) ‎]]
#[[Congenital myopathy ‎]]
#[[Pheniramine ‎]]
#[[Sarcopenia ‎]]
#[[Serine protease ‎]]
#[[Sexual orientation ‎]]
#[[Small interfering RNA ‎]]
#[[Sulfite ‎]]
#[[White matter ‎]]
#[[Heteroscedasticity ‎]]
#[[Huxley's layer ‎]]
#[[Hydrazine ‎]]
#[[Incidence ‎]]
#[[Interstitial ‎]]
#[[Intrauterine growth retardation ‎]]
#[[Jervell and Lange-Nielsen syndrome ‎]]
#[[Diaphragmatic elevation ‎]]
#[[Diet and heart disease ‎]]
#[[Docosanol ‎]]
#[[Dorsal scapular nerve ‎]]
#[[Enterochromaffin cell ‎]]
#[[Erosion (dental) ‎]]
#[[Ethisterone ‎]]
#[[Thermophile ‎]]
#[[Troponin T ‎]]
#[[Ureteric bud ‎]]
#[[Vaccine Adverse Event Reporting System ‎]]
#[[Vecuronium ‎]]
#[[Ventricular remodeling ‎]]
#[[Breast pain and discharge ‎]]
#[[Carboxyglutamate ‎]]
#[[Cardinal ligament ‎]]
#[[Flexor digitorum brevis muscle ‎]]
#[[Folding (chemistry) ‎]]
#[[Galen ‎]]
#[[Gene nomenclature ‎]]
#[[Geniculate ganglion ‎]]
#[[Great auricular nerve ‎]]
#[[Guidelines for echocardiography ‎]]
#[[HLA-B*82 ‎]]
#[[HLA-B73 ‎]]
#[[Hand surgery ‎]]
#[[Health care industry ‎]]
#[[Federal Food, Drug, and Cosmetic Act ‎]]
#[[Focal seizures ‎]]
#[[Fosmid ‎]]
#[[Gantenerumab ‎]]
#[[Georges J. F. Köhler ‎]]
#[[Glomerulosclerosis ‎]]
#[[Glycogen debranching enzyme ‎]]
#[[Gonadoblastoma ‎]]
#[[HIV test ‎]]
#[[HLA-B78 ‎]]
#[[Sphincter of Oddi ‎]]
#[[State University of New York ‎]]
#[[Subscapularis muscle ‎]]
#[[Achilles tendinitis ‎]]
#[[Acute stress reaction ‎]]
#[[Acyl chloride ‎]]
#[[Midgut ‎]]
#[[Mitogen ‎]]
#[[Neurochemistry ‎]]
#[[Ketobemidone ‎]]
#[[Laryngocele ‎]]
#[[Levosalbutamol ‎]]
#[[Life support ‎]]
#[[MEDEVAC ‎]]
#[[MMRV vaccine ‎]]
#[[Oral contraceptive ‎]]
#[[Oxprenolol ‎]]
#[[Permanent teeth ‎]]
#[[Peroneus tertius ‎]]
#[[Phototoxicity ‎]]
#[[Posterior cutaneous nerve of arm ‎]]
#[[Radium ‎]]
#[[Reactive oxygen species ‎]]
#[[Repressor ‎]]
#[[Rizatriptan (patient information) ‎]]
#[[S cell ‎]]
#[[Chemical decomposition ‎]]
#[[Chloroethane ‎]]
#[[Chlorpropamide ‎]]
#[[Chronic mountain sickness ‎]]
#[[Coefficient of thermal expansion ‎]]
#[[Congenital syphilis ‎]]
#[[Contraction (childbirth) ‎]]
#[[Controlled substance ‎]]
#[[Ascomycota ‎]]
#[[Balanitis circinata ‎]]
#[[CD20 ‎]]
#[[CD40 (protein) ‎]]
#[[Deliriant ‎]]
#[[Diphallia ‎]]
#[[Dubowitz syndrome ‎]]
#[[Encainide ‎]]
#[[Facioscapulohumeral muscular dystrophy ‎]]
#[[Failure rate ‎]]
#[[Vytorin detailed information ‎]]
#[[Zinc deficiency ‎]]
#[[Hemolytic disease of the newborn (anti-RhE) ‎]]
#[[Interlobar veins ‎]]
#[[Iridocorneal endothelial syndrome ‎]]
#[[Isoflurane ‎]]
#[[Ivermectin ‎]]
#[[Jones fracture ‎]]
#[[Tetracene ‎]]
#[[Therapeutic index ‎]]
#[[Tolpropamine ‎]]
#[[Trisomy 16 ‎]]
#[[Validity (statistics) ‎]]
#[[Thymectomy ‎]]
#[[Tiludronate ‎]]
#[[Timothy syndrome ‎]]
#[[Tincture ‎]]
#[[Togaviridae ‎]]
#[[Trauma surgery ‎]]
#[[Varices ‎]]
#[[Veins of the upper extremity ‎]]
#[[Pseudounipolar neuron ‎]]
#[[Racetam ‎]]
#[[Refractive index ‎]]
#[[Regression toward the mean ‎]]
#[[Retrotransposon ‎]]
#[[1-(3-Chlorophenyl)piperazine ‎]]
#[[4-HO-DiPT ‎]]
#[[Anatomical snuff box ‎]]
#[[Anterior compartment of leg ‎]]
#[[Aortopulmonary window ‎]]
#[[Appetite ‎]]
#[[First-line treatment ‎]]
#[[Fluorescein ‎]]
#[[Friedrich Wöhler ‎]]
#[[Fundic glands ‎]]
#[[HLA-A30 ‎]]
#[[Habitat ‎]]
#[[Sexual arousal ‎]]
#[[Statistical independence ‎]]
#[[Steeple sign ‎]]
#[[Sulfamethoxazole ‎]]
#[[Sultiame ‎]]
#[[Olfactory nerve ‎]]
#[[Oxaloacetic acid ‎]]
#[[Pancreatic polypeptide ‎]]
#[[Mesterolone ‎]]
#[[Minimum-variance unbiased estimator ‎]]
#[[Monoclonal antibody therapy ‎]]
#[[Myotonia ‎]]
#[[Negative selection ‎]]
#[[Nephrostomy ‎]]
#[[Neuropathology ‎]]
#[[Nicofuranose ‎]]
#[[Norepinephrine reuptake inhibitor ‎]]
#[[Nuclear pore ‎]]
#[[Kidd antigen system ‎]]
#[[Lambda phage ‎]]
#[[Large cell ‎]]
#[[Levomepromazine ‎]]
#[[Lipid pneumonia ‎]]
#[[List of infectious diseases ‎]]
#[[Malignant rhabdoid tumour ‎]]
#[[Indinavir (patient information) ‎]]
#[[Inferior olivary nucleus ‎]]
#[[Inguinal canal ‎]]
#[[Intrafusal muscle fiber ‎]]
#[[Deuterium ‎]]
#[[Doxazosin drug interactions ‎]]
#[[Dysopia ‎]]
#[[Endotoxin ‎]]
#[[Ensembl ‎]]
#[[Factor analysis ‎]]
#[[Cavity of the body of the uterus ‎]]
#[[Chloracne ‎]]
#[[Choroid plexus cyst ‎]]
#[[Clostridium perfringens ‎]]
#[[Concrescence ‎]]
#[[Cone dystrophy ‎]]
#[[Cyclopia ‎]]
#[[Avogadro's law ‎]]
#[[Azoospermia ‎]]
#[[Backhousia citriodora ‎]]
#[[Balancing selection ‎]]
#[[Behaviorism ‎]]
#[[Benactyzine ‎]]
#[[Beta-2 adrenergic receptor ‎]]
#[[Body of sternum ‎]]
#[[Body piercing ‎]]
#[[Bradykinin ‎]]
#[[Artery to the ductus deferens ‎]]
#[[B. F. Skinner ‎]]
#[[Baltimore classification ‎]]
#[[Bicarbonate buffering system ‎]]
#[[Mucous gland ‎]]
#[[Nicotinyl alcohol ‎]]
#[[ATC code M03 ‎]]
#[[Anergy ‎]]
#[[Arndt-Eistert synthesis ‎]]
#[[Aromatase ‎]]
#[[Tar ‎]]
#[[Technetium-99m ‎]]
#[[The heart in psoriasis ‎]]
#[[Tibial nerve ‎]]
#[[Tocilizumab ‎]]
#[[Type I hypersensitivity ‎]]
#[[Valence electron ‎]]
#[[Prediabetes ‎]]
#[[Pyrimidine metabolism ‎]]
#[[Quazepam ‎]]
#[[Ramogen ‎]]
#[[Omega-6 fatty acid ‎]]
#[[PCI in the bifurcation lesion ‎]]
#[[Paraldehyde ‎]]
#[[Parathyroidectomy ‎]]
#[[Parvalbumin ‎]]
#[[Pesticide poisoning ‎]]
#[[Plasticity ‎]]
#[[Polymyxin ‎]]
#[[Flexor pollicis brevis muscle ‎]]
#[[Focal adhesion ‎]]
#[[George Wald ‎]]
#[[Gunther disease ‎]]
#[[Gustatory system ‎]]
#[[Healthy diet ‎]]
#[[Science (journal) ‎]]
#[[Skin whitening ‎]]
#[[Cefpodoxime ‎]]
#[[Censoring (statistics) ‎]]
#[[Costal pleura ‎]]
#[[Diethylpropion (patient information) ‎]]
#[[Dorsal nerve of the penis ‎]]
#[[Echinococcus ‎]]
#[[Endoneurium ‎]]
#[[Ethylestrenol ‎]]
#[[Euchromatin ‎]]
#[[Family medicine ‎]]
#[[Kinesiology ‎]]
#[[Labioscrotal folds ‎]]
#[[Lactalbumin ‎]]
#[[Leukodystrophy ‎]]
#[[Lisp ‎]]
#[[Luxating patella ‎]]
#[[Maspin ‎]]
#[[Hepatitis B vaccine ‎]]
#[[Human development ‎]]
#[[Hygiene ‎]]
#[[Infundibulum of uterine tube ‎]]
#[[Interaction ‎]]
#[[Intrauterine hypoxia ‎]]
#[[Ionization ‎]]
#[[Isothermal process ‎]]
#[[Helix ‎]]
#[[Hh antigen system ‎]]
#[[Hyperactivity ‎]]
#[[Ice cream ‎]]
#[[In situ ‎]]
#[[Intravenous drug use ‎]]
#[[Islamic medicine ‎]]
#[[First rib ‎]]
#[[Folliculogenesis ‎]]
#[[Glucose-6-phosphate dehydrogenase ‎]]
#[[Hallux varus ‎]]
#[[5-alpha reductase ‎]]
#[[Adductor pollicis muscle ‎]]
#[[Alcohol abuse ‎]]
#[[Allylamine ‎]]
#[[Analysis of covariance ‎]]
#[[Arylsulfatase B ‎]]
#[[Aspartic acid ‎]]
#[[Bauxite fibrosis ‎]]
#[[Bioaccumulation ‎]]
#[[Bioartificial liver device ‎]]
#[[Borax ‎]]
#[[Calcium glucoheptonate ‎]]
#[[Membranous urethra ‎]]
#[[Monte Carlo method ‎]]
#[[NMDA ‎]]
#[[National Institute of Diabetes and Digestive and Kidney Diseases ‎]]
#[[Nephrologist ‎]]
#[[Nissl body ‎]]
#[[Oligodendrocyte ‎]]
#[[Organic peroxide ‎]]
#[[Organogenesis ‎]]
#[[Orientations of Proteins in Membranes database ‎]]
#[[Perineal nerve ‎]]
#[[Phosphatidylinositol (4,5)-bisphosphate ‎]]
#[[Positive predictive value ‎]]
#[[Tetrachlorodecaoxide ‎]]
#[[Tissue factor pathway inhibitor ‎]]
#[[Tuberculous meningitis ‎]]
#[[Tymazoline ‎]]
#[[Ullmann reaction ‎]]
#[[Ulnar nerve ‎]]
#[[Urethral syndrome ‎]]
#[[Urinary urgency ‎]]
#[[Veganism ‎]]
#[[Posterior intercostal arteries ‎]]
#[[Potassium cyanide ‎]]
#[[Pyrazole ‎]]
#[[Left gastro-omental artery ‎]]
#[[Leg swelling ‎]]
#[[Lichen planopilaris ‎]]
#[[Male genital examination ‎]]
#[[Maturity onset diabetes of the young ‎]]
#[[Decanoic acid ‎]]
#[[Demyelinating disease ‎]]
#[[Earth's atmosphere ‎]]
#[[Electroconvulsive therapy ‎]]
#[[Endoderm ‎]]
#[[Ethacridine lactate ‎]]
#[[Scattering ‎]]
#[[Siderosis ‎]]
#[[Somite ‎]]
#[[Spirulina (dietary supplement) ‎]]
#[[Stachyose ‎]]
#[[Striated muscle ‎]]
#[[Subclavian artery disease ‎]]
#[[Sushruta ‎]]
#[[Celiac ganglia ‎]]
#[[Chaos theory ‎]]
#[[Chemotype ‎]]
#[[Chromosome 16 (human) ‎]]
#[[Congenital anomalies of the coronary circulation ‎]]
#[[Contraceptive patch ‎]]
#[[Creatine ‎]]
#[[Yoga ‎]]
#[[Zona pellucida ‎]]
#[[Vinegar ‎]]
#[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure ‎]]
#[[Ticarcillin ‎]]
#[[Tubulointerstitial diseases of the kidney ‎]]
#[[3-Methylfentanyl ‎]]
#[[4-Fluoroamphetamine ‎]]
#[[ATC code N03 ‎]]
#[[Ablepharon macrostomia syndrome ‎]]
#[[Acanthocyte ‎]]
#[[Acral lentiginous melanoma ‎]]
#[[Adolphe Quetelet ‎]]
#[[Aluminium sulfate ‎]]
#[[Anorexia (symptom) ‎]]
#[[Antibiotic sensitivity ‎]]
#[[Heritability ‎]]
#[[Hexosaminidase ‎]]
#[[Insular cortex ‎]]
#[[Internal pudendal veins ‎]]
#[[Intravenous fluids ‎]]
#[[Femoral nerve ‎]]
#[[Flurazepam ‎]]
#[[Follicular lymphoma ‎]]
#[[Fosfomycin ‎]]
#[[Fuchs' dystrophy ‎]]
#[[Gardner's syndrome ‎]]
#[[Ginseng ‎]]
#[[HLA-A28 ‎]]
#[[HLA-Cw*16 ‎]]
#[[HLA-DQ5 ‎]]
#[[Otelixizumab ‎]]
#[[Oxidoreductase ‎]]
#[[Percoll ‎]]
#[[Pica (disorder) ‎]]
#[[Autonomic ganglion ‎]]
#[[Brønsted-Lowry acid-base theory ‎]]
#[[Busulfan ‎]]
#[[Campylobacteriosis ‎]]
#[[Mediastinal mass ‎]]
#[[Mediastinal pleura ‎]]
#[[Meprobamate ‎]]
#[[Merocrine ‎]]
#[[Mesenchyme ‎]]
#[[Mobilome ‎]]
#[[N-Ethyl-3-piperidyl benzilate ‎]]
#[[National Marrow Donor Program ‎]]
#[[Non-coding RNA ‎]]
#[[Carmine ‎]]
#[[Carnegie stages ‎]]
#[[Cavernous sinus ‎]]
#[[Cediranib ‎]]
#[[Center for Information Technology ‎]]
#[[Chemist ‎]]
#[[Chromate ‎]]
#[[Circumflex scapular artery ‎]]
#[[Cyanocobalamin Injection (patient information) ‎]]
#[[Cyclic vomiting syndrome ‎]]
#[[Dacryoadenitis ‎]]
#[[Decrease of urinary stream ‎]]
#[[Dientamoebiasis ‎]]
#[[Dimension ‎]]
#[[Echo in tetralogy of fallot ‎]]
#[[Egg activation ‎]]
#[[Equilibrioception ‎]]
#[[European Heart Journal Announces Articles to be Available in Open Source Format ‎]]
#[[Facial pain ‎]]
#[[Primase ‎]]
#[[Probability theory ‎]]
#[[Procyclidine (patient information) ‎]]
#[[Proportional hazards models ‎]]
#[[Pulp (tooth) ‎]]
#[[R-type calcium channel ‎]]
#[[Ragnar Granit ‎]]
#[[Rubrospinal tract ‎]]
#[[Kruskal-Wallis one-way analysis of variance ‎]]
#[[Lateral nasal cartilage ‎]]
#[[Lead(II) acetate ‎]]
#[[Levosimendan ‎]]
#[[Ligase ‎]]
#[[Likelihood function ‎]]
#[[Loxoprofen ‎]]
#[[Mayo Clinic ‎]]
#[[Mazindol ‎]]
#[[Streptococcus viridans ‎]]
#[[Sulfacetamide ‎]]
#[[Superior mesenteric artery ‎]]
#[[Suspensory muscle of the duodenum ‎]]
#[[TRPV ‎]]
#[[Seyferth-Gilbert homologation ‎]]
#[[Skin changes ‎]]
#[[Spirapril ‎]]
#[[Sterol ‎]]
#[[Substitution (chemistry) ‎]]
#[[Superior gemellus muscle ‎]]
#[[Bedwetting ‎]]
#[[Biological activity ‎]]
#[[Bromfenac ‎]]
#[[Acetylsalicylic acid (patient information) ‎]]
#[[Acromion ‎]]
#[[Adapalene ‎]]
#[[Bedwetting ‎]]
#[[Biological activity ‎]]
#[[Bromfenac ‎]]
#[[Carob tree ‎]]
#[[Wikipedia:Manual of Style (mathematics) ‎]]
#[[Lactated Ringer's solution ‎]]
#[[Lanatoside C ‎]]
#[[Lesser cornu ‎]]
#[[Levine's sign ‎]]
#[[List of inorganic compounds ‎]]
#[[Maximum a posteriori ‎]]
#[[Medullary cystic kidney disease ‎]]
#[[Menstrual cup ‎]]
#[[Deodorant ‎]]
#[[Deoxycytidine triphosphate ‎]]
#[[Diltiazem drug interactions ‎]]
#[[Diosmin ‎]]
#[[Diphenyl oxalate ‎]]
#[[Echo in tetralogy of fallot ‎]]
#[[Efferent ducts ‎]]
#[[Epigallocatechin gallate ‎]]
#[[Eukaryotic initiation factor ‎]]
#[[Factor analysis ‎]]
#[[Cavernous sinus ‎]]
#[[Chernoff's inequality ‎]]
#[[Choriocapillaris ‎]]
#[[Chromosome 3 (human) ‎]]
#[[Clobetasol (patient information) ‎]]
#[[Cochran-Armitage test for trend ‎]]
#[[Convergent evolution ‎]]
#[[Cyanocobalamin Injection (patient information) ‎]]
#[[Decompression sickness ‎]]
#[[Ablepharon macrostomia syndrome ‎]]
#[[Acetylsalicylic acid (patient information) ‎]]
#[[Acral lentiginous melanoma ‎]]
#[[Acromion ‎]]
#[[Adapalene ‎]]
#[[Airway obstruction ‎]]
#[[Aminomethylbenzoic acid ‎]]
#[[Anemia of chronic disease ‎]]
#[[Antiviral ‎]]
#[[Otelixizumab ‎]]
#[[Patchouli ‎]]
#[[Peroneus brevis ‎]]
#[[Pica (disorder) ‎]]
#[[Primase ‎]]
#[[Pterygopalatine ganglion ‎]]
#[[Respiratory tract ‎]]
#[[Radial neuropathy ‎]]
#[[Respiratory splinting ‎]]
#[[Rifamycin ‎]]
#[[Rilonacept ‎]]
#[[Scale (zoology) ‎]]
#[[Wikipedia:Accessibility ‎]]
#[[Methoxamine ‎]]
#[[Microbial biodegradation ‎]]
#[[Microvillous inclusion disease ‎]]
#[[Mixed Mullerian tumor ‎]]
#[[Multiple system atrophy ‎]]
#[[NANOG (medicine) ‎]]
#[[Nav1.4 ‎]]
#[[Neural tube ‎]]
#[[Nicomorphine ‎]]
#[[Nocebo ‎]]
#[[Occam's razor ‎]]
#[[Selective mutism ‎]]
#[[Semitendinosus muscle ‎]]
#[[Sphygmomanometer ‎]]
#[[Sterol ‎]]
#[[Hispanic Paradox ‎]]
#[[Hymenorrhaphy ‎]]
#[[Hypha ‎]]
#[[Hypoblast ‎]]
#[[Hypodermic needle ‎]]
#[[Infection control ‎]]
#[[Infratemporal fossa ‎]]
#[[Intermediate mesoderm ‎]]
#[[Intravenous fluids ‎]]
#[[Karyorrhexis ‎]]
#[[Kava ‎]]
#[[Kelvin ‎]]
#[[Aselizumab ‎]]
#[[Autism therapies ‎]]
#[[Bareback (sex) ‎]]
#[[Benign familial neonatal convulsions ‎]]
#[[Biliary atresia ‎]]
#[[Bipolar cell ‎]]
#[[Birth trauma ‎]]
#[[Blastomycosis ‎]]
#[[CPR mask ‎]]
#[[Calamine ‎]]
#[[Carnosinemia ‎]]
#[[Gerald Edelman ‎]]
#[[Grief ‎]]
#[[Gynecological surgery ‎]]
#[[HLA-B59 ‎]]
#[[The GRACE risk score ‎]]
#[[Thiazole ‎]]
#[[Thymopoietin ‎]]
#[[Tinea ‎]]
#[[Travoprost ‎]]
#[[Trifluoperazine ‎]]
#[[Trigeminal nerve nuclei ‎]]
#[[Trimipramine (patient information) ‎]]
#[[Triosephosphate isomerase ‎]]
#[[Tropicamide ‎]]
#[[Tuaminoheptane ‎]]
#[[Two-pore channel ‎]]
#[[Ulf von Euler ‎]]
#[[Urethral cancer ‎]]
#[[Osmotic diuresis ‎]]
#[[Ovarian artery ‎]]
#[[Oxiracetam ‎]]
#[[Pentamidine ‎]]
#[[Plasmolysis ‎]]
#[[Polyomavirus ‎]]
#[[Posterior compartment of leg ‎]]
#[[Cediranib ‎]]
#[[Central tolerance ‎]]
#[[Chlamydophila ‎]]
#[[Cloning vector ‎]]
#[[Cross-link ‎]]
#[[DNA sequencer ‎]]
#[[Dasatinib ‎]]
#[[Ketoacidosis ‎]]
#[[Lymphokine-activated killer cell ‎]]
#[[Diamagnetism ‎]]
#[[Dimercaprol ‎]]
#[[Efficiency (statistics) ‎]]
#[[Egg activation ‎]]
#[[European Heart Journal Announces Articles to be Available in Open Source Format ‎]]
#[[Extracorporeal ‎]]
#[[FSH-receptor ‎]]
#[[5-Methyltetrahydrofolate-homocysteine methyltransferase ‎]]
#[[Alefacept ‎]]
#[[Amniotic cavity ‎]]
#[[Anileridine ‎]]
#[[ADHD predominantly inattentive ‎]]
#[[ATC code A11 ‎]]
#[[Actinobacillus ‎]]
#[[Adenosine monophosphate ‎]]
#[[Adrenergic ‎]]
#[[Affymetrix ‎]]
#[[Allergic conjunctivitis ‎]]
#[[Anopsia ‎]]
#[[Ansa cervicalis ‎]]
#[[Antithrombotic therapy ‎]]
#[[Fibrinolysin ‎]]
#[[Foot drop ‎]]
#[[Genotoxicity ‎]]
#[[Glycoside hydrolase ‎]]
#[[HLA-B48 ‎]]
#[[Health care systems ‎]]
#[[Heavy chain disease ‎]]
#[[Hepatic cysts ‎]]
#[[Neurofibrosarcoma ‎]]
#[[Nicotine poisoning ‎]]
#[[Nitrile ‎]]
#[[Nitro compound ‎]]
#[[Protonation ‎]]
#[[R-factor ‎]]
#[[René Favaloro ‎]]
#[[Reproductive health ‎]]
#[[Respiratory compensation ‎]]
#[[Ritiometan ‎]]
#[[Salicylamide ‎]]
#[[Articaine ‎]]
#[[Asparagus ‎]]
#[[Atelosteogenesis, type II ‎]]
#[[Axillary artery ‎]]
#[[Basiliximab ‎]]
#[[Bazedoxifene ‎]]
#[[Benzenediol ‎]]
#[[Benzoxonium chloride ‎]]
#[[Bias ‎]]
#[[Blink ‎]]
#[[Borax ‎]]
#[[Brodmann area ‎]]
#[[Bronchial veins ‎]]
#[[Calcium metabolism ‎]]
#[[Streptococcus viridans ‎]]
#[[Subcostal nerve ‎]]
#[[Sunitinib ‎]]
#[[Superior labial artery ‎]]
#[[Superior vesical artery ‎]]
#[[Sydney Brenner ‎]]
#[[Teva Pharmaceutical Industries ‎]]
#[[Hepatoerythropoietic porphyria ‎]]
#[[Hormone replacement therapy (menopause) ‎]]
#[[Human artificial chromosome ‎]]
#[[Hydrophthalmos ‎]]
#[[Hydroxide ‎]]
#[[Inferior labial artery ‎]]
#[[Initiation factor ‎]]
#[[Insulin-like growth factor 2 ‎]]
#[[Interleukin 10 ‎]]
#[[Deslanoside ‎]]
#[[Diagnosis and mechanism of this bradyarrhythmia answer (July 2008) ‎]]
#[[Dilaceration ‎]]
#[[Epikeratophakia ‎]]
#[[Exocrine pancreatic insufficiency ‎]]
#[[Cholesterylester transfer protein ‎]]
#[[Convergence insufficiency ‎]]
#[[Cross-reactivity ‎]]
#[[Curve fitting ‎]]
#[[Cutaneous leishmaniasis ‎]]
#[[Tinidazole ‎]]
#[[Tongue swelling ‎]]
#[[Toxocariasis ‎]]
#[[Venous ulcer ‎]]
#[[Pancreatic fistula ‎]]
#[[Pathogenicity island ‎]]
#[[Perioperative mortality ‎]]
#[[Phantom limb ‎]]
#[[Phosphatidylserine ‎]]
#[[Probability density function ‎]]
#[[Kevin Trudeau ‎]]
#[[Lentinan ‎]]
#[[Meglitinide ‎]]
#[[Keutel syndrome ‎]]
#[[Lacrimal lake ‎]]
#[[Magnesium pyridoxal 5-phosphate glutamate ‎]]
#[[Mast cell stabilizer ‎]]
#[[Megestrol ‎]]
#[[Self-injury ‎]]
#[[Silver sulfadiazine ‎]]
#[[Sodium salicylate ‎]]
#[[Spotted fever ‎]]
#[[Substantia nigra ‎]]
#[[Synovial fluid ‎]]
#[[Table of standard reduction potentials for half-reactions important in biochemistry ‎]]
#[[Tendon reflex ‎]]
#[[Flexor hallucis longus muscle ‎]]
#[[Glycerate 3-phosphate ‎]]
#[[H10N7 ‎]]
#[[HLA-DQ1 ‎]]
#[[APACHE II ‎]]
#[[ATC code S02 ‎]]
#[[Acetoacetic acid ‎]]
#[[Adefovir ‎]]
#[[Wishart distribution ‎]]
#[[Wrist and hand pain ‎]]
#[[Atrial branches of coronary arteries ‎]]
#[[Auriculares muscles ‎]]
#[[Autocorrelation ‎]]
#[[Bambuterol ‎]]
#[[Bertilimumab ‎]]
#[[Carl Jung ‎]]
#[[Milk allergy ‎]]
#[[Models of nucleotide substitution ‎]]
#[[Newborn screening ‎]]
#[[Non ST Elevation Myocardial Infarction: Diagnosis ‎]]
#[[Null cell ‎]]
#[[Psyllium (patient information) ‎]]
#[[Reaction intermediate ‎]]
#[[Oxametacin ‎]]
#[[Peritoneal disease ‎]]
#[[Population genetics ‎]]
#[[Prevertebral ganglia ‎]]
#[[Probenecid ‎]]
#[[Prochiral ‎]]
#[[Carotid sinus ‎]]
#[[Caudate lobe of liver ‎]]
#[[Central pontine myelinolysis ‎]]
#[[Cervical pleura ‎]]
#[[Charles Louis Alphonse Laveran ‎]]
#[[Chemical classification ‎]]
#[[Chorionic villus sampling ‎]]
#[[Coitus interruptus ‎]]
#[[Cold-blooded ‎]]
#[[Cryptosporidium ‎]]
#[[Cuneate nucleus ‎]]
#[[César Milstein ‎]]
#[[Deep circumflex iliac artery ‎]]
#[[Histamine receptor ‎]]
#[[ICD-10 Chapter G ‎]]
#[[Immunophilin ‎]]
#[[Indoprofen ‎]]
#[[International Conference on Emerging Infectious Diseases ‎]]
#[[Japanese Honeysuckle ‎]]
#[[Dermatofibrosarcoma ‎]]
#[[Dielectric constant ‎]]
#[[Dimethyl ether ‎]]
#[[Drosophila melanogaster ‎]]
#[[Dysphoria ‎]]
#[[Electrofuge ‎]]
#[[Emtricitabine (patient information) ‎]]
#[[Eosinophilia-myalgia syndrome ‎]]
#[[Epidemic model ‎]]
#[[Ergosterol ‎]]
#[[Etidronic acid ‎]]
#[[Faropenem ‎]]
#[[Female condom ‎]]
#[[Tilidine ‎]]
#[[Triphenylmethane ‎]]
#[[Tubulin ‎]]
#[[Vascular access steal syndrome ‎]]
#[[Vesicular and bullous lesions ‎]]
#[[Theca externa ‎]]
#[[Thermoreceptor ‎]]
#[[Thyrohyoid muscle ‎]]
#[[Titermax ‎]]
#[[Totipotency ‎]]
#[[Twelfth rib ‎]]
#[[Typical antipsychotic ‎]]
#[[Ultimobranchial body ‎]]
#[[Uroscopy ‎]]
#[[Mineral ascorbates ‎]]
#[[Molecular evolution ‎]]
#[[Monotreme ‎]]
#[[Myc ‎]]
#[[Ofloxacin ‎]]
#[[Flavin ‎]]
#[[Flosequinan ‎]]
#[[Flu season ‎]]
#[[Fluoride poisoning ‎]]
#[[Fusion gene ‎]]
#[[General surgery ‎]]
#[[Golimumab ‎]]
#[[H7N2 ‎]]
#[[HLA-A43 ‎]]
#[[HLA-DQ8 ‎]]
#[[Headgear ‎]]
#[[Health Impact Assessment ‎]]
#[[Heat shock protein 47 ‎]]
#[[Liver dialysis ‎]]
#[[MMR vaccine controversy ‎]]
#[[Managed care ‎]]
#[[Medical abortion ‎]]
#[[Medullary cavity ‎]]
#[[Medullary interstitium ‎]]
#[[Spleen transplantation ‎]]
#[[Stimulus (physiology) ‎]]
#[[Substance abuse ‎]]
#[[TRPP ‎]]
#[[Tajima's D ‎]]
#[[Aziridine ‎]]
#[[Base excess ‎]]
#[[Behaviour therapy ‎]]
#[[Bilaminar disc ‎]]
#[[Bile canaliculus ‎]]
#[[Bronchial artery ‎]]
#[[Butene ‎]]
#[[Cancer immunotherapy ‎]]
#[[Abderhalden-Kaufmann-Lignac syndrome ‎]]
#[[Alveolus ‎]]
#[[Amino sugar ‎]]
#[[Apudoma ‎]]
#[[Aromatic compound ‎]]
#[[Ylide ‎]]
#[[Zanamivir ‎]]
#[[Desmin ‎]]
#[[Efflux (microbiology) ‎]]
#[[Elastic cartilage ‎]]
#[[Epidemiological study ‎]]
#[[Febarbamate ‎]]
#[[Chromosome 8 (human) ‎]]
#[[Clopidogrel (patient information) ‎]]
#[[Combat stress reaction ‎]]
#[[Cranial cavity ‎]]
#[[Cumulative incidence ‎]]
#[[Cyclopentamine ‎]]
#[[Pronephros ‎]]
#[[Prontosil ‎]]
#[[Quantitative genetics ‎]]
#[[RNA editing ‎]]
#[[RNA polymerase ‎]]
#[[Renal glucose reabsorption ‎]]
#[[Right lobe of liver ‎]]
#[[Root mean square ‎]]
#[[Rothmund-Thomson syndrome ‎]]
#[[Otto Loewi ‎]]
#[[Parasomnia ‎]]
#[[Plagiocephaly ‎]]
#[[Hydride ‎]]
#[[Hydrophilic interaction liquid chromatography ‎]]
#[[Hyperkalemic periodic paralysis ‎]]
#[[Immunologic adjuvant ‎]]
#[[Influenzavirus C ‎]]
#[[International Medical Commission on Bhopal ‎]]
#[[International Nucleotide Sequence Database Collaboration ‎]]
#[[Heteroatom ‎]]
#[[Horizontal cell ‎]]
#[[House Mouse ‎]]
#[[ICAM-1 ‎]]
#[[Isocarboxazid (patient information) ‎]]
#[[Jacques Monod ‎]]
#[[1,3-dipole ‎]]
#[[ATC code A01 ‎]]
#[[ATC code A14 ‎]]
#[[ATC code D04 ‎]]
#[[Abarelix ‎]]
#[[Abatacept ‎]]
#[[Acetaminophen and Hydrocodone (patient information) ‎]]
#[[Adductor brevis muscle ‎]]
#[[Aleglitazar ‎]]
#[[Anterior arch of the atlas ‎]]
#[[Applied behavior analysis ‎]]
#[[Artery of the pterygoid canal ‎]]
#[[Gamma Knife ‎]]
#[[Gliquidone ‎]]
#[[Glycoprotein IIb/IIIa ‎]]
#[[HLA-B61 ‎]]
#[[Transition metal ‎]]
#[[Trismus ‎]]
#[[Trochlear nerve ‎]]
#[[Tyrothricin ‎]]
#[[United States Department of Agriculture ‎]]
#[[Vellus hair ‎]]
#[[Vesicular breathing ‎]]
#[[Vocal cord paresis ‎]]
#[[Metaplasia ‎]]
#[[Methylcobalamin ‎]]
#[[Articular disk ‎]]
#[[Blood-borne disease ‎]]
#[[Breech birth ‎]]
#[[Carbocation ‎]]
#[[KvLQT2 ‎]]
#[[Leuprolide ‎]]
#[[Mass ‎]]
#[[Median eminence ‎]]
#[[Selection bias ‎]]
#[[Somatoform disorder ‎]]
#[[Stanley B. Prusiner ‎]]
#[[Stomodeum ‎]]
#[[Tensor fasciae latae ‎]]
#[[Overeaters Anonymous ‎]]
#[[Papain ‎]]
#[[Parasympathomimetic drug ‎]]
#[[Paroöphoron ‎]]
#[[Pasteurellosis ‎]]
#[[Peginterferon alfa-2a ‎]]
#[[Pentazocine ‎]]
#[[Pethidine ‎]]
#[[Phenylbutazone ‎]]
#[[Pivot joint ‎]]
#[[Polyembryoma ‎]]
#[[Posterior cutaneous nerve of thigh ‎]]
#[[Posterior tibial artery ‎]]
#[[Posterior vein of the left ventricle ‎]]
#[[Pressure ‎]]
#[[Cholesterol side-chain cleavage enzyme ‎]]
#[[Colorado tick fever ‎]]
#[[Cosmid ‎]]
#[[Cronbach's alpha ‎]]
#[[DNase footprinting assay ‎]]
#[[Woodhouse-Sakati syndrome ‎]]
#[[Dipeptidyl peptidase-4 inhibitors ‎]]
#[[Dorsal mesentery ‎]]
#[[Drospirenone ‎]]
#[[Ecology ‎]]
#[[Endocrine gland neoplasm ‎]]
#[[Endolymphatic sac ‎]]
#[[Ergonovine ‎]]
#[[Etizolam ‎]]
#[[Etofenamate ‎]]
#[[Psoas minor muscle ‎]]
#[[Psychosomatic medicine ‎]]
#[[Pyramid of thyroid ‎]]
#[[Refeeding syndrome ‎]]
#[[Schedule IV ‎]]
#[[Proscillaridin ‎]]
#[[Protein kinase C ‎]]
#[[Psicose ‎]]
#[[Pulmonary capillary wedge pressure ‎]]
#[[Quadratus plantae muscle ‎]]
#[[Rate-determining step ‎]]
#[[Repugnant market ‎]]
#[[Rescinnamine ‎]]
#[[Respiratory burst ‎]]
#[[Rimantadine ‎]]
#[[Scid mouse ‎]]
#[[Kombucha ‎]]
#[[Lacrimal papilla ‎]]
#[[Letrozole ‎]]
#[[Lincosamides ‎]]
#[[Lipoid congenital adrenal hyperplasia ‎]]
#[[Logit ‎]]
#[[Macrobiotic diet ‎]]
#[[Markers of Developing Metabolic Syndrome ‎]]
#[[Maternal death ‎]]
#[[Max Delbrück ‎]]
#[[Mechanism of action ‎]]
#[[Hierarchical linear modeling ‎]]
#[[Human genome ‎]]
#[[IL-2 receptor ‎]]
#[[Immunoconjugate ‎]]
#[[Inhalational anaesthetic ‎]]
#[[Irradiation ‎]]
#[[Ambulatory blood pressure ‎]]
#[[Ankyrins ‎]]
#[[Balsalazide ‎]]
#[[Bartholin's ducts ‎]]
#[[Benfotiamine ‎]]
#[[Bezoar ‎]]
#[[Bietti's crystalline dystrophy ‎]]
#[[Blastocoele ‎]]
#[[Brachialis muscle ‎]]
#[[Calgranulin ‎]]
#[[Carnitine-acylcarnitine translocase deficiency ‎]]
#[[Ferid Murad ‎]]
#[[Flexor pollicis longus muscle ‎]]
#[[HLA-DQ3 ‎]]
#[[HLA-DQ6 ‎]]
#[[Zinc acetate ‎]]
#[[Kombucha ‎]]
#[[Lacrimal papilla ‎]]
#[[Letrozole ‎]]
#[[Lilliefors test ‎]]
#[[Lipoid congenital adrenal hyperplasia ‎]]
#[[Lytic cycle ‎]]
#[[Macrobiotic diet ‎]]
#[[Markers of Developing Metabolic Syndrome ‎]]
#[[Maternal death ‎]]
#[[Max Delbrück ‎]]
#[[Mechanism of action ‎]]
#[[Posterior interosseous nerve ‎]]
#[[Premature ejaculation ‎]]
#[[Proscillaridin ‎]]
#[[Protein kinase C ‎]]
#[[Psicose ‎]]
#[[Pulmonary capillary wedge pressure ‎]]
#[[Quadratus plantae muscle ‎]]
#[[Rate-determining step ‎]]
#[[Repugnant market ‎]]
#[[Rescinnamine ‎]]
#[[Respiratory burst ‎]]
#[[Rimantadine ‎]]
#[[Aicardi syndrome ‎]]
#[[Ambulatory blood pressure ‎]]
#[[Ankyrins ‎]]
#[[IL-2 receptor ‎]]
#[[Imipenem ‎]]
#[[Immunoconjugate ‎]]
#[[Immunoglobulin allotype ‎]]
#[[Inferior orbital fissure ‎]]
#[[Inhalational anaesthetic ‎]]
#[[Monobenzone ‎]]
#[[Mycoplasma pneumoniae ‎]]
#[[Myocardial ischemia ‎]]
#[[N-Bromosuccinimide ‎]]
#[[National Institute on Deafness and Other Communication Disorders ‎]]
#[[Natural reservoir ‎]]
#[[Nd:YAG laser ‎]]
#[[Non-Kekulé molecule ‎]]
#[[Obturator hernia ‎]]
#[[Pathogenic bacteria ‎]]
#[[Peroxisome ‎]]
#[[Placental abruption ‎]]
#[[Population ‎]]
#[[Scid mouse ‎]]
#[[Slit lamp ‎]]
#[[Stable isotope ‎]]
#[[Staphylococcus epidermidis ‎]]
#[[Stroma of iris ‎]]
#[[TLR 2 ‎]]
#[[Carnitine-acylcarnitine translocase deficiency ‎]]
#[[Castor oil ‎]]
#[[Center for Drug Evaluation and Research ‎]]
#[[Cholesteatoma ‎]]
#[[Chromosome 10 (human) ‎]]
#[[Cord blood ‎]]
#[[Cyclin ‎]]
#[[Cytotrophoblast ‎]]
#[[Dacryocystorhinostomy ‎]]
#[[Datura ‎]]
#[[Carfentanil ‎]]
#[[Cefotaxime ‎]]
#[[Coiled coil ‎]]
#[[Collagenous colitis ‎]]
#[[Color vision ‎]]
#[[Potato ‎]]
#[[Praseodymium ‎]]
#[[Psilocybe cubensis ‎]]
#[[Psychedelic plants ‎]]
#[[Pyramidal cell ‎]]
#[[Quadratus lumborum muscle ‎]]
#[[ROMK ‎]]
#[[Racemic ‎]]
#[[Replacement joint ‎]]
#[[Richard Axel ‎]]
#[[Robust statistics ‎]]
#[[Rotation ‎]]
#[[Decitabine ‎]]
#[[Diacerein ‎]]
#[[Dimethyltryptamine ‎]]
#[[Ethanol fuel ‎]]
#[[Ethidium bromide ‎]]
#[[Thyroid function tests ‎]]
#[[Tigecycline ‎]]
#[[Toremifene ‎]]
#[[Transcellular fluid ‎]]
#[[Trioxsalen ‎]]
#[[Troglitazone ‎]]
#[[Vestibular nuclei ‎]]
#[[Barbital ‎]]
#[[Belatacept ‎]]
#[[Bimatoprost ‎]]
#[[Biochip ‎]]
#[[Biologist ‎]]
#[[British National Formulary ‎]]
#[[Buccal artery ‎]]
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#[[Plasmodium falciparum ‎]]
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#[[Niflumic acid ‎]]
#[[Wikipedia:Template limits ‎]]
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#[[Pyrazinamide ‎]]
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#[[Batrachotoxin ‎]]
#[[Body modification ‎]]
#[[Bunaftine ‎]]
#[[Calcium hexamine thiocyanate ‎]]
#[[Carbetocin ‎]]
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#[[49, XXXXX ‎]]
#[[8-Chlorotheophylline ‎]]
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#[[Adrafinil ‎]]
#[[Terminal bronchiole ‎]]
#[[The Physical Examination in Cardiovascular Disease:The Neck ‎]]
#[[Thyroid ima artery ‎]]
#[[Treatment of paroxysmal nocturnal hemoglobinuria with the anti-complement antibody eculizumab helps prevent thromboembolism ‎]]
#[[Triphenylphosphine ‎]]
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#[[Unsaturated compound ‎]]
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#[[Inferior salivatory nucleus ‎]]
#[[Journal of the American Medical Association ‎]]
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#[[Murashige and Skoog medium ‎]]
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#[[Protein metabolism ‎]]
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#[[Robert W. Holley ‎]]
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#[[Buserelin ‎]]
#[[Calcium acetate ‎]]
#[[Calcium silicate ‎]]
#[[Observational study ‎]]
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#[[Oxide ‎]]
#[[P-rep ‎]]
#[[P2Y12 ‎]]
#[[Periplasmic space ‎]]
#[[Periventricular leukomalacia ‎]]
#[[Phosphorus pentoxide ‎]]
#[[Pia mater ‎]]
#[[Dental plaque ‎]]
#[[Depressor labii inferioris muscle ‎]]
#[[Deviance (statistics) ‎]]
#[[Doripenem ‎]]
#[[Double helix ‎]]
#[[Dysfunctional uterine bleeding ‎]]
#[[E. Donnall Thomas ‎]]
#[[Ego-dystonic sexual orientation ‎]]
#[[Endothermic ‎]]
#[[Enteropathy ‎]]
#[[Excited state ‎]]
#[[Eye pain ‎]]
#[[Fasciolosis ‎]]
#[[Carnitine O-palmitoyltransferase ‎]]
#[[Case study ‎]]
#[[Cefoperazone ‎]]
#[[Cerebral crus ‎]]
#[[Certolizumab pegol ‎]]
#[[Computational genomics ‎]]
#[[Cricoid ‎]]
#[[Daniel Nathans ‎]]
#[[Kegel exercise ‎]]
#[[Keto acid ‎]]
#[[Leonardo da Vinci ‎]]
#[[Lipodystrophy ‎]]
#[[List of distinct cell types in the adult human body ‎]]
#[[Lynestrenol ‎]]
#[[ACHE ‎]]
#[[AMPA receptor ‎]]
#[[Arachidonic acid ‎]]
#[[Tacrine ‎]]
#[[The On-Time 2 trial Suggests Benefit with Early Administration of Tirofiban in the Ambulance following Acute Myocardial Infarction. ‎]]
#[[Thrombin-activatable fibrinolysis inhibitor ‎]]
#[[Transpyloric plane ‎]]
#[[Transversus thoracis muscle ‎]]
#[[Tyramine ‎]]
#[[Unterberger test ‎]]
#[[Seed ‎]]
#[[Social medicine ‎]]
#[[Stigmine ‎]]
#[[Stunned myocardium ‎]]
#[[Superacid ‎]]
#[[Syncytiotrophoblast ‎]]
#[[TGN1412 ‎]]
#[[TNM ‎]]
#[[Medial longitudinal fissure ‎]]
#[[Mesovarium ‎]]
#[[Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes ‎]]
#[[N-Methyl-N-isopropyltryptamine ‎]]
#[[Nalorphine ‎]]
#[[Nanobacterium ‎]]
#[[Nav1.9 ‎]]
#[[Nucleoplasm ‎]]
#[[Fenbufen ‎]]
#[[Fencamfamine ‎]]
#[[Flunoxaprofen ‎]]
#[[Fly ‎]]
#[[Garlic ‎]]
#[[HLA-B42 ‎]]
#[[HLA-DQ9 ‎]]
#[[Hearing loss with craniofacial syndromes ‎]]
#[[Hematologic disease ‎]]
#[[Heparin cofactor II ‎]]
#[[Hepatic artery proper ‎]]
#[[History of biochemistry ‎]]
#[[Hyperostosis ‎]]
#[[Inferior phrenic vein ‎]]
#[[Injury prevention ‎]]
#[[Inner ear ‎]]
#[[Intermediate density lipoprotein ‎]]
#[[Isomerisation ‎]]
#[[John Carew Eccles ‎]]
#[[Proglumetacin ‎]]
#[[Posterior spinal artery ‎]]
#[[Precursor mRNA ‎]]
#[[Quantitative polymerase chain reaction ‎]]
#[[RNA dependent RNA polymerase ‎]]
#[[Rifapentin ‎]]
#[[Rocuronium ‎]]
#[[Romanowsky stain ‎]]
#[[Agoraphobia ‎]]
#[[Alveolitis ‎]]
#[[Amalgam ‎]]
#[[American Medical Association ‎]]
#[[Aminobenzoic acid ‎]]
#[[Aminotransferases ‎]]
#[[Argon ‎]]
#[[Oligoclonal band ‎]]
#[[Osteopenia ‎]]
#[[PDD not otherwise specified ‎]]
#[[Pedigree chart ‎]]
#[[Plantar arch ‎]]
#[[Porencephaly ‎]]
#[[Xeroderma ‎]]
#[[Attributable risk ‎]]
#[[Benzopyrene ‎]]
#[[Bite ‎]]
#[[COX-inhibiting nitric oxide donator ‎]]
#[[Calvin cycle ‎]]
#[[Carbanion ‎]]
#[[Kebuzone ‎]]
#[[Kugelberg-Welander disease ‎]]
#[[Lactone ‎]]
#[[Light-dependent reaction ‎]]
#[[List of clinically important bacteria ‎]]
#[[Magnetofection ‎]]
#[[Matrix (biology) ‎]]
#[[Desogestrel ‎]]
#[[Dihydropyridine ‎]]
#[[Disaccharide ‎]]
#[[Drug Enforcement Administration ‎]]
#[[Eclampsia ‎]]
#[[Eutectic point ‎]]
#[[Extensor carpi ulnaris muscle ‎]]
#[[Extensor pollicis longus muscle ‎]]
#[[Extreme value ‎]]
#[[Fair coin ‎]]
#[[Chalicosis ‎]]
#[[Charles Robert Richet ‎]]

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Dendrimer

2009-06-29T13:55:53Z

LBiller:

{{SI}}
{{EH}}
[[Image:graphs.jpg|thumbnail|230px|left|Figure 1 Dendrimer and dendron]]
[[Image:First Gen Dendrimer ChemEurJ 2002 3858.jpg|thumbnail|230px|left|Crystal structure of a first-generation polyphenylene dendrimer reported by Müllen and coworkers in Chem.-Eur. J., 2002, 3858-3864.]]

==Overview==
'''Dendrimers''' are repeatedly branched [[molecule]]s. The huge number of papers on dendritic architectures such as dendrimers, dendronized, hyperbranched and brush-polymers has generated a vast variety of inconsistent terms and definitions making a clear and concise unfolding of this topic highly difficult. The purpose of this section is to provide the vocabulary required for the description of chemical and physical phenomena as well as application aspects associated with the research in the area of dendritic molecules.

Dendritic molecules are repeatedly branched species that are characterized by their structure perfection. The latter is based on the evaluation of both symmetry and polydispersity. The area of dendritic molecules can roughly be divided into the low-molecular weight and the high-molecular weight species. The first category includes dendrimers and dendrons whereas the second encompasses dendronized polymers, hyperbranched polymers, and brush-polymers (also called bottle-brushes).

The name comes from the [[Greek language|Greek]] "δενδρον"/''dendron'', meaning "tree". Synonymous terms are arborols and cascade-molecules. Dendrimer is an internationally accepted term.
Dendrimers and dendrons are repeatedly branched, monodisperse, and usually highly symmetric compounds. There is no apparent difference in defining dendrimer and dendron. A dendron usually contains a single chemically addressable group that is called focal point.
Because of the lack of the molar mass distribution high-molar-mass dendrimers and dendrons are macromolecules but not polymers.

The first dendrimers were described by Vögtle in 1978<ref>"Cascade"- and "Nonskid-Chain-like" Syntheses of Molecular Cavity Topologies Egon Buhleier, Winfried Wehner, Fritz Vögtle Synthesis '''1978'''; 1978: 155-158 {{DOI|10.1055/s-1978-24702}}</ref>, by Denkewalter and coworkers at Allied Corporation as [[Poly-lysine|polylysine]] dendrimers in 1981<ref> Patent 4,289,872 (published 1981, filed 1979) and 4,410,688 (published 1983, filed 1981) </ref>, by Tomalia at [[Dow Chemical]] in 1983<ref>Dow patent is 4,507,466 (published 1985, filed 1983)</ref> and in 1985<ref>''A New Class of Polymers: Starburst-Dendritic Macromolecules'' D. A. Tomalia, H. Baker, J. Dewald, M. Hall, G. Kallos, S. Martin, J. Roeck, J. Ryder and P. Smith Polymer Journal, Vol. 17 ('''1985''') No. 1 pp.117-132 {{DOI|10.1295/polymj.17.117}}</ref>, and by Newkome in 1985<ref>Micelles. Part 1. Cascade molecules: a new approach to micelles. A [27]-arborol George R. Newkome, Zhongqi Yao, Gregory R. Baker, Vinod K. Gupta J. Org. Chem.; '''1985'''; 50(11); 2003-2004. {{DOI|10.1021/jo00211a052}} </ref>. In 1990s dendrimers caused an explosion of scientific interest because of their unique molecular architecture (Fig 1). This resulted in over 5,000 scientific papers and patents published by the end of 2005.

==Properties and applications==
The properties of dendrimers are dominated by the [[functional groups]] on the molecular surface. Dendritic encapsulation of functional molecules allows for the isolation of the active site, a structure that mimics the structure of active sites in biomaterials because dendritic scaffolds separate internal and external functions.<ref>S. Hecht, J. M. J. Fréchet,Angew. Chem. Int. Ed. 200140, 74</ref><ref>J. M. J. Fréchet, D. A. Tomalia,Dendrimers and Other Dendritic Polymers, John Wiley & Sons, Ltd. NY, NY.</ref><ref>M. Fischer, F. Vogtle, Angew. Chem. Int. Ed.1999,38, 884</ref>. For example, a dendrimer can be water-soluble when its [[end-group]] is a [[Hydrophilicity|hydrophilic group]], like a [[carboxyl group]]. It is theoretically possible to design a water-soluble dendrimer with internal [[hydrophobicity]], which would allow it to carry a hydrophobic [[drug]] in its interior. Recently it has been shown that redox-active nanoparticles can be synthesized, placing the redox molecules between the nanoparticle core and the dendritic wedges; despite their isolation, some of the redox molecules (COOH in this case) remained uncoupled, and thus still reactive.<ref>article in press</ref>

Another property is that the volume of a dendrimer increases when it has a [[positive charge]]. If this property can be applied, dendrimers can be used for drug delivery systems (DDS) that can give medication to the affected part inside a patient's body directly<ref>[http://www.dendrimerweb.com DendrimerWeb]</ref>.

=== Photonic excited molecules ===

The inside of a dendrimer has a unique chemical environment because of its high [[density]]. From this property, it has been discovered that [[azobenzene]] is [[photoisomerization|photoisomerized]] by very weak infrared rays when covered by a dendrimer <ref>Dong-Lin Jiang, Takuzou Aida, Nature 388, 454-456 (1997)</ref>. Through the discovery of a function that catches light and conveys this [[energy]] using [[excitation]] of the molecule, attempts have recently been made to synthesize dendrimers that insert [[porphyrin]], absorb light, and [[photosynthesis|photosynthesize]] artificially. In addition, the development of organic electroluminescent devices and their applications has been undertaken by researchers all over the world.

==Synthesis==
In the [[synthesis]] of dendrimers, [[monomer]]s lead to a [[monodisperse]] polymer, tree-like, or generational structure. There are two defined methods of dendrimer synthesis, [[divergent synthesis]] and [[convergent synthesis]]. Divergent syntheses assemble the molecule from the core, extending radially to the periphery and in contrast convergent methods start at the surface and proceed inwards, before the attachment of pre-synthesised dendrons to the core.

However, because a repeated [[reaction]] which consists of many steps is needed to protect the [[active site]], it is difficult to synthesize dendrimers even if both methods are used. This is why there are obstacles to the synthesis of large quantities of dendrimers. Presently, the only kilogram-scale producers of dendrimers is Dendritech <ref>Dendritech Inc., from Midland, Michigan, USA.[http://www.dendritech.com Dendritech].</ref>

The original Newkome dendrimer or '''arborol''' (1985) started by [[nucleophilic substitution]] of 1-bromopentane by ''triethyl sodiomethanetricarboxylate'' in [[dimethylformamide]] and [[benzene]]. The [[ester]] groups were then [[organic reduction|reduced]] by [[lithium aluminium hydride]] to a [[alcohol|triol]] in a [[protective group|deprotection]] step. Activation of the chain ends was achieved by converting the alcohol groups to [[tosylate]] groups with [[tosyl chloride]] and [[pyridine]]. The tosyl group then served as [[leaving group]]s in another reaction with the tricarboxylate, forming generation two.

[[Image:DendrimerNewkome1985.png|400px|center|The Newkome 1985 dendrimer system]]

This sequence can be repeated many times.

==References==
{{reflist}}
[[Category:Chemistry]]

[[fr:Dendrimère]]
[[ja:デンドリマー]]
[[pl:Dendrymer]]

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{{WikiDoc Sources}}

Nitrogen oxide

2009-06-26T16:52:50Z

LBiller: /* Biogenic sources */

{{SI}}
{{EH}}

==Overview==
The term '''nitrogen oxide''' typically refers to any [[binary compound]] of [[oxygen]] and [[nitrogen]], or to a mixture of such compounds:

* [[Nitric oxide]] (NO), nitrogen(II) oxide
* [[Nitrogen dioxide]] (NO2), nitrogen(IV) oxide
* [[Nitrous oxide]] (N2O)
* [[Dinitrogen trioxide]] (N2O3), nitrogen(II, IV) oxide
* [[Dinitrogen tetroxide]] (N2O4), nitrogen(IV) oxide
* [[Dinitrogen pentoxide]] (N2O5), nitrogen(V) oxide
(Note that the last three are unstable.)

[[Chemical reaction]]s that produce nitrogen oxides often produce several, the proportions depending on the specific reaction and conditions. This is one reason why secondary production of N2O is undesirable; the other two stable oxides — which are extremely toxic — are liable to be produced.

<gallery perrow="3">
Image:Nitric-oxide-3D-vdW.png|<center>'''Nitric oxide''', NO</center>
Image:Nitrogen-dioxide-3D-vdW.png|<center>'''Nitrogen dioxide''', NO2</center>
Image:Nitrous-oxide-3D-vdW.png|<center>'''Nitrous oxide''', N2O</center>
Image:Dinitrogen-trioxide-3D-vdW.png|<center>'''Dinitrogen trioxide''', N2O3</center>
Image:Dinitrogen-tetroxide-3D-vdW.png|<center>'''Dinitrogen tetroxide''', N2O4</center>
Image:Dinitrogen-pentoxide-3D-vdW.png|<center>'''Dinitrogen pentoxide''', N2O5</center>
</gallery>

==NOx==

'''NOx''' is a generic term for mono-nitrogen oxides (NO and NO2). These oxides are produced during [[combustion]], especially combustion at high temperatures.

At ambient temperatures, the oxygen and nitrogen gases in air will not react with each other. In an [[internal combustion engine]], combustion of a mixture of air and fuel produces combustion temperatures high enough to drive endothermic reactions between atmospheric nitrogen and oxygen in the flame, yielding various [[oxide]]s of nitrogen. In areas of high motor vehicle traffic, such as in large cities, the amount of nitrogen oxides emitted into the atmosphere can be quite significant.

In the presence of excess oxygen (O2), [[nitric oxide]] (NO) will be converted to [[nitrogen dioxide]] (NO2), with the time required dependent on the concentration in air as shown below:<ref> {{cite web|url=http://www.branchenv.com/nox/nox_info.asp |title=NOx Removal |accessdate=2007-12-26 |publisher=Branch Environmental Corp }}</ref>

{| class=”wikitable”
|-
! NO concentration in air
(ppm)
! Time required for half NO
to be oxidized to NO2
(min)
|-
|20,000
|0.175
|-
|10,000
|0.35
|-
| 1,000
| 3.5
|-
|100
|35
|-
|10
|350
|-
|1
|3500
|}

When NOx and [[volatile organic compound]]s (VOCs) react in the presence of sunlight, they form photochemical [[smog]], a significant form of air pollution, especially in the summer. Children, people with lung diseases such as asthma, and people who work or exercise outside are susceptible to adverse effects of smog such as damage to lung tissue and reduction in lung function.<ref>{{cite web|url=http://www.epa.gov/airprogm/oar/urbanair/nox/hlth.html |title=Health and Environmental Impacts of NOx |accessdate=2007-12-26 |publisher=[[United States Environmental Protection Agency]] }}</ref>

Mono-nitrogen oxides eventually form [[nitric acid]] when dissolved in atmospheric moisture, forming a component of [[acid rain]]. The following chemical reaction occurs when nitrogen dioxide reacts with water: 
2NO2 + H2O → HNO2 + HNO3
(nitrogen dioxide + water → nitrous acid + nitric acid). 
Nitrous acid then decomposes as follows: 
3HNO2 → HNO3 + 2NO + H2O
(nitrous acid → nitric acid + nitric oxide + water), 
where [[nitric oxide]] will [[oxidize]] to form nitrogen dioxide that again reacts with water, ultimately forming nitric acid: 
4NO + 3O2 + 2H2O → 4HNO3 (nitric oxide + oxygen + water → nitric acid).

Mono-nitrogen oxides are also involved in tropospheric production of [[ozone]].<ref>
{{cite journal
|author=D. Fowler, ''et al.''
|year=1998
|title=The atmospheric budget of oxidized nitrogen and its role in ozone formation and deposition
|journal=New Phytologist
|volume=139
|pages=11-23
}}</ref>

NOx should not be confused with NOS, a term used to refer to [[Nitrous|nitrous oxide]] (N2O) in the context of its use as a power booster for internal combustion engines.

==Definition of NOx and NOy in atmospheric chemistry==
In [[atmospheric chemistry]] the term NOx is used to mean the total concentration of [[Nitric oxide|NO]] plus [[Nitrogen dioxide|NO2]]. During daylight NO and NO2 are in equilibrium with the ratio NO/NO2 determined by the intensity of sunshine (which converts NO2 to NO) and ozone (which reacts with NO to give back NO2). NO and NO2 are also central to the formation of [[tropospheric ozone]]. This definition excludes other oxides of nitrogen such as Nitrous Oxide. NOy (reactive odd nitrogen) is defined as the sum of NOx plus the compounds produced from the oxidation of NOx which include [[nitric acid]], [[peroxyacetyl nitrate]]. In this context nitrous oxide and [[ammonia]] are not considered as reactive nitrogen compounds.

== Industrial sources of NOx ==
The three primary sources of NOx in [[combustion]] processes:

* thermal NOx
* fuel NOx
* prompt NOx

Thermal NOx formation, which is highly temperature dependent, is recognized as the most relevant source when combusting natural gas. Fuel NOx tends to dominate during the combustion of fuels, such as coal, which have a significant nitrogen content, particularly when burned in combustors designed to minimise thermal NOx. The contribution of prompt NOx is normally considered negligible. A fourth source, called ''feed NOx'' is associated with the combustion of nitrogen present in the feed material of cement rotary kilns, at between 300° and 800°C, where it is also a minor contributor.

=== Thermal NOx ===
Thermal NOx refers to NOx formed through high temperature oxidation of the diatomic nitrogen found in combustion air. The formation rate is primarily a function of temperature and the residence time of nitrogen at that temperature. At high temperatures, usually above 1600°C (2900°F), molecular nitrogen (N2) and oxygen (O2) in the combustion air disassociate into their atomic states and participate in a series of reactions.

The three principal reactions producing thermal NOx are:

(Extended Zeldovich Mechanism)
*'''N2 + O → NO + N'''
*'''N + O2 → NO + O'''
*'''N + OH → NO + H'''

all 3 reactions are reversible. Zeldovich was the first to suggest the importance of the first two reactions. The last reaction of atomic Nitrogen with Hydroxyl radical, OH, was added by Lavovie, Heywood and Keck to the mechanism and makes a significiant contribution to the formation of thermal NOxx.

===Fuel NOx===
The major source of NOx production from nitrogen-bearing fuels such as certain coals and oil, is the conversion of fuel bound nitrogen to NOx during combustion. During combustion, the nitrogen bound in the fuel is released as a [[Radical (chemistry)|free radical]] and ultimately forms free N2, or NO. Fuel NOx can contribute as much as 50% of total emissions when combusting oil and as much as 80% when combusting coal.

Although the complete mechanism is not fully understood, there are two primary paths of formation. The first involves the oxidation of volatile nitrogen species during the initial stages of combustion. During the release and prior to the oxidation of the volatiles, nitrogen reacts to form several intermediaries which are then oxidized into NO. If the volatiles evolve into a reducing atmosphere, the nitrogen evolved can readily be made to form nitrogen gas, rather than NOx. The second path involves the combustion of nitrogen contained in the char matrix during the combustion of the char portion of the fuels. This reaction occurs much more slowly than the volatile phase. Only around 20% of the char nitrogen is ultimately emitted as NOx, since much of the NOx that forms during this process is reduced to nitrogen by the char, which is nearly pure carbon.

===Prompt NOx===
This third source is attributed to the reaction of atmospheric nitrogen, N2, with radicals such as C, CH, and CH2 fragments derived from fuel, where this cannot be explained by either the aforementioned thermal or fuel processes. Occurring in the earliest stage of combustion, this results in the formation of fixed species of nitrogen such as NH (nitrogen monohydride), HCN ([[hydrogen cyanide]]), H2CN (dihydrogen cyanide) and CN- ([[cyano]] radical) which can oxidize to NO. In fuels that contain nitrogen, the incidence of prompt NOx is especially minimal and it is generally only of interest for the most exacting emission targets.

=== Regulation and emission control technologies ===

The United States Environmental Protection Agency (EPA) regulates and enforces NOx emission limits in the U.S. in accordance to legislation passed by the United States Congress. The Kyoto Protocol, ratified by 54 nations in 1997, calls for a substantial world wide reduction of greenhouse gases including nitrous oxide.

Technologies such as flameless oxidation (FLOX®) and staged combustion significantly reduce thermal NOx in industrial processes. Bowin low NOx technology is a hybrid of staged-premixed-radiant combustion technology with a major surface combustion preceded by a minor radiant combustion. In the Bowin burner, air and fuel gas are premixed at a ratio greater than or equal to the stoichiometric combustion requirement.<ref>Bob Joynt & Stephen Wu, ''Nitrogen oxides emissions standards for domestic gas appliances background study'' Combustion Engineering Consultant; February 2000</ref> Water Injection technology, wherby water is introduced into the combustion chamber, is also becoming an important means of NOx reduction through increased efficiency in the overall combustion process. Alternatively, the water (e.g. 10 to 50%) is emulsified into the fuel oil prior to the injection and combustion. This emulsification can either be made in-line (unstabilized) just before the injection or as a drop-in fuel with chemical additives for long term emulsion stability (stabilized). Other technologies, such as selective catalytic reduction (SCR) and selective non-catalytic reduction (SNCR) reduce post combustion NOx.

The use of exhaust gas recirculation and [[catalytic converter]]s in motor vehicle engines have significantly reduced emissions.

== Biogenic sources ==

Agricultural fertilization and the use of nitrogen fixing [[plant]]s also contribute to atmospheric NO''x'', by promoting [[nitrogen fixation]] by microorganisms.<ref>
{{cite journal
|author=J.N. Galloway, ''et al.''
|month=Sep
|year=2004
|title=Nitrogen cycles: past, present, and future
|journal=Biogeochemistry
|volume=70
|issue=2
|pages=153-226
|doi=10.1007/s10533-004-0370-0
}}</ref><ref>
{{cite journal
|author=E.A. Davidson & W. Kingerlee
|year=1997
|title=A global inventory of nitric oxide emissions from soils
|journal=Nutrient Cycling in Agroecosystems
|volume=48
|pages=37-50
}}</ref>

==References==
{{reflist}}

{{SIB}}
[[ar:أكسيد نيتروجين]]
[[bg:Азотни оксиди]]
[[da:Nitrogenoxider]]
[[de:Stickoxide]]
[[es:Óxidos de nitrógeno]]
[[fr:NOx (chimie)]]
[[ko:질소 산화물]]
[[it:NOx]]
[[nl:Stikstofoxiden]]
[[ja:窒素酸化物]]
[[pl:Tlenki azotu]]
[[ru:Оксиды азота]]
[[sl:Dušikov oksid]]
[[fi:Typpioksidi]]
[[sv:Kväveoxider]]
[[uk:Азоту оксид]]
[[zh:氮氧化物]]
{{WH}}
{{WikiDoc Sources}}

Nitrogen oxide

2009-06-26T16:51:50Z

LBiller: /* Regulation and emission control technologies */

{{SI}}
{{EH}}

==Overview==
The term '''nitrogen oxide''' typically refers to any [[binary compound]] of [[oxygen]] and [[nitrogen]], or to a mixture of such compounds:

* [[Nitric oxide]] (NO), nitrogen(II) oxide
* [[Nitrogen dioxide]] (NO2), nitrogen(IV) oxide
* [[Nitrous oxide]] (N2O)
* [[Dinitrogen trioxide]] (N2O3), nitrogen(II, IV) oxide
* [[Dinitrogen tetroxide]] (N2O4), nitrogen(IV) oxide
* [[Dinitrogen pentoxide]] (N2O5), nitrogen(V) oxide
(Note that the last three are unstable.)

[[Chemical reaction]]s that produce nitrogen oxides often produce several, the proportions depending on the specific reaction and conditions. This is one reason why secondary production of N2O is undesirable; the other two stable oxides — which are extremely toxic — are liable to be produced.

<gallery perrow="3">
Image:Nitric-oxide-3D-vdW.png|<center>'''Nitric oxide''', NO</center>
Image:Nitrogen-dioxide-3D-vdW.png|<center>'''Nitrogen dioxide''', NO2</center>
Image:Nitrous-oxide-3D-vdW.png|<center>'''Nitrous oxide''', N2O</center>
Image:Dinitrogen-trioxide-3D-vdW.png|<center>'''Dinitrogen trioxide''', N2O3</center>
Image:Dinitrogen-tetroxide-3D-vdW.png|<center>'''Dinitrogen tetroxide''', N2O4</center>
Image:Dinitrogen-pentoxide-3D-vdW.png|<center>'''Dinitrogen pentoxide''', N2O5</center>
</gallery>

==NOx==

'''NOx''' is a generic term for mono-nitrogen oxides (NO and NO2). These oxides are produced during [[combustion]], especially combustion at high temperatures.

At ambient temperatures, the oxygen and nitrogen gases in air will not react with each other. In an [[internal combustion engine]], combustion of a mixture of air and fuel produces combustion temperatures high enough to drive endothermic reactions between atmospheric nitrogen and oxygen in the flame, yielding various [[oxide]]s of nitrogen. In areas of high motor vehicle traffic, such as in large cities, the amount of nitrogen oxides emitted into the atmosphere can be quite significant.

In the presence of excess oxygen (O2), [[nitric oxide]] (NO) will be converted to [[nitrogen dioxide]] (NO2), with the time required dependent on the concentration in air as shown below:<ref> {{cite web|url=http://www.branchenv.com/nox/nox_info.asp |title=NOx Removal |accessdate=2007-12-26 |publisher=Branch Environmental Corp }}</ref>

{| class=”wikitable”
|-
! NO concentration in air
(ppm)
! Time required for half NO
to be oxidized to NO2
(min)
|-
|20,000
|0.175
|-
|10,000
|0.35
|-
| 1,000
| 3.5
|-
|100
|35
|-
|10
|350
|-
|1
|3500
|}

When NOx and [[volatile organic compound]]s (VOCs) react in the presence of sunlight, they form photochemical [[smog]], a significant form of air pollution, especially in the summer. Children, people with lung diseases such as asthma, and people who work or exercise outside are susceptible to adverse effects of smog such as damage to lung tissue and reduction in lung function.<ref>{{cite web|url=http://www.epa.gov/airprogm/oar/urbanair/nox/hlth.html |title=Health and Environmental Impacts of NOx |accessdate=2007-12-26 |publisher=[[United States Environmental Protection Agency]] }}</ref>

Mono-nitrogen oxides eventually form [[nitric acid]] when dissolved in atmospheric moisture, forming a component of [[acid rain]]. The following chemical reaction occurs when nitrogen dioxide reacts with water: 
2NO2 + H2O → HNO2 + HNO3
(nitrogen dioxide + water → nitrous acid + nitric acid). 
Nitrous acid then decomposes as follows: 
3HNO2 → HNO3 + 2NO + H2O
(nitrous acid → nitric acid + nitric oxide + water), 
where [[nitric oxide]] will [[oxidize]] to form nitrogen dioxide that again reacts with water, ultimately forming nitric acid: 
4NO + 3O2 + 2H2O → 4HNO3 (nitric oxide + oxygen + water → nitric acid).

Mono-nitrogen oxides are also involved in tropospheric production of [[ozone]].<ref>
{{cite journal
|author=D. Fowler, ''et al.''
|year=1998
|title=The atmospheric budget of oxidized nitrogen and its role in ozone formation and deposition
|journal=New Phytologist
|volume=139
|pages=11-23
}}</ref>

NOx should not be confused with NOS, a term used to refer to [[Nitrous|nitrous oxide]] (N2O) in the context of its use as a power booster for internal combustion engines.

==Definition of NOx and NOy in atmospheric chemistry==
In [[atmospheric chemistry]] the term NOx is used to mean the total concentration of [[Nitric oxide|NO]] plus [[Nitrogen dioxide|NO2]]. During daylight NO and NO2 are in equilibrium with the ratio NO/NO2 determined by the intensity of sunshine (which converts NO2 to NO) and ozone (which reacts with NO to give back NO2). NO and NO2 are also central to the formation of [[tropospheric ozone]]. This definition excludes other oxides of nitrogen such as Nitrous Oxide. NOy (reactive odd nitrogen) is defined as the sum of NOx plus the compounds produced from the oxidation of NOx which include [[nitric acid]], [[peroxyacetyl nitrate]]. In this context nitrous oxide and [[ammonia]] are not considered as reactive nitrogen compounds.

== Industrial sources of NOx ==
The three primary sources of NOx in [[combustion]] processes:

* thermal NOx
* fuel NOx
* prompt NOx

Thermal NOx formation, which is highly temperature dependent, is recognized as the most relevant source when combusting natural gas. Fuel NOx tends to dominate during the combustion of fuels, such as coal, which have a significant nitrogen content, particularly when burned in combustors designed to minimise thermal NOx. The contribution of prompt NOx is normally considered negligible. A fourth source, called ''feed NOx'' is associated with the combustion of nitrogen present in the feed material of cement rotary kilns, at between 300° and 800°C, where it is also a minor contributor.

=== Thermal NOx ===
Thermal NOx refers to NOx formed through high temperature oxidation of the diatomic nitrogen found in combustion air. The formation rate is primarily a function of temperature and the residence time of nitrogen at that temperature. At high temperatures, usually above 1600°C (2900°F), molecular nitrogen (N2) and oxygen (O2) in the combustion air disassociate into their atomic states and participate in a series of reactions.

The three principal reactions producing thermal NOx are:

(Extended Zeldovich Mechanism)
*'''N2 + O → NO + N'''
*'''N + O2 → NO + O'''
*'''N + OH → NO + H'''

all 3 reactions are reversible. Zeldovich was the first to suggest the importance of the first two reactions. The last reaction of atomic Nitrogen with Hydroxyl radical, OH, was added by Lavovie, Heywood and Keck to the mechanism and makes a significiant contribution to the formation of thermal NOxx.

===Fuel NOx===
The major source of NOx production from nitrogen-bearing fuels such as certain coals and oil, is the conversion of fuel bound nitrogen to NOx during combustion. During combustion, the nitrogen bound in the fuel is released as a [[Radical (chemistry)|free radical]] and ultimately forms free N2, or NO. Fuel NOx can contribute as much as 50% of total emissions when combusting oil and as much as 80% when combusting coal.

Although the complete mechanism is not fully understood, there are two primary paths of formation. The first involves the oxidation of volatile nitrogen species during the initial stages of combustion. During the release and prior to the oxidation of the volatiles, nitrogen reacts to form several intermediaries which are then oxidized into NO. If the volatiles evolve into a reducing atmosphere, the nitrogen evolved can readily be made to form nitrogen gas, rather than NOx. The second path involves the combustion of nitrogen contained in the char matrix during the combustion of the char portion of the fuels. This reaction occurs much more slowly than the volatile phase. Only around 20% of the char nitrogen is ultimately emitted as NOx, since much of the NOx that forms during this process is reduced to nitrogen by the char, which is nearly pure carbon.

===Prompt NOx===
This third source is attributed to the reaction of atmospheric nitrogen, N2, with radicals such as C, CH, and CH2 fragments derived from fuel, where this cannot be explained by either the aforementioned thermal or fuel processes. Occurring in the earliest stage of combustion, this results in the formation of fixed species of nitrogen such as NH (nitrogen monohydride), HCN ([[hydrogen cyanide]]), H2CN (dihydrogen cyanide) and CN- ([[cyano]] radical) which can oxidize to NO. In fuels that contain nitrogen, the incidence of prompt NOx is especially minimal and it is generally only of interest for the most exacting emission targets.

=== Regulation and emission control technologies ===

The United States Environmental Protection Agency (EPA) regulates and enforces NOx emission limits in the U.S. in accordance to legislation passed by the United States Congress. The Kyoto Protocol, ratified by 54 nations in 1997, calls for a substantial world wide reduction of greenhouse gases including nitrous oxide.

Technologies such as flameless oxidation (FLOX®) and staged combustion significantly reduce thermal NOx in industrial processes. Bowin low NOx technology is a hybrid of staged-premixed-radiant combustion technology with a major surface combustion preceded by a minor radiant combustion. In the Bowin burner, air and fuel gas are premixed at a ratio greater than or equal to the stoichiometric combustion requirement.<ref>Bob Joynt & Stephen Wu, ''Nitrogen oxides emissions standards for domestic gas appliances background study'' Combustion Engineering Consultant; February 2000</ref> Water Injection technology, wherby water is introduced into the combustion chamber, is also becoming an important means of NOx reduction through increased efficiency in the overall combustion process. Alternatively, the water (e.g. 10 to 50%) is emulsified into the fuel oil prior to the injection and combustion. This emulsification can either be made in-line (unstabilized) just before the injection or as a drop-in fuel with chemical additives for long term emulsion stability (stabilized). Other technologies, such as selective catalytic reduction (SCR) and selective non-catalytic reduction (SNCR) reduce post combustion NOx.

The use of exhaust gas recirculation and [[catalytic converter]]s in motor vehicle engines have significantly reduced emissions.

== Biogenic sources ==

[[Agricultural]] [[fertilization (soil)|fertilization]] and the use of [[nitrogen fixing]] [[plant]]s also contribute to atmospheric NO''x'', by promoting [[nitrogen fixation]] by microorganisms.<ref>
{{cite journal
|author=J.N. Galloway, ''et al.''
|month=Sep
|year=2004
|title=Nitrogen cycles: past, present, and future
|journal=Biogeochemistry
|volume=70
|issue=2
|pages=153-226
|doi=10.1007/s10533-004-0370-0
}}</ref><ref>
{{cite journal
|author=E.A. Davidson & W. Kingerlee
|year=1997
|title=A global inventory of nitric oxide emissions from soils
|journal=Nutrient Cycling in Agroecosystems
|volume=48
|pages=37-50
}}</ref>

==References==
{{reflist}}

{{SIB}}
[[ar:أكسيد نيتروجين]]
[[bg:Азотни оксиди]]
[[da:Nitrogenoxider]]
[[de:Stickoxide]]
[[es:Óxidos de nitrógeno]]
[[fr:NOx (chimie)]]
[[ko:질소 산화물]]
[[it:NOx]]
[[nl:Stikstofoxiden]]
[[ja:窒素酸化物]]
[[pl:Tlenki azotu]]
[[ru:Оксиды азота]]
[[sl:Dušikov oksid]]
[[fi:Typpioksidi]]
[[sv:Kväveoxider]]
[[uk:Азоту оксид]]
[[zh:氮氧化物]]
{{WH}}
{{WikiDoc Sources}}