{ "cells": [ { "cell_type": "code", "execution_count": 1, "metadata": {}, "outputs": [], "source": [ "from langchain.text_splitter import RecursiveCharacterTextSplitter\n", "from langchain.document_loaders import PyPDFLoader\n", "from langchain.document_loaders import DirectoryLoader\n", "from langchain.vectorstores import FAISS\n", "from langchain.embeddings import HuggingFaceEmbeddings\n", "from langchain.llms import CTransformers\n", "from langchain.prompts import PromptTemplate\n", "from langchain.chains import RetrievalQA\n", "import os" ] }, { "cell_type": "code", "execution_count": 2, "metadata": {}, "outputs": [], "source": [ "def load_pdf(data):\n", " loader = DirectoryLoader(data,\n", " glob=\"*.pdf\",\n", " loader_cls=PyPDFLoader)\n", " \n", " documents = loader.load()\n", " return documents" ] }, { "cell_type": "code", "execution_count": 3, "metadata": {}, "outputs": [], "source": [ "extracted_data = load_pdf(\"./data\")" ] }, { "cell_type": "code", "execution_count": 4, "metadata": {}, "outputs": [], "source": [ "def text_split(extracted_data):\n", " text_splitter = RecursiveCharacterTextSplitter(chunk_size = 500, chunk_overlap = 20)\n", " text_chunks = text_splitter.split_documents(extracted_data)\n", " return text_chunks" ] }, { "cell_type": "code", "execution_count": 5, "metadata": {}, "outputs": [ { "name": "stdout", "output_type": "stream", "text": [ "Total number of chunks: 8205\n" ] } ], "source": [ "chunks = text_split(extracted_data)\n", "length = len(chunks)\n", "print(\"Total number of chunks:\", length)" ] }, { "cell_type": "code", "execution_count": 6, "metadata": {}, "outputs": [ { "data": { "text/plain": [ "[Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 1, 'page_label': '2'}, page_content='The GALE\\nENCYCLOPEDIA\\nof MEDICINE\\nSECOND EDITION'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 2, 'page_label': '3'}, page_content='The GALE\\nENCYCLOPEDIA\\nof MEDICINE\\nSECOND EDITION\\nJACQUELINE L. LONGE, EDITOR\\nDEIRDRE S. BLANCHFIELD, ASSOCIATE EDITOR\\nVOLUME\\nA-B\\n1'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 3, 'page_label': '4'}, page_content='STAFF\\nJacqueline L. Longe, Project Editor\\nDeirdre S. Blanchfield, Associate Editor\\nChristine B. Jeryan, Managing Editor\\nDonna Olendorf, Senior Editor\\nStacey Blachford, Associate Editor\\nKate Kretschmann, Melissa C. McDade, Ryan\\nThomason, Assistant Editors\\nMark Springer, Technical Specialist\\nAndrea Lopeman, Programmer/Analyst\\nBarbara J. Yarrow,Manager, Imaging and Multimedia\\nContent\\nRobyn V . Young,Project Manager, Imaging and\\nMultimedia Content\\nDean Dauphinais, Senior Editor, Imaging and'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 3, 'page_label': '4'}, page_content='Multimedia Content\\nKelly A. Quin, Editor, Imaging and Multimedia Content\\nLeitha Etheridge-Sims, Mary K. Grimes, Dave Oblender,\\nImage Catalogers\\nPamela A. Reed, Imaging Coordinator\\nRandy Bassett, Imaging Supervisor\\nRobert Duncan, Senior Imaging Specialist\\nDan Newell, Imaging Specialist\\nChristine O’Bryan,Graphic Specialist\\nMaria Franklin, Permissions Manager\\nMargaret A. Chamberlain, Permissions Specialist\\nMichelle DiMercurio, Senior Art Director\\nMike Logusz, Graphic Artist'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 3, 'page_label': '4'}, page_content='Mary Beth Trimper,Manager, Composition and\\nElectronic Prepress\\nEvi Seoud, Assistant Manager, Composition Purchasing\\nand Electronic Prepress\\nDorothy Maki, Manufacturing Manager\\nWendy Blurton, Senior Manufacturing Specialist\\nThe GALE\\nENCYCLOPEDIA\\nof MEDICINE\\nSECOND EDITION\\nSince this page cannot legibly accommodate all copyright notices, the\\nacknowledgments constitute an extension of the copyright notice.\\nWhile every effort has been made to ensure the reliability of the infor-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 3, 'page_label': '4'}, page_content='mation presented in this publication, the Gale Group neither guarantees\\nthe accuracy of the data contained herein nor assumes any responsibili-\\nty for errors, omissions or discrepancies. The Gale Group accepts no\\npayment for listing, and inclusion in the publication of any organiza-\\ntion, agency, institution, publication, service, or individual does not\\nimply endorsement of the editor or publisher. Errors brought to the\\nattention of the publisher and verified to the satisfaction of the publish-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 3, 'page_label': '4'}, page_content='er will be corrected in future editions.\\nThis book is printed on recycled paper that meets Environmental Pro-\\ntection Agency standards.\\nThe paper used in this publication meets the minimum requirements of\\nAmerican National Standard for Information Sciences-Permanence\\nPaper for Printed Library Materials, ANSI Z39.48-1984.\\nThis publication is a creative work fully protected by all applicable\\ncopyright laws, as well as by misappropriation, trade secret, unfair com-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 3, 'page_label': '4'}, page_content='petition, and other applicable laws. The authors and editor of this work\\nhave added value to the underlying factual material herein through one\\nor more of the following: unique and original selection, coordination,\\nexpression, arrangement, and classification of the information.\\nGale Group and design is a trademark used herein under license.\\nAll rights to this publication will be vigorously defended.\\nCopyright © 2002\\nGale Group\\n27500 Drake Road\\nFarmington Hills, MI 48331-3535'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 3, 'page_label': '4'}, page_content='All rights reserved including the right of reproduction in whole or in\\npart in any form.\\nISBN 0-7876-5489-2 (set)\\n0-7876-5490-6 (V ol. 1)\\n0-7876-5491-4 (V ol. 2)\\n0-7876-5492-2 (V ol. 3)\\n0-7876-5493-0 (V ol. 4)\\n0-7876-5494-9 (V ol. 5)\\nPrinted in the United States of America\\n10 9 8 7 6 5 4 3 2 1\\nLibrary of Congress Cataloging-in-Publication Data\\nGale encyclopedia of medicine / Jacqueline L. Longe, editor;\\nDeirdre S. Blanchfield, associate editor — 2nd ed.\\np. cm.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 3, 'page_label': '4'}, page_content='p. cm.\\nIncludes bibliographical references and index.\\nContents: V ol. 1. A-B — v. 2. C-F — v. 3.\\nG-M — v. 4. N-S — v. 5. T-Z.\\nISBN 0-7876-5489-2 (set: hardcover) — ISBN 0-7876-5490-6\\n(vol. 1) — ISBN 0-7876-5491-4 (vol. 2) — ISBN 0-7876-5492-2\\n(vol. 3) — ISBN 0-7876-5493-0 (vol. 4) — ISBN 0-7876-5494-9\\n(vol. 5)\\n1. Internal medicine—Encyclopedias. I. Longe, Jacqueline L. \\nII. Blanchfield, Deirdre S. III. Gale Research Company.\\nRC41.G35 2001\\n616’.003—dc21\\n2001051245'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 4, 'page_label': '5'}, page_content='Introduction.................................................... ix\\nAdvisory Board.............................................. xi\\nContributors ................................................. xiii\\nEntries\\nVolume 1: A-B.............................................. 1\\nVolume 2: C-F.......................................... 625\\nVolume 3: G-M....................................... 1375\\nVolume 4: N-S........................................ 2307'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 4, 'page_label': '5'}, page_content='Volume 5: T-Z........................................ 3237\\nOrganizations ............................................ 3603\\nGeneral Index............................................ 3625\\nGALE ENCYCLOPEDIA OF MEDICINE 2 V\\nCONTENTS'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 5, 'page_label': '6'}, page_content='The Gale Encyclopedia of Medicine 2is a medical ref-\\nerence product designed to inform and educate readers\\nabout a wide variety of disorders, conditions, treatments,\\nand diagnostic tests. The Gale Group believes the product\\nto be comprehensive, but not necessarily definitive. It is\\nintended to supplement, not replace, consultation with a\\nphysician or other healthcare practitioner. While the Gale\\nGroup has made substantial efforts to provide information'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 5, 'page_label': '6'}, page_content='that is accurate, comprehensive, and up-to-date, the Gale\\nGroup makes no representations or warranties of any\\nkind, including without limitation, warranties of mer-\\nchantability or fitness for a particular purpose, nor does it\\nguarantee the accuracy, comprehensiveness, or timeliness\\nof the information contained in this product. Readers\\nshould be aware that the universe of medical knowledge\\nis constantly growing and changing, and that differences'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 5, 'page_label': '6'}, page_content='of medical opinion exist among authorities. Readers are\\nalso advised to seek professional diagnosis and treatment\\nfor any medical condition, and to discuss information\\nobtained from this book with their health care provider.\\nGALE ENCYCLOPEDIA OF MEDICINE 2 VII\\nPLEASE READ—IMPORTANT INFORMATION'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 6, 'page_label': '7'}, page_content='The Gale Encyclopedia of Medicine 2 (GEM2) is a\\none-stop source for medical information on nearly 1,700\\ncommon medical disorders, conditions, tests, and treat-\\nments, including high-profile diseases such as AIDS,\\nAlzheimer’s disease, cancer, and heart attack. This ency-\\nclopedia avoids medical jargon and uses language that\\nlaypersons can understand, while still providing thor-\\nough coverage of each topic. The Gale Encyclopedia of\\nMedicine 2 fills a gap between basic consumer health'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 6, 'page_label': '7'}, page_content='resources, such as single-volume family medical guides,\\nand highly technical professional materials.\\nSCOPE\\nAlmost 1,700 full-length articles are included in the\\nGale Encyclopedia of Medicine 2 , including disorders/\\nconditions, tests/procedures, and treatments/therapies.\\nMany common drugs are also covered, with generic drug\\nnames appearing first and brand names following in\\nparentheses, eg. acetaminophen (Tylenol). Throughout\\nthe Gale Encyclopedia of Medicine 2 , many prominent'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 6, 'page_label': '7'}, page_content='individuals are highlighted as sidebar biographies that\\naccompany the main topical essays. Articles follow a\\nstandardized format that provides information at a\\nglance. Rubrics include:\\nDisorders/Conditions Tests/Treatments\\nDefinition Definition\\nDescription Purpose\\nCauses and symptoms Precautions\\nDiagnosis Description\\nTreatment Preparation\\nAlternative treatment Aftercare\\nPrognosis Risks\\nPrevention Normal/Abnormal results\\nResources Resources\\nKey terms Key terms'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 6, 'page_label': '7'}, page_content='Key terms Key terms\\nIn recent years there has been a resurgence of interest\\nin holistic medicine that emphasizes the connection\\nbetween mind and body. Aimed at achieving and main-\\ntaining good health rather than just eliminating disease,\\nthis approach has come to be known as alternative medi-\\ncine. The Gale Encyclopedia of Medicine 2 includes a\\nnumber of essays on alternative therapies, ranging from\\ntraditional Chinese medicine to homeopathy and from'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 6, 'page_label': '7'}, page_content='meditation to aromatherapy. In addition to full essays on\\nalternative therapies, the encyclopedia features specific\\nAlternative treatmentsections for diseases and condi-\\ntions that may be helped by complementary therapies.\\nINCLUSION CRITERIA\\nA preliminary list of diseases, disorders, tests and treat-\\nments was compiled from a wide variety of sources,\\nincluding professional medical guides and textbooks as\\nwell as consumer guides and encyclopedias. The general'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 6, 'page_label': '7'}, page_content='advisory board, made up of public librarians, medical\\nlibrarians and consumer health experts, evaluated the top-\\nics and made suggestions for inclusion. The list was sorted\\nby category and sent to GEM2 medical advisors, certified\\nphysicians with various medical specialities, for review.\\nFinal selection of topics to include was made by the med-\\nical advisors in conjunction with the Gale Group editor.\\nABOUT THE CONTRIBUTORS\\nThe essays were compiled by experienced medical'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 6, 'page_label': '7'}, page_content='writers, including physicians, pharmacists, nurses, and\\nother health care professionals. GEM2 medical advisors\\nreviewed the completed essays to insure that they are\\nappropriate, up-to-date, and medically accurate.\\nHOW TO USE THIS BOOK\\nThe Gale Encyclopedia of Medicine 2 has been\\ndesigned with ready reference in mind.\\n• Straight alphabetical arrangement allows users to\\nlocate information quickly.\\n• Bold-faced terms function as print hyperlinks that'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 6, 'page_label': '7'}, page_content='point the reader to related entries in the encyclopedia.\\nGALE ENCYCLOPEDIA OF MEDICINE 2 IX\\nINTRODUCTION'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 7, 'page_label': '8'}, page_content='• Cross-references placed throughout the encyclopedia\\ndirect readers to where information on subjects with-\\nout entries can be found. Synonyms are also cross-ref-\\nerenced.\\n• A list of key terms are provided where appropriate to\\ndefine unfamiliar terms or concepts.\\n• Valuable contact information for organizations and\\nsupport groups is included with each entry. The\\nappendix contains an extensive list of organizations\\narranged in alphabetical order.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 7, 'page_label': '8'}, page_content='• Resources section directs users to additional sources\\nof medical information on a topic.\\n• A comprehensive general index allows users to easily\\ntarget detailed aspects of any topic, including Latin\\nnames.\\nGRAPHICS\\nThe Gale Encyclopedia of Medicine 2 is enhanced\\nwith over 675 color images, including photos, charts,\\ntables, and customized line drawings.\\nGALE ENCYCLOPEDIA OF MEDICINE 2X\\nIntroduction'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 8, 'page_label': '9'}, page_content='MEDICAL ADVISORS\\nA. Richard Adrouny, M.D.,\\nF.A.C.P.\\nClinical Assistant Professor of\\nMedicine\\nDivision of Oncology\\nStanford University\\nDirector of Medical Oncology\\nCommunity Hospital of Los Gatos-\\nSaratoga\\nLos Gatos, CA\\nLaurie Barclay, M.D.\\nNeurological Consulting Services\\nTampa, FL\\nKenneth J. Berniker, M.D.\\nAttending Physician\\nEmergency Department\\nKaiser Permanente Medical Center\\nVallejo, CA\\nRosalyn Carson-DeWitt, M.D.\\nDurham, NC\\nRobin Dipasquale, N.D.\\nClinical Faculty\\nBastyr University'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 8, 'page_label': '9'}, page_content='Bastyr University\\nSeattle, W A\\nFaye Fishman, D.O.\\nRandolph, NJ\\nJ. Gary Grant, M.D.\\nPacific Grove, CA\\nLaith F. Gulli, M.D.\\nM.Sc., M.Sc.(MedSci), MSA,\\nMsc.Psych., MRSNZ\\nFRSH, FRIPHH, FAIC, FZS\\nDAPA, DABFC, DABCI\\nConsultant Psychotherapist in\\nPrivate Practice\\nLathrup Village, MI\\nL. Anne Hirschel, D.D.S.\\nSouthfield, MI\\nLarry I. Lutwick M.D., F.A.C.P.\\nDirector, Infectious Diseases\\nV A Medical Center\\nBrooklyn, NY\\nIra Michelson, M.D., M.B.A.,\\nF.A.C.O.G.\\nPhysician and Clinical Instructor'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 8, 'page_label': '9'}, page_content='University of Michigan\\nAnn Arbor, MI\\nSusan Mockus, M.D.\\nScientific Consultant\\nSeattle, W A\\nRalph M. Myerson, M.D.,\\nF.A.C.P.\\nClinical Professor of Medicine\\nMedical College of Pennsylvania–\\nHahnemann University\\nPhiladelphia, PA\\nRonald Pies, M.D.\\nClinical Professor of Psychiatry\\nTufts University\\nSchool of Medicine\\nBoston, MA\\nLecturer on Psychiatry\\nHarvard Medical School\\nCambridge, MA\\nLee A. Shratter, M.D.\\nStaff Radiologist\\nThe Permanente Medical Group\\nRichmond, CA\\nAmy B. Tuteur, M.D.\\nSharon, MA'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 8, 'page_label': '9'}, page_content='Sharon, MA\\nLIBRARIAN ADVISORS\\nMaureen O. Carleton, MLIS\\nMedical Reference Specialist\\nKing County Library System\\nBellevue, W A\\nElizabeth Clewis Crim, MLS\\nCollection Specialist\\nPrince William Public Library, V A\\nValerie J. Lawrence, MLS\\nAssistant Librarian\\nWestern States Chiropractic\\nCollege\\nPortland, OR\\nBarbara J. O’Hara, MLS\\nAdult Services Librarian\\nFree Library of Philadelphia, PA\\nAlan M. Rees, MLS\\nProfessor Emeritus\\nCase Western Reserve University\\nCleveland, OH'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 8, 'page_label': '9'}, page_content='Cleveland, OH\\nGALE ENCYCLOPEDIA OF MEDICINE 2 XI\\nADVISORY BOARD\\nA number of experts in the library and medical communities provided invaluable assistance in the formulation of this ency-\\nclopedia. Our advisory board performed a myriad of duties, from defining the scope of coverage to reviewing individual\\nentries for accuracy and accessibility. The editor would like to express her appreciation to them.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 9, 'page_label': '10'}, page_content='Margaret Alic, Ph.D.\\nScience Writer\\nEastsound, W A\\nJanet Byron Anderson\\nLinguist/Language Consultant\\nRocky River, OH\\nLisa Andres, M.S., C.G.C.\\nCertified Genetic Counselor and\\nMedical Writer\\nSan Jose, CA\\nGreg Annussek\\nMedical Writer/Editor\\nNew York, NY\\nBill Asenjo, M.S., C.R.C.\\nScience Writer\\nIowa City, IA\\nSharon A. Aufox, M.S., C.G.C.\\nGenetic Counselor\\nRockford Memorial Hospital\\nRockford, IL\\nSandra Bain Cushman\\nMassage Therapist, Alexander\\nTechnique Practitioner\\nCharlottesville, V A\\nHoward Baker'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 9, 'page_label': '10'}, page_content='Howard Baker\\nMedical Writer\\nNorth York, Ontario\\nLaurie Barclay, M.D.\\nNeurological Consulting Services\\nTampa, FL\\nJeanine Barone\\nNutritionist, Exercise Physiologist\\nNew York, NY\\nJulia R. Barrett\\nScience Writer\\nMadison, WI\\nDonald G. Barstow, R.N.\\nClincal Nurse Specialist\\nOklahoma City, OK\\nCarin Lea Beltz, M.S.\\nGenetic Counselor and Program\\nDirector\\nThe Center for Genetic Counseling\\nIndianapolis, IN\\nLinda K. Bennington, C.N.S.\\nScience Writer\\nVirginia Beach, V A\\nIssac R. Berniker\\nMedical Writer'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 9, 'page_label': '10'}, page_content='Medical Writer\\nVallejo, CA\\nKathleen Berrisford, M.S.V .\\nScience Writer\\nBethanne Black\\nMedical Writer\\nAtlanta, GA\\nJennifer Bowjanowski, M.S.,\\nC.G.C.\\nGenetic Counselor\\nChildren’s Hospital Oakland\\nOakland, CA\\nMichelle Q. Bosworth, M.S., C.G.C.\\nGenetic Counselor\\nEugene, OR\\nBarbara Boughton\\nHealth and Medical Writer\\nEl Cerrito, CA\\nCheryl Branche, M.D.\\nRetired General Practitioner\\nJackson, MS\\nMichelle Lee Brandt\\nMedical Writer\\nSan Francisco, CA\\nMaury M. Breecher, Ph.D.\\nHealth Communicator/Journalist'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 9, 'page_label': '10'}, page_content='Northport, AL\\nRuthan Brodsky\\nMedical Writer\\nBloomfield Hills, MI\\nTom Brody, Ph.D.\\nScience Writer\\nBerkeley, CA\\nLeonard C. Bruno, Ph.D.\\nMedical Writer\\nChevy Chase, MD\\nDiane Calbrese\\nMedical Sciences and Technology\\nWriter\\nSilver Spring, Maryland\\nRichard H. Camer\\nEditor\\nInternational Medical News Group\\nSilver Spring, MD\\nRosalyn Carson-DeWitt, M.D.\\nMedical Writer\\nDurham, NC\\nLata Cherath, Ph.D.\\nScience Writing Intern\\nCancer Research Institute\\nNew York, NY\\nLinda Chrisman\\nMassage Therapist and Educator'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 9, 'page_label': '10'}, page_content='Oakland, CA\\nLisa Christenson, Ph.D.\\nScience Writer\\nHamden, CT\\nGeoffrey N. Clark, D.V .M.\\nEditor\\nCanine Sports Medicine Update\\nNewmarket, NH\\nGALE ENCYCLOPEDIA OF MEDICINE 2 XIII\\nCONTRIBUTORS'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 10, 'page_label': '11'}, page_content='Rhonda Cloos, R.N.\\nMedical Writer\\nAustin, TX\\nGloria Cooksey, C.N.E\\nMedical Writer\\nSacramento, CA\\nAmy Cooper, M.A., M.S.I.\\nMedical Writer\\nVermillion, SD\\nDavid A. Cramer, M.D.\\nMedical Writer\\nChicago, IL\\nEsther Csapo Rastega, R.N., B.S.N.\\nMedical Writer\\nHolbrook, MA\\nArnold Cua, M.D.\\nPhysician\\nBrooklyn, NY\\nTish Davidson, A.M.\\nMedical Writer\\nFremont, California\\nDominic De Bellis, Ph.D.\\nMedical Writer/Editor\\nMahopac, NY\\nLori De Milto\\nMedical Writer\\nSicklerville, NJ\\nRobert S. Dinsmoor\\nMedical Writer'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 10, 'page_label': '11'}, page_content='Medical Writer\\nSouth Hamilton, MA\\nStephanie Dionne, B.S.\\nMedical Writer\\nAnn Arbor, MI\\nMartin W. Dodge, Ph.D.\\nTechnical Writer/Editor\\nCentinela Hospital and Medical\\nCenter\\nInglewood, CA\\nDavid Doermann\\nMedical Writer\\nSalt Lake City, UT\\nStefanie B. N. Dugan, M.S.\\nGenetic Counselor\\nMilwaukee, WI\\nDoug Dupler, M.A.\\nScience Writer\\nBoulder, CO\\nJulie A. Gelderloos\\nBiomedical Writer\\nPlaya del Rey, CA\\nGary Gilles, M.A.\\nMedical Writer\\nWauconda, IL\\nHarry W. Golden\\nMedical Writer\\nShoreline Medical Writers'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 10, 'page_label': '11'}, page_content='Old Lyme, CT\\nDebra Gordon\\nMedical Writer\\nNazareth, PA\\nMegan Gourley\\nWriter\\nGermantown, MD\\nJill Granger, M.S.\\nSenior Research Associate\\nUniversity of Michigan\\nAnn Arbor, MI\\nAlison Grant\\nMedical Writer\\nAverill Park, NY\\nElliot Greene, M.A.\\nformer president, American\\nMassage Therapy Association\\nMassage Therapist\\nSilver Spring, MD\\nPeter Gregutt\\nWriter\\nAsheville, NC\\nLaith F. Gulli, M.D.\\nM.Sc., M.Sc.(MedSci), M.S.A.,\\nMsc.Psych, MRSNZ\\nFRSH, FRIPHH, FAIC, FZS\\nDAPA, DABFC, DABCI'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 10, 'page_label': '11'}, page_content='DAPA, DABFC, DABCI\\nConsultant Psychotherapist in\\nPrivate Practice\\nLathrup Village, MI\\nKapil Gupta, M.D.\\nMedical Writer\\nWinston-Salem, NC\\nMaureen Haggerty\\nMedical Writer\\nAmbler, PA\\nClare Hanrahan\\nMedical Writer\\nAsheville, NC\\nThomas Scott Eagan\\nStudent Researcher\\nUniversity of Arizona\\nTucson, AZ\\nAltha Roberts Edgren\\nMedical Writer\\nMedical Ink\\nSt. Paul, MN\\nKaren Ericson, R.N.\\nMedical Writer\\nEstes Park, CO\\nL. Fleming Fallon Jr., M.D.,\\nDr.PH\\nAssociate Professor of Public\\nHealth'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 10, 'page_label': '11'}, page_content='Health\\nBowling Green State University\\nBowling Green, OH\\nFaye Fishman, D.O.\\nPhysician\\nRandolph, NJ\\nJanis Flores\\nMedical Writer\\nLexikon Communications\\nSebastopol, CA\\nRisa Flynn\\nMedical Writer\\nCulver City, CA\\nPaula Ford-Martin\\nMedical Writer\\nChaplin, MN\\nJanie F. Franz\\nWriter\\nGrand Forks, ND\\nSallie Freeman, Ph.D., B.S.N.\\nMedical Writer\\nAtlanta, GA\\nRebecca J. Frey, Ph.D.\\nResearch and Administrative\\nAssociate\\nEast Rock Institute\\nNew Haven, CT\\nCynthia L. Frozena, R.N.\\nNurse, Medical Writer'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 10, 'page_label': '11'}, page_content='Manitowoc, WI\\nRon Gasbarro, Pharm.D.\\nMedical Writer\\nNew Milford, PA\\nGALE ENCYCLOPEDIA OF MEDICINE 2XIV\\nContributors'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 11, 'page_label': '12'}, page_content='Ann M. Haren\\nScience Writer\\nMadison, CT\\nJudy C. Hawkins, M.S.\\nGenetic Counselor\\nThe University of Texas Medical\\nBranch\\nGalveston, TX\\nCaroline Helwick\\nMedical Writer\\nNew Orleans, LA\\nDavid Helwig\\nMedical Writer\\nLondon, Ontario\\nLisette Hilton\\nMedical Writer\\nBoca Raton, FL\\nKatherine S. Hunt, M.S.\\nGenetic Counselor\\nUniversity of New Mexico Health\\nSciences Center\\nAlbuquerque, NM\\nKevin Hwang, M.D.\\nMedical Writer\\nMorristown, NJ\\nHolly Ann Ishmael, M.S., C.G.C.\\nGenetic Counselor'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 11, 'page_label': '12'}, page_content='Genetic Counselor\\nThe Children’s Mercy Hospital\\nKansas City, MO\\nDawn A. Jacob, M.S.\\nGenetic Counselor\\nObstetrix Medical Group of Texas\\nFort Worth, TX\\nSally J. Jacobs, Ed.D.\\nMedical Writer\\nLos Angeles, CA\\nMichelle L. Johnson, M.S., J.D.\\nPatent Attorney and Medical Writer\\nPortland, OR\\nPaul A. Johnson, Ed.M.\\nMedical Writer\\nSan Diego, CA\\nCindy L. A. Jones, Ph.D.\\nBiomedical Writer\\nSagescript Communications\\nLakewood, CO\\nDavid Kaminstein, M.D.\\nMedical Writer\\nJohn T. Lohr, Ph.D.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 11, 'page_label': '12'}, page_content='John T. Lohr, Ph.D.\\nAssistant Director, Biotechnology\\nCenter\\nUtah State University\\nLogan, UT\\nLarry Lutwick, M.D., F.A.C.P.\\nDirector, Infectious Diseases\\nV A Medical Center\\nBrooklyn, NY\\nSuzanne M. Lutwick\\nMedical Writer\\nBrooklyn, NY\\nNicole Mallory, M.S.\\nMedical Student\\nWayne State University\\nDetroit, MI\\nWarren Maltzman, Ph.D.\\nConsultant, Molecular Pathology\\nDemarest, NJ\\nAdrienne Massel, R.N.\\nMedical Writer\\nBeloit, WI\\nRuth E. Mawyer, R.N.\\nMedical Writer\\nCharlottesville, V A'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 11, 'page_label': '12'}, page_content='Richard A. McCartney M.D.\\nFellow, American College of\\nSurgeons\\nDiplomat American Board of\\nSurgery\\nRichland, W A\\nBonny McClain, Ph.D.\\nMedical Writer\\nGreensboro, NC\\nSally C. McFarlane-Parrott\\nMedical Writer\\nAnn Arbor, MI\\nMercedes McLaughlin\\nMedical Writer\\nPhoenixville, CA\\nAlison McTavish, M.Sc.\\nMedical Writer and Editor\\nMontreal, Quebec\\nLiz Meszaros\\nMedical Writer\\nLakewood, OH\\nWest Chester, PA\\nBeth A. Kapes\\nMedical Writer\\nBay Village, OH\\nChristine Kuehn Kelly\\nMedical Writer\\nHavertown, PA'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 11, 'page_label': '12'}, page_content='Havertown, PA\\nBob Kirsch\\nMedical Writer\\nOssining, NY\\nJoseph Knight, P.A.\\nMedical Writer\\nWinton, CA\\nMelissa Knopper\\nMedical Writer\\nChicago, IL\\nKaren Krajewski, M.S., C.G.C.\\nGenetic Counselor\\nAssistant Professor of Neurology\\nWayne State University\\nDetroit, MI\\nJeanne Krob, M.D., F.A.C.S.\\nPhysician, writer\\nPittsburgh, PA\\nJennifer Lamb\\nMedical Writer\\nSpokane, W A\\nRichard H. Lampert\\nSenior Medical Editor\\nW.B. Saunders Co.\\nPhiladelphia, PA\\nJeffrey P. Larson, R.P.T.\\nPhysical Therapist\\nSabin, MN'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 11, 'page_label': '12'}, page_content='Sabin, MN\\nJill Lasker\\nMedical Writer\\nMidlothian, V A\\nKristy Layman\\nMusic Therapist\\nEast Lansing, MI\\nVictor Leipzig, Ph.D.\\nBiological Consultant\\nHuntington Beach, CA\\nLorraine Lica, Ph.D.\\nMedical Writer\\nSan Diego, CA\\nGALE ENCYCLOPEDIA OF MEDICINE 2 XV\\nContributors'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 12, 'page_label': '13'}, page_content='Betty Mishkin\\nMedical Writer\\nSkokie, IL\\nBarbara J. Mitchell\\nMedical Writer\\nHallstead, PA\\nMark A. Mitchell, M.D.\\nMedical Writer\\nSeattle, W A\\nSusan J. Montgomery\\nMedical Writer\\nMilwaukee, WI\\nLouann W. Murray, PhD\\nMedical Writer\\nHuntington Beach, CA\\nBilal Nasser, M.Sc.\\nSenior Medical Student\\nUniversidad Iberoamericana\\nSanto Domingo, Domincan \\nRepublic\\nLaura Ninger\\nMedical Writer\\nWeehawken, NJ\\nNancy J. Nordenson\\nMedical Writer\\nMinneapolis, MN\\nTeresa Norris, R.N.\\nMedical Writer\\nUte Park, NM'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 12, 'page_label': '13'}, page_content='Ute Park, NM\\nLisa Papp, R.N.\\nMedical Writer\\nCherry Hill, NJ\\nPatience Paradox\\nMedical Writer\\nBainbridge Island, W A\\nBarbara J. Pettersen\\nGenetic Counselor\\nGenetic Counseling of Central\\nOregon\\nBend, OR\\nGenevieve Pham-Kanter, M.S.\\nMedical Writer\\nChicago, IL\\nCollette Placek\\nMedical Writer\\nWheaton, IL\\nBelinda Rowland, Ph.D.\\nMedical Writer\\nV oorheesville, NY\\nAndrea Ruskin, M.D.\\nWhittingham Cancer Center\\nNorwalk, CT\\nLaura Ruth, Ph.D.\\nMedical, Science, & Technology\\nWriter\\nLos Angeles, CA\\nKaren Sandrick'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 12, 'page_label': '13'}, page_content='Karen Sandrick\\nMedical Writer\\nChicago, IL\\nKausalya Santhanam, Ph.D.\\nTechnical Writer\\nBranford, CT\\nJason S. Schliesser, D.C.\\nChiropractor\\nHolland Chiropractic, Inc.\\nHolland, OH\\nJoan Schonbeck\\nMedical Writer\\nNursing\\nMassachusetts Department of\\nMental Health\\nMarlborough, MA\\nLaurie Heron Seaver, M.D.\\nClinical Geneticist\\nGreenwood Genetic Center\\nGreenwood, SC\\nCatherine Seeley\\nMedical Writer\\nKristen Mahoney Shannon, M.S.,\\nC.G.C.\\nGenetic Counselor\\nCenter for Cancer Risk Analysis'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 12, 'page_label': '13'}, page_content='Massachusetts General Hospital\\nBoston, MA\\nKim A. Sharp, M.Ln.\\nWriter\\nRichmond, TX\\nJudith Sims, M.S.\\nMedical Writer\\nLogan, UT\\nJoyce S. Siok, R.N.\\nMedical Writer\\nSouth Windsor, CT\\nJ. Ricker Polsdorfer, M.D.\\nMedical Writer\\nPhoenix, AZ\\nScott Polzin, M.S., C.G.C.\\nMedical Writer\\nBuffalo Grove, IL\\nElizabeth J. Pulcini, M.S.\\nMedical Writer\\nPhoenix, Arizona\\nNada Quercia, M.S., C.C.G.C.\\nGenetic Counselor\\nDivision of Clinical and Metabolic\\nGenetics\\nThe Hospital for Sick Children\\nToronto, ON, Canada'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 12, 'page_label': '13'}, page_content='Toronto, ON, Canada\\nAnn Quigley\\nMedical Writer\\nNew York, NY\\nRobert Ramirez, B.S.\\nMedical Student\\nUniversity of Medicine & Dentistry\\nof New Jersey\\nStratford, NJ\\nKulbir Rangi, D.O.\\nMedical Doctor and Writer\\nNew York, NY\\nEsther Csapo Rastegari, Ed.M.,\\nR.N./B.S.N.\\nRegistered Nurse, Medical Writer\\nHolbrook, MA\\nToni Rizzo\\nMedical Writer\\nSalt Lake City, UT\\nMartha Robbins\\nMedical Writer\\nEvanston, IL\\nRichard Robinson\\nMedical Writer\\nTucson, AZ\\nNancy Ross-Flanigan\\nScience Writer\\nBelleville, MI'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 12, 'page_label': '13'}, page_content='Belleville, MI\\nAnna Rovid Spickler, D.V .M.,\\nPh.D.\\nMedical Writer\\nMoorehead, KY\\nGALE ENCYCLOPEDIA OF MEDICINE 2XVI\\nContributors'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 13, 'page_label': '14'}, page_content='Jennifer Sisk\\nMedical Writer\\nHavertown, PA\\nPatricia Skinner\\nMedical Writer\\nAmman, Jordan\\nGenevieve Slomski, Ph.D.\\nMedical Writer\\nNew Britain, CT\\nStephanie Slon\\nMedical Writer\\nPortland, OR\\nLinda Wasmer Smith\\nMedical Writer\\nAlbuquerque, NM\\nJava O. Solis, M.S.\\nMedical Writer\\nDecatur, GA\\nElaine Souder, PhD\\nMedical Writer\\nLittle Rock, AR\\nJane E. Spehar\\nMedical Writer\\nCanton, OH\\nLorraine Steefel, R.N.\\nMedical Writer\\nMorganville, NJ\\nKurt Sternlof\\nScience Writer\\nNew Rochelle, NY\\nRoger E. Stevenson, M.D.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 13, 'page_label': '14'}, page_content='Director\\nGreenwood Genetic Center\\nGreenwood, SC\\nDorothy Stonely\\nMedical Writer\\nLos Gatos, CA\\nAmy Vance, M.S., C.G.C.\\nGenetic Counselor\\nGeneSage, Inc.\\nSan Francisco, CA\\nMichael Sherwin Walston\\nStudent Researcher\\nUniversity of Arizona\\nTucson, AZ\\nRonald Watson, Ph.D.\\nScience Writer\\nTucson, AZ\\nEllen S. Weber, M.S.N.\\nMedical Writer\\nFort Wayne, IN\\nKen R. Wells\\nFreelance Writer\\nLaguna Hills, CA\\nJennifer F. Wilson, M.S.\\nScience Writer\\nHaddonfield, NJ\\nKathleen D. Wright, R.N.\\nMedical Writer\\nDelmar, DE'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 13, 'page_label': '14'}, page_content='Delmar, DE\\nJennifer Wurges\\nMedical Writer\\nRochester Hills, MI\\nMary Zoll, Ph.D.\\nScience Writer\\nNewton Center, MA\\nJon Zonderman\\nMedical Writer\\nOrange, CA\\nMichael V . Zuck, Ph.D.\\nMedical Writer\\nBoulder, CO\\nLiz Swain\\nMedical Writer\\nSan Diego, CA\\nDeanna M. Swartout-Corbeil,\\nR.N.\\nMedical Writer\\nThompsons Station, TN\\nKeith Tatarelli, J.D.\\nMedical Writer\\nMary Jane Tenerelli, M.S.\\nMedical Writer\\nEast Northport, NY\\nCatherine L. Tesla, M.S., C.G.C.\\nSenior Associate, Faculty'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 13, 'page_label': '14'}, page_content='Dept. of Pediatrics, Division of\\nMedical Genetics\\nEmory University School of\\nMedicine\\nAtlanta, GA\\nBethany Thivierge\\nBiotechnical Writer/Editor\\nTechnicality Resources\\nRockland, ME\\nMai Tran, Pharm.D.\\nMedical Writer\\nTroy, MI\\nCarol Turkington\\nMedical Writer\\nLancaster, PA\\nJudith Turner, B.S.\\nMedical Writer\\nSandy, UT\\nAmy B. Tuteur, M.D.\\nMedical Advisor\\nSharon, MA\\nSamuel Uretsky, Pharm.D.\\nMedical Writer\\nWantagh, NY\\nGALE ENCYCLOPEDIA OF MEDICINE 2 XVII\\nContributors'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 14, 'page_label': '15'}, page_content='Abdominal aorta ultrasound see Abdominal\\nultrasound\\nAbdominal aortic aneurysm see Aortic\\naneurysm\\nAbdominal hernia see Hernia\\nAbdominal thrust see Heimlich maneuver\\nAbdominal ultrasound\\nDefinition\\nUltrasound technology allows doctors to “see”\\ninside a patient without resorting to surgery. A transmit-\\nter sends high frequency sound waves into the body,\\nwhere they bounce off the different tissues and organs to\\nproduce a distinctive pattern of echoes. A receiver'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 14, 'page_label': '15'}, page_content='“hears” the returning echo pattern and forwards it to a\\ncomputer, which translates the data into an image on a\\ntelevision screen. Because ultrasound can distinguish\\nsubtle variations between soft, fluid-filled tissues, it is\\nparticularly useful in providing diagnostic images of the\\nabdomen. Ultrasound can also be used in treatment.\\nPurpose\\nThe potential medical applications of ultrasound\\nwere first recognized in the 1940s as an outgrowth of the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 14, 'page_label': '15'}, page_content='sonar technology developed to detect submarines during\\nWorld War II. The first useful medical images were pro-\\nduced in the early 1950s, and, by 1965, ultrasound quali-\\nty had improved to the point that it came into general\\nmedical use. Improvements in the technology, applica-\\ntion, and interpretation of ultrasound continue. Its low\\ncost, versatility, safety and speed have brought it into the\\ntop drawer of medical imaging techniques.\\nWhile pelvic ultrasound is widely known and com-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 14, 'page_label': '15'}, page_content='monly used for fetal monitoring during pregnancy ,\\nultrasound is also routinely used for general abdominal\\nimaging. It has great advantage over x-ray imaging tech-\\nnologies in that it does not damage tissues with ionizing\\nradiation. Ultrasound is also generally far better than\\nplain x rays at distinguishing the subtle variations of soft\\ntissue structures, and can be used in any of several\\nmodes, depending on the need at hand.\\nAs an imaging tool, abdominal ultrasound generally'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 14, 'page_label': '15'}, page_content='is warranted for patients afflicted with: chronic or acute\\nabdominal pain; abdominal trauma; an obvious or sus-\\npected abdominal mass; symptoms of liver disease, pan-\\ncreatic disease,gallstones , spleen disease, kidney dis-\\nease and urinary blockage; or symptoms of an abdominal\\naortic aneurysm. Specifically:\\n• Abdominal pain. Whether acute or chronic, pain can\\nsignal a serious problem—from organ malfunction or\\ninjury to the presence of malignant growths. Ultrasound'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 14, 'page_label': '15'}, page_content='scanning can help doctors quickly sort through poten-\\ntial causes when presented with general or ambiguous\\nsymptoms. All of the major abdominal organs can be\\nstudied for signs of disease that appear as changes in\\nsize, shape and internal structure.\\n• Abdominal trauma. After a serious accident, such as a\\ncar crash or a fall, internal bleeding from injured\\nabdominal organs is often the most serious threat to\\nsurvival. Neither the injuries nor the bleeding are'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 14, 'page_label': '15'}, page_content='immediately apparent. Ultrasound is very useful as an\\ninitial scan when abdominal trauma is suspected, and it\\ncan be used to pinpoint the location, cause, and severity\\nof hemorrhaging. In the case of puncture wounds,f r o m\\na bullet for example, ultrasound can locate the foreign\\nobject and provide a preliminary survey of the damage.\\nThe easy portability and versatility of ultrasound tech-\\nnology has brought it into common emergency room\\nuse, and even into limited ambulance service.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 14, 'page_label': '15'}, page_content='• Abdominal mass. Abnormal growths—tumors, cysts,\\nabscesses, scar tissue and accessory organs—can be\\nA\\nGALE ENCYCLOPEDIA OF MEDICINE 2 1\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 1'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='located and tentatively identified with ultrasound. In\\nparticular, potentially malignant solid tumors can be\\ndistinguished from benign fluid-filled cysts and\\nabscesses. Masses and malformations in any organ or\\npart of the abdomen can be found.\\n• Liver disease. The types and underlying causes of liver\\ndisease are numerous, though jaundice tends to be a\\ngeneral symptom. Ultrasound can differentiate between\\nmany of the types and causes of liver malfunction, and'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='is particularly good at identifying obstruction of the\\nbile ducts and cirrhosis , which is characterized by\\nabnormal fibrous growths and reduced blood flow.\\n• Pancreatic disease. Inflammation and malformation of\\nthe pancreas are readily identified by ultrasound, as are\\npancreatic stones (calculi), which can disrupt proper\\nfunctioning.\\n• Gallstones. Gallstones cause more hospital admissions\\nthan any other digestive malady. These calculi can\\ncause painful inflammation of the gallbladder and also'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='obstruct the bile ducts that carry digestive enzymes\\nfrom the gallbladder and liver to the intestines. Gall-\\nstones are readily identifiable with ultrasound.\\n• Spleen disease. The spleen is particularly prone to\\ninjury during abdominal trauma. It may also become\\npainfully inflamed when beset with infection or\\ncancer. These conditions also lend themselves well to\\nultrasonic inspection and diagnosis.\\n• Kidney disease. The kidneys are also prone to traumatic'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='injury and are the organs most likely to form calculi,\\nwhich can block the flow of urine and cause blood poi-\\nsoning (uremia). A variety of diseases causing distinct\\nchanges in kidney morphology can also lead to com-\\nplete kidney failure. Ultrasound imaging has proven\\nextremely useful in diagnosing kidney disorders.\\n• Abdominal aortic aneurysm. This is a bulging weak\\nspot in the abdominal aorta, which supplies blood\\ndirectly from the heart to the entire lower body. These'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='aneurysms are relatively common and increase in\\nprevalence with age. A burst aortic aneurysm is immi-\\nnently life-threatening. However, they can be readily\\nidentified and monitored with ultrasound before acute\\ncomplications result.\\nUltrasound technology can also be used for treat-\\nment purposes, most frequently as a visual aid during\\nsurgical procedures—such as guiding needle placement\\nto drain fluid from a cyst, or to extract tumor cells for'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='biopsy. Increasingly, direct therapeutic applications for\\nultrasound are being developed.\\nThe direct therapeutic value of ultrasonic waves lies\\nin their mechanical nature. They are shock waves, just like\\naudible sound, and vibrate the materials through which\\nthey pass. These vibrations are mild, virtually unnotice-\\nable at the frequencies and intensities used for imaging.\\nProperly focused however, high-intensity ultrasound can\\nbe used to heat and physically agitate targeted tissues.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='High-intensity ultrasound is used routinely to treat\\nsoft tissue injuries, such as strains, tears and associated\\nscarring. The heating and agitation are believed to pro-\\nmote rapid healing through increased circulation. Strong-\\nly focused, high-intensity, high-frequency ultrasound can\\nalso be used to physically destroy certain types of\\ntumors, as well as gallstones and other types of calculi.\\nDeveloping new treatment applications for ultrasound is\\nan active area of medical research.\\nPrecautions'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='Precautions\\nProperly performed, ultrasound imaging is virtually\\nwithout risk or side effects. Some patients report feeling\\na slight tingling and/or warmth while being scanned, but\\nmost feel nothing at all. Ultrasound waves of appropriate\\nfrequency and intensity are not known to cause or aggra-\\nvate any medical condition, though any woman who\\nthinks she might be pregnant should raise the issue with\\nher doctor before undergoing an abdominal ultrasound.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='The value of ultrasound imaging as a medical tool,\\nhowever, depends greatly on the quality of the equipment\\nused and the skill of the medical personnel operating it.\\nImproperly performed and/or interpreted, ultrasound can\\nbe worse than useless if it indicates that a problem exists\\nwhere there is none, or fails to detect a significant condi-\\ntion. Basic ultrasound equipment is relatively inexpen-\\nsive to obtain, and any doctor with the equipment can'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='perform the procedure whether qualified or not. Patients\\nshould not hesitate to verify the credentials of techni-\\ncians and doctors performing ultrasounds, as well as the\\nquality of the equipment used and the benefits of the pro-\\nposed procedure.\\nIn cases where ultrasound is used as a treatment tool,\\npatients should educate themselves about the proposed\\nprocedure with the help of their doctors—as is appropri-\\nate before any surgical procedure. Also, any abdominal'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='ultrasound procedure, diagnostic or therapeutic, may be\\nhampered by a patient’s body type or other factors, such\\nas the presence of excessive bowel gas (which is opaque\\nto ultrasound). In particular, very obese people are often\\nnot good candidates for abdominal ultrasound.\\nDescription\\nUltrasound includes all sound waves above the fre-\\nquency of human hearing—about 20 thousand hertz, or\\ncycles per second. Medical ultrasound generally uses fre-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 15, 'page_label': '16'}, page_content='quencies between one and 10 million hertz (1-10 MHz).\\nGALE ENCYCLOPEDIA OF MEDICINE 22\\nAbdominal ultrasound\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 2'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 16, 'page_label': '17'}, page_content='KEY TERMS\\nAccessory organ —A lump of tissue adjacent to an\\norgan that is similar to it, but which serves no\\nimportant purpose, if functional at all. While not\\nnecessarily harmful, such organs can cause prob-\\nlems if they grow too large or become cancerous. In\\nany case, their presence points to an underlying\\nabnormality in the parent organ.\\nBenign—In medical usage, benign is the opposite of\\nmalignant. It describes an abnormal growth that is\\nstable, treatable and generally not life-threatening.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 16, 'page_label': '17'}, page_content='Biopsy—The surgical removal and analysis of a tis-\\nsue sample for diagnostic purposes. Usually, the\\nterm refers to the collection and analysis of tissue\\nfrom a suspected tumor to establish malignancy.\\nCalculus —Any type of hard concretion (stone) in\\nthe body, but usually found in the gallbladder, pan-\\ncreas and kidneys. They are formed by the accumu-\\nlation of excess mineral salts and other organic\\nmaterial such as blood or mucous. Calculi (pl.) can'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 16, 'page_label': '17'}, page_content='cause problems by lodging in and obstructing the\\nproper flow of fluids, such as bile to the intestines or\\nurine to the bladder.\\nCirrhosis—A chronic liver disease characterized by\\nthe invasion of connective tissue and the degenera-\\ntion of proper functioning—jaundice is often an\\naccompanying symptom. Causes of cirrhosis include\\nalcoholism, metabolic diseases, syphilis and conges-\\ntive heart disease.\\nCommon bile duct —The branching passage\\nthrough which bile—a necessary digestive'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 16, 'page_label': '17'}, page_content='enzyme—travels from the liver and gallbladder into\\nthe small intestine. Digestive enzymes from the\\npancreas also enter the intestines through the com-\\nmon bile duct.\\nComputed tomography scan (CT scan)—A special-\\nized type of x-ray imaging that uses highly focused\\nand relatively low energy radiation to produce\\ndetailed two-dimensional images of soft tissue\\nstructures, particularly the brain. CT scans are the\\nchief competitor to ultrasound and can yield higher'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 16, 'page_label': '17'}, page_content='quality images not disrupted by bone or gas. They\\nare, however, more cumbersome, time consuming\\nand expensive to perform, and they use ionizing\\nelectromagnetic radiation.\\nDoppler—The Doppler effect refers to the apparent\\nchange in frequency of sound wave echoes returning\\nto a stationary source from a moving target. If the\\nobject is moving toward the source, the frequency\\nincreases; if the object is moving away, the frequen-\\ncy decreases. The size of this frequency shift can be'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 16, 'page_label': '17'}, page_content='used to compute the object’s speed—be it a car on\\nthe road or blood in an artery. The Doppler effect\\nholds true for all types of radiation, not just sound.\\nFrequency—Sound, whether traveling through air\\nor the human body, produces vibrations—mole-\\ncules bouncing into each other—as the shock wave\\ntravels along. The frequency of a sound is the num-\\nber of vibrations per second. Within the audible\\nrange, frequency means pitch—the higher the fre-\\nquency, the higher a sound’s pitch.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 16, 'page_label': '17'}, page_content='Ionizing radiation—Radiation that can damage liv-\\ning tissue by disrupting and destroying individual\\ncells at the molecular level. All types of nuclear\\nradiation—x rays, gamma rays and beta rays—are\\npotentially ionizing. Sound waves physically vibrate\\nthe material through which they pass, but do not\\nionize it.\\nJaundice—A condition that results in a yellow tint\\nto the skin, eyes and body fluids. Bile retention in\\nthe liver, gallbladder and pancreas is the immediate'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 16, 'page_label': '17'}, page_content='cause, but the underlying cause could be as simple\\nas obstruction of the common bile duct by a gall-\\nstone or as serious as pancreatic cancer. Ultrasound\\ncan distinguish between these conditions.\\nMalignant—The term literally means growing worse\\nand resisting treatment. It is used as a synonym for\\ncancerous and connotes a harmful condition that\\ngenerally is life-threatening.\\nMorphology—Literally, the study of form. In medi-\\ncine, morphology refers to the size, shape and'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 16, 'page_label': '17'}, page_content='structure rather than the function of a given organ.\\nAs a diagnostic imaging technique, ultrasound facil-\\nitates the recognition of abnormal morphologies as\\nsymptoms of underlying conditions.\\nGALE ENCYCLOPEDIA OF MEDICINE 2 3\\nAbdominal ultrasound\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 3'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='Higher frequency ultrasound waves produce more\\ndetailed images, but are also more readily absorbed and\\nso cannot penetrate as deeply into the body. Abdominal\\nultrasound imaging is generally performed at frequencies\\nbetween 2-5 MHz.\\nAn ultrasound machine consists of two parts: the\\ntransducer and the analyzer. The transducer both produces\\nthe sound waves that penetrate the body and receives the\\nreflected echoes. Transducers are built around piezoelec-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='tric ceramic chips. (Piezoelectric refers to electricity that\\nis produced when you put pressure on certain crystals\\nsuch as quartz). These ceramic chips react to electric puls-\\nes by producing sound waves ( they are transmitting\\nwaves) and react to sound waves by producing electric\\npulses (receiving). Bursts of high frequency electric puls-\\nes supplied to the transducer causes it to produce the\\nscanning sound waves. The transducer then receives the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='returning echoes, translates them back into electric pulses\\nand sends them to the analyzer—a computer that orga-\\nnizes the data into an image on a television screen.\\nBecause sound waves travel through all the body’s\\ntissues at nearly the same speed—about 3,400 miles per\\nhour—the microseconds it takes for each echo to be\\nreceived can be plotted on the screen as a distance into the\\nbody. The relative strength of each echo, a function of the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='specific tissue or organ boundary that produced it, can be\\nplotted as a point of varying brightness. In this way, the\\nechoes are translated into a picture. Tissues surrounded\\nby bone or filled with gas (the stomach, intestines and\\nbowel) cannot be imaged using ultrasound, because the\\nwaves are blocked or become randomly scattered.\\nFour different modes of ultrasound are used in med-\\nical imaging:\\n• A-mode. This is the simplest type of ultrasound in'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='which a single transducer scans a line through the body\\nwith the echoes plotted on screen as a function of\\ndepth. This method is used to measure distances within\\nthe body and the size of internal organs. Therapeutic\\nultrasound aimed at a specific tumor or calculus is also\\nA-mode, to allow for pinpoint accurate focus of the\\ndestructive wave energy.\\n• B-mode. In B-mode ultrasound, a linear array of trans-\\nducers simultaneously scans a plane through the body'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='that can be viewed as a two-dimensional image on\\nscreen. Ultrasound probes containing more than 100\\ntransducers in sequence form the basis for these most\\ncommonly used scanners, which cost about $50,000.\\n• M-Mode. The M stands for motion. A rapid sequence\\nof B-mode scans whose images follow each other in\\nsequence on screen enables doctors to see and mea-\\nsure range of motion, as the organ boundaries that\\nproduce reflections move relative to the probe. M-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='mode ultrasound has been put to particular use in\\nstudying heart motion.\\n• Doppler mode. Doppler ultrasonography includes the\\ncapability of accurately measuring velocities of moving\\nmaterial, such as blood in arteries and veins. The prin-\\nciple is the same as that used in radar guns that measure\\nthe speed of a car on the highway. Doppler capability is\\nmost often combined with B-mode scanning to produce\\nimages of blood vessels from which blood flow can be'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='directly measured. This technique is used extensively to\\ninvestigate valve defects, arteriosclerosis and hyper-\\ntension, particularly in the heart, but also in the abdom-\\ninal aorta and the portal vein of the liver. These\\nmachines cost about $250,000.\\nThe actual procedure for a patient undergoing an\\nabdominal ultrasound is relatively simple, regardless of\\nthe type of scan or its purpose. Fasting for at least eight\\nhours prior to the procedure ensures that the stomach is'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='empty and as small as possible, and that the intestines\\nand bowels are relatively inactive. Fasting also allows the\\ngall bladder to be seen, as it contracts after eating and\\nmay not be seen if the stomach is full. In some cases, a\\nfull bladder helps to push intestinal folds out of the way\\nso that the gas they contain does not disrupt the image.\\nThe patient’s abdomen is then greased with a special gel\\nthat allows the ultrasound probe to glide easily across the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='skin while transmitting and receiving ultrasonic pulses.\\nThis procedure is conducted by a doctor with the\\nassistance of a technologist skilled in operating the\\nequipment. The probe is moved around the abdomen to\\nobtain different views of the target areas. The patient will\\nlikely be asked to change positions from side to side and\\nto hold their breath as necessary to obtain the desired\\nviews. Discomfort during the procedure is minimal.\\nThe many types and uses of ultrasound technology'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='makes it difficult to generalize about the time and costs\\ninvolved. Relatively simple imaging—scanning a suspi-\\ncious abdominal mass or a suspected abdominal aortic\\naneurysm—will take about half an hour to perform and\\nwill cost a few hundred dollars or more, depending on\\nthe quality of the equipment, the operator and other fac-\\ntors. More involved techniques such as multiple M-mode\\nand Doppler-enhanced scans, or cases where the targets\\nnot well defined in advance, generally take more time'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='and are more expensive.\\nRegardless of the type of scan used and the potential\\ndifficulties encountered, ultrasound remains faster and\\nless expensive than computed tomography scans (CT),\\nits primary rival in abdominal imaging. Furthermore, as\\nabdominal ultrasounds are generally undertaken as\\n“medically necessary” procedures designed to detect the\\npresence of suspected abnormalities, they are covered\\nGALE ENCYCLOPEDIA OF MEDICINE 24\\nAbdominal ultrasound'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 17, 'page_label': '18'}, page_content='GEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 4'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 18, 'page_label': '19'}, page_content='under most types of major medical insurance. As always,\\nthough, the patient would be wise to confirm that their\\ncoverage extends to the specific procedure proposed. For\\nnonemergency situations, most underwriters stipulate\\nprior approval as a condition of coverage.\\nSpecific conditions for which ultrasound may be\\nselected as a treatment option—certain types of tumors,\\nlesions,kidney stones and other calculi, muscle and lig-\\nament injuries, etc.—are described in detail under the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 18, 'page_label': '19'}, page_content='appropriate entries in this encyclopedia.\\nPreparation\\nA patient undergoing abdominal ultrasound will be\\nadvised by their physician about what to expect and how\\nto prepare. As mentioned above, preparations generally\\ninclude fasting and arriving for the procedure with a full\\nbladder, if necessary. This preparation is particularly use-\\nful if the gallbladder, ovaries or veins are to be examined.\\nAftercare\\nIn general, no aftercare related to the abdominal\\nultrasound procedure itself is required.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 18, 'page_label': '19'}, page_content='Risks\\nAbdominal ultrasound carries with it no recognized\\nrisks or side effects, if properly performed using appropri-\\nate frequency and intensity ranges. Sensitive tissues, par-\\nticularly those of the reproductive organs, could possibly\\nsustain damage if violently vibrated by overly intense\\nultrasound waves. In general though, such damage would\\nonly result from improper use of the equipment.\\nAny woman who thinks she might be pregnant\\nshould raise this issue with her doctor before undergoing'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 18, 'page_label': '19'}, page_content='an abdominal ultrasound, as a fetus in the early stages of\\ndevelopment could be injured by ultrasound meant to\\nprobe deeply recessed abdominal organs.\\nNormal results\\nAs a diagnostic imaging technique, a normal abdom-\\ninal ultrasound is one that indicates the absence of the\\nsuspected condition that prompted the scan. For example,\\nsymptoms such as a persistent cough, labored breathing,\\nand upper abdominal pain suggest the possibility of,\\namong other things, an abdominal aortic aneurysm. An'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 18, 'page_label': '19'}, page_content='ultrasound scan that indicates the absence of an aneurysm\\nwould rule out this life-threatening condition and point to\\nother, less serious causes.\\nAbnormal results\\nBecause abdominal ultrasound imaging is generally\\nundertaken to confirm a suspected condition, the results\\nof a scan often will prove abnormal—that is they will\\nconfirm the diagnosis, be it kidney stones, cirrhosis of\\nthe liver or an aortic aneurysm. At that point, appropriate'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 18, 'page_label': '19'}, page_content='medical treatment as prescribed by a patient’s doctor is in\\norder. See the relevant disease and disorder entries in this\\nencyclopedia for more information.\\nResources\\nBOOKS\\nHall, Rebecca. The Ultrasonic Handbook: Clinical, Etiologic\\nand Pathologic Implications of Sonographic Findings.\\nPhiladelphia: Lippincott, 1993.\\nKevles, Bettyann Holtzmann. Naked to the Bone: Medical\\nImaging in the Twentieth Century.New Brunswick, NJ:\\nRutgers University Press, 1997.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 18, 'page_label': '19'}, page_content='Kremkau, Frederick W. Diagnostic Ultrasound: Principles and\\nInstruments. Philadelphia: W. B. Saunders Co., 1993.\\nShtasel, Philip. Medical Tests and Diagnostic Procedures: A\\nPatient’s Guide to Just What the Doctor Ordered.New\\nYork: Harper & Row, 1991.\\nTempkin, Betty Bates. Ultrasound Scanning: Principles and\\nProtocols. Philadelphia: W. B. Saunders Co., 1993.\\nThe Patient’s Guide to Medical Tests.Ed. Barry L. Zaret, et al.\\nBoston: Houghton Mifflin, 1997.\\nPERIODICALS'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 18, 'page_label': '19'}, page_content='PERIODICALS\\n“Ultrasound Detects Stomach Problems.”USA Today Maga-\\nzine (October 1992): 5.\\nFreundlich, Naomi. “Ultrasound: What’s Wrong with this Pic-\\nture?” Business Week(15 September 1997): 84-5.\\nMcDonagh, D. Brian. “Ultrasound: Unsung Medical Hero.”\\nUSA Today Magazine(September 1996): 66-7.\\nMurray, Maxine. “Basics of Ultrasonography.”Student British\\nMedical Journal (August 1996): 269-72.\\nTait, N., and J. M. Little. “The Treatment of Gallstones.”\\nBritish Medical Journal (8 July 1995): 99-105.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 18, 'page_label': '19'}, page_content='ORGANIZATIONS\\nAmerican College of Gastroenterology. 4900 B South 31st St.,\\nArlington, V A 22206-1656. (703) 820-7400. .\\nAmerican Institute of Ultrasound in Medicine. 14750 Sweitzer\\nLane, Suite 100, Laurel, MD 20707-5906. (800) 638-\\n5352. .\\nAmerican Society of Radiologic Technologists. 15000 Central\\nAve., SE, Albuquerque, NM 87123-3917. (505) 298-4500.\\n.\\nKurt Richard Sternlof\\nAbdominal wall defects\\nDefinition'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 18, 'page_label': '19'}, page_content='Definition\\nAbdominal wall defects are birth (congenital)\\ndefects that allow the stomach or intestines to protrude.\\nGALE ENCYCLOPEDIA OF MEDICINE 2 5\\nAbdominal wall defects\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 5'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 19, 'page_label': '20'}, page_content='Description\\nMany unexpected and fascinating events occur dur-\\ning the development of a fetus inside the womb. The\\nstomach and intestines begin development outside the\\nbaby’s abdomen and only later does the abdominal wall\\nenclose them. Occasionally, either the umbilical opening\\nis too large, or it develops improperly, allowing the bow-\\nels or stomach to remain outside or squeeze through the\\nabdominal wall.\\nCauses and symptoms\\nThere are many causes for birth defects that still'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 19, 'page_label': '20'}, page_content='remain unclear. Presently, the cause(s) of abdominal wall\\ndefects is unknown, and any symptoms the mother may\\nhave to indicate that the defects are present in the fetus\\nare nondescript.\\nDiagnosis\\nAt birth, the problem is obvious, because the base of\\nthe umbilical cord at the navel will bulge or, in worse\\ncases, contain viscera (internal organs). Before birth, an\\nultrasound examination may detect the problem. It is\\nalways necessary in children with one birth defect to look'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 19, 'page_label': '20'}, page_content='for others, because birth defects are usually multiple.\\nTreatment\\nAbdominal wall defects are effectively treated with\\nsurgical repair. Unless there are accompanying anom-\\nalies, the surgical procedure is not overly complicated.\\nThe organs are normal, just misplaced. However, if the\\ndefect is large, it may be difficult to fit all the viscera into\\nthe small abdominal cavity.\\nPrognosis\\nIf there are no other defects, the prognosis after sur-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 19, 'page_label': '20'}, page_content='gical repair of this condition is relatively good. However,\\nKEY TERMS\\nHernia—Movement of a structure into a place it\\ndoes not belong.\\nUmbilical —Referring to the opening in the\\nabdominal wall where the blood vessels from the\\nplacenta enter.\\nViscera—Any of the body’s organs located in the\\nchest or abdomen.\\n10% of those with more severe or additional abnormali-\\nties die from it. The organs themselves are fully function-\\nal; the difficulty lies in fitting them inside the abdomen.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 19, 'page_label': '20'}, page_content='The condition is, in fact, a hernia requiring only replace-\\nment and strengthening of the passageway through\\nwhich it occurred. After surgery, increased pressure in\\nthe stretched abdomen can compromise the function of\\nthe organs inside.\\nPrevention\\nSome, but by no means all, birth defects are pre-\\nventable by early and attentive prenatal care, good nutri-\\ntion, supplemental vitamins , diligent avoidance of all\\nunnecessary drugs and chemicals—especially tobacco—'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 19, 'page_label': '20'}, page_content='and other elements of a healthy lifestyle.\\nResources\\nPERIODICALS\\nDunn, J. C., and E. W. Fonkalsrud. “Improved Survival of\\nInfants with Omphalocele.”American Journal of Surgery\\n173 (April 1997): 284-7.\\nLanger, J. C. “Gastroschisis and Omphalocele.”Seminars in\\nPediatric Surgery5 (May 1996): 124-8.\\nJ. Ricker Polsdorfer, MD\\nAbnormal heart rhythms see Arrhythmias\\nABO blood typing see Blood typing and\\ncrossmatching\\nABO incompatibility see Erythroblastosis\\nfetalis\\nAbortion, habitual see Recurrent'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 19, 'page_label': '20'}, page_content='miscarriage\\nAbortion, partial birth\\nDefinition\\nPartial birth abortion is a method of late-term abor-\\ntion that terminates a pregnancy and results in the death\\nand intact removal of a fetus. This procedure is most\\ncommonly referred to as intact dilatation and extraction\\n(D & X).\\nPurpose\\nPartial birth abortion, or D&X, is performed to end a\\npregnancy and results in the death of a fetus, typically in\\nGALE ENCYCLOPEDIA OF MEDICINE 26\\nAbortion, partial birth'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 19, 'page_label': '20'}, page_content='GEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 6'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 20, 'page_label': '21'}, page_content='the late second or third trimester. Although D&X is high-\\nly controversial, some physicians argue that it has advan-\\ntages that make it a preferable procedure in some circum-\\nstances. One perceived advantage is that the fetus is\\nremoved largely intact, allowing for better evaluation and\\nautopsyof the fetus in cases of known fetal anomalies.\\nIntact removal of the fetus may also confer a lower risk\\nof puncturing the uterus or damaging the cervix. Another'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 20, 'page_label': '21'}, page_content='perceived advantage is that D&X ends the pregnancy\\nwithout requiring the woman to go through labor, which\\nmay be less emotionally traumatic than other methods of\\nlate-term abortion. In addition, D&X may offer a lower\\ncost and shorter procedure time.\\nPrecautions\\nWomen considering D&X should be aware of the\\nhighly controversial nature of this procedure. A contro-\\nversy common to all late-term abortions is whether the\\nfetus is viable, or able to survive outside of the woman’s'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 20, 'page_label': '21'}, page_content='body. A specific area of controversy with D&X is that\\nfetal death does not occur until after most of the fetal\\nbody has exited the uterus. Several states have taken\\nlegal action to limit or ban D&X and many physicians\\nwho perform abortions do not perform D&X. This may\\nrestrict the availability of this procedure to women seek-\\ning late-term abortion.\\nDescription\\nIntact D&X, or partial birth abortion first involves\\nadministration of medications to cause the cervix to'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 20, 'page_label': '21'}, page_content='dilate, usually over the course of several days. Next, the\\nphysician rotates the fetus to a footling breech position.\\nThe body of the fetus is then drawn out of the uterus feet\\nfirst, until only the head remains inside the uterus. Then,\\nthe physician uses an instrument to puncture the base of\\nthe skull, which collapses the fetal head. Typically, the\\ncontents of the fetal head are then partially suctioned out,\\nwhich results in the death of the fetus, and reduces the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 20, 'page_label': '21'}, page_content='sizes of the fetal head enough to allow it to pass through\\nthe cervix. The dead and otherwise intact fetus is then\\nremoved from the woman’s body.\\nPreparation\\nMedical preparation for D&X involves an outpatient\\nvisit to administer medications, such as laminaria ,t o\\ncause the cervix to begin dilating.\\nIn addition, preparation may involve fulfilling local\\nlegal requirements, such as a mandatory waiting period,\\ncounseling, or an informed consent procedure reviewing'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 20, 'page_label': '21'}, page_content='stages of fetal development,childbirth, alternative abor-\\ntion methods, and adoption.\\nKEY TERMS\\nCervix—The narrow outer end of the uterus that\\nseparates the uterus from the vaginal canal.\\nFootling breech —A position of the fetus while in\\nthe uterus where the feet of the fetus are nearest\\nthe cervix would be the first part of the fetus to exit\\nthe uterus, with the head of the fetus being the last\\npart to exit the uterus.\\nLaminaria —A medical product made from a cer-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 20, 'page_label': '21'}, page_content='tain type of seaweed that is physically placed near\\nthe cervix to cause it to dilate.\\nAftercare\\nD&X typically does not require an overnight hospi-\\ntal stay, so a follow up appointment may be scheduled to\\nmonitor the woman for any complications.\\nRisks\\nWith all abortion, the later in pregnancy an abortion\\nis performed, the more complicated the procedure and\\nthe greater the risk of injury to the woman. In addition to\\nassociated emotion reactions, D&X carries the risk of'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 20, 'page_label': '21'}, page_content='injury to the woman, including heavy bleeding, blood\\nclots, damage to the cervix or uterus, pelvic infection,\\nand anesthesia-related complications. There is also a risk\\nof incomplete abortion, meaning that the fetus is not\\ndead when removed from the woman’s body. Possible\\nlong-term risks include difficulty becoming pregnant or\\ncarrying a future pregnancy to term.\\nNormal results\\nThe expected outcome of D&X is the termination of\\na pregnancy with removal of a dead fetus from the\\nwoman’s body.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 20, 'page_label': '21'}, page_content='woman’s body.\\nResources\\nPERIODICALS\\nEpner, Janet E., et al. “Late-term Abortion.”JAMA 280, no. 8\\n(26 August 1998): 724-729.\\nSprang, M. LeRoy, and Neerhof, Mark G. “Rationale for Ban-\\nning Abortions Late in Pregnancy.”JAMA (26 August\\n1998): 744-747.\\nSwomley, John M. “The ‘Partial-birth’ Debate in 1998.”\\nHumanist (March/April 1998): 5-7.\\nGrimes, David A. “The Continuing Need for Late Abortion.”\\nJAMA (26 August 1998): 747-750.\\nGALE ENCYCLOPEDIA OF MEDICINE 2 7\\nAbortion, partial birth'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 20, 'page_label': '21'}, page_content='GEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 7'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 21, 'page_label': '22'}, page_content='ORGANIZATIONS\\nPlanned Parenthood Federation of America. 810 Seventh Ave.,\\nNew York, NY 10019. (212) 541-7800. FAX: (212) 245-\\n1845.\\nOTHER\\nStatus of partial-birth abortion laws in the states. Othmer Insti-\\ntute at Planned Parenthood of NYC. 2000.\\nStefanie B. N. Dugan, M.S.\\nAbortion, selective\\nDefinition\\nSelective abortion, also known as selective reduc-\\ntion, refers to choosing to abort a fetus, typically in a\\nmulti-fetal pregnancy, to decrease the health risks to the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 21, 'page_label': '22'}, page_content='mother in carrying and giving birth to more than one or\\ntwo babies, and also to decrease the risk of complications\\nto the remaining fetus(es). The term selective abortion\\nalso refers to choosing to abort a fetus for reasons such as\\nthe woman is carrying a fetus which likely will be born\\nwith some birth defect or impairment, or because the sex\\nof the fetus is not preferred by the individual.\\nPurpose\\nA woman may decide to abort for health reasons, for'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 21, 'page_label': '22'}, page_content='example, she is at higher risk for complications during preg-\\nnancy because of a disorder or disease such as diabetes.\\nHowever, selective reduction is recommended often in\\ncases of multi-fetal pregnancy, or the presence of more than\\none fetus, typically, at least three or more fetuses. In the\\ngeneral population, multi-fetal pregnancy happens in only\\nabout 1-2% of pregnant women. But multi-fetal pregnan-\\ncies occur far more often in women using fertility drugs.\\nPrecautions'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 21, 'page_label': '22'}, page_content='Precautions\\nBecause women or couples who use fertility drugs\\nhave made an extra effort to become pregnant, it is possi-\\nble that the individuals may be unwilling or uncomfort-\\nable with the decision to abort a fetus in cases of multi-\\nfetal pregnancy. Individuals engaging in fertility treat-\\nment should be made aware of the risk of multi-fetal\\npregnancy and consider the prospect of recommended\\nreduction before undergoing fertility treatment.\\nDescription'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 21, 'page_label': '22'}, page_content='Description\\nSelective reduction is usually performed between\\nnine and 12 weeks of pregnancy and is most successful\\nwhen performed in early pregnancy. It is a simple proce-\\ndure and can be performed on an outpatient basis. A nee-\\ndle is inserted into the woman’s stomach or vagina and\\npotassium chloride is injected into the fetus.\\nPreparation\\nIndividuals who have chosen selective reduction to\\nsafeguard the remaining fetuses should be counseled'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 21, 'page_label': '22'}, page_content='prior to the procedure. Individuals should receive infor-\\nmation regarding the risks of a multi-fetal pregnancy to\\nboth the fetuses and the mother compared with the risks\\nafter the reduction.\\nIndividuals seeking an abortion for any reason\\nshould consider the ethical implications whether it be\\nbecause the fetus is not the preferred sex or because the\\nfetus would be born with a severe birth defect.\\nAftercare\\nCounseling should continue after the abortion'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 21, 'page_label': '22'}, page_content='because it is a traumatic event. Individuals may feel\\nguilty about choosing one fetus over another. Mental\\nhealth professionals should be consulted throughout the\\nprocess.\\nRisks\\nAbout 75% of women who undergo selective reduc-\\ntion will go into premature labor . About 4-5% of\\nwomen undergoing selective reduction also miscarry one\\nor more of the remaining fetuses. The risks associated\\nwith multi-fetal pregnancy is considered higher.\\nNormal results\\nIn cases where a multi-fetal pregnancy, three or'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 21, 'page_label': '22'}, page_content='more fetuses, is reduced to two, the twin fetuses typically\\ndevelop as they would as if they were conceived as twins.\\nResources\\nBOOKS\\nKnobil, Ernst and Jimmy D. Neill, editors. “Abortion.” In\\nEncyclopedia of Reproduction. San Diego: Adademic\\nPress, 1998, pp.1-5.\\nScott, James R., editor. “Induced Abortion.” In Danforth’s\\nObstetrics and Gynecology. Philadelphia: Lippincott\\nWilliams & Wilkins, 1999, pp.567-578.\\nPERIODICALS\\nAuthor unspecified. “Multiple Pregnancy Associated With'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 21, 'page_label': '22'}, page_content='Infertility Therapy.”American Society for Reproductive\\nMedicine, A Practice Committee Report (November\\n2000): 1-8.\\nGALE ENCYCLOPEDIA OF MEDICINE 28\\nAbortion, selective\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 8'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 22, 'page_label': '23'}, page_content='ORGANIZATIONS\\nThe American Society for Reproductive Medicine. 1209 Mont-\\ngomery Highway, Birmingham, AL 35216-2809. (205)\\n978-5000. .\\nThe Alan Guttmacher Institute. 120 Wall Street, New York, NY\\n10005. (212) 248-1111. .\\nMeghan M. Gourley\\nAbortion, spontaneous see Miscarriage\\nAbortion, therapeutic\\nDefinition\\nTherapeutic abortion is the intentional termination\\nof a pregnancy before the fetus can live independently.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 22, 'page_label': '23'}, page_content='Abortion has been a legal procedure in the United States\\nsince 1973.\\nPurpose\\nAn abortion may be performed whenever there is\\nsome compelling reason to end a pregnancy. Women\\nhave abortions because continuing the pregnancy would\\ncause them hardship, endanger their life or health, or\\nbecause prenatal testing has shown that the fetus will be\\nborn with severe abnormalities.\\nAbortions are safest when performed within the first\\nsix to 10 weeks after the last menstrual period. The cal-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 22, 'page_label': '23'}, page_content='culation of this date is referred to as the gestational age\\nand is used in determining the stage of pregnancy. For\\nexample, a woman who is two weeks late having her\\nperiod is said to be six weeks pregnant, because it is six\\nweeks since she last menstruated.\\nAbout 90% of women who have abortions do so\\nbefore 13 weeks and experience few complications.\\nAbortions performed between 13-24 weeks have a higher\\nKEY TERMS\\nMulti-fetal pregnancy —A pregnancy of two or\\nmore fetuses.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 22, 'page_label': '23'}, page_content='more fetuses.\\nSelective reduction—Typically referred to in cases\\nof multifetal pregnancy, when one or more fetuses\\nare aborted to preserve the viability of the remain-\\ning fetuses and decrease health risks to the mother.\\nrate of complications. Abortions after 24 weeks are\\nextremely rare and are usually limited to situations where\\nthe life of the mother is in danger.\\nPrecautions\\nMost women are able to have abortions at clinics or\\noutpatient facilities if the procedure is performed early in'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 22, 'page_label': '23'}, page_content='pregnancy. Women who have stable diabetes, controlled\\nepilepsy, mild to moderate high blood pressure, or who\\nare HIV positive can often have abortions as outpatients\\nif precautions are taken. Women with heart disease, pre-\\nvious endocarditis, asthma, lupus erythematosus, uter-\\nine fibroid tumors, blood clotting disorders, poorly con-\\ntrolled epilepsy, or some psychological disorders usually\\nneed to be hospitalized in order to receive special moni-\\ntoring and medications during the procedure.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 22, 'page_label': '23'}, page_content='Description\\nV ery early abortions\\nBetween five and seven weeks, a pregnancy can be\\nended by a procedure called menstrual extraction. This\\nprocedure is also sometimes called menstrual regulation,\\nmini-suction, or preemptive abortion. The contents of the\\nuterus are suctioned out through a thin (3-4 mm) plastic\\ntube that is inserted through the undilated cervix. Suction\\nis applied either by a bulb syringe or a small pump.\\nAnother method is called the “morning after” pill, or'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 22, 'page_label': '23'}, page_content='emergency contraception . Basically, it involves taking\\nhigh doses of birth control pills within 24 to 48 hours of\\nhaving unprotected sex. The high doses of hormones\\ncauses the uterine lining to change so that it will not sup-\\nport a pregnancy. Thus, if the egg has been fertilized, it is\\nsimply expelled from the body.\\nThere are two types of emergency contraception.\\nOne type is identical to ordinary birth control pills, and\\nuses the hormones estrogen and progestin). This type is'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 22, 'page_label': '23'}, page_content='available with a prescription under the brand name Pre-\\nven. But women can even use their regular birth control\\npills for emergency contraception, after they check with\\ntheir doctor about the proper dose. About half of women\\nwho use birth control pills for emergency contraception\\nget nauseated and 20 percent vomit. This method cuts the\\nrisk of pregnancy 75 percent.\\nThe other type of morning-after pill contains only\\none hormone: progestin, and is available under the brand'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 22, 'page_label': '23'}, page_content='name Plan B. It is more effective than the first type with\\na lower risk of nausea and vomiting. It reduces the risk\\nof pregnancy 89 percent.\\nWomen should check with their physicians regard-\\ning the proper dose of pills to take, as it depends on the\\nGALE ENCYCLOPEDIA OF MEDICINE 2 9\\nAbortion, therapeutic\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 9'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 23, 'page_label': '24'}, page_content='brand of birth control pill. Not all birth control pills will\\nwork for emergency contraception.\\nMenstrual extractions are safe, but because the\\namount of fetal material is so small at this stage of devel-\\nopment, it is easy to miss. This results in an incomplete\\nabortion that means the pregnancy continues.\\nFirst trimester abortions\\nThe first trimester of pregnancy includes the first 13\\nweeks after the last menstrual period. In the United\\nStates, about 90% of abortions are performed during this'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 23, 'page_label': '24'}, page_content='period. It is the safest time in which to have an abortion,\\nand the time in which women have the most choice of\\nhow the procedure is performed.\\nMEDICAL ABORTIONS. Medical abortions are brought\\nabout by taking medications that end the pregnancy. The\\nadvantages of a first trimester medical abortion are:\\n• The procedure is non-invasive; no surgical instruments\\nare used.\\n• Anesthesia is not required.\\n• Drugs are administered either orally or by injection.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 23, 'page_label': '24'}, page_content='• The procedure resembles a natural miscarriage.\\nDisadvantages of a medical abortion are:\\n• The effectiveness decreases after the seventh week.\\n• The procedure may require multiple visits to the doctor.\\n• Bleeding after the abortion lasts longer than after a sur-\\ngical abortion.\\n• The woman may see the contents of her womb as it is\\nexpelled.\\nTwo different medications can be used to bring about\\nan abortion. Methotrexate (Rheumatrex) works by stop-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 23, 'page_label': '24'}, page_content='ping fetal cells from dividing which causes the fetus to die.\\nOn the first visit to the doctor, the woman receives\\nan injection of methotrexate. On the second visit, about\\na week later, she is given misoprostol (Cytotec), an\\noxygenated unsaturated cyclic fatty acid responsible for\\nvarious hormonal reactions such as muscle contraction\\n(prostaglandin), that stimulates contractions of the\\nuterus. Within two weeks, the woman will expel the\\ncontents of her uterus, ending the pregnancy. A follow-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 23, 'page_label': '24'}, page_content='up visit to the doctor is necessary to assure that the\\nabortion is complete.\\nWith this procedure, a woman will feel cramping\\nand may feel nauseated from the misoprostol. This\\ncombination of drugs is 90-96% effective in ending\\npregnancy.\\nMifepristone (RU-486), which goes by the brand\\nname Mifeprex, works by blocking the action of prog-\\nesterone, a hormone needed for pregnancy to continue,\\nthen stimulates uterine contractions thus ending the\\npregnancy. It can be taken a much as 49 days after the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 23, 'page_label': '24'}, page_content='first day of a woman’s last period. On the first visit to\\nthe doctor, a woman takes a mifepristone pill. Two days\\nlater she returns and, if the miscarriage has not\\noccurred, takes two misoprostol pills, which causes the\\nuterus to contract. Five percent of women won’t need to\\ntake misoprostol. After an observation period, she\\nreturns home.\\nWithin four days, 90% of women have expelled the\\ncontents of their uterus and completed the abortion.\\nWithin 14 days, 95-97% of women have completed the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 23, 'page_label': '24'}, page_content='abortion. A third follow-up visit to the doctor is neces-\\nsary to confirm through observation or ultrasound that\\nthe procedure is complete. In the event that it is not, a\\nsurgical abortion is performed. Studies show that 4.5 to 8\\npercent of women need surgery or a blood transfusion\\nafter taking mifepristone, and the pregnancy persists in\\nabout 1 percent of women. In this case, surgical abortion\\nis recommended because the fetus may be damanged.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 23, 'page_label': '24'}, page_content='Side effects include nausea, vaginal bleeding and heavy\\ncramping. The bleeding is typically heavier than a nor-\\nmal period and may last up to 16 days.\\nMifepristone is not recommended for women with\\nectopic pregnancy, an IUD, who have been taking long-\\nGALE ENCYCLOPEDIA OF MEDICINE 210\\nAbortion, therapeutic\\nUterus\\nEmbryonic\\ntissue\\nVagina Vulsellum\\nCervix\\nSpeculum\\nExtraction tube\\nBetween 5 and 7 weeks, a pregnancy can be ended by a pro-\\ncedure called menstrual extraction.The contents of the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 23, 'page_label': '24'}, page_content='uterus are suctioned out through a thin extraction tube that\\nis inserted through the undilated cervix.(Illustration by Elec-\\ntronic Illustrators Group.)\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 10'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 24, 'page_label': '25'}, page_content='term steroidal therapy, have bleeding abnormalities or on\\nblood-thinners such as Coumadin.\\nSurgical abortions\\nFirst trimester surgical abortions are performed\\nusing vacuum aspiration. The procedure is also called\\ndilation and evacuation (D & E), suction dilation, vacu-\\num curettage, or suction curettage.\\nAdvantages of a vacuum aspiration abortion are:\\n• It is usually done as a one-day outpatient procedure.\\n• The procedure takes only 10-15 minutes.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 24, 'page_label': '25'}, page_content='• Bleeding after the abortion lasts five days or less.\\n• The woman does not see the products of her womb\\nbeing removed.\\nDisadvantages include:\\n• The procedure is invasive; surgical instruments are used.\\n• Infection may occur.\\nDuring a vacuum aspiration, the woman’s cervix is\\ngradually dilated by expanding rods inserted into the\\ncervical opening. Once dilated, a tube attached to a suc-\\ntion pump is inserted through the cervix and the con-\\ntents of the uterus are suctioned out. The procedure is'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 24, 'page_label': '25'}, page_content='97-99% effective. The amount of discomfort a woman\\nfeels varies considerably. Local anesthesia is often\\ngiven to numb the cervix, but it does not mask uterine\\ncramping. After a few hours of rest, the woman may\\nreturn home.\\nSecond trimester abortions\\nAlthough it is better to have an abortion during the\\nfirst trimester, some second trimester abortions may be\\ninevitable. The results of genetic testing are often not\\navailable until 16 weeks. In addition, women, especially'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 24, 'page_label': '25'}, page_content='teens, may not have recognized the pregnancy or come to\\nterms with it emotionally soon enough to have a first\\ntrimester abortion. Teens make up the largest group hav-\\ning second trimester abortions.\\nSome second trimester abortions are performed as a\\nD & E. The procedures are similar to those used in the\\nfirst trimester, but a larger suction tube must be used\\nbecause more material must be removed. This increases\\nthe amount of cervical dilation necessary and increases'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 24, 'page_label': '25'}, page_content='the risk of the procedure. Many physicians are reluctant\\nto perform a D & E this late in pregnancy, and for some\\nwomen is it not a medically safe option.\\nThe alternative to a D & E in the second trimester is\\nan abortion by induced labor. Induced labor may require\\nan overnight stay in a hospital. The day before the proce-\\ndure, the woman visits the doctor for tests, and to either\\nKEY TERMS\\nEndocarditis —An infection of the inner mem-\\nbrane lining of the heart.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 24, 'page_label': '25'}, page_content='Fibroid tumors —Fibroid tumors are non-cancer-\\nous (benign) growths in the uterus. They occur in\\n30-40% of women over age 40, and do not need\\nto be removed unless they are causing symptoms\\nthat interfere with a woman’s normal activities.\\nLupus erythematosus —A chronic inflammatory\\ndisease in which inappropriate immune system\\nreactions cause abnormalities in the blood vessels\\nand connective tissue.\\nProstaglandin —Oxygenated unsaturated cyclic\\nfatty acids responsible for various hormonal reac-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 24, 'page_label': '25'}, page_content='tions such as muscle contraction.\\nRh negative —Lacking the Rh factor, genetically\\ndetermined antigens in red blood cells that pro-\\nduce immune responses. If an Rh negative woman\\nis pregnant with an Rh positive fetus, her body will\\nproduce antibodies against the fetus’s blood, caus-\\ning a disease known as Rh disease. Sensitization to\\nthe disease occurs when the women’s blood is\\nexposed to the fetus’s blood. Rh immune globulin\\n(RhoGAM) is a vaccine that must be given to a'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 24, 'page_label': '25'}, page_content='woman after an abortion, miscarriage, or prenatal\\ntests in order to prevent sensitization to Rh disease.\\nhave rods inserted in her cervix to help dilate it or to\\nreceive medication that will soften the cervix and speed\\nup labor.\\nOn the day of the abortion, drugs, usually prosta-\\nglandins to induce contractions, and a salt water solution,\\nare injected into the uterus. Contractions begin, and with-\\nin eight to 72 hours the woman delivers the fetus.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 24, 'page_label': '25'}, page_content='Side effects of this procedure include nausea, vomit-\\ning, and diarrhea from the prostaglandins, and pain\\nfrom uterine cramps. Anesthesia of the sort used in\\nchildbirthcan be given to mask the pain. Many women\\nare able to go home a few hours after the procedure.\\nVery early abortions cost between $200-$400. Later\\nabortions cost more. The cost increases about $100 per\\nweek between the thirteenth and sixteenth week. Second\\ntrimester abortions are much more costly because they'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 24, 'page_label': '25'}, page_content='often involve more risk, more services, anesthesia, and\\nsometimes a hospital stay. Insurance carriers and HMOs\\nmay or may not cover the procedure. Federal law pro-\\nGALE ENCYCLOPEDIA OF MEDICINE 2 11\\nAbortion, therapeutic\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 11'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 25, 'page_label': '26'}, page_content='hibits federal funds including Medicaid funds, from\\nbeing used to pay for an elective abortion.\\nPreparation\\nThe doctor must know accurately the stage of a\\nwoman’s pregnancy before an abortion is performed. The\\ndoctor will ask the woman questions about her menstrual\\ncycle and also do a physical examination to confirm the\\nstage of pregnancy. This may be done at an office visit\\nbefore the abortion or on the day of the abortion. Some\\nstates require a waiting period before an abortion can be'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 25, 'page_label': '26'}, page_content='performed. Others require parental or court consent for a\\nchild under age 18 to receive an abortion.\\nDespite the fact that almost half of all women in the\\nUnited States have had at least one abortion by the time\\nthey reach age 45, abortion is surrounded by controversy.\\nWomen often find themselves in emotional turmoil when\\ndeciding if an abortion is a procedure they wish to under-\\ngo. Pre-abortion counseling is important in helping a\\nwoman resolve any questions she may have about having'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 25, 'page_label': '26'}, page_content='the procedure.\\nAftercare\\nRegardless of the method used to perform the abor-\\ntion, a woman will be observed for a period of time to\\nmake sure her blood pressure is stable and that bleeding\\nis controlled. The doctor may prescribe antibiotics to\\nreduce the chance of infection. Women who are Rh nega-\\ntive (lacking genetically determined antigens in their red\\nblood cells that produce immune responses) should be\\ngiven a human Rh immune globulin (RhoGAM) after the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 25, 'page_label': '26'}, page_content='procedure unless the father of the fetus is also Rh nega-\\ntive. This prevents blood incompatibility complications\\nin future pregnancies.\\nBleeding will continue for about five days in a surgical\\nabortion and longer in a medical abortion. To decrease the\\nrisk of infection, a woman should avoid intercourse and not\\nuse tampons and douches for two weeks after the abortion.\\nA follow-up visit is a necessary part of the woman’s\\naftercare. Contraception will be offered to women who'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 25, 'page_label': '26'}, page_content='wish to avoid future pregnancies, because menstrual\\nperiods normally resume within a few weeks.\\nRisks\\nSerious complications resulting from abortions per-\\nformed before 13 weeks are rare. Of the 90% of women\\nwho have abortions in this time period, 2.5% have minor\\ncomplications that can be handled without hospitaliza-\\ntion. Less than 0.5% have complications that require a\\nhospital stay. The rate of complications increases as the\\npregnancy progresses.\\nComplications from abortions can include:'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 25, 'page_label': '26'}, page_content='• uncontrolled bleeding\\n• infection\\n• blood clots accumulating in the uterus\\n• a tear in the cervix or uterus\\n• missed abortion where the pregnancy continues\\n• incomplete abortion where some material from the\\npregnancy remains in the uterus\\nWomen who experience any of the following symp-\\ntoms of post-abortion complications should call the clin-\\nic or doctor who performed the abortion immediately.\\n• severe pain\\n• fever over 100.4°F (38.2°C)\\n• heavy bleeding that soaks through more than one sani-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 25, 'page_label': '26'}, page_content='tary pad per hour\\n• foul-smelling discharge from the vagina\\n• continuing symptoms of pregnancy\\nNormal results\\nUsually the pregnancy is ended without complica-\\ntion and without altering future fertility.\\nResources\\nBOOKS\\nCarlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn.\\n“Abortion.” In The Harvard Guide to Women’s Health.\\nCambridge, MA: Harvard University Press, 1996.\\nDeCherney, Alan H., and Martin L. Peroll. “Contraception and\\nFamily Planning.” In Current Obstetric and Gynecologic'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 25, 'page_label': '26'}, page_content='Diagnosis and Treatment.Norwalk, CT: Appleton &\\nLange, 1994.\\nORGANIZATION\\nNational Abortion Federation. (800) 772-9100. .\\nDebra Gordon\\nAbrasions see Wounds\\nAbruptio placentae see Placental abruption\\nAbscess\\nDefinition\\nAn abscess is an enclosed collection of liquefied tis-\\nsue, known as pus, somewhere in the body. It is the result\\nof the body’s defensive reaction to foreign material.\\nGALE ENCYCLOPEDIA OF MEDICINE 212\\nAbcess'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 25, 'page_label': '26'}, page_content='Abcess\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 12'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 26, 'page_label': '27'}, page_content='Description\\nThere are two types of abscesses, septic and sterile.\\nMost abscesses are septic, which means that they are the\\nresult of an infection. Septic abscesses can occur any-\\nwhere in the body. Only a germ and the body’s immune\\nresponse are required. In response to the invading germ,\\nwhite blood cells gather at the infected site and begin\\nproducing chemicals called enzymes that attack the germ\\nby digesting it. These enzymes act like acid, killing the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 26, 'page_label': '27'}, page_content='germs and breaking them down into small pieces that can\\nbe picked up by the circulation and eliminated from the\\nbody. Unfortunately, these chemicals also digest body\\ntissues. In most cases, the germ produces similar chemi-\\ncals. The result is a thick, yellow liquid—pus—contain-\\ning digested germs, digested tissue, white blood cells,\\nand enzymes.\\nAn abscess is the last stage of a tissue infection that\\nbegins with a process called inflammation. Initially, as'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 26, 'page_label': '27'}, page_content='the invading germ activates the body’s immune system,\\nseveral events occur:\\n• Blood flow to the area increases.\\n• The temperature of the area increases due to the\\nincreased blood supply.\\n• The area swells due to the accumulation of water, blood,\\nand other liquids.\\n• It turns red.\\n• It hurts, because of the irritation from the swelling and\\nthe chemical activity.\\nThese four signs—heat, swelling, redness, and pain—\\ncharacterize inflammation.\\nAs the process progresses, the tissue begins to turn'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 26, 'page_label': '27'}, page_content='to liquid, and an abscess forms. It is the nature of an\\nabscess to spread as the chemical digestion liquefies\\nmore and more tissue. Furthermore, the spreading fol-\\nlows the path of least resistance—the tissues most easily\\ndigested. A good example is an abscess just beneath the\\nskin. It most easily continues along beneath the skin\\nrather than working its way through the skin where it\\ncould drain its toxic contents. The contents of the abscess'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 26, 'page_label': '27'}, page_content='also leak into the general circulation and produce symp-\\ntoms just like any other infection. These include chills,\\nfever, aching, and general discomfort.\\nSterile abscesses are sometimes a milder form of the\\nsame process caused not by germs but by non-living irri-\\ntants such as drugs. If an injected drug like penicillin is\\nnot absorbed, it stays where it was injected and may\\ncause enough irritation to generate a sterile abscess—\\nsterile because there is no infection involved. Sterile'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 26, 'page_label': '27'}, page_content='abscesses are quite likely to turn into hard, solid lumps as\\nthey scar, rather than remaining pockets of pus.\\nCauses and symptoms\\nMany different agents cause abscesses. The most\\ncommon are the pus-forming (pyogenic) bacteria like\\nStaphylococcus aureus, which is nearly always the cause\\nof abscesses under the skin. Abscesses near the large\\nbowel, particularly around the anus, may be caused by\\nany of the numerous bacteria found within the large'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 26, 'page_label': '27'}, page_content='bowel. Brain abscesses and liver abscesses can be caused\\nby any organism that can travel there through the circula-\\ntion. Bacteria, amoeba, and certain fungi can travel in\\nthis fashion. Abscesses in other parts of the body are\\ncaused by organisms that normally inhabit nearby struc-\\ntures or that infect them. Some common causes of specif-\\nic abscesses are:\\n• skin abscesses by normal skin flora\\n• dental and throat abscesses by mouth flora\\n• lung abscesses by normal airway flora,pneumonia'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 26, 'page_label': '27'}, page_content='germs, or tuberculosis\\n• abdominal and anal abscesses by normal bowel flora\\nSpecific types of abscesses\\nListed below are some of the more common and\\nimportant abscesses.\\n• Carbuncles and other boils. Skin oil glands (sebaceous\\nglands) on the back or the back of the neck are the ones\\nusually infected. The most common germ involved is\\nStaphylococcus aureus. Acne is a similar condition of\\nsebaceous glands on the face and back.\\n• Pilonidal abscess. Many people have as a birth defect a'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 26, 'page_label': '27'}, page_content='tiny opening in the skin just above the anus. Fecal bac-\\nteria can enter this opening, causing an infection and\\nsubsequent abscess.\\nGALE ENCYCLOPEDIA OF MEDICINE 2 13\\nAbcess\\nAn amoebic abscess caused by Entameoba histolytica.\\n(Phototake NYC. Reproduced by permission.)\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 13'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 27, 'page_label': '28'}, page_content='• Retropharyngeal, parapharyngeal, peritonsillar abscess.\\nAs a result of throat infections like strep throat and\\ntonsillitis, bacteria can invade the deeper tissues of the\\nthroat and cause an abscess. These abscesses can com-\\npromise swallowing and even breathing.\\n• Lung abscess. During or after pneumonia, whether it’s\\ndue to bacteria [common pneumonia], tuberculosis,\\nfungi, parasites, or other germs, abscesses can develop\\nas a complication.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 27, 'page_label': '28'}, page_content='as a complication.\\n• Liver abscess. Bacteria or amoeba from the intestines\\ncan spread through the blood to the liver and cause\\nabscesses.\\n• Psoas abscess. Deep in the back of the abdomen on\\neither side of the lumbar spine lie the psoas muscles.\\nThey flex the hips. An abscess can develop in one of\\nthese muscles, usually when it spreads from the appen-\\ndix, the large bowel, or the fallopian tubes.\\nDiagnosis\\nThe common findings of inflammation—heat, red-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 27, 'page_label': '28'}, page_content='ness, swelling, and pain—easily identify superficial\\nabscesses. Abscesses in other places may produce only\\ngeneralized symptoms such as fever and discomfort. If\\nthe patient’s symptoms and physical examination do not\\nhelp, a physician may have to resort to a battery of tests to\\nKEY TERMS\\nCellulitis—Inflammation of tissue due to infection.\\nEnzyme—Any of a number of protein chemicals\\nthat can change other chemicals.\\nFallopian tubes—Part of the internal female anato-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 27, 'page_label': '28'}, page_content='my that carries eggs from the ovaries to the uterus.\\nFlora—Living inhabitants of a region or area.\\nPyogenic—Capable of generating pus. Streptococ-\\ncus, Staphocococcus , and bowel bacteria are the\\nprimary pyogenic organisms.\\nSebaceous glands—Tiny structures in the skin that\\nproduce oil (sebum). If they become plugged,\\nsebum collects inside and forms a nurturing place\\nfor germs to grow.\\nSepticemia —The spread of an infectious agent\\nthroughout the body by means of the blood\\nstream.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 27, 'page_label': '28'}, page_content='stream.\\nSinus—A tubular channel connecting one body\\npart with another or with the outside.\\nlocate the site of an abscess, but usually something in the\\ninitial evaluation directs the search. Recent or chronic dis-\\nease in an organ suggests it may be the site of an abscess.\\nDysfunction of an organ or system—for instance, seizures\\nor altered bowel function—may provide the clue. Pain\\nand tenderness on physical examination are common\\nfindings. Sometimes a deep abscess will eat a small chan-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 27, 'page_label': '28'}, page_content='nel (sinus) to the surface and begin leaking pus. A sterile\\nabscess may cause only a painful lump deep in the but-\\ntock where a shot was given.\\nTreatment\\nSince skin is very resistant to the spread of infection,\\nit acts as a barrier, often keeping the toxic chemicals of\\nan abscess from escaping the body on their own. Thus,\\nthe pus must be drained from the abscess by a physician.\\nThe surgeon determines when the abscess is ready for\\ndrainage and opens a path to the outside, allowing the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 27, 'page_label': '28'}, page_content='pus to escape. Ordinarily, the body handles the remaining\\ninfection, sometimes with the help of antibiotics or other\\ndrugs. The surgeon may leave a drain (a piece of cloth or\\nrubber) in the abscess cavity to prevent it from closing\\nbefore all the pus has drained out.\\nAlternative treatment\\nIf an abscess is directly beneath the skin, it will be\\nslowly working its way through the skin as it is more\\nrapidly working its way elsewhere. Since chemicals'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 27, 'page_label': '28'}, page_content='work faster at higher temperatures, applications of hot\\ncompresses to the skin over the abscess will hasten the\\ndigestion of the skin and eventually result in its breaking\\ndown, releasing the pus spontaneously. This treatment is\\nbest reserved for smaller abscesses in relatively less dan-\\ngerous areas of the body—limbs, trunk, back of the neck.\\nIt is also useful for all superficial abscesses in their very\\nearly stages. It will “ripen” them.\\nContrast hydrotherapy , alternating hot and cold'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 27, 'page_label': '28'}, page_content='compresses, can also help assist the body in resorption of\\nthe abscess. There are two homeopathic remedies that\\nwork to rebalance the body in relation to abscess forma-\\ntion,Silica and Hepar sulphuris . In cases of septic\\nabscesses, bentonite clay packs (bentonite clay and a\\nsmall amount of Hydrastis powder) can be used to draw\\nthe infection from the area.\\nPrognosis\\nOnce the abscess is properly drained, the prognosis\\nis excellent for the condition itself. The reason for the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 27, 'page_label': '28'}, page_content='abscess (other diseases the patient has) will determine\\nthe overall outcome. If, on the other hand, the abscess\\nruptures into neighboring areas or permits the infectious\\nGALE ENCYCLOPEDIA OF MEDICINE 214\\nAbcess\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 14'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 28, 'page_label': '29'}, page_content='agent to spill into the bloodstream, serious or fatal conse-\\nquences are likely. Abscesses in and around the nasal\\nsinuses, face, ears, and scalp may work their way into the\\nbrain. Abscesses within an abdominal organ such as the\\nliver may rupture into the abdominal cavity. In either\\ncase, the result is life threatening. Blood poisoning is a\\nterm commonly used to describe an infection that has\\nspilled into the blood stream and spread throughout the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 28, 'page_label': '29'}, page_content='body from a localized origin. Blood poisoning, known to\\nphysicians as septicemia, is also life threatening.\\nOf special note, abscesses in the hand are more seri-\\nous than they might appear. Due to the intricate structure\\nand the overriding importance of the hand, any hand\\ninfection must be treated promptly and competently.\\nPrevention\\nInfections that are treated early with heat (if superfi-\\ncial) or antibiotics will often resolve without the forma-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 28, 'page_label': '29'}, page_content='tion of an abscess. It is even better to avoid infections\\naltogether by taking prompt care of open injuries, partic-\\nularly puncture wounds. Bites are the most dangerous of\\nall, even more so because they often occur on the hand.\\nResources\\nBOOKS\\nBennett, J. Claude, and Fred Plum, eds. Cecil Textbook of Med-\\nicine. Philadelphia: W. B. Saunders Co., 1996.\\nCurrent Medical Diagnosis and Treatment, 1996.35th ed. Ed.\\nStephen McPhee, et al. Stamford: Appleton & Lange, 1995.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 28, 'page_label': '29'}, page_content='Harrison’s Principles of Internal Medicine.Ed. Anthony S.\\nFauci, et al. New York: McGraw-Hill, 1997.\\nJ. Ricker Polsdorfer, MD\\nAbscess drainage see Abscess incision and\\ndrainage\\nAbscess incision & drainage\\nDefinition\\nAn infected skin nodule that contains pus may need to\\nbe drained via a cut if it does not respond to antibiotics.\\nThis allows the pus to escape, and the infection to heal.\\nPurpose\\nAn abscess is a pus-filled sore, usually caused by a'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 28, 'page_label': '29'}, page_content='bacterial infection. The pus is made up of both live and\\ndead organisms and destroyed tissue from the white\\nblood cells that were carried to the area to fight the infec-\\ntion. Abscesses are often found in the soft tissue under\\nthe skin, such as the armpit or the groin. However, they\\nmay develop in any organ, and are commonly found in\\nthe breast and gums. Abscesses are far more serious and\\ncall for more specific treatment if they are located in\\ndeep organs such as the lung, liver or brain.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 28, 'page_label': '29'}, page_content='Because the lining of the abscess cavity tends to\\ninterfere with the amount of the drug that can penetrate\\nthe source of infection from the blood, the cavity itself\\nmay require draining. Once an abscess has fully formed,\\nit often does not respond to antibiotics. Even if the\\nantibiotic does penetrate into the abscess, it doesn’t func-\\ntion as well in that environment.\\nPrecautions\\nAn abscess can usually be diagnosed visually, al-\\nthough an imaging technique such as a computed tomog-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 28, 'page_label': '29'}, page_content='raphy scan may be used to confirm the extent of the\\nabscess before drainage. Such procedures may also be\\nneeded to localize internal abscesses, such as those in the\\nabdominal cavity or brain.\\nGALE ENCYCLOPEDIA OF MEDICINE 2 15\\nAbcess incision & drainage\\nLiver\\nStomach\\nSpleen\\nColon\\nCommon sites of abscess \\nabove and below the liver\\nAlthough abscesses are often found in the soft tissue under\\nthe skin, such as the armpit or the groin, they may develop'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 28, 'page_label': '29'}, page_content='in any organ, such as the liver.(Illustration by Electronic Illus-\\ntrators Group.)\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 15'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 29, 'page_label': '30'}, page_content='Description\\nA doctor will cut into the lining of the abscess, allow-\\ning the pus to escape either through a drainage tube or by\\nleaving the cavity open to the skin. How big the incision\\nis depends on how quickly the pus is encountered.\\nOnce the abscess is opened, the doctor will clean\\nand irrigate the wound thoroughly with saline. If it is not\\ntoo large or deep, the doctor may simply pack the\\nabscess wound with gauze for 24–48 hours to absorb the\\npus and discharge.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 29, 'page_label': '30'}, page_content='pus and discharge.\\nIf it is a deeper abscess, the doctor may insert a\\ndrainage tube after cleaning out the wound. Once the tube is\\nin place, the surgeon closes the incision with simple stitch-\\nes, and applies a sterile dressing. Drainage is maintained for\\nseveral days to help prevent the abscess from reforming.\\nPreparation\\nThe skin over the abscess will be cleansed by swab-\\nbing gently with an antiseptic solution.\\nAftercare\\nMuch of the pain around the abscess will be gone'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 29, 'page_label': '30'}, page_content='after the surgery. Healing is usually very fast. After the\\ntube is taken out, antibiotics may be continued for sever-\\nal days. Applying heat and keeping the affected area ele-\\nvated may help relieve inflammation.\\nRisks\\nIf there is any scarring, it is likely to become much\\nless noticeable as time goes on, and eventually almost\\ninvisible. Occasionally, an abscess within a vital organ\\n(such as the brain) damages enough surrounding tissue\\nthat there is some permanent loss of normal function.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 29, 'page_label': '30'}, page_content='Normal results\\nMost abscesses heal after drainage alone; others\\nrequire drainage and antibiotic drug treatment.\\nResources\\nBOOKS\\nTurkington, Carol A., and Jeffrey S. Dover. Skin Deep. New\\nYork: Facts on File, 1998.\\nKEY TERMS\\nWhite blood cells —Cells that protect the body\\nagainst infection.\\nORGANIZATIONS\\nNational Institute of Arthritis and Musculoskeletal and Skin\\nDiseases. 9000 Rockville Pike, Bldg. 31, Rm 9A04,\\nBethesda, MD 20892.\\nCarol A. Turkington\\nAbuse\\nDefinition'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 29, 'page_label': '30'}, page_content='Abuse\\nDefinition\\nAbuse is defined as any thing that is harmful, injuri-\\nous, or offensive. Abuse also includes excessive and\\nwrongful misuse of anything. There are several major types\\nof abuse: physical and sexual abuse of a child or an adult,\\nsubstance abuse, elderly abuse, and emotional abuse.\\nDescription\\nPhysical abuse of a child is the infliction of injury by\\nan other person. The injuries can include punching, kick-\\ning, biting, burning, beating, or pulling the victim’s hair.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 29, 'page_label': '30'}, page_content='The physical abuse inflicted on a child can result in\\nbruises, burns, poisoning , broken bones, and internal\\nhemorrhages. Physical assault against an adult primarily\\noccurs with women, usually in the form of domestic vio-\\nlence. It is estimated that approximately three million\\nchildren witness domestic violence every year.\\nSexual abuse of a child refers to sexual behavior\\nbetween an adult and child or between two children, one\\nof whom is dominant or significantly older. The sexual'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 29, 'page_label': '30'}, page_content='behaviors can include touching breasts, genitals, and but-\\ntocks; either dressed or undressed. The behavior can also\\ninclude exhibitionism, cunnilingus, fellatio, or penetra-\\ntion of the vagina or anus with sexual organs or objects.\\nPornographic photography is also used in sexual\\nabuse with children. Reported sex offenders are 97%\\nmale. Females are more often perpetrators in child-care\\nsettings, since children may confuse sexual abuse by a\\nfemale with normal hygiene care. Sexual abuse by step-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 29, 'page_label': '30'}, page_content='fathers is five times more common than with biological\\nfathers. Sexual abuse of daughters by stepfathers or\\nfathers is the most common form of incest.\\nSexual abuse can also take the form of rape. The\\nlegal definition of rape includes only slight penile pene-\\ntration in the victim’s outer vulva area. Complete erec-\\ntion and ejaculation are not necessary. Rape is the perpe-\\ntration of an act of sexual intercourse whether:\\n• will is overcome by force or fear (from threats or by use\\nof drugs).'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 29, 'page_label': '30'}, page_content='of drugs).\\nGALE ENCYCLOPEDIA OF MEDICINE 216\\nAbuse\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 16'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='• mental impairment renders the victim incapable of\\nrational judgment.\\n• if the victim is below the legal age established for con-\\nsent.\\nSubstance abuse is an abnormal pattern of substance\\nusage leading to significant distress or impairment. The\\ncriteria include one or more of the following occurring\\nwithin a 12-month period:\\n• recurrent substance use resulting in failure to fulfill\\nobligations at home, work, or school.\\n• using substance in situations that are physically danger-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='ous (i.e., while driving).\\n• recurrent substance-related legal problems.\\n• continued usage despite recurrent social and interper-\\nsonal problems (i.e., arguments and fights with signifi-\\ncant other).\\nAbuse in the elderly is common and occurs mostly\\nas a result of caretaker burnout, due to the high level of\\ndependency frail, elderly patients usually require. Abuse\\ncan be manifested by physical signs, fear, and delaying\\nor not reporting the need for advanced medical care.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='Elderly patients may also exhibit financial abuse (money\\nor possessions taken away) and abandonment.\\nEmotional abuse generally continues even after phys-\\nical assaults have stopped. In most cases it is a personally\\ntailored form of verbal or gesture abuse expressed to illic-\\nit a provoked response.\\nCauses and symptoms\\nChildren who have been abused usually have a variety\\nof symptoms that encompass behavioral, emotional, and\\npsychosomatic problems. Children who have been physi-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='cally abused tend to be more aggressive, angry, hostile,\\ndepressed, and have low self-esteem. Additionally, they\\nexhibit fear,anxiety, and nightmares. Severe psychological\\nproblems may result in suicidal behavior or posttraumatic\\nstressdisorder. Physically abused children may complain\\nof physical illness even in the absence of a cause. They\\nmay also suffer from eating disorders and encopresis. Chil-\\ndren who are sexually abused may exhibit abnormal sexual'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='behavior in the form of aggressiveness and hyperarousal.\\nAdolescents may display promiscuity, sexual acting out,\\nand—in some situations—homosexual contact.\\nPhysical abuse directed towards adults can ultimately\\nlead to death. Approximately 50% of women murdered\\nin the United States were killed by a former or current\\nmale partner. Approximately one-third of emergency\\nroom consultations by women were prompted due to\\ndomestic violence. Female victims who are married also'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='have a higher rate of internal injuries and unconscious-\\nKEY TERMS\\nEncopresis—Abnormalities relating to bowel move-\\nments that can occur as a result of stress or fear.\\nness than victims of stranger assault (mugging, robbery).\\nPhysical abuse or rape can also occur between married\\npersons and persons of the same gender. Perpetrators usu-\\nally sexually assault their victims to dominate, hurt, and\\ndebase them. It is common for physical and sexual vio-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='lence to occur at the same time. A large percentage of sex-\\nually assaulted persons were also physically abused in the\\nform of punching, beating, or threatening the victim with\\na weapon such as a gun or knife. Usually males who are\\nhurt and humiliated tend to physical assault persons\\nwhom they are intimately involved with, such as spouses\\nand/or children. Males who assault a female tend to have\\nexperienced or witnessed violence during childhood.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='They also tend to abuse alcohol, to be sexually assaultive,\\nand are at increased risk for assaultive behavior directed\\nagainst children. Jealous males tend to monitor the\\nwomen’s movements and whereabouts and to isolate\\nother sources of protection and support. They interpret\\ntheir behavior as betrayal of trust and this causes resent-\\nment and explosive anger outbursts during periods of los-\\ning control. Males may also use aggression against'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='females in an effort to control and intimidate partners.\\nAbuse in the elderly usually occurs in the frail, elderly\\ncommunity. The caretaker is usually the perpetrator. Care-\\ntaker abuse can be suspected if there is evidence suggest-\\ning behavioral changes in the elderly person when the\\ncaretaker is present. Additionally, elderly abuse can be\\npossible if there are delays between injuries and treatment,\\ninconsistencies between injury and explanations, lack of'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='hygiene or clothing, and prescriptions no being filled.\\nDiagnosis\\nChildren who are victims of domestic violence are\\nfrequently injured attempting to protect their mother\\nfrom an abusive partner. Injuries are visible by inspection\\nor self-report. Physical abuse of an adult may be also be\\nevident by inspection with visible cuts and/or bruises or\\nself report.\\nSexual abuse of both a child and an adult can be\\ndiagnosed with a history from the victim. Victims can be'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 30, 'page_label': '31'}, page_content='assessed for ejaculatory evidence from the perpetrator.\\nEjaculatory specimens can be retrieved from the mouth,\\nrectum, and clothing. Tests for sexually transmitted dis-\\neases may be performed.\\nGALE ENCYCLOPEDIA OF MEDICINE 2 17\\nAbuse\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 17'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 31, 'page_label': '32'}, page_content='Elderly abuse can be suspected if the elderly patient\\ndemonstrates a fear from the caretaker. Additionally,\\nelderly abuse can be suspected if there are signs indicat-\\ning intentional delay of required medical care or a\\nchange in medical status.\\nSubstance abuse can be suspected in a person who\\ncontinues to indulge in their drug of choice despite recur-\\nrent negative consequences. The diagnosis can be made\\nafter administration of a comprehensive bio-psycho-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 31, 'page_label': '32'}, page_content='social exam and standardized chemical abuse assess-\\nments by a therapist.\\nTreatment\\nChildren who are victims of physical or sexual abuse\\ntypically require psychological support and medical atten-\\ntion. A complaint may be filed with the local family social\\nservices that will initiate investigations. The authorities\\nwill usually follow up the allegation or offense. Children\\nmay also be referred for psychological evaluation and/or\\ntreatment. The victim may be placed in foster care pending'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 31, 'page_label': '32'}, page_content='the investigation outcome. The police may also investigate\\nphysical and sexual abuse of an adult. The victim may\\nrequire immediate medical care and long-term psychologi-\\ncal treatment. It is common for children to be adversely\\naffected by domestic violence situations and the local fam-\\nily services agency may be involved.\\nSubstance abusers should elect treatment, either inpa-\\ntient or outpatient, depending on severity of addiction.\\nLong term treatment and/or medications may be utilized to'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 31, 'page_label': '32'}, page_content='assist in abstinence. The patient should be encouraged to\\nparticipate in community centered support groups.\\nPrognosis\\nThe prognosis depends on the diagnosis. Usually\\nvictims of physical and sexual abuse require therapy to\\ndeal with emotional distress associated with the incident.\\nPerpetrators require further psychological evaluation and\\ntreatment. Victims of abuse may have a variety of emo-\\ntional problems including depression, acts of suicide, or'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 31, 'page_label': '32'}, page_content='anxiety. Children of sexual abuse may as adults enter\\nabusive relationships or have problems with intimacy.\\nThe substance abuser may experience relapses, since the\\ncardinal feature of all addictive disorders is a tendency to\\nreturn to symptoms. Elderly patients may suffer from\\nfurther medical problems and/or anxiety, and in some\\ncases neglect may precipitate death.\\nPrevention\\nPrevention programs are geared to education and\\nawareness. Detection of initial symptoms or characteris-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 31, 'page_label': '32'}, page_content='tic behaviors may assist in some situations. In some\\ncases treatment may be sought before incident. The pro-\\nfessional treating the abused persons must develop a\\nclear sense of the relationship dynamics and the chances\\nfor continued harm.\\nResources\\nBOOKS\\nBehrman, Richard E., et al, eds. Nelson Textbook of Pediatrics.\\n16th ed. W. B. Saunders Company, 2000.\\nDuthie, Edmund H., et al, eds. Practice of Geriatrics. 3rd ed.\\nW. B. Saunders Company, 1998.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 31, 'page_label': '32'}, page_content='Rosen, Peter. Emergency Medicine: Concepts and Clinical\\nPractice. 4th ed. Mosby-Year Book, Inc., 1998.\\nPERIODICALS\\nNarendra, K., and S. Lazoritz. “Physical Assessment: Evalua-\\ntion for Possible Physical and Sexual Abuse.”Pediatric\\nClinics of North America 45 (Feb. 1998).\\nStringham, P. “Mental Health: Domestic Violence.”Primary\\nCare; Clinics in Office Practice26 (June 1999).\\nORGANIZATIONS\\nNational Clearinghouse on Child Abuse and Neglect Informa-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 31, 'page_label': '32'}, page_content='tion. 330 C Street SW, Washington, DC 20447. (800) 392-\\n3366.\\nOTHER\\nElder Abuse Prevention. .\\nNational Institute on Drug Abuse. .\\nLaith Farid Gulli, M.D.\\nBilal Nasser, M.Sc.\\nAcceleration-deceleration cervical injury\\nsee Whiplash\\nACE inhibitors see Angiotensin-converting\\nenzyme inhibitors\\nAcetaminophen\\nDefinition\\nAcetaminophen is a medicine used to relieve pain\\nand reduce fever.\\nPurpose\\nAcetaminophen is used to relieve many kinds of'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 31, 'page_label': '32'}, page_content='minor aches and pains—headaches, muscle aches, back-\\naches, toothaches, menstrual cramps, arthritis, and the\\naches and pains that often accompany colds.\\nGALE ENCYCLOPEDIA OF MEDICINE 218\\nAcetaminophen\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 18'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 32, 'page_label': '33'}, page_content='Description\\nThis drug is available without a prescription. Aceta-\\nminophen—or APAP—is sold under various brand\\nnames, including Tylenol, Panadol,Aspirin Free Anacin,\\nand Bayer Select Maximum Strength Headache Pain\\nRelief Formula. Many multi-symptom cold, flu, and\\nsinus medicines also contain acetaminophen. Check the\\ningredients listed on the container to see if aceta-\\nminophen is included in the product.\\nStudies have shown that acetaminophen relieves pain'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 32, 'page_label': '33'}, page_content='and reduces fever about as well as aspirin. But differences\\nbetween these two common drugs exist. Acetaminophen\\nis less likely than aspirin to irritate the stomach. However,\\nunlike aspirin, acetaminophen does not reduce the red-\\nness, stiffness, or swelling that accompany arthritis.\\nRecommended dosage\\nThe usual dosage for adults and children age 12 and\\nover is 325-650 mg every 4- 6 hours as needed. No more\\nthan 4 grams (4000 mg) should be taken in 24 hours.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 32, 'page_label': '33'}, page_content='Because the drug can potentially harm the liver, people\\nwho drink alcohol in large quantities should take consid-\\nerably less acetaminophen and possibly should avoid the\\ndrug completely.\\nFor children ages 6-11 years, the usual dose is 150-\\n300 mg, three to four times a day. Check with a physician\\nfor dosages for children under age 6 years.\\nPrecautions\\nNever take more than the recommended dosage of\\nacetaminophen unless told to do so by a physician or\\ndentist.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 32, 'page_label': '33'}, page_content='dentist.\\nPatients should not use acetaminophen for more than\\n10 days to relieve pain (5 days for children) or for more\\nthan 3 days to reduce fever, unless directed to do so by a\\nphysician. If symptoms do not go away—or if they get\\nworse—contact a physician. Anyone who drinks three or\\nmore alcoholic beverages a day should check with a\\nphysician before using this drug and should never take\\nmore than the recommended dosage. A risk of liver dam-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 32, 'page_label': '33'}, page_content='age exists from combining large amounts of alcohol and\\nacetaminophen. People who already have kidney or liver\\ndisease or liver infections should also consult with a\\nphysician before using the drug. So should women who\\nare pregnant or breastfeeding.\\nSmoking cigarettes may interfere with the effective-\\nness of acetaminophen. Smokers may need to take higher\\ndoses of the medicine, but should not take more than the\\nrecommended daily dosage unless told by a physician to\\ndo so.\\nKEY TERMS'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 32, 'page_label': '33'}, page_content='do so.\\nKEY TERMS\\nArthritis —Inflammation of the joints. The condi-\\ntion causes pain and swelling.\\nFatigue—Physical or mental weariness.\\nInflammation—A response to irritation, infection,\\nor injury, resulting in pain, redness, and swelling.\\nMany drugs can interact with one another. Consult\\na physician or pharmacist before combining aceta-\\nminophen with any other medicine. Do not use two\\ndifferent acetaminophen-containing products at the\\nsame time.\\nAcetaminophen interferes with the results of some'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 32, 'page_label': '33'}, page_content='medical tests. Before having medical tests done, check to\\nsee whether taking acetaminophen will affect the results.\\nAvoiding the drug for a few days before the tests may be\\nnecessary.\\nSide effects\\nAcetaminophen causes few side effects. The most\\ncommon one is lightheadedness. Some people may\\nexperience trembling and pain in the side or the lower\\nback. Allergic reactions do occur in some people, but\\nthey are rare. Anyone who develops symptoms such as'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 32, 'page_label': '33'}, page_content='a rash, swelling, or difficulty breathing after taking\\nacetaminophen should stop taking the drug and get\\nimmediate medical attention. Other rare side effects\\ninclude yellow skin or eyes, unusual bleeding or bruis-\\ning, weakness,fatigue , bloody or black stools, bloody\\nor cloudy urine, and a sudden decrease in the amount\\nof urine.\\nOverdoses of acetaminophen may cause nausea,\\nvomiting, sweating, and exhaustion. Very large overdoses\\ncan cause liver damage. In case of an overdose, get'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 32, 'page_label': '33'}, page_content='immediate medical attention.\\nInteractions\\nAcetaminophen may interact with a variety of other\\nmedicines. When this happens, the effects of one or both\\nof the drugs may change or the risk of side effects may\\nbe greater. Among the drugs that may interact with\\nacetaminophen are alcohol,nonsteroidal anti-inflam-\\nmatory drugs (NSAIDs) such as Motrin, oral contra-\\nceptives, the antiseizure drug phenytoin (Dilantin), the\\nblood-thinning drug warfarin (Coumadin), the choles-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 32, 'page_label': '33'}, page_content='terol-lowering drug cholestyramine (Questran), the\\nantibiotic Isoniazid, and zidovudine (Retrovir, AZT).\\nGALE ENCYCLOPEDIA OF MEDICINE 2 19\\nAcetaminophen\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 19'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 33, 'page_label': '34'}, page_content='Check with a physician or pharmacist before combining\\nacetaminophen with any other prescription or nonpre-\\nscription (over-the-counter) medicine.\\nNancy Ross-Flanigan\\nAcetylsalicylic acid see Aspirin\\nAchalasia\\nDefinition\\nAchalasia is a disorder of the esophagus that pre-\\nvents normal swallowing.\\nDescription\\nAchalasia affects the esophagus, the tube that carries\\nswallowed food from the back of the throat down into the\\nstomach. A ring of muscle called the lower esophageal'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 33, 'page_label': '34'}, page_content='sphincter encircles the esophagus just above the entrance to\\nthe stomach. This sphincter muscle is normally contracted\\nto close the esophagus. When the sphincter is closed, the\\ncontents of the stomach cannot flow back into the esopha-\\ngus. Backward flow of stomach contents (reflux) can irri-\\ntate and inflame the esophagus, causing symptoms such as\\nheartburn. The act of swallowing causes a wave of\\nesophageal contraction called peristalsis. Peristalsis pushes'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 33, 'page_label': '34'}, page_content='food along the esophagus. Normally, peristalsis causes the\\nesophageal sphincter to relax and allow food into the stom-\\nach. In achalasia, which means “failure to relax,” the\\nesophageal sphincter remains contracted. Normal peristal-\\nsis is interrupted and food cannot enter the stomach.\\nCauses and symptoms\\nCauses\\nAchalasia is caused by degeneration of the nerve\\ncells that normally signal the brain to relax the\\nesophageal sphincter. The ultimate cause of this degener-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 33, 'page_label': '34'}, page_content='ation is unknown. Autoimmune disease or hidden infec-\\ntion is suspected.\\nSymptoms\\nDysphagia, or difficulty swallowing, is the most com-\\nmon symptom of achalasia. The person with achalasia usu-\\nally has trouble swallowing both liquid and solid foods,\\noften feeling that food “gets stuck” on the way down. The\\nperson has chest pain that is often mistaken for angina\\npectoris (cardiac pain). Heartburn and difficulty belching\\nare common. Symptoms usually get steadily worse. Other'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 33, 'page_label': '34'}, page_content='symptoms may include nighttime cough or recurrent\\npneumoniacaused by food passing into the lower airways.\\nDiagnosis\\nDiagnosis of achalasia begins with a careful medical\\nhistory. The history should focus on the timing of symp-\\ntoms and on eliminating other medical conditions that\\nmay cause similar symptoms. Tests used to diagnose\\nachalasia include:\\n• Esophageal manometry. In this test, a thin tube is\\npassed into the esophagus to measure the pressure\\nexerted by the esophageal sphincter.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 33, 'page_label': '34'}, page_content='• X ray of the esophagus. Barium may be swallowed to\\nact as a contrast agent. Barium reveals the outlines of\\nthe esophagus in greater detail and makes it easier to\\nsee its constriction at the sphincter.\\n• Endoscopy. In this test, a tube containing a lens and a\\nlight source is passed into the esophagus. Endoscopy is\\nused to look directly at the surface of the esophagus.\\nThis test can also detect tumors that cause symptoms\\nlike those of achalasia. Cancer of the esophagus occurs'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 33, 'page_label': '34'}, page_content='as a complication of achalasia in 2-7% of patients.\\nTreatment\\nThe first-line treatment for achalasia is balloon dila-\\ntion. In this procedure, an inflatable membrane or bal-\\nloon is passed down the esophagus to the sphincter and\\ninflated to force the sphincter open. Dilation is effective\\nin about 70% of patients.\\nThree other treatments are used for achalasia when\\nballoon dilation is inappropriate or unacceptable.\\n• Botulinum toxin injection. Injected into the sphincter,'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 33, 'page_label': '34'}, page_content='botulinum toxin paralyzes the muscle and allows it to\\nrelax. Symptoms usually return within one to two years.\\n• Esophagomyotomy. This surgical procedure cuts the\\nsphincter muscle to allow the esophagus to open.\\nEsophagomyotomy is becoming more popular with the\\ndevelopment of techniques allowing very small abdom-\\ninal incisions.\\n• Drug therapy. Nifedipine, a calcium-channel blocker,\\nreduces muscle contraction. Taken daily, this drug pro-\\nvides relief for about two-thirds of patients for as long'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 33, 'page_label': '34'}, page_content='as two years.\\nPrognosis\\nMost patients with achalasia can be treated effective-\\nly. Achalasia does not reduce life expectancy unless\\nesophageal carcinoma develops.\\nGALE ENCYCLOPEDIA OF MEDICINE 220\\nAchalasia\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 20'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 34, 'page_label': '35'}, page_content='Prevention\\nThere is no known way to prevent achalasia.\\nResources\\nBOOKS\\nGrendell, James H., Kenneth R. McQuaid, and Scott L. Fried-\\nman, eds. Current Diagnosis and Treatment in Gastroen-\\nterology. Stamford: Appleton & Lange, 1996.\\nRichard Robinson\\nAchondroplasia\\nDefinition\\nAchondroplasia is the most common cause of\\ndwarfism, or significantly abnormal short stature.\\nKEY TERMS\\nBotulinum toxin—Any of a group of potent bacte-\\nrial toxins or poisons produced by different strains'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 34, 'page_label': '35'}, page_content='of the bacterium Clostridium botulinum . The tox-\\nins cause muscle paralysis.\\nDysphagia—Difficulty in swallowing.\\nEndoscopy—A test in which a viewing device and\\na light source are introduced into the esophagus by\\nmeans of a flexible tube. Endoscopy permits visual\\ninspection of the esophagus for abnormalities.\\nEsophageal manometry —A test in which a thin\\ntube is passed into the esophagus to measure the\\ndegree of pressure exerted by the muscles of the\\nesophageal wall.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 34, 'page_label': '35'}, page_content='esophageal wall.\\nEsophageal sphincter —A circular band of muscle\\nthat closes the last few centimeters of the esopha-\\ngus and prevents the backward flow of stomach\\ncontents.\\nEsophagomyotomy —A surgical incision through\\nthe muscular tissue of the esophagus.\\nEsophagus—The muscular tube that leads from the\\nback of the throat to the entrance of the stomach.\\nPeristalsis —The coordinated, rhythmic wave of\\nsmooth muscle contraction that forces food\\nthrough the digestive tract.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 34, 'page_label': '35'}, page_content='Reflux—An abnormal backward or return flow of\\na fluid.\\nDescription\\nAchondroplasia is one of a number of chondodystro-\\nphies, in which the development of cartilage, and there-\\nfore, bone is disturbed. The disorder appears in approxi-\\nmately one in every 10,000 births. Achondroplasia is\\nusually diagnosed at birth, owing to the characteristic\\nappearance of the newborn.\\nNormal bone growth depends on the production of\\ncartilage (a fibrous connective tissue). Over time, calci-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 34, 'page_label': '35'}, page_content='um is deposited within the cartilage, causing it to hard-\\nen and become bone. In achondroplasia, abnormalities\\nof this process prevent the bones (especially those in\\nthe limbs) from growing as long as they normally\\nshould, at the same time allowing the bones to become\\nabnormally thickened. The bones in the trunk of the\\nbody and the skull are mostly not affected, although the\\nopening from the skull through which the spinal cord\\npasses (foramen magnum) is often narrower than nor-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 34, 'page_label': '35'}, page_content='mal, and the opening (spinal canal) through which the\\nspinal cord runs in the back bones (vertebrae) becomes\\nincreasingly and abnormally small down the length of\\nthe spine.\\nCauses and symptoms\\nAchondroplasia is caused by a genetic defect. It is a\\ndominant trait, meaning that anybody with the genetic\\ndefect will display all the symptoms of the disorder. A\\nparent with the disorder has a 50% chance of passing it\\nGALE ENCYCLOPEDIA OF MEDICINE 2 21\\nAchondroplasia'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 34, 'page_label': '35'}, page_content='Achondroplasia\\nAn x-ray image of an achondroplastic person’s head and\\nchest.(Custom Medical Stock Photo. Reproduced by permission.)\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 21'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 35, 'page_label': '36'}, page_content='on to the offspring. Although achondroplasia can be\\npassed on to subsequent offspring, the majority of cases\\noccur due to a new mutation (change) in a gene. Interest-\\ningly enough, the defect seen in achondroplasia is one of\\nonly a few defects known to increase in frequency with\\nincreasing age of the father (many genetic defects are\\nlinked to increased age of the mother).\\nPeople with achondroplasia have abnormally short\\narms and legs. Their trunk is usually of normal size, as is'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 35, 'page_label': '36'}, page_content='their head. The appearance of short limbs and normal\\nhead size actually makes the head appear to be oversized.\\nThe bridge of the nose often has a scooped out appear-\\nance termed “saddle nose.” The lower back has an abnor-\\nmal curvature, or sway back. The face often displays an\\noverly prominent forehead, and a relative lack of devel-\\nopment of the face in the area of the upper jaw. Because\\nthe foramen magnum and spinal canal are abnormally\\nnarrowed, nerve damage may occur if the spinal cord or'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 35, 'page_label': '36'}, page_content='nerves become compressed. The narrowed foramen mag-\\nnum may disrupt the normal flow of fluid between the\\nbrain and the spinal cord, resulting in the accumulation\\nof too much fluid in the brain (hydrocephalus). Children\\nwith achondroplasia have a very high risk of serious and\\nrepeated middle ear infections, which can result in hear-\\ning loss. The disease does not affect either mental capac-\\nity, or reproductive ability.\\nKEY TERMS\\nCartilage—A flexible, fibrous type of connective tis-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 35, 'page_label': '36'}, page_content='sue which serves as a base on which bone is built.\\nForamen magnum—The opening at the base of the\\nskull, through which the spinal cord and the brain-\\nstem pass.\\nHydrocephalus —An abnormal accumulation of\\nfluid within the brain. This accumulation can be\\ndestructive by pressing on brain structures, and\\ndamaging them.\\nMutation—A new, permanent change in the struc-\\nture of a gene, which can result in abnormal struc-\\nture or function somewhere in the body.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 35, 'page_label': '36'}, page_content='Spinal canal —The opening that runs through the\\ncenter of the column of spinal bones (vertebrae),\\nand through which the spinal cord passes.\\nVertebrae—The individual bones of the spinal col-\\numn which are stacked on top of each other. There\\nis a hole in the center of each bone, through\\nwhich the spinal cord passes.\\nDiagnosis\\nDiagnosis is often made at birth due to the characteris-\\ntically short limbs, and the appearance of a large head. X-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 35, 'page_label': '36'}, page_content='ray examination will reveal a characteristic appearance to\\nthe bones, with the bones of the limbs appearing short in\\nlength, yet broad in width. A number of measurements of\\nthe bones in x-ray images will reveal abnormal proportions.\\nTreatment\\nNo treatment will reverse the defect present in achon-\\ndroplasia. All patients with the disease will be short, with\\nabnormally proportioned limbs, trunk, and head. Treat-\\nment of achondroplasia primarily addresses some of the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 35, 'page_label': '36'}, page_content='complications of the disorder, including problems due to\\nnerve compression, hydrocephalus, bowed legs, and\\nabnormal curves in the spine. Children with achondropla-\\nsia who develop middle ear infections (acute otitis\\nmedia) will require quick treatment with antibiotics and\\ncareful monitoring in order to avoid hearing loss.\\nPrognosis\\nAchondroplasia is a disease which causes consider-\\nable deformity. However, with careful attention paid to\\nthe development of dangerous complications (nerve'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 35, 'page_label': '36'}, page_content='compression, hydrocephalus), most people are in good\\nhealth, and can live a normal lifespan.\\nPrevention\\nThe only form of prevention is through genetic\\ncounseling, which could help parents assess their risk of\\nhaving a child with achondroplasia.\\nResources\\nBOOKS\\nHall, Bryan D. “Achondroplasia.” In Nelson Textbook of Pedi-\\natrics, ed. Richard E. Behrman. Philadelphia: W. B. Saun-\\nders Co., 1996.\\nHorton, W. A., and J. T. Hecht. “The Chondrodysplasias.” In'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 35, 'page_label': '36'}, page_content='Connective Tissue and Its Heritable Disorders, ed. R. M.\\nRoyce and B. Steinmann. Somerset, NJ: Wiley-Liss, 1993.\\nKrane, Stephen M., and Alan L. Schiller. “Achondroplasia.” In\\nHarrison’s Principles of Internal Medicine, ed. Anthony\\nS. Fauci, et al. New York: McGraw-Hill, 1997.\\nWhyte, Michael, P. “Achondroplasia.” In Cecil Textbook of\\nMedicine, ed. J. Claude Bennett and Fred Plum. Philadel-\\nphia: W. B. Saunders Co., 1996.\\nORGANIZATIONS\\nLittle People of America, c/o Mary Carten. 7238 Piedmont'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 35, 'page_label': '36'}, page_content='Drive, Dallas, TX 75227-9324. (800) 243-9273.\\nRosalyn Carson-DeWitt, MD\\nGALE ENCYCLOPEDIA OF MEDICINE 222\\nAchondroplasia\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 22'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 36, 'page_label': '37'}, page_content='Achromatopsia see Color blindness\\nAcid indigestion see Heartburn\\nAcid phosphatase test\\nDefinition\\nAcid phosphatase is an enzyme found throughout\\nthe body, but primarily in the prostate gland. Like all\\nenzymes, it is needed to trigger specific chemical reac-\\ntions. Acid phosphatase testing is done to diagnose\\nwhether prostate cancer has spread to other parts of the\\nbody (metastasized), and to check the effectiveness of\\ntreatment. The test has been largely supplanted by the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 36, 'page_label': '37'}, page_content='prostate specific antigen test (PSA).\\nPurpose\\nThe male prostate gland has 100 times more acid\\nphosphatase than any other body tissue. When prostate\\ncancerspreads to other parts of the body, acid phos-\\nphatase levels rise, particularly if the cancer spreads to\\nthe bone. One-half to three-fourths of persons who have\\nmetastasized prostate cancer have high acid phosphatase\\nlevels. Levels fall after the tumor is removed or reduced\\nthrough treatment.\\nTissues other than prostate have small amounts of'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 36, 'page_label': '37'}, page_content='acid phosphatase, including bone, liver, spleen, kidney,\\nand red blood cells and platelets. Damage to these tissues\\ncauses a moderate increase in acid phosphatase levels.\\nAcid phosphatase is very concentrated in semen.\\nRape investigations will often include testing for the\\npresence of acid phosphatase in vaginal fluid.\\nPrecautions\\nThis is not a screening test for prostate cancer. Acid\\nphosphatase levels rise only after prostate cancer has\\nmetastasized.\\nDescription'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 36, 'page_label': '37'}, page_content='Description\\nLaboratory testing measures the amount of acid\\nphosphatase in a person’s blood, and can determine from\\nwhat tissue the enzyme is coming. For example, it is\\nimportant to know if the increased acid phosphatase is\\nfrom the prostate or red blood cells. Acid phosphatase\\nfrom the prostate, called prostatic acid phosphatase\\n(PAP), is the most medically significant type of acid\\nphosphatase.\\nKEY TERMS\\nEnzyme—A substance needed to trigger specific\\nchemical reactions.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 36, 'page_label': '37'}, page_content='chemical reactions.\\nMetastasize —Spread to other parts of the body;\\nusually refers to cancer.\\nProstate gland—A gland of the male reproductive\\nsystem.\\nSubtle differences between prostatic acid phos-\\nphatase and acid phosphatases from other tissues cause\\nthem to react differently in the laboratory when mixed\\nwith certain chemicals. For example, adding the chemi-\\ncal tartrate to the test mixture inhibits the activity of pro-\\nstatic acid phosphatase but not red blood cell acid phos-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 36, 'page_label': '37'}, page_content='phatase. Laboratory test methods based on these differ-\\nences reveal how much of a person’s total acid phos-\\nphatase is derived from the prostate. Results are usually\\navailable the next day.\\nPreparation\\nThis test requires drawing about 5-10 mL of blood.\\nThe patient should not have a rectal exam or prostate\\nmassage for two to three days prior to the test.\\nAftercare\\nDiscomfort or bruising may occur at the puncture\\nsite, and the person may feel dizzy or faint. Applying'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 36, 'page_label': '37'}, page_content='pressure to the puncture site until the bleeding stops will\\nreduce bruising. Warm packs to the puncture site will\\nrelieve discomfort.\\nNormal results\\nNormal results vary based on the laboratory and the\\nmethod used.\\nAbnormal results\\nThe highest levels of acid phosphatase are found in\\nmetastasized prostate cancer. Diseases of the bone, such\\nas Paget’s disease or hyperparathyroidism; diseases of\\nblood cells, such as sickle cell disease or multiple'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 36, 'page_label': '37'}, page_content='myeloma; or lysosomal disorders, such as Gaucher’s dis-\\nease, will show moderately increased levels.\\nCertain medications can cause temporary increases\\nor decreases in acid phosphatase levels. Manipulation of\\nthe prostate gland through massage, biopsy, or rectal\\nexam before a test can increase the level.\\nGALE ENCYCLOPEDIA OF MEDICINE 2 23\\nAcid phosphatase test\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 23'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 37, 'page_label': '38'}, page_content='Resources\\nBOOKS\\nA Manual of Laboratory and Diagnostic Tests.5th ed. Ed.\\nFrancis Fishback. Philadelphia: Lippincott, 1996.\\nGarza, Diana, and Kathleen Becan-McBride. Phlebotomy\\nHandbook. 4th ed. Stamford: Appleton & Lange, 1996.\\nPERIODICALS\\nMoul, Judd W., et al. “The Contemporary Value of Pretreat-\\nment Prostatic Acid Phosphatase to Predict Pathological\\nStage and Recurrence in Radical Prostatectomy Cases.”\\nJournal of Urology(Mar. 1998): 935-940.\\nNancy J. Nordenson\\nAcid reflux see Heartburn'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 37, 'page_label': '38'}, page_content='Acidosis see Respiratory acidosis; Renal\\ntubular acidosis; Metabolic acidosis\\nAcne\\nDefinition\\nAcne is a common skin disease characterized by\\npimples on the face, chest, and back. It occurs when the\\npores of the skin become clogged with oil, dead skin\\ncells, and bacteria.\\nDescription\\nAcne vulgaris, the medical term for common acne, is\\nthe most common skin disease. It affects nearly 17 million\\npeople in the United States. While acne can arise at any'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 37, 'page_label': '38'}, page_content='age, it usually begins at puberty and worsens during ado-\\nlescence. Nearly 85% of people develop acne at some time\\nbetween the ages of 12-25 years. Up to 20% of women\\ndevelop mild acne. It is also found in some newborns.\\nThe sebaceous glands lie just beneath the skin’s sur-\\nface. They produce an oil called sebum, the skin’s natural\\nmoisturizer. These glands and the hair follicles within\\nwhich they are found are called sebaceous follicles.\\nThese follicles open onto the skin through pores. At'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 37, 'page_label': '38'}, page_content='puberty, increased levels of androgens (male hormones)\\ncause the glands to produce too much sebum. When\\nexcess sebum combines with dead, sticky skin cells, a\\nhard plug, or comedo, forms that blocks the pore. Mild\\nnoninflammatory acne consists of the two types of come-\\ndones, whiteheads and blackheads.\\nModerate and severe inflammatory types of acne\\nresult after the plugged follicle is invaded by Propioni-\\nbacterium acnes , a bacteria that normally lives on the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 37, 'page_label': '38'}, page_content='skin. A pimple forms when the damaged follicle weakens\\nand bursts open, releasing sebum, bacteria, and skin and\\nwhite blood cells into the surrounding tissues. Inflamed\\npimples near the skin’s surface are called papules; when\\ndeeper, they are called pustules. The most severe type of\\nacne consists of cysts (closed sacs) and nodules (hard\\nswellings). Scarring occurs when new skin cells are laid\\ndown to replace damaged cells.\\nThe most common sites of acne are the face, chest,'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 37, 'page_label': '38'}, page_content='shoulders, and back since these are the parts of the body\\nwhere the most sebaceous follicles are found.\\nCauses and symptoms\\nThe exact cause of acne is unknown. Several risk\\nfactors have been identified:\\n• Age. Due to the hormonal changes they experience,\\nteenagers are more likely to develop acne.\\n• Gender. Boys have more severe acne and develop it\\nmore often than girls.\\n• Disease. Hormonal disorders can complicate acne in\\ngirls.\\n• Heredity. Individuals with a family history of acne have'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 37, 'page_label': '38'}, page_content='greater susceptibility to the disease.\\n• Hormonal changes. Acne can flare up before menstrua-\\ntion, during pregnancy, and menopause.\\n• Diet. No foods cause acne, but certain foods may cause\\nflare-ups.\\n• Drugs. Acne can be a side effect of drugs including\\ntranquilizers, antidepressants, antibiotics, oral contra-\\nceptives, and anabolic steroids.\\n• Personal hygiene. Abrasive soaps, hard scrubbing, or\\npicking at pimples will make them worse.\\n• Cosmetics. Oil-based makeup and hair sprays worsen'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 37, 'page_label': '38'}, page_content='acne.\\n• Environment. Exposure to oils and greases, polluted air,\\nand sweating in hot weather aggravate acne.\\n• Stress. Emotional stress may contribute to acne.\\nAcne is usually not conspicuous, although inflamed\\nlesions may cause pain, tenderness, itching, or swelling.\\nThe most troubling aspects of these lesions are the nega-\\ntive cosmetic effects and potential for scarring. Some\\npeople, especially teenagers, become emotionally upset\\nabout their condition, and have problems forming rela-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 37, 'page_label': '38'}, page_content='tionships or keeping jobs.\\nDiagnosis\\nAcne patients are often treated by family doctors.\\nComplicated cases are referred to a dermatologist, a skin\\nGALE ENCYCLOPEDIA OF MEDICINE 224\\nAcne\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 24'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 38, 'page_label': '39'}, page_content='disease specialist, or an endocrinologist, a specialist who\\ntreats diseases of the body’s endocrine (hormones and\\nglands) system.\\nAcne has a characteristic appearance and is not diffi-\\ncult to diagnose. The doctor takes a complete medical\\nhistory, including questions about skin care, diet, factors\\ncausing flare-ups, medication use, and prior treatment.\\nPhysical examinationincludes the face, upper neck,\\nchest, shoulders, back, and other affected areas. Under'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 38, 'page_label': '39'}, page_content='good lighting, the doctor determines what types and how\\nmany blemishes are present, whether they are inflamed,\\nwhether they are deep or superficial, and whether there is\\nscarring or skin discoloration.\\nIn teenagers, acne is often found on the forehead,\\nnose, and chin. As people get older, acne tends to appear\\ntowards the outer part of the face. Adult women may\\nhave acne on their chins and around their mouths. The\\nelderly may develop whiteheads and blackheads on the'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 38, 'page_label': '39'}, page_content='upper cheeks and skin around the eyes.\\nLaboratory tests are not done unless the patient\\nappears to have a hormonal disorder or other medical\\nproblem. In this case, blood analyses or other tests may\\nbe ordered. Most insurance plans cover the costs of diag-\\nnosing and treating acne.\\nTreatment\\nAcne treatment consists of reducing sebum produc-\\ntion, removing dead skin cells, and killing bacteria with\\ntopical drugs and oral medications. Treatment choice'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 38, 'page_label': '39'}, page_content='depends upon whether the acne is mild, moderate, or\\nsevere.\\nDrugs\\nTOPICAL DRUGS. Treatment for mild noninflamma-\\ntory acne consists of reducing the formation of new\\ncomedones with topical tretinoin, benzoyl peroxide, ada-\\npalene, or salicylic acid. Tretinoin is especially effective\\nbecause it increases turnover (death and replacement) of\\nskin cells. When complicated by inflammation, topical\\nantibiotics may be added to the treatment regimen.\\nImprovement is usually seen in two to four weeks.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 38, 'page_label': '39'}, page_content='Topical medications are available as cream, gel,\\nlotion, or pad preparations of varying strengths. They\\ninclude antibiotics (agents that kill bacteria), such as ery-\\nthromycin, clindamycin (Cleocin-T), and meclocycline\\n(Meclan); comedolytics (agents that loosen hard plugs\\nand open pores) such as the vitamin A acid tretinoin\\n(Retin-A), salicylic acid, adapalene (Differin), resorci-\\nnol, and sulfur. Drugs that act as both comedolytics and\\nantibiotics, such as benzoyl peroxide, azelaic acid'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 38, 'page_label': '39'}, page_content='(Azelex), or benzoyl peroxide plus erythromycin (Benza-\\nmycin), are also used. These drugs may be used for\\nmonths to years to achieve disease control.\\nAfter washing with mild soap, the drugs are applied\\nalone or in combination, once or twice a day over the\\nentire affected area of skin. Possible side effects include\\nmild redness, peeling, irritation, dryness, and an increased\\nsensitivity to sunlight that requires use of a sunscreen.\\nORAL DRUGS. Oral antibiotics are taken daily for'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 38, 'page_label': '39'}, page_content='two to four months. The drugs used include tetracycline,\\nerythromycin, minocycline (Minocin), doxycycline, clin-\\ndamycin (Cleocin), and trimethoprim- sulfamethoxazole\\n(Bactrim, Septra). Possible side effects include allergic\\nreactions, stomach upset, vaginal yeast infections,dizzi-\\nness, and tooth discoloration.\\nThe goal of treating moderate acne is to decrease\\ninflammation and prevent new comedone formation. One\\neffective treatment is topical tretinoin along with a topical'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 38, 'page_label': '39'}, page_content='GALE ENCYCLOPEDIA OF MEDICINE 2 25\\nAcne\\nAcne vulgaris affecting a woman’s face. Acne is the general\\nname given to a skin disorder in which the sebaceous\\nglands become inflamed.(Photograph by Biophoto Associ-\\nates, Photo Researchers, Inc. Reproduced by permission.)\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 25'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 39, 'page_label': '40'}, page_content='or oral antibiotic. A combination of topical benzoyl per-\\noxide and erythromycin is also very effective. Improve-\\nment is normally seen within four to six weeks, but treat-\\nment is maintained for at least two to four months.\\nA drug reserved for the treatment of severe acne, oral\\nisotretinoin (Accutane), reduces sebum production and\\ncell stickiness. It is the treatment of choice for severe acne\\nwith cysts and nodules, and is used with or without topical'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 39, 'page_label': '40'}, page_content='or oral antibiotics. Taken for four to five months, it pro-\\nvides long-term disease control in up to 60% of patients. If\\nthe acne reappears, another course of isotretinoin may be\\nneeded by about 20% of patients, while another 20% may\\ndo well with topical drugs or oral antibiotics. Side effects\\ninclude temporary worsening of the acne, dry skin, nose-\\nbleeds, vision disorders, and elevated liver enzymes, blood\\nfats and cholesterol. This drug must not be taken during'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 39, 'page_label': '40'}, page_content='pregnancy since it causes birth defects.\\nAnti-androgens, drugs that inhibit androgen produc-\\ntion, are used to treat women who are unresponsive to\\nother therapies. Certain types of oral contraceptives (for\\nKEY TERMS\\nAndrogens —Male sex hormones that are linked\\nwith the development of acne.\\nAntiandrogens—Drugs that inhibit the production\\nof androgens.\\nAntibiotics—Medicines that kill bacteria.\\nComedo—A hard plug composed of sebum and\\ndead skin cells. The mildest type of acne.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 39, 'page_label': '40'}, page_content='Comedolytic —Drugs that break up comedones\\nand open clogged pores.\\nCorticosteroids —A group of hormones produced\\nby the adrenal glands with different functions,\\nincluding regulation of fluid balance, androgen\\nactivity, and reaction to inflammation.\\nEstrogens —Hormones produced by the ovaries,\\nthe female sex glands.\\nIsotretinoin —A drug that decreases sebum pro-\\nduction and dries up acne pimples.\\nSebaceous follicles —A structure found within the\\nskin that houses the oil-producing glands and hair'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 39, 'page_label': '40'}, page_content='follicles, where pimples form.\\nSebum—An oily skin moisturizer produced by\\nsebaceous glands.\\nTretinoin—A drug that works by increasing the\\nturnover (death and replacement) of skin cells.\\nexample, Ortho-Tri-Cyclen) and female sex hormones\\n(estrogens) reduce hormone activity in the ovaries. Other\\ndrugs, for example, spironolactone and corticosteroids,\\nreduce hormone activity in the adrenal glands. Improve-\\nment may take up to four months.\\nOral corticosteroids, or anti-inflammatory drugs, are'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 39, 'page_label': '40'}, page_content='the treatment of choice for an extremely severe, but rare\\ntype of destructive inflammatory acne called acne fulmi-\\nnans, found mostly in adolescent males. Acne congloba-\\nta, a more common form of severe inflammation, is char-\\nacterized by numerous, deep, inflammatory nodules that\\nheal with scarring. It is treated with oral isotretinoin and\\ncorticosteroids.\\nOther treatments\\nSeveral surgical or medical treatments are available\\nto alleviate acne or the resulting scars:'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 39, 'page_label': '40'}, page_content='• Comedone extraction. The comedo is removed from the\\npore with a special tool.\\n• Chemical peels. Glycolic acid is applied to peel off the\\ntop layer of skin to reduce scarring.\\n• Dermabrasion. The affected skin is frozen with a chem-\\nical spray, and removed by brushing or planing.\\n• Punch grafting. Deep scars are excised and the area\\nrepaired with small skin grafts.\\n• Intralesional injection. Corticosteroids are injected\\ndirectly into inflamed pimples.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 39, 'page_label': '40'}, page_content='• Collagen injection. Shallow scars are elevated by colla-\\ngen (protein) injections.\\nAlternative treatment\\nAlternative treatments for acne focus on proper\\ncleansing to keep the skin oil-free; eating a well-bal-\\nanced diet high in fiber, zinc, and raw foods; and avoid-\\ning alcohol, dairy products,smoking , caffeine ,\\nsugar,processed foods, and foods high in iodine, such as\\nsalt. Supplementation with herbs such as burdock root\\n(Arctium lappa ), red clover ( Trifolium pratense ), and'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 39, 'page_label': '40'}, page_content='milk thistle (Silybum marianum), and with nutrients such\\nas essential fatty acids, vitamin B complex, zinc, vitamin\\nA, and chromium is also recommended. Chinese herbal\\nremedies used for acne include cnidium seed (Cnidium\\nmonnieri) and honeysuckle flower ( Lonicera japonica ).\\nWholistic physicians or nutritionists can recommend the\\nproper amounts of these herbs.\\nPrognosis\\nAcne is not curable, although long-term control is\\nachieved in up to 60% of patients treated with'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 39, 'page_label': '40'}, page_content='GALE ENCYCLOPEDIA OF MEDICINE 226\\nAcne\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 26'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 40, 'page_label': '41'}, page_content='isotretinoin. It can be controlled by proper treatment,\\nwith improvement taking two or more months. Acne\\ntends to reappear when treatment stops, but spontaneous-\\nly improves over time. Inflammatory acne may leave\\nscars that require further treatment.\\nPrevention\\nThere are no sure ways to prevent acne, but the fol-\\nlowing steps may be taken to minimize flare-ups:\\n• gentle washing of affected areas once or twice every day\\n• avoid abrasive cleansers\\n• use noncomedogenic makeup and moisturizers'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 40, 'page_label': '41'}, page_content='• shampoo often and wear hair off face\\n• eat a well-balanced diet, avoiding foods that trigger\\nflare-ups\\n• unless told otherwise, give dry pimples a limited\\namount of sun exposur\\n• do not pick or squeeze blemishes\\n• reduce stress\\nResources\\nBOOKS\\nBalch, James F., and Phyllis A. Balch. “The Disorders: Acne.”\\nIn Prescription for Nutritional Healing, ed. Amy C. Teck-\\nlenburg, et al. New York: Avery Publishing Group, 1997.\\nBark, Joseph P. Your Skin: An Owner’s Guide.Englewood'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 40, 'page_label': '41'}, page_content='Cliffs, NJ: Prentice Hall, 1995.\\nGoldstein, Sanford M., and Richard B. Odom. “Skin &\\nAppendages: Pustular Disorders.” In Current Medical\\nDiagnosis and Treatment, 1996.35th ed. Ed. Stephen\\nMcPhee, et al. Stamford: Appleton & Lange, 1995.\\nKaptchuk, Ted J., Z’ev Rosenberg, and K’an Herb Co., Inc.\\nK’an Herbals: Formulas by Ted Kaptchuk, O.M.D.San\\nFrancisco: Andrew Miller, 1996.\\nPERIODICALS\\n“Adult Acne.”Harvard Women’s Health Watch(Mar. 1995): 4-\\n5.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 40, 'page_label': '41'}, page_content='5.\\nBergfeld, Wilma F. “The Evaluation and Management of Acne:\\nEconomic Considerations.” Journal of the American\\nAcademy of Dermatology 32 (1995): S52-6.\\nBillings, Laura. “Getting Clear.”Health Magazine, Apr. 1997,\\n48-52.\\nChristiano, Donna. “Acne Treatment Meant for Grown- Ups.”\\nAmerican Health (Oct. 1994): 23-4.\\n“Clearly Better New Treatments Help Adult Acne.”Prevention\\nMagazine, Aug. 1997, 50-51.\\nLeyden, James J. “Therapy For Acne Vulgaris.”New England'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 40, 'page_label': '41'}, page_content='Journal of Medicine 17 (Apr. 1997): 1156-1162.\\nNguyen, Quan H., Y . Alyssa Kim, and Robert A. Schwartz.\\n“Management of Acne Vulgaris.”American Family Physi-\\ncian (July 1994): 89-96.\\n“Pimple Control Pill?” Prevention Magazine, May 1997, 132.\\nORGANIZATIONS\\nAmerican Academy of Dermatology. 930 N. Meacham Road,\\nP.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-\\n0230. .\\nMercedes McLaughlin\\nAcne rosacea see Rosacea\\nAcoustic neurinoma see Acoustic neuroma\\nAcoustic neuroma'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 40, 'page_label': '41'}, page_content='Acoustic neuroma\\nDefinition\\nAn acoustic neuroma is a benign tumor involving\\ncells of the myelin sheath that surrounds the vestibulo-\\ncochlear nerve (eighth cranial nerve).\\nDescription\\nThe vestibulocochlear nerve extends from the inner\\near to the brain and is made up of a vestibular branch,\\noften called the vestibular nerve, and a cochlear branch,\\ncalled the cochlear nerve. The vestibular and cochlear\\nnerves lie next to one another. They also run along side'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 40, 'page_label': '41'}, page_content='other cranial nerves. People possess two of each type of\\nvestibulocochlear nerve, one that extends from the left\\near and one that extends from the right ear.\\nThe vestibular nerve transmits information concern-\\ning balance from the inner ear to the brain and the cochlear\\nnerve transmits information about hearing. The vestibular\\nnerve, like many nerves, is surrounded by a cover called a\\nmyelin sheath. A tumor, called a schwannoma, can some-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 40, 'page_label': '41'}, page_content='times develop from the cells of the myelin sheath. A tumor\\nis an abnormal growth of tissue that results from the\\nuncontrolled growth of cells. Acoustic neuromas are often\\ncalled vestibular schwannomas because they are tumors\\nthat arise from the myelin sheath that surrounds the\\nvestibular nerve. Acoustic neuromas are considered\\nbenign (non-cancerous) tumors since they do not spread to\\nother parts of the body. They can occur anywhere along'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 40, 'page_label': '41'}, page_content='the vestibular nerve but are most likely to occur where the\\nvestibulocochlear nerve passes through the tiny bony canal\\nthat connects the brain and the inner ear.\\nAn acoustic neuroma can arise from the left vestibu-\\nlar nerve or the right vestibular nerve. A unilateral tumor\\nis a tumor arising from one nerve and a bilateral tumor\\narises from both vestibular nerves. Unilateral acoustic\\nneuromas usually occur spontaneously (by chance). Bilat-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 40, 'page_label': '41'}, page_content='eral acoustic neuromas occur as part of a hereditary con-\\nGALE ENCYCLOPEDIA OF MEDICINE 2 27\\nAcoustic neuroma\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 27'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='dition called Neurofibromatosis Type 2 (NF2). A person\\nwith NF2 has inherited a predisposition for developing\\nacoustic neuromas and other tumors of the nerve cells.\\nAcoustic neuromas usually grow slowly and can\\ntake years to develop. Some acoustic neuromas remain\\nso small that they do not cause any symptoms. As the\\nacoustic neuroma grows it can interfere with the func-\\ntioning of the vestibular nerve and can cause vertigo and\\nbalance difficulties. If the acoustic nerve grows large'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='enough to press against the cochlear nerve, then hearing\\nloss and a ringing (tinnitus) in the affected ear will usu-\\nally occur. If untreated and the acoustic neuroma contin-\\nues to grow it can press against other nerves in the region\\nand cause other symptoms. This tumor can be life threat-\\nening if it becomes large enough to press against and\\ninterfere with the functioning of the brain.\\nCauses and symptoms\\nCauses\\nAn acoustic neuroma is caused by a change or'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='absence of both of the NF2 tumor suppressor genes in a\\nnerve cell. Every person possesses a pair of NF2 genes in\\nevery cell of their body including their nerve cells. One\\nNF2 gene is inherited from the egg cell of the mother and\\none NF2 gene is inherited from the sperm cell of the\\nfather. The NF2 gene is responsible for helping to pre-\\nvent the formation of tumors in the nerve cells. In partic-\\nular the NF2 gene helps to prevent acoustic neuromas.\\nOnly one unchanged and functioning NF2 gene is'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='necessary to prevent the formation of an acoustic neuro-\\nma. If both NF2 genes become changed or missing in\\none of the myelin sheath cells of the vestibular nerve\\nthen an acoustic neuroma will usually develop. Most uni-\\nlateral acoustic neuromas result when the NF2 genes\\nbecome spontaneously changed or missing. Someone\\nwith a unilateral acoustic neuroma that has developed\\nspontaneously is not at increased risk for having children\\nwith an acoustic neuroma. Some unilateral acoustic neu-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='romas result from the hereditary condition NF2. It is also\\npossible that some unilateral acoustic neuromas may be\\ncaused by changes in other genes responsible for pre-\\nventing the formation of tumors.\\nBilateral acoustic neuromas result when someone is\\naffected with the hereditary condition NF2. A person with\\nNF2 is typically born with one unchanged and one\\nchanged or missing NF2 gene in every cell of their body.\\nSometimes they inherit this change from their mother or'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='father. Sometimes the change occurs spontaneously when\\nthe egg and sperm come together to form the first cell of\\nthe baby. The children of a person with NF2 have a 50%\\nchance of inheriting the changed or missing NF2 gene.\\nA person with NF2 will develop an acoustic neuro-\\nma if the remaining unchanged NF2 gene becomes spon-\\ntaneously changed or missing in one of the myelin sheath\\ncells of their vestibular nerve. People with NF2 often\\ndevelop acoustic neuromas at a younger age. The mean'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='age of onset of acoustic neuroma in NF2 is 31 years of\\nage versus 50 years of age for sporadic acoustic neuro-\\nmas. Not all people with NF2, however, develop acoustic\\nneuromas. People with NF2 are at increased risk for\\ndeveloping cataracts and tumors in other nerve cells.\\nMost people with a unilateral acoustic neuroma are\\nnot affected with NF2. Some people with NF2, however,\\nonly develop a tumor in one of the vestibulocochlear\\nnerves. Others may initially be diagnosed with a unilater-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='al tumor but may develop a tumor in the other nerve a\\nnumber of years later. NF2 should be considered in some-\\none under the age of 40 who has a unilateral acoustic neu-\\nroma. Someone with a unilateral acoustic neuroma and\\nother family members diagnosed with NF2 probably is\\naffected with NF2. Someone with a unilateral acoustic\\nneuroma and other symptoms of NF2 such as cataracts\\nand other tumors may also be affected with NF2. On the\\nother hand, someone over the age of 50 with a unilateral'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='acoustic neuroma, no other tumors and no family history\\nof NF2 is very unlikely to be affected with NF2.\\nSymptoms\\nSmall acoustic neuromas usually only interfere with\\nthe functioning of the vestibulocochlear nerve. The most\\ncommon first symptom of an acoustic neuroma is hearing\\nloss, which is often accompanied by a ringing sound (tin-\\nnitis). People with acoustic neuromas sometimes report\\ndifficulties in using the phone and difficulties in perceiving'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='the tone of a musical instrument or sound even when their\\nhearing appears to be otherwise normal. In most cases the\\nhearing loss is initially subtle and worsens gradually over\\ntime until deafness occurs in the affected ear. In approxi-\\nmately 10% of cases the hearing loss is sudden and severe.\\nAcoustic neuromas can also affect the functioning of\\nthe vestibular branch of the vestibulocochlear nerve and\\nvan cause vertigo and dysequilibrium. Twenty percent of'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='small tumors are associated with periodic vertigo, which\\nis characterized by dizziness or a whirling sensation.\\nLarger acoustic neuromas are less likely to cause vertigo\\nbut more likely to cause dysequilibrium. Dysequilibrium,\\nwhich is characterized by minor clumsiness and a gener-\\nal feeling of instability, occurs in nearly 50% of people\\nwith an acoustic neuroma.\\nAs the tumor grows larger it can press on the surround-\\ning cranial nerves. Compression of the fifth cranial nerve'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 41, 'page_label': '42'}, page_content='can result in facial pain and or numbness. Compression of\\nthe seventh cranial nerve can cause spasms, weakness or\\nGALE ENCYCLOPEDIA OF MEDICINE 228\\nAcoustic neuroma\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 28'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 42, 'page_label': '43'}, page_content='paralysis of the facial muscles. Double vision is a rare\\nsymptom but can result when the 6th cranial nerve is affect-\\ned. Swallowing and/or speaking difficulties can occur if the\\ntumor presses against the 9th, 10th, or 12th cranial nerves.\\nIf left untreated, the tumor can become large enough\\nto press against and affect the functioning of the brain\\nstem. The brain stem is the stalk like portion of the brain\\nthat joins the spinal cord to the cerebrum, the thinking and'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 42, 'page_label': '43'}, page_content='reasoning part of the brain. Different parts of the brain-\\nstem have different functions such as the control of breath-\\ning and muscle coordination. Large tumors that impact the\\nbrain stem can result in headaches, walking difficulties\\n(gait ataxia) and involuntary shaking movements of the\\nmuscles (tremors). In rare cases when an acoustic neuro-\\nma remains undiagnosed and untreated it can cause nau-\\nsea, vomiting, lethargy and eventually coma, respiratory'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 42, 'page_label': '43'}, page_content='difficulties and death. In the vast majority of cases, how-\\never, the tumor is discovered and treated long before it is\\nlarge enough to cause such serious manifestations.\\nDiagnosis\\nAnyone with symptoms of hearing loss should under-\\ngo hearing evaluations. Pure tone and speech audiometry\\nKEY TERMS\\nBenign tumor—A localized overgrowth of cells that\\ndoes not spread to other parts of the body.\\nChromosome—A microscopic structure, made of a\\ncomplex of proteins and DNA, that is found within'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 42, 'page_label': '43'}, page_content='each cell of the body.\\nComputed tomography (CT)—An examination that\\nuses a computer to compile and analyze the images\\nproduced by x rays projected at a particular part of\\nthe body.\\nCranial nerves—The set of twelve nerves found on\\neach side of the head and neck that control the sen-\\nsory and muscle functions of a number of organs\\nsuch as the eyes, nose, tongue face and throat.\\nDNA testing—Testing for a change or changes in a\\ngene or genes.\\nGene—A building block of inheritance, made up of'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 42, 'page_label': '43'}, page_content='a compound called DNA (deoxyribonucleic acid)\\nand containing the instructions for the production\\nof a particular protein. Each gene is found on a spe-\\ncific location on a chromosome.\\nMagnetic resonance imaging (MRI) —A test which\\nuses an external magnetic field instead of x rays to\\nvisualize different tissues of the body.\\nMyelin sheath —The cover that surrounds many\\nnerve cells and helps to increase the speed by\\nwhich information travels along the nerve.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 42, 'page_label': '43'}, page_content='Neurofibromatosis type 2 (NF2) —A hereditary\\ncondition associated with an increased risk of bilat-\\neral acoustic neuromas, other nerve cell tumors and\\ncataracts.\\nProtein—A substance produced by a gene that is\\ninvolved in creating the traits of the human body\\nsuch as hair and eye color or is involved in control-\\nling the basic functions of the human body.\\nSchwannoma —A tumor derived from the cells of\\nthe myelin sheath that surrounds many nerve cells.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 42, 'page_label': '43'}, page_content='Tinnitus—A ringing sound or other noise in the ear.\\nVertigo—A feeling of spinning or whirling.\\nVestibulocochlear nerve (Eighth cranial nerve) —\\nNerve that transmits information, about hearing and\\nbalance from the ear to the brain.\\nare two screening tests that are often used to evaluate hear-\\ning. Pure tone audiometry tests to see how well someone\\ncan hear tones of different volume and pitch and speech\\naudiometry tests to see how well someone can hear and'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 42, 'page_label': '43'}, page_content='recognize speech. An acoustic neuroma is suspected in\\nsomeone with unilateral hearing loss or hearing loss that is\\nless severe in one ear than the other ear(asymmetrical).\\nSometimes an auditory brainstem response (ABR,\\nBAER) test is performed to help establish whether\\nsomeone is likely to have an acoustic neuroma. During\\nthe ABR examination, a harmless electrical impulse is\\npassed from the inner ear to the brainstem. An acoustic\\nneuroma can interfere with the passage of this electri-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 42, 'page_label': '43'}, page_content='cal impulse and this interference can, sometimes be\\nidentified through the ABR evaluation. A normal ABR\\nexamination does not rule out the possibility of an\\nacoustic neuroma. An abnormal ABR examination\\nincreases the likelihood that an acoustic neuroma is\\npresent but other tests are necessary to confirm the\\npresence of a tumor.\\nIf an acoustic neuroma is strongly suspected then\\nmagnetic resonance imaging (MRI) is usually per-\\nformed. The MRI is a very accurate evaluation that is'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 42, 'page_label': '43'}, page_content='GALE ENCYCLOPEDIA OF MEDICINE 2 29\\nAcoustic neuroma\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 29'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='able to detect nearly 100% of acoustic neuromas. Com-\\nputerized tomography (CT scan, CAT scan)is unable to\\nidentify smaller tumors; but it can be used when an\\nacoustic neuroma is suspected and an MRI evaluation\\ncannot be performed.\\nOnce an acoustic neuroma is diagnosed, an evalua-\\ntion by genetic specialists such as a geneticist and genet-\\nic counselor may be recommended. The purpose of this\\nevaluation is to obtain a detailed family history and'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='check for signs of NF2. If NF2 is strongly suspected\\nthen DNA testing may be recommended. DNA testing\\ninvolves checking the blood cells obtained from a rou-\\ntine blood draw for the common gene changes associat-\\ned with NF2.\\nTreatment\\nThe three treatment options for acoustic neuroma\\nare surgery, radiation, and observation. The physician\\nand patient should discuss the pros and cons of the differ-\\nent options prior to making a decision about treatment.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='The patient’s, physical health, age, symptoms, tumor\\nsize, and tumor location should be considered.\\nMicrosurgery\\nThe surgical removal of the tumor or tumors is the\\nmost common treatment for acoustic neuroma. In most\\ncases the entire tumor is removed during the surgery. If\\nthe tumor is large and causing significant symptoms, yet\\nthere is a need to preserve hearing in that ear, then only\\npart of the tumor may be removed. During the procedure\\nthe tumor is removed under microscopic guidance and'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='general anesthetic. Monitoring of the neighboring cranial\\nnerves is done during the procedure so that damage to\\nthese nerves can be prevented. If preservation of hearing\\nis a possibility, then monitoring of hearing will also take\\nplace during the surgery.\\nMost people stay in the hospital four to seven days\\nfollowing the surgery. Total recovery usually takes four\\nto six weeks. Most people experience fatigue and head\\ndiscomfort following the surgery. Problems with balance'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='and head and neck stiffness are also common. The mor-\\ntality rate of this type of surgery is less than 2% at most\\nmajor centers. Approximately 20% of patients experi-\\nence some degree of post-surgical complications. In most\\ncases these complications can be managed successfully\\nand do not result in long term medical problems. Surgery\\nbrings with it a risk of stroke, damage to the brain stem,\\ninfection, leakage of spinal fluid and damage to the cra-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='nial nerves. Hearing loss and/or tinnitis often result from\\nthe surgery. A follow-up MRI is recommended one to\\nfive years following the surgery because of possible\\nregrowth of the tumor.\\nStereotactic Radiation therapy\\nDuring stereotactic radiation therapy , also called\\nradiosurgery or radiotherapy, many small beams of radia-\\ntion are aimed directly at the acoustic neuroma. The radi-\\nation is administered in a single large dose, under local'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='anesthetic and is performed on an outpatient basis. This\\nresults in a high dose of radiation to the tumor but little\\nradiation exposure to the surrounding area. This treat-\\nment approach is limited to small or medium tumors.\\nThe goal of the surgery is to cause tumor shrinkage or at\\nleast limit the growth of the tumor. The long term effica-\\ncy and risks of this treatment approach are not known.\\nPeriodic MRI monitoring throughout the life of the\\npatient is therefore recommended.'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='Radiation therapy can cause hearing loss which can\\nsometimes occurs even years later. Radiation therapy can\\nalso cause damage to neighboring cranial nerves, which\\ncan result in symptoms such as numbness, pain or paralysis\\nof the facial muscles. In many cases these symptoms are\\ntemporary. Radiation treatment can also induce the forma-\\ntion of other benign or malignant schwannomas. This type\\nof treatment may therefore be contraindicated in the treat-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='ment of acoustic neuromas in those with NF2 who are pre-\\ndisposed to developing schwannomas and other tumors.\\nObservation\\nAcoustic neuromas are usually slow growing and in\\nsome cases they will stop growing and even become\\nsmaller or disappear entirely. It may therefore be appro-\\npriate in some cases to hold off on treatment and to peri-\\nodically monitor the tumor through MRI evaluations.\\nLong-term observation may be appropriate for example\\nin an elderly person with a small acoustic neuroma and'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='few symptoms. Periodic observation may also be indicat-\\ned for someone with a small and asymptomatic acoustic\\nneuroma that was detected through an evaluation for\\nanother medical problem. Observation may also be sug-\\ngested for someone with an acoustic neuroma in the only\\nhearing ear or in the ear that has better hearing. The dan-\\nger of an observational approach is that as the tumor\\ngrows larger it can become more difficult to treat.\\nPrognosis'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='Prognosis\\nThe prognosis for someone with a unilateral acoustic\\nneuroma is usually quite good provided the tumor is diag-\\nnosed early and appropriate treatment is instituted. Long\\nterm hearing loss and tinnitis in the affected ear are com-\\nmon, even if appropriate treatment is provided. Regrowth of\\nthe tumor is also a possibility following surgery or radiation\\ntherapy and repeat treatment may be necessary. The progno-\\nsis can be poorer for those with NF2 who have an increased'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 43, 'page_label': '44'}, page_content='risk of bilateral acoustic neuromas and other tumors.\\nGALE ENCYCLOPEDIA OF MEDICINE 230\\nAcoustic neuroma\\nGEM - 0001 to 0432 - A 10/22/03 1:41 PM Page 30'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 44, 'page_label': '45'}, page_content='Resources\\nBOOKS\\nFilipo, R., and Barbara Maurizio Acoustic neuroma: trends and\\ncontroversies: proceedings of the Symposium Acoustic\\nNeuroma: Trends and Controversies, Rome, Italy, Novem-\\nber 13–15, 1997.The Hague, Netherlands: Kugler,1999.\\nMalis, Leonard Acoustic Neuroma New York: Elsevier, 1998.\\nRoland, Peter, and Bradley Marple. Diagnosis and Manage-\\nment of Acoustic Neuroma (Sipac).Alexandria, V A:\\nAmerican Academy of Otolaryngology—Head and Neck\\nSurvey Foundation, 1998.\\nPERIODICALS'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 44, 'page_label': '45'}, page_content='PERIODICALS\\nBroad, R. W. “Management of Acoustic Neuroma.” In New\\nEngland Journal of Medicine. 340(14) (8 April\\n1999):1119.\\nLederman G, E. Arbit, and J. Lowry. “Management of Acoustic\\nNeuroma.” New England Journal of Medicine. 340(14) (8\\nApril 1999):1119–1120.\\nLevo H., I. Pyykko, and G. Blomstedt. “Non-surgical Treat-\\nment of Vestibular Schwannoma Patients.”Acta Oto-\\nLaryngologica 529 (1997): 56–8.\\nO’Donoghue G.M., T. Nikolopoulos and J. Thomsen. “Man-'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 44, 'page_label': '45'}, page_content='agement of Acoustic Neuroma.” In New England Journal\\nof Medicine 340(14) (8 April 1999):1120–1121.\\nRigby, P. L., et al. “Acoustic Neuroma Surgery: Outcome\\nAnalysis of Patient-Perceived Disability.” In American\\nJournal of Otology 18 (July 1997): 427–35.\\nvan Roijen, L., et al. “Costs and Effects of Microsurgery versus\\nRadiosurgery in Treating Acoustic Neuroma.” In Acta\\nNeurochirurgica 139 (1997): 942–48.\\nORGANIZATIONS\\nAcoustic Neuroma Association. 600 Peachtree Pkwy, Suite'),\n", " Document(metadata={'source': 'data\\\\Medical_book_merged.pdf', 'page': 44, 'page_label': '45'}, page_content='108, Cumming, GA 30041-6899. Phone:(770) 205-8211.\\nFax: (770) 205-0239. ANAusa@aol.com . 28 June 2001.\\nAcoustic Neuroma Association of Canada Box 369, Edmonton,\\nAB T5J 2J6. 1-800-561-ANAC(2622). (780)428-3384.\\nanac@compusmart.ab.ca. . 28 June\\n2001.\\nBritish Acoustic Neuroma Association. Oak House, Ransom\\nWood Business Park, Southwell Road West, Mansfield,\\nNottingham, NG21 0HJ. Tel: 01623 632143. Fax: 01623\\n635313. bana@btclick.com.