Saw Palmetto - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References 0597842981, 9780597842986, 9781417512188

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SAW

PALMETTO A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Saw Palmetto: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84298-1 1. Saw Palmetto-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on saw palmetto. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON SAW PALMETTO ........................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Saw Palmetto ................................................................................ 6 The National Library of Medicine: PubMed ................................................................................ 16 CHAPTER 2. NUTRITION AND SAW PALMETTO .............................................................................. 23 Overview...................................................................................................................................... 23 Finding Nutrition Studies on Saw Palmetto ............................................................................... 23 Federal Resources on Nutrition ................................................................................................... 27 Additional Web Resources ........................................................................................................... 27 CHAPTER 3. ALTERNATIVE MEDICINE AND SAW PALMETTO ........................................................ 29 Overview...................................................................................................................................... 29 The Combined Health Information Database............................................................................... 29 National Center for Complementary and Alternative Medicine.................................................. 30 Additional Web Resources ........................................................................................................... 37 General References ....................................................................................................................... 40 CHAPTER 4. CLINICAL TRIALS AND SAW PALMETTO .................................................................... 41 Overview...................................................................................................................................... 41 Recent Trials on Saw Palmetto .................................................................................................... 41 Keeping Current on Clinical Trials ............................................................................................. 41 CHAPTER 5. PATENTS ON SAW PALMETTO .................................................................................... 43 Overview...................................................................................................................................... 43 Patents on Saw Palmetto ............................................................................................................. 43 Patent Applications on Saw Palmetto ......................................................................................... 52 Keeping Current .......................................................................................................................... 58 CHAPTER 6. BOOKS ON SAW PALMETTO ........................................................................................ 59 Overview...................................................................................................................................... 59 Book Summaries: Federal Agencies.............................................................................................. 59 Book Summaries: Online Booksellers........................................................................................... 60 Chapters on Saw Palmetto ........................................................................................................... 61 CHAPTER 7. PERIODICALS AND NEWS ON SAW PALMETTO .......................................................... 63 Overview...................................................................................................................................... 63 News Services and Press Releases................................................................................................ 63 Newsletter Articles ...................................................................................................................... 65 Academic Periodicals covering Saw Palmetto.............................................................................. 65 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 69 Overview...................................................................................................................................... 69 NIH Guidelines............................................................................................................................ 69 NIH Databases............................................................................................................................. 71 Other Commercial Databases....................................................................................................... 73 APPENDIX B. PATIENT RESOURCES ................................................................................................. 75 Overview...................................................................................................................................... 75 Patient Guideline Sources............................................................................................................ 75 Finding Associations.................................................................................................................... 77 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 79 Overview...................................................................................................................................... 79 Preparation................................................................................................................................... 79 Finding a Local Medical Library.................................................................................................. 79 Medical Libraries in the U.S. and Canada ................................................................................... 79

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ONLINE GLOSSARIES.................................................................................................................. 85 Online Dictionary Directories ..................................................................................................... 85 SAW PALMETTO DICTIONARY................................................................................................ 86 INDEX .............................................................................................................................................. 121

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with saw palmetto is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about saw palmetto, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to saw palmetto, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on saw palmetto. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to saw palmetto, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on saw palmetto. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON SAW PALMETTO Overview In this chapter, we will show you how to locate peer-reviewed references and studies on saw palmetto.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and saw palmetto, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “saw palmetto” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Saw Palmetto for the Treatment of Men with Lower Urinary Tract Symptoms Source: Journal of Urology. 163(5): 1408-1412. May 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: Saw palmetto extracts remain the most popular medicinal botanical used by men to treat voiding symptoms secondary to benign prostatic hyperplasia (BPH). This article reports on a comprehensive review of the literature on the use of saw palmetto in men with lower urinary tract symptoms. The author focused on studies that assessed the mechanism of action and clinical results of saw palmetto in men with BPH. A variety of potential mechanisms of action of saw palmetto have been demonstrated through in vitro studies, including 5 alpha reductase inhibition, adrenergic receptor antagonism,

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and intraprostatic androgen receptor blockade. Clinical evidence of the relevance of these effects is largely unavailable. The use of saw palmetto in men with BPH is safe with no recognized adverse effects. No effect on serum prostate specific antigen (PSA) has been noted. Placebo controlled trials and meta analyses have suggested that saw palmetto leads to subjective and objective improvement in men with lower urinary tract symptoms. However, the author cautions that most studies are significantly limited by methodological flaws, small patient numbers, and brief treatment intervals. The author concludes that the evidence suggests saw palmetto may have a significant effect on urinary flow rates and symptoms scores compared to placebo in men with lower urinary tract symptoms. However, large scale, placebo controlled trials are needed to assess the efficacy of saw palmetto. 1 figure. 1 table. 69 references. •

Risk-Benefit Profile of Commonly Used Herbal Therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava Source: Annals of Internal Medicine. 136(1): 42-53. January 1, 2002. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: The use of herbal remedies is increasing so a risk-benefit profile of commonly used herbs is needed. This article provides a clinically oriented overview of the efficacy and safety of ginkgo, St. John's wort, ginseng, Echinacea, saw palmetto, and kava. Wherever possible, assessments are based on systematic reviews of randomized clinical trials. Encouraging data support the efficacy of some of these popular herbal medicinal products, and the potential for doing good seems greater than that for doing harm. The published evidence suggests that gingko is of questionable use for memory loss and tinnitus but has some effect on dementia and intermittent claudication. St. John's wort is effective for mild to moderate depression, but serious concerns exist about its interactions with several conventional drugs. Well-conducted clinical trials do not support the efficacy of ginseng to treat any condition. Echinacea may be helpful in the treatment or prevention of upper respiratory tract infections, but trial data are not fully convincing. Saw palmetto has been shown in short-term trials to be effective in reducing the symptoms of benign prostatic hyperplasia (BPH). Kava is an effective short term treatment for anxiety. None of these herbal medicines is free of adverse effects. The authors conclude that because the evidence is incomplete, risk-benefit assessments are not completely reliable, and much knowledge is still lacking. 4 tables. 76 references.

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Saw Palmetto for Prostate Disorders Source: American Family Physician. 67(6): 1281-1283. March 2003. Contact: Available from American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114-2797. (800) 274-2237. Website: www.aafp.org/afp. Summary: This article considers saw palmetto, an herbal product used in the treatment of symptoms related to benign prostatic hyperplasia (BPH). The active component is found in the fruit of the American dwarf palm tree. Studies have demonstrated the effectiveness of saw palmetto in reducing symptoms associated with benign prostatic hyperplasia. Saw palmetto appears to have efficacy similar to that of medications like finasteride, but it is better tolerated and less expensive. There are no known drug interactions with saw palmetto, and reported side effects are minor and rare. No data on its long-term usage are available. The herbal product also has been used to treat chronic prostatitis, but currently there is no evidence of its efficacy. 1 table. 11 references.

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Herbal Update: Saw Palmetto and the Prostate Source: Patient Care for the Nurse Practitioner. 2(4): 8, 11-13. April 1999. Contact: Available from Medical Economics Company. Subscriber Services Department, Patient Care for the Nurse Practitioner, P.O. Box 3000, Denville, NJ 07834-9662. (800) 432-4570. Summary: This article on saw palmetto and the prostate is from a column that focuses on complementary and alternative medicine. The author first notes the changes in attitude that have occurred in the U.S. Food and Drug Administration (FDA) to be more supportive of alternative medicine. Less than a decade after being banned as a therapeutic agent in the United States, saw palmetto is now expected to be the first herbal product to be licensed as a drug with a specific indication (for benign prostatic hyperplasia, or BPH). The medication relieves symptoms but does not reduce prostate enlargement. The hypothesized mechanisms of action include inhibition of testosterone5-alphareductase (which converts testosterone to dihydrotestosterone) and alteration in steroid receptor levels; antiedematous and antiinflammatory effects have also been shown. No health hazards or side effects are known when the medication is taken as designated, although rare stomach complaints have been reported. Research studies have shown that saw palmetto was superior to placebo and comparable with finasteride in improving urologic symptoms. Sidebars offer cautions and encouragement for physicians working with patients who choose to use herbal therapies. 5 references.

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Effects of a Saw Palmetto Herbal Blend in Men with Symptomatic Benign Prostatic Hyperplasia Source: Journal of Urology. 163(5): 1451-1456. May 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a randomized, placebo controlled trial that tested the effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia (BPH). The authors randomized 44 men aged 45 to 80 years old with symptomatic BPH into a trial of a saw palmetto herbal blend versus placebo. Results showed both saw palmetto herbal blend and placebo groups had improved clinical parameters with a slight advantage in the saw palmetto group (not statistically significant). Neither prostate specific antigen (PSA) nor prostate volume changed from baseline. Prostate epithelial contraction was noted, especially in the transition zone, where percent epithelium decreased from 17.8 percent at baseline to 10.7 percent after 6 months of saw palmetto herbal blend. Histological studies showed that the percent of atrophic glands increased from 25.2 percent to 40.9 percent after treatment with saw palmetto herbal blend. The mechanism of action appeared to be nonhormonal, but it was not identified by tissue studies of apotosis, cellular proliferation, angiogenesis, growth factors, or androgen receptor expression. The authors noted no adverse effects of saw palmetto herbal blend. When the study was no longer blinded, 41 men elected to continue therapy in an open label extension. The authors conclude that saw palmetto herbal blend appears to be a safe, highly desirable option for men with moderately symptomatic BPH. Saw palmetto herbal blend therapy was associated with epithelial contraction, especially in the transition zone, indicating a possible mechanism of action underlying the clinical significance detected in other studies. 2 appendices. 4 figures. 4 tables. 23 references.

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Saw Palmetto for BPH: A Review of a Meta-Analysis Source: JAAPA. Journal of the American Academy of Physician Assistants. 15(5): 59-64. May 2002. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This continuing education article helps physician assistants understand how to formulate a question in response to a clinical problem presented by a patient; in this case, the question of whether saw palmetto berry (SPB) extract will be effective for a patient with benign prostatic hyperplasia (BPH). The author describes how a focused literature search can help in answering the clinical question and guides readers in learning how to evaluate the evidence returned by the literature search. The author uses a meta-analysis on saw palmetto for the example and explains how to measure the evidence presented in a meta-analysis. Evidence shows that saw palmetto is more effective than placebo and is equivalent to finasteride in improving urinary symptoms and flow measures in men with BPH. Since the case patient is similar to those studied in gender, age, and symptomatology, reasonable potential exists that SPB extract will improve his mild to moderate urinary symptoms. 2 tables. 6 references.

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Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review Source: JAMA. Journal of the American Medical Association. 280(18): 1604-1609. November 11, 1998. Summary: This journal article reviews the research on the efficacy and safety of saw palmetto extract (Serenoa repens) in men with symptomatic benign prostatic hyperplasia (BPH). A comprehensive search of the literature identified 18 randomized controlled trials involving 2,393 men who met inclusion criteria. Studies were included if the participants had symptomatic BPH, the intervention was a preparation of Serenoa repens alone or in combination with other phytotherapeutic agents, a control group received a placebo or other pharmacological therapies for BPH, and the treatment duration was at least 30 days. Results from doctor and participant assessments showed that Serenoa repens was superior to a placebo and comparable with finasteride in improving urinary tract symptom scores, nocturia, peak and mean urine flow rates, and residual urine volume. Adverse effects due to Serenoa repens generally were mild and comparable with a placebo. Erectile dysfunction was more common with finasteride (4.9 percent) than with S repens (1.1 percent). The withdrawal rates in men receiving Serenoa repens, a placebo, and finasteride were 9.1 percent, 7 percent, and 11.2 percent, respectively. The authors conclude that Serenoa repens appears to improve urologic symptoms and flow measures in men with BPH; its efficacy is similar to that of finasteride but with fewer adverse effects. The article has 4 figures and 51 references.

Federally Funded Research on Saw Palmetto The U.S. Government supports a variety of research studies relating to saw palmetto. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable 2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration

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database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to saw palmetto. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore saw palmetto. The following is typical of the type of information found when searching the CRISP database for saw palmetto: •

Project Title: ALTERNATE THERAPIES FOR BENIGN PROSTATE SYMPTOMS Principal Investigator & Institution: Roehrborn, Claus G.; Professor and Chair; Urology; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) are very common findings in aging men and present a considerable health care burden both in terms of morbidity as well as health care resource utilization. Aside from the standard therapy transurethral resection of the prostate (TURP), minimally invasive surgical therapies (MIST) have been developed over the past decade, which are utilized to varying degrees. In addition, three classes of medications are currently being utilized for the treatment of LUTS and BPH: alpha adrenergic receptor blocker, 5 alpha reductase inhibitors (5 ARI), and phytotherapeutic agents. The use of alpha blocker is supported by RCTs of up to 12 mo duration and open label extension trials up to 60 mo duration. Use of the 5 ARI is supported by RCTs of up to 48 mo duration and open label extension trials up to 72 mo. duration. Of the many different phytotherapeutic preparations available, few have been studied in randomized placebo-controlled trials usually 6 mo or shorter in duration. The most commonly used preparation is saw palmetto extract, which has undergone the most extensive testing including randomized trials of up to 12 mo duration in direct comparison to an alpha blocker, however, not against placebo. Given the widespread use of these over the counter preparation data regarding the relative safety and efficacy of the most commonly used compounds are urgently needed. The purpose of the consortium is to develop and carry out a relevant clinical trial involving these compounds. A randomized, placebo-controlled trial of saw pametto extract and pygeum africanum with a 4 to 6 yrs follow-up period is proposed enrolling approx 3,000 patients at the participating centers with the following objectives: Determine the efficacy.of saw palmetto and pygeum africanum compared with placebo in preventing the progression of LUTS and BPH defined (1) as a twice validated increase in the AUA Symptom Index by four or more points from baseline, (2) as the development of either spontaneous or precipitated acute urinary retention (AUR), (3) as the need for MIST or surgical therapy for BPH with or without a preceding episode of AUR, (4) as the development of renal insufficiency ( due to BPH), recurrent urinary tract infection (UTI) (due to BPH), or incontinence. (5) Determine the efficacy of saw palmetto and pygeum africanum compared with placebo in terms of improving the AUA SI, other humanistic questionnaires, sexual functioning, global subjective assessment and maximum urinary flow rate from baseline to end of study. (7) Determine whether baseline parameters are

(FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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able to predict response to the different therapies administered. (8) Determine whether saw palmetto or pygeum africanum compared to placebo induce measurable changes in prostate volume, transition zone volume, serum PSA and other serum or tissue based biomarkers of BPH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ALTERNATE THERAPIES FOR BENIGN PROSTATE SYMPTOMS Principal Investigator & Institution: Dixon, Chistopher M.; Urology; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): Over the past 10 years, medical therapy for men with symptomatic benign prostatic hyperplasia (BPH) has become first-line therapy. Well-designed clinical trials have defined the role of medical therapy for symptom reduction, improved quality of life and diminished the likelihood of disease progression. Phytotherapy for BPH has long been a popular therapeutic option in spite of the lack of compelling scientific information about the mechanism(s) of action, magnitude of symptom improvement, adverse effects or long-term preventative role of these extracts. The primary objective of this application is to determine whether the long-term use of saw palmetto or pygeum africanum delays or prevents the progression of clinical BPH as compared to placebo. Clinical progression will be specifically defined as symptom progression, acute urinary retention, recurrent infection or urosepsis, urinary incontinence or renal insufficiency. Patients will also be classified if they crossover to other BPH treatment options (watchful waiting, medical or invasive treatment). The secondary research questions include an assessment of the natural history of BPH in a well-defined population, differences over time between the 3 cohorts with respect to symptom score, quality of life, urinary flow rates, post void urinary residual, sexual function and prostate volume. The subgroup hypotheses will assess whether treatment response is related to symptom severity, urinary flow rate, residual urine, prostate size or prostate specific antigen hopefully providing some insight into the mechanism of action should these agents be proven effective. The study will enroll approximately 3000 men at 10 centers during the first 2 years. Patients will be followed at 3-month intervals for 4 to 6 years using standard outcome measures. This trial will determine whether saw palmetto or pygeum africanum are worthwhile alternative for the treatment of men with symptomatic BPH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ALTERNATIVE THERAPIES FOR BENIGN PROSTATE SYMPTOMS Principal Investigator & Institution: Kreder, Karl J.; Professor; Urology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): The long-term objectives and specific aims of this proposal are to establish the University of Iowa Department of Urology and Preventive Medicine trials group as a Clinical Evaluation and Treatment Center (CETC) in a multiinstitutional research consortium. The purpose of this consortium is to study the effect of phytotherapy using Sernoa repens (saw palmetto) and Pygeum africanum in men with benign prostatic hyperplasia (BPH). A large segment of the United States population uses phytotherapy for treatment of symptoms of BPH, yet there is little scientific data regarding long-term treatment with these agents. Our proposal here at the CETC will enroll 300 patients in this trial during the enrollment period and follow them

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for the duration of the trial for a minimum of four years and a maximum of six years. The primary outcome measure will be the clinical progression of BPH. The recruitment, marketing, and retention strategies outlined in the following sections will ensure this level of participation as well as maximize the center's ability to recruit minority populations. This center has all the clinical and laboratory support required as stated in the protocol. The following sections outline innovative methods to recruit a large number of men with BPH as well as multiple strategies to ensure long-term compliance and completion of all scheduled follow-up visits. In summary, this proposal outlines what we believe are the outstanding credentials of the University of Iowa Department of Urology and Preventive Medicine to serve as a Clinical Evaluation and Treatment Center for this multi-institutional clinical trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HYPERPLASIA

ALTERNATIVE

THERAPIES

FOR

BENIGN

PROSTATIC

Principal Investigator & Institution: Nickel, J Curtis.; Queen's University at Kingston Kingston K7l 3N6, Canada Kingston, Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-MAR-2009 Summary: (provided by applicant): Serenoa repens (saw palmetto) and Pygeum africanum appear to have modest benefit on the pathophysiology of established benign prostatic hyperplasia (BPH) but even more importantly these agents may affect the pathogenesis of the progressive disease process. Almost every individual study, systematic review and meta-analysis report analyzing the effect of these phytotherapeutic agents on BPH have come to the same conclusion: further research is needed to determine the long term safety and effectiveness and ability to prevent complications associated with progressive BPH. The primary objective of this study is to determine if serenoa repens or pygeum africanum delays or prevents clinical progression of benign prostatic hyperplasia compared to placebo treatment. Secondary objectives will compare relative efficacy of these two treatments and also determine whether either of these agents ameliorate symptoms of BPH, improve BPH specific quality of life, improve maximum flow rate and reduce residual urine in men with BPH. Men with mild to moderate symptoms of BPH who do not desire or require immediate medical or surgical treatment will be randomized to placebo, serenoa repens or pygeum africanum after placebo run in and will be followed for disease progression for a minimum of four years. Progression will be defined as an increase in AUA symptom score of 4 or more points from baseline, or occurrence of any of the following complications of BPH; acute urinary retention, incontinence, obstructive uropathy (measured as increased creatinine) or BPH related urinary tract infection. The Canadian BPH Research Group (Canadian CETC) have demonstrated experience and expertise in designing and implementing multi-center clinical trials in BPH and are the most successful research group in Canada in recruiting patients to multi-center BPH trials. The principal investigator has been a successful and effective collaborator in studies funded by NIH-NIDDK. The members of this group have demonstrated their willingness and ability to work in an effective and congenial manner in collaborative international multi-center studies including NIH sponsored collaborative groups. The Canadian BPH study group would be a valuable partner in the proposed NIH phytotherapeutic BPH prevention trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Saw Palmetto

Project Title: ALTERNATIVE THERAPIES FOR BENIGN PROSTATIC SYMPTOMS Principal Investigator & Institution: Naslund, Michael J.; Surgery; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): The purpose of this request is to establish a cooperative group of approximately 10 prostate evaluation and treatment centers nationwide which will develop and conduct a prospective, randomized, double-blind, placebo controlled clinical trial to determine whether Saw Palmetto(SP) and/or Pygeum Africanum(AP) can prevent the clinical progression of benign prostatic hyperplasia (BPH). BPH is a common disease in men over 50 which can lead to bothersome voiding symptoms, urinary retention, permanent bladder damage, renal failure, urinary tract infections, urosepsis or urinary incontinence. Treatment options with documented efficacy include medication, several thermotherapy options, and surgical prostatectomy. Phytotherapy is another treatment option for BPH which is used widely in Europe and is experiencing increasing utilization in the United States. Two common phytotherapeutic agents SP and PA. Despite the widespread use of these substances, there is no convincing data in the literature which demonstrates efficacy for the treatment of BPH. These phytotherapeutic substances do appear to be safe from the patients' perspective. The objective of this trial is to determine if SP and/or PA can prevent the clinical progression of BPH, as defined by the development of: acute urinary retention, renal insufficiency due to BPH, recurrent urinary tract infections, urinary incontinence, or an increase in the international prostate symptom score (IPSS) of 4 or more points over a four year trial. Parameters to be assessed in the subjects enrolled in this trial include IPSS, peak urinary flow rate, post void residual volumes, quality of life and sexual health questionnaires, prostate size determined by prostatic ultrasound, blood count and blood chemistries, urinalysis, serum hormone levels, a history and physical examination. Patients will be assessed every 3 months over a four year trial period. The chosen group of collaborators will meet to design the protocol including diagnostic criteria, inclusion/exclusion criteria, safety measurements and quality of life outcome measurements. The trial will commence after the protocol has been developed, an operations manual has been completed and data collection techniques have been established. Each site will obtain IRB approval of the final protocol. When the study is complete and the data has been analyzed, publication of relevent results will be done. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ALTERNATIVE VARIABLILITY

THERAPIES

FOR

BPH,

MULTIETHNIC

Principal Investigator & Institution: Kaplan, Steven A.; Professor of Urology, Vice Chair; Urology; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): Benign prostatic hyperplasia (BPH) is the most common affliction of men over the age of 50. There has been a rapid increase in the use of alternative therapies and specifically, phytotherapuetic agents, to treat BPH. Published studies have focused on the relative efficacy, i.e. symptoms, urinary flow rate and nocturia and side effect profile of these therapies. To date, there have been no studies which have described the natural history of BPH progression in those who are treated with phytotherapeutic agents such as Serenoa repens (Saw palmetto berry) or Pygeurn africanum (African plum tree). Moreover, the natural history of BPH in various age and ethnic groups have been poorly characterized. The Prostate Canter and the The

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Center for Holistic Urology at The New York Presbyterian Hospital evaluates and treats an ethnically diverse group of more than 3,200 men per year with lower urinary tract symptoms secondary to BPH. It is well positioned to meet the recruitment and patient retention goals as a CETC in this important multi - center, 7 year trial. This trial will provide enormous insight into the progression of BPH and related symptoms in both an untreated population, i.e. placebo versus one treated with phytotherapeutic agents. This is of particular importance because efficacy can be truly determined only with an understanding of the untreated natural history of BPH. Our primary objective is to ascertain if Serenoa repens or Pygeum africanum delays or prevents the clinical progression of BPH. Patients will be classified as 1) Progression of disease as defined by one of the following: rise in baseline AUA Symptom Score of 4 points; urinary retention; incontinence; or recurrent urinary tract infections; 2) Crossover to known therapy, i.e. medical or invasive prior to clinical progression; 3) non - compliance with the coded medication treatment regimen including patients who elect watchful waiting or open label phytotherapy. Secondary outcomes include comparative efficacy between Serenoa repens and Pygeum africanum as defined by symptoms and urodynamic measurements. Through this full scale BPH trial, we hope to ascertain: A) the effects, if any, of phytotherapeutic agents on the clinical progression of BPH, B) the optimal temporal intervention in the treatment of BPH, C) whether specific ethnic groups manifest various forms of BPH resulting in different rates of progression and differential response to therapy? and, D) whether concomitant prostate conditions such as prostatitis are effected by phytotherapeutic intervention for BPH? Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONIC PROSTATITIS COLLABORATIVE RESEARCH NETWORK Principal Investigator & Institution: Schaeffer, Anthony J.; Professor and Chairman; Urology; Northwestern University 633 Clark Street Evanston, Il 60208 Timing: Fiscal Year 2003; Project Start 05-SEP-2003; Project End 28-FEB-2008 Summary: (provided by applicant): This proposal is in response to an invitation for a cooperative agreement (contract) for one of ten clinical centers to collaboratively establish, perform, maintain and evaluate multiple therapeutic trials, either sequentially or concurrently for treatments of prostatitis through the collection and analysis of information and clinical samples from patients with the disorder. The long-term objective will be attained by: 1. Developing a protocol(s) and manual of operations through the joint efforts of the Steering Committee consisting of members of the clinical centers, data coordinating center, and the NIDDK project scientist. The investigator from the clinical centers in conjunction with the data coordinating center, will have responsibility in developing the protocol(s). 2. Recruiting and admitting patients into the study who have met agreed upon diagnostic entry criteria, have standard demographic information, symptoms related to prostatitis and who will provide clinical samples collected at established intervals will be enrolled. Northwestern's proposed clinical trial is to conduct a prospective multi-center randomized blinded placebo controlled trial of Saw palmetto (SP) or Pygeum africanum (PA) or placebo in patients with symptoms of chronic pelvic pain syndrome (CPPS). Because of the widespread use of these medications for the treatment of CPPS and lower urinary tract symptoms in men, and the neat total lack of well-performed studies on the efficacy and long-term effects, a placebo controlled trial is needed as defined using the CPCRN criterion. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Saw Palmetto

Project Title: CLINICAL EVALUATION & TREATMENT CENTER FOR BPH Principal Investigator & Institution: Andriole, Gerald L.; Surgery; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are one of the most common disorders of the aging U.S. male. Over the last decade significant advances have been made in characterizing this abnormality and treating it with medical therapy (such as alpha blockers and 5 alpha reductase inhibitors) and minimally invasive surgical techniques (such as stents, lasers, hyperthermia and others). Despite this, use of non-traditional medical therapies for LUTS has greatly increased in recent years. Most trials evaluating these agents are limited by small size, short study interval and absence of standardized testing instruments. For these reasons there is a need to evaluate non-traditional agents such as saw palmetto and pygeum Africanum in a large scale, randomized, placebo-controlled, long-term trial. In this application, we propose one such study, describe our clinical research environment, including patient population, facilities, personnel, experience with prior studies, and other methods to assure recruitment, protocol compliance, and retention for such a study. We describe our willingness to develop a final protocol and collaborate in performing it. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DATA COORDINATING CENTER FOR BENIGN PROSTATE SYMPTOMS Principal Investigator & Institution: Lee, Jeannette Y.; Research Professor; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): This proposal is for the Medical Statistics Section (MSS) at the University of Alabama at Birmingham to serve as the Data Coordinating Center (DCC) for the study of alternative therapies in benign prostate symptoms. It is anticipated that 10 Clinical Evaluation and Treatment Centers (CETCs) will enroll approximately 3100 men with benign prostatic hyperplasia (BPH) in a randomized, double-masked, placebo-controlled study of two phytotherapy agents, Serenoa repens (Saw palmetto) and Pygeum africanum in the treatment of BPH. Specific aims of the DCC are to: provide statistical expertise in study design and analyses; provide data management support for the study; develop and maintain a WEB-based system for data transmission and communication from the CETCs to the DCC; establish a Phytotherapy Distribution Center to distribute Saw palmetto, Pygeum africanum and placebo to the CETCs; and provide administrative support for meetings of the Steering and Planning Committee, Executive Committee, Data Safety and Monitoring Board and any subcommittees formed during the progress of the trial. The strengths of the MSS in serving as the DCC are: its well-established infrastructure (personnel, computing facilities, communications networks, and data management system) for providing support to clinical trials; its experience in serving as the coordinating center for NIHsupported multicenter clinical trials groups; and its participation in the UAB Chemoprevention Center. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFECTS OF SAW PALMETTO EXTRACT ON SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA Principal Investigator & Institution: Hess, David L.; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002 Summary: Saw palmetto extract (SPE) has seen wide use in Europe for self treatment of benign prostatic hyperplasia (BPH), although the mechanism of action on the human prostate is unknown and efficacy of treatment remains unproven. Suggested mechanisms include inhibition of androgen action and an anti-inflammatory effect. These possibilities were evaluated by study of prostate biopsy specimens obtained before and after treatment with SPE in men during a 6 month randomized clinical trial vs a placebo. Ultrasound-guided sextant biopsies were obtained from 41 men prior to and after 6 months of placebo (n=20) or SPE (n=20) treatment (320 mg/day). The 82 tissue samples were batch processed by routine histology; by morphometry for quantitative tissue composition of the inner and outer gland; by a histopathologic scoring system for acute and chronic inflammation and for atrophy; by immunohistochemical assessment of apoptosis, cell proliferation, and androgen receptor expression; an d by a tissue homogenate assay for androgen levels (expressed as ng/g of prostate tissue). A contraction in the transition zone epithelium from 17.8% before to 10.7% after 6 months of treatment was found in the SPE group (p < 0.01). In a parallel, independent analysis, the epithelial atrophy scores increased from 25.2% before to 40.9% after SPE (p < 0.01). In placebo patients, no significant changes were seen in any tissue measures. None of the other tissue studies revealed any significant changes from baseline during SPE treatment. SPE appears to exert a suppressant effect on the prostatic epithelium, especially the transition zone. Since no alterations in prostatic androgen metabolism or apoptosis markers could be demonstrated, the data suggest that the effect is mediated by a mechanism unrelated to changes in tissue hormone concentrations, receptor expression or to obvious anti-inflammatory effects. How epithelial suppression related to clinical effects, in the absence of pro state volume contraction, is not clear. However, our observation of significant epithelial involution following 6 months of SPE use should encourage further investigation. FUNDING Urological Sciences Research Foundation PUBLICATIONS None PUBLICATIONS None Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PHYTHOTHERAPY FOR THE TREATMENT OF BPH SYMPTOMS Principal Investigator & Institution: Foster, Harris E.; Associate Professor; Surgery; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): Benign prostatic hyperplasia (BPH) is the most common non-malignant neoplasm in the aging male. The number of men with lower urinary tract symptoms secondary to BPH, is expected to increase substantially as the population ages. Interest in using complementary and alternative medicines, such as phytotherapy, to prevent and manage health care needs has increased dramatically in recent years. The use of phytotherapy to relieve lower urinary tract symptoms, particularly BPH, has spurred interest in Serenoa repens (Saw palmetto) and Pygeum africanum. Both phytotherapeutic agents are used extensively in this country to relieve symptoms of BPH, but little is known about their mechanism of action, efficacy, safety, or the side effects. Although a number of randomized placebo-controlled trials have been published, all suffer from a variety of shortcomings. A long-term randomized

14

Saw Palmetto

placebo-controlled trial is needed to determine if Serenoa repens or Pygeum africanum prevents clinical progression of BPH. Secondary objectives should include a direct comparison of the two phytotherapeutic agents in their ability to improve the symptoms of BPH, the relationship between prostate size and clinical progression of BPH or regression of symptoms, and the ability of objective diagnostic studies to determine which patients are optimal candidates for phytotherapy. The primary goal of this application is to emphasize the ability of Yale University School of Medicine and Yale New Haven Hospital to successfully implement this protocol so that quality data is obtained to achieve the goals of a final protocol yet to be determined. The advantages of this site include: 1) investigators with recent experience in successfully implementing similar including National Institutes of Health (NIH)-sponsored] protocols; 2) an institution with the necessary infrastructure and experience in participating in large multi-center protocols; 3) the presence of the university in an ethnically and socioeconomically diverse community; and 4) peripheral sites in minority communities, that can facilitate inclusion of the historically underserved. The above characteristics and strategies make the Yale University School of Medicine and the Yale-New Haven Hospital an outstanding candidate for a Clinical Center. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHYTOTHERAPY OF PROSTATEIC SYMPTOMS (POPW) Principal Investigator & Institution: Crawford, E D.; Professor; Surgery; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): Lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) are common in the aging male There are few welldesigned, long term, multi-center, randomized clinical trials comparing the subjective and objective outcomes of physiotherapy of prostatic symptoms (POPS) AIM 1 To collaborate with a research consortium to design and conduct a multi-center randomized phase III clinical trial comparing saw palmetto, Pygeum africanum, or a placebo for treatment of symptomatic BPH AIM 2 To recruit and randomize 300 men (in two years) with symptomatic BPH who meet the protocol guidelines AIM 3 To design and implement a prospective randomized controlled trial for treatment of BPH that will determine which of the following predict successful treatment outcomes patient characteristics, AUA symptoms score, uroflow rate, and prostate size AIM 4 To design and implement recruitment interventions among racial and ethnic minority men and procedures for the maintenance of the long-term participation of study subjects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SAW PROGRESSION

PALMETTO

AND

PYGEUM

AFRICANUM

ON

BPH

Principal Investigator & Institution: Mcvary, Kevin T.; Associate Professor; Urology; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2009 Summary: (provided by applicant): The proposal is a response for a research project (cooperative agreement) by the NIH-NIDDK for consideration for one of 10 Clinical Evaluation and Treatment Centers (CETC) forming a consortium to develop and conduct a randomized placebo controlled trial to evaluate whether the use of Saw palmetto (SP) or Pygeum africanum (PA) can prevent the progression of BPH. Health Relatedness: BPH is the most common neoplastic condition afflicting men and

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constitutes a major factor impacting Americans. Current studies estimate 30% of American males will require a surgical procedure to correct this problem sometime in their life. Increasing attention has been paid to plant extracts (or phytotherapy) use by patients to self-treat medical ailments such as BPH. Until more appropriately conducted trials are undertaken, the efficacy of phytotherapeutic agents will remain unproven. This study will be crucial to answering that question as well as others pertaining to the progression of BPH. Specific Aims: The primary aim of this study is to address whether SP or PA alter BPH progression or simply delay the time to surgical therapy. The data accumulated should provide evidence regarding long term effects of these therapies on objective parameters of BPH including the AUA symptom score, maximal urinary flow rates, or prostate size and how these medications compare in their impact on the same. Design and Method: In three treatment arms 1000 patients with symptoms of BPH will be assigned to either SP, PA or placebo and followed for 4-6 years. Progression parameters will include: 1) changes in the AUA symptom score, 2) urinary retention, 3) recurrent UTI, 4) renal insufficiency, 5) urinary incontinence or 6) crossover to known therapy. Objective parameters of BPH will include prostate size, maximal urinary flow rates, and AUA symptom score. Secondary Aim: Unique to this submission is whether a chief complaint analysis, sleep scale measures or direct/indirect healthcare costs analysis provides reliable or useful information. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SAW PALMETTO EXTRACT IN BENIGN PROSTATIC HYPERPLASIA Principal Investigator & Institution: Avins, Andrew L.; Assistant Clinical Professor; Northern California Institute Res & Educ 4150 Clement Street (151-Nc) San Francisco, Ca 941211545 Timing: Fiscal Year 2001; Project Start 23-AUG-1999; Project End 31-AUG-2004 Summary: This proposal describes a double-blind, placebo-controlled randomized clinical trial of the effect of saw palmetto extract on symptoms, objective parameters of disease severity, and quality of life in men with moderate-to-severe benign prostatic hyperplasia. BPH, one of the most common morbid medical conditions in middle-aged and elderly men, is generally treated with alpha-adrenergic blocking agents, finasteride, surgical interventions, or no specific therapy ("watchful waiting"). In the past several years, however, many patients have begun to self-medicate with an extract of the saw palmetto plant (Serenoa repens), a medicinal herb grown in the southeastern United States. Saw palmetto has become the fifth leading medicinal herb consumed in the U.S. and is considered first-line therapy for BPH in several Western European countries. Several small studies suggest that saw palmetto may have clinical benefit, but the methodologic quality of most prior studies has been poor. Very few side effects of the herb have been observed, but few studies have been conducted for more than three months. We propose to conduct a high-quality clinical trial of saw palmetto, with careful attention to the methodologic deficiencies of prior studies. After a single-blind placebo run-in period, 224 patients with mode moderate-to-severe BPH (American Urological Association Symptom Index score greater than or equal to 8) and objective measurement of urinary obstruction, will be randomized to receive either 160mg BID of the herbal extract or an identical placebo. Patients will discontinue any other medical therapy for BPH prior to enrollment and all participants will undergo a trans-rectal ultrasound examination at baseline and closeout. Participants in the trial will be seen at 3-month intervals for a total one-year follow-up. Outcome measurements include changes in the AUASI score (the primary outcome measurement), the peak urinary flow rate, the post-void residual urine volume, the BPH Impact Index, the Olmstead County

16

Saw Palmetto

Study Questionnaire of BPH-specific symptoms and quality of life, and the Short-Form 36 (a generic health status instrument). Numerous laboratory parameters will measured at intervals throughout the trial and symptomatic side effects will be assessed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SAW PALMETTO USE AND RISK OF PROSTATE CANCER Principal Investigator & Institution: Lee, I-Min; Assistant Professor of Medicine; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 18-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Apart from non-melanoma skin cancer, prostate cancer is the most commonly diagnosed cancer among men in the United States today. In spite of its importance, few modifiable predictors of this disease have been established. Well-established risk factors for prostate cancer (e.g., age) are not amenable to modification and, hence, have limited utility as targets of primary prevention strategies. There is a need to identify other risk factors that can be controlled. 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone, has been proposed to play a key role in the etiology of prostate cancer; thus, the NCI is currently testing finasteride, a 5-alpha reductase inhibitor, in the prevention of prostate cancer in an ongoing, randomized clinical trial. No information is available on other agents capable of inhibiting 5-alpha reductase and prostate cancer risk in men. Saw palmetto, derived from the berry of the American palm tree, can inhibit 5-alpha reductase activity. Saw palmetto has been shown to be as effective as finasteride in the treatment of urinary symptoms from benign prostatic hyperplasia. No data are available regarding its association with prostate cancer incidence in men; however, in vitro studies show inhibition of growth of prostate cancer cell lines. Therefore, we propose to conduct a retrospective cohort study among 16,700 physicians (mean age 67 years) to test the hypothesis that saw palmetto use reduces the risk of developing prostate cancer. These men currently are being followed as part of two other funded studies, the Physicians' Health Study I and II. Information on the development of prostate cancer is being collected in these two studies, as is a whole host of other information on health habits and medical history. In this application, we propose to retrospectively collect details on the use of saw palmetto (when started and stopped, dose, brand) by adding questions to the scheduled 72-month follow-up questionnaire in these two other studies. During the proposed period of study, we anticipate that 790 cases of prostate cancer will develop. Power calculations show adequate power to detect a 45% reduction in risk of prostate cancer associated with saw palmetto use. At little additional cost, the data from this study will contribute to the knowledge infrastructure regarding whether large scale, informative trials on saw palmetto use and prostate cancer risk should be supported in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 3

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text

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The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with saw palmetto, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “saw palmetto” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for saw palmetto (hyperlinks lead to article summaries): •

A double-blind trial of an extract of the plant Serenoa repens in benign prostatic hyperplasia. Author(s): Champault G, Patel JC, Bonnard AM. Source: British Journal of Clinical Pharmacology. 1984 September; 18(3): 461-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6207850&dopt=Abstract

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A scientific basis for the therapeutic effects of Pygeum africanum and Serenoa repens. Author(s): Levin RM, Das AK. Source: Urological Research. 2000 June; 28(3): 201-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10929430&dopt=Abstract

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Biologically active acylglycerides from the berries of saw-palmetto (Serenoa repens). Author(s): Shimada H, Tyler VE, McLaughlin JL. Source: Journal of Natural Products. 1997 April; 60(4): 417-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9134750&dopt=Abstract

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Comparative effects of alfuzosin versus Serenoa repens in the treatment of symptomatic benign prostatic hyperplasia. Author(s): Grasso M, Montesano A, Buonaguidi A, Castelli M, Lania C, Rigatti P, Rocco F, Cesana BM, Borghi C. Source: Arch Esp Urol. 1995 January-February; 48(1): 97-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7537488&dopt=Abstract

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Comparison of finasteride (Proscar) and Serenoa repens (Permixon) in the inhibition of 5-alpha reductase in healthy male volunteers. Author(s): Strauch G, Perles P, Vergult G, Gabriel M, Gibelin B, Cummings S, Malbecq W, Malice MP. Source: European Urology. 1994; 26(3): 247-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7805711&dopt=Abstract

journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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Effect of the lipidic lipidosterolic extract of Serenoa repens (Permixon) on the ionophore A23187-stimulated production of leukotriene B4 (LTB4) from human polymorphonuclear neutrophils. Author(s): Paubert-Braquet M, Mencia Huerta JM, Cousse H, Braquet P. Source: Prostaglandins, Leukotrienes, and Essential Fatty Acids. 1997 September; 57(3): 299-304. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9384520&dopt=Abstract

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Effect of the lipidosterolic extract of Serenoa repens (Permixon) and its major components on basic fibroblast growth factor-induced proliferation of cultures of human prostate biopsies. Author(s): Paubert-Braquet M, Cousse H, Raynaud JP, Mencia-Huerta JM, Braquet P. Source: European Urology. 1998; 33(3): 340-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9555564&dopt=Abstract

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Effects of long-term treatment with Serenoa repens (Permixon) on the concentrations and regional distribution of androgens and epidermal growth factor in benign prostatic hyperplasia. Author(s): Di Silverio F, Monti S, Sciarra A, Varasano PA, Martini C, Lanzara S, D'Eramo G, Di Nicola S, Toscano V. Source: The Prostate. 1998 October 1; 37(2): 77-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9759701&dopt=Abstract

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Effects of the lipidosterolic extract of Serenoa repens (Permixon) on human prostatic cell lines. Author(s): Ravenna L, Di Silverio F, Russo MA, Salvatori L, Morgante E, Morrone S, Cardillo MR, Russo A, Frati L, Gulino A, Petrangeli E. Source: The Prostate. 1996 October; 29(4): 219-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8876705&dopt=Abstract

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Effects of the sabal serrulata extract IDS 89 and its subfractions on 5 alpha-reductase activity in human benign prostatic hyperplasia. Author(s): Weisser H, Tunn S, Behnke B, Krieg M. Source: The Prostate. 1996 May; 28(5): 300-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8610056&dopt=Abstract

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Efficacy and tolerability of the lipidosterolic extract of Serenoa repens (Permixon) in benign prostatic hyperplasia: a double-blind comparison of two dosage regimens. Author(s): Stepanov VN, Siniakova LA, Sarrazin B, Raynaud JP. Source: Adv Ther. 1999 September-October; 16(5): 231-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10915398&dopt=Abstract

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Enzyme activities in tissue of human benign prostatic hyperplasia after three months' treatment with the Sabal serrulata extract IDS 89 (Strogen) or placebo. Author(s): Weisser H, Behnke B, Helpap B, Bach D, Krieg M. Source: European Urology. 1997; 31(1): 97-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9032543&dopt=Abstract

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Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Author(s): Di Silverio F, D'Eramo G, Lubrano C, Flammia GP, Sciarra A, Palma E, Caponera M, Sciarra F. Source: European Urology. 1992; 21(4): 309-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1281103&dopt=Abstract

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Experience in treating benign prostatic hypertrophy with Sabal serrulata for one year. Author(s): Romics I, Schmitz H, Frang D. Source: International Urology and Nephrology. 1993; 25(6): 565-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7513678&dopt=Abstract

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Extract from Serenoa repens suppresses the invasion activity of human urological cancer cells by inhibiting urokinase-type plasminogen activator. Author(s): Ishii K, Usui S, Sugimura Y, Yamamoto H, Yoshikawa K, Hiran K. Source: Biological & Pharmaceutical Bulletin. 2001 February; 24(2): 188-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11217090&dopt=Abstract

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Induction of apoptosis and inhibition of cell proliferation by the lipido-sterolic extract of Serenoa repens (LSESr, Permixon in benign prostatic hyperplasia. Author(s): Vacherot F, Azzouz M, Gil-Diez-De-Medina S, Colombel M, De La Taille A, Lefrere Belda MA, Abbou CC, Raynaud JP, Chopin DK. Source: The Prostate. 2000 November 1; 45(3): 259-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11074529&dopt=Abstract

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Inhibition of androgen metabolism and binding by a liposterolic extract of “Serenoa repens B” in human foreskin fibroblasts. Author(s): Sultan C, Terraza A, Devillier C, Carilla E, Briley M, Loire C, Descomps B. Source: J Steroid Biochem. 1984 January; 20(1): 515-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6708534&dopt=Abstract

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Lack of effects of a lyposterolic extract of Serenoa repens on plasma levels of testosterone, follicle-stimulating hormone, and luteinizing hormone. Author(s): Casarosa C, Cosci di Coscio M, Fratta M. Source: Clinical Therapeutics. 1988; 10(5): 585-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2485240&dopt=Abstract

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Saw Palmetto

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Long-term clinical and biologic effects of the lipidosterolic extract of Serenoa repens in patients with symptomatic benign prostatic hyperplasia. Author(s): Pytel YA, Vinarov A, Lopatkin N, Sivkov A, Gorilovsky L, Raynaud JP. Source: Adv Ther. 2002 November-December; 19(6): 297-306. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12665050&dopt=Abstract

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Myristoleic acid, a cytotoxic component in the extract from Serenoa repens, induces apoptosis and necrosis in human prostatic LNCaP cells. Author(s): Iguchi K, Okumura N, Usui S, Sajiki H, Hirota K, Hirano K. Source: The Prostate. 2001 April; 47(1): 59-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11304730&dopt=Abstract

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Sabal serrulata extract (Strogen forte) in the treatment of symptomatic benign prostatic hyperplasia. Author(s): Kondas J, Philipp V, Dioszeghy G. Source: International Urology and Nephrology. 1996; 28(6): 767-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9089044&dopt=Abstract

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Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia. Author(s): Plosker GL, Brogden RN. Source: Drugs & Aging. 1996 November; 9(5): 379-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8922564&dopt=Abstract

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Serenoa repens (Permixon): a 5alpha-reductase types I and II inhibitor-new evidence in a coculture model of BPH. Author(s): Bayne CW, Donnelly F, Ross M, Habib FK. Source: The Prostate. 1999 September 1; 40(4): 232-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10420151&dopt=Abstract

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Serenoa repens extract for benign prostate hyperplasia: a randomized controlled trial. Author(s): Willetts KE, Clements MS, Champion S, Ehsman S, Eden JA. Source: Bju International. 2003 August; 92(3): 267-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887481&dopt=Abstract

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Serenoa repens for benign prostatic hyperplasia. Author(s): Wilt T, Ishani A, Mac Donald R. Source: Cochrane Database Syst Rev. 2002; (3): Cd001423. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12137626&dopt=Abstract

Studies

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Serenoa repens for benign prostatic hyperplasia. Author(s): Wilt T, Ishani A, Stark G, MacDonald R, Mulrow C, Lau J. Source: Cochrane Database Syst Rev. 2000; (2): Cd001423. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796790&dopt=Abstract

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The lipidosterolic extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a comparison of two dosage regimens. Author(s): Giannakopoulos X, Baltogiannis D, Giannakis D, Tasos A, Sofikitis N, Charalabopoulos K, Evangelou A. Source: Adv Ther. 2002 November-December; 19(6): 285-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12665049&dopt=Abstract

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The selectivity and specificity of the actions of the lipido-sterolic extract of Serenoa repens (Permixon) on the prostate. Author(s): Bayne CW, Ross M, Donnelly F, Habib FK. Source: The Journal of Urology. 2000 September; 164(3 Pt 1): 876-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10953171&dopt=Abstract

23

CHAPTER 2. NUTRITION AND SAW PALMETTO Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and saw palmetto.

Finding Nutrition Studies on Saw Palmetto The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “saw palmetto” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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Saw Palmetto

The following information is typical of that found when using the “Full IBIDS Database” to search for “saw palmetto” (or a synonym): •

Uses of saw palmetto (Serenoa repens, Arecaceae) in Florida. Author(s): Florida International University, Miami, FL. Source: Bennett, B.C. Hicklin, J.R. Economic-botany (USA). (Oct-December 1998). volume 52(4) page 381-393.

Additional physician-oriented references include: •

Benign prostatic hyperplasia treated with saw palmetto: a literature search and an experimental case study. Author(s): Department of Family Practice, University of Vermont, USA. [email protected] Source: McPartland, J M Pruitt, P L J-Am-Osteopath-Assoc. 2000 February; 100(2): 89-96 0098-6151

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ConsumerLab.com tests ginkgo and saw palmetto products. Source: Blumenthal, M. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. 2000. (48) page 66. 0899-5648

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Determination of the fatty acid content of pumpkin seed, pygeum, and saw palmetto. Source: Ganzera, M. Croom, E.M. Jr. Khan, I.A. J-med-food. Larchmont, NY : Mary Ann Liebert, Inc., c1998-. 1999. volume 2 (1) page 21-27. 1096-620X

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Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. Author(s): Department of Urology, University of California Los Angeles School of Medicine, Los Angeles, CA, USA. Source: Marks, L S Partin, A W Epstein, J I Tyler, V E Simon, I Macairan, M L Chan, T L Dorey, F J Garris, J B Veltri, R W Santos, P B Stonebrook, K A deKernion, J B J-Urol. 2000 May; 163(5): 1451-6 0022-5347

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Extracts from fruits of saw palmetto (Sabal serrulata) and roots of stinging nettle (Urtica dioica): viable alternatives in the medical treatment of benign prostatic hyperplasia and associated lower urinary tracts symptoms. Source: Koch, E. Planta-med. Stuttgart : Georg Thieme Verlag,. August 2001. volume 67 (6) page 489-500. 0032-0943

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Herbal supplements. Is saw palmetto good for the prostate? Source: Anonymous Harv-Health-Lett. 1998 May; 23(7): 6 1052-1577

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Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature. Author(s): University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. [email protected] Source: Cheema, P El Mefty, O Jazieh, A R J-Intern-Med. 2001 August; 250(2): 167-9 0954-6820

Nutrition

25

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On call. Last week I received a mailing from a Canadian company that did not support American drugs like Hytrin and Proscar in dealing with enlarged prostates. There were about 30 testimonials in favor of its product. The company says that zinc is an essential ingredient to shrink the prostate. It further states the need for pyridoxine and certain amino acids, Serenoa, repens (saw palmetto), serrulata, Panax extract, and hydrangea extract. Comments from various European magazines are also cited. Source: Simon, H B Harv-Mens-Health-Watch. 2000 April; 4(9): 8 1089-1102

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Phase II study on saw palmetto for BPH. Source: Johnston, B.A. HerbalGram (USA). (Spr 1998). (no. 42) page 11. usa palmae medicinal properties prostate hyperplasia research projects 0899-5648

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Premature fruit drop in saw palmettos caused by Colletotrichum gloeosporioides. Source: Carrington, M.E. Roberts, P.D. Urs, N.V.R.R. McGovern, R.J. Seijo, T.E. Mullahey, J.J. Plant-dis. [St. Paul, Minn., American Phytopathological Society]. February 2001. volume 85 (2) page 122-125. 0191-2917

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Randomized trial of a combination of natural products (cernitin, saw palmetto, Bsitosterol, vitamin E) on symptoms of benign prostatic hyperplasia (BPH). Author(s): Department of Physiology and Biophysics, Georgetown University Medical Center, Washington, DC 20007, USA. [email protected] Source: Preuss, H G Marcusen, C Regan, J Klimberg, I W Welebir, T A Jones, W A IntUrol-Nephrol. 2001; 33(2): 217-25 0301-1623

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Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Author(s): Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA Source: Gerber, G S Kuznetsov, D Johnson, B C Burstein, J D Urology. 2001 December; 58(6): 960-4; discussion 964-5 1527-9995

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Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms. Author(s): Department of Surgery, University of Chicago Pritzker School of Medicine, Illinois, USA. Source: Gerber, G S Zagaja, G P Bales, G T Chodak, G W Contreras, B A Urology. 1998 June; 51(6): 1003-7 0090-4295

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Saw palmetto alters nuclear measurements reflecting DNA content in men with symptomatic BPH: evidence for a possible molecular mechanism. Author(s): Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. Source: Veltri, R W Marks, L S Miller, M C Bales, W D Fan, J Macairan, M L Epstein, J I Partin, A W Urology. 2002 October; 60(4): 617-22 1527-9995

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Saw palmetto berry extract inhibits cell growth and Cox-2 expression in prostatic cancer cells. Author(s): Boston BioProducts Inc., Ashland, MA 01721, USA. Source: Goldmann W, H Sharma A, L Currier S, J Johnston P, D Rana, A Sharma C, P Cell-Biol-Int. 2001; 25(11): 1117-24 1065-6995

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Saw palmetto extracts for benign prostatic hyperplasia. Author(s): University of Health Sciences, College of Osteopathic Medicine, Kansas City, Missouri, USA. [email protected] Source: Segars, L W J-Fam-Pract. 1999 February; 48(2): 88-9 0094-3509

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Saw Palmetto

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Saw palmetto for benign prostatic hyperplasia. Source: Anonymous Med-Lett-Drugs-Ther. 1999 February 12; 41(1046): 18 0025-732X

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Saw palmetto for BPH symptoms. Source: Knaus, J Adv-Nurse-Pract. 2002 June; 10(6): 26-7 1096-6293

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Saw palmetto for the treatment of men with lower urinary tract symptoms. Author(s): Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA. Source: Gerber, G S J-Urol. 2000 May; 163(5): 1408-12 0022-5347

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Saw palmetto gets strong public boost: USP publishes monograph and Consumer Reports gives thumbs up, recognizing benefits for BPH. Source: Blumenthal, M. HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. 2000. (50) page 32-37. 0899-5648

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Saw palmetto, nettles, and pygeum for male pattern baldness. Source: HerbalGram. Austin, TX : American Botanical Council and the Herb Research Foundation. 2000. (49) page 31. 0899-5648

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Saw Palmetto: a fountain of youth. Source: Carrington, M.E. Mullahey, J.J. Roka, F. Proc-Am-Forage-Grassl-Counc-1992. Georgetown, Tex. : American Forage and Grassland Council. 1997. volume 6 page 233237.

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Sensitization to saw palmetto and minoxidil in separate topical extemporaneous treatments for androgenetic alopecia. Author(s): Skin and Cancer Foundation, Melbourne, Victoria, Australia. [email protected] Source: Sinclair, R D Mallari, R S Tate, B Australas-J-Dermatol. 2002 November; 43(4): 311-2 0004-8380

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Somatic embryogenesis and plant regeneration from immature embryos of saw palmetto, an important landscape and medicinal plant. Source: Gallo Meagher, M. Green, J. Plant-cell,-tissue-organ-cult. Dordrecht, The Netherlands : Kluwer Academic Publishers. March 2002. volume 68 (3) page 253-256. 0167-6857

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That pesky prostate and the saw palmetto. Source: Powers, J E S-D-J-Med. 1997 December; 50(12): 453-4 0038-3317

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The clinical applications of Ginkgo biloba, St. John's wort, saw palmetto, and soy. Author(s): University of Mississippi Medical Center, Jackson, USA. Source: Glisson, J Crawford, R Street, S Nurse-Pract. 1999 June; 24(6): 28, 31, 35-6 passim; quiz 47-9 0361-1817

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The Risk-Benefit Profile of Commonly Used Herbal Therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Source: Ernst, Edzard Ann-Intern-Med. 2002 January 1; 136(1): 42-53 0003-4819

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Tissue effects of saw palmetto and finasteride: use of biopsy cores for in situ quantification of prostatic androgens. Author(s): Urological Sciences Research Foundation, Culver City, California, USA. Source: Marks, L S Hess, D L Dorey, F J Luz Macairan, M Cruz Santos, P B Tyler, V E Urology. 2001 May; 57(5): 999-1005 1527-9995

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What is saw palmetto used for, and does it interact with any medications? Author(s): University of Chicago School of Medicine, IL, USA. Source: Gerber, G Health-News. 2000 June; 6(6): 10 1081-5880

Nutrition

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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Saw Palmetto

The following is a specific Web list relating to saw palmetto; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Food and Diet Pumpkin Seeds Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. PALMETTO

ALTERNATIVE

MEDICINE

AND

SAW

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to saw palmetto. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “saw palmetto” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

Herbal Medicine Boom: Understanding What Patients Are Taking Source: Cleveland Clinic Journal of Medicine. 65(3): 129-134. March 1998. Summary: This journal article is designed to help physicians guide their patients in the use of herbal medicines. The first section outlines the reasons why people take herbal medicines, including a fear or distrust of physicians, the belief that natural is better, disappointment with allopathic care, and cultural influences. The second section lists some of the most commonly used herbal medications, their reputed effects, and what is known about possible side effects and drug interactions. The herbal medicines are ginseng, garlic, ginkgo, echinacea, ma huang, saw palmetto, St. John's wort, valerian, and yohimbe. The final section explains why herbal medicine should be regulated; and proposes that manufacturers should be required to ensure the standardization, purity,

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Saw Palmetto

and consistency of their products. The article includes a list of practical suggestions to offer patients about the use of herbal medicines, and 30 references. •

Herbal Medicines: Poison or Potions? Source: Journal of Laboratory and Clinical Medicine. 139(6): 343-8. June 2002. Summary: This journal article provides a wide variety of information on herbal medicines, including the reasons for their use, safety issues, beneficial effects, adverse effects, and the role that physicians can play in helping patients make informed treatment decisions. The article gives examples of adverse effects from specific herbs, including: Herbal Ecstasy and Parkinson's syndrome; Chinese medications with undeclared prescription drugs; Indian herbal medications with lead contamination; valerian withdrawal syndrome; adverse reactions of St. John's wort; mu tong and nephropathy; saw palmetto and liver disease; dong quai and hypertension; and kombucha mushroom and coagulation disorders. 1 table. 38 references. 6 pages.

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Review of 12 Commonly Used Medical Herbs Source: Archives of Family Medicine. 7(6): 523-536. November-December 1998. Summary: This journal article reviews the literature on 12 of the most commonly used and best-studied medicinal herbs in the United States: chamomile, echinacea, feverfew, garlic, ginger, ginkgo, ginseng, goldenseal, milk thistle, St. John's wort, saw palmetto, and valerian. For each herb, it lists the common and scientific names, common and investigational uses, and side effects; and then reviews existing data on the herb's history, safety, and efficacy. The article also summarizes general information about herbal therapies, including a brief history of the regulation of medicinal herbs, important similarities and differences between medications approved by the Food and Drug Administration and herbal therapies, and the nature of available data about medicinal herbs. Finally, it provides a list of introductory resources on the topic of medicinal herbs, guidelines for patients, and a selected list of potentially toxic herbs. The article has 6 tables and 112 references.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to saw palmetto and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “saw palmetto” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to saw palmetto: •

“Bust enhancing” herbal products. Author(s): Fugh-Berman A. Source: Obstetrics and Gynecology. 2003 June; 101(6): 1345-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798545&dopt=Abstract

Alternative Medicine 31

•

A note on the effects of feeding saw palmetto berries, Serenoa repens (Bartram) Small, to rats. Author(s): FEURT SD, FOX LE. Source: J Am Pharm Assoc Am Pharm Assoc (Baltim). 1954 October; 43(10): 636-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13211410&dopt=Abstract

•

A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. Author(s): Kaplan SA, Volpe MA, Te AE. Source: The Journal of Urology. 2004 January; 171(1): 284-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14665895&dopt=Abstract

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A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. Author(s): Prager N, Bickett K, French N, Marcovici G. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 2002 April; 8(2): 143-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12006122&dopt=Abstract

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An alternative medicine study of herbal effects on the penetration of zona-free hamster oocytes and the integrity of sperm deoxyribonucleic acid. Author(s): Ondrizek RR, Chan PJ, Patton WC, King A. Source: Fertility and Sterility. 1999 March; 71(3): 517-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10065791&dopt=Abstract

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Analytical accuracy and reliability of commonly used nutritional supplements in prostate disease. Author(s): Feifer AH, Fleshner NE, Klotz L. Source: The Journal of Urology. 2002 July; 168(1): 150-4; Discussion 154. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12050511&dopt=Abstract

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Benign prostatic hyperplasia treated with saw palmetto: a literature search and an experimental case study. Author(s): McPartland JM, Pruitt PL. Source: J Am Osteopath Assoc. 2000 February; 100(2): 89-96. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10732392&dopt=Abstract

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Biologically active acylglycerides from the berries of saw-palmetto (Serenoa repens). Author(s): Shimada H, Tyler VE, McLaughlin JL.

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Source: Journal of Natural Products. 1997 April; 60(4): 417-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9134750&dopt=Abstract •

Botanical derivatives for the prostate. Author(s): Cristoni A, Di Pierro F, Bombardelli E. Source: Fitoterapia. 2000 August; 71 Suppl 1: S21-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10930709&dopt=Abstract

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By the way, doctor. I'm 77 and have an enlarged prostate. I take Proscar once a day and saw palmetto three times a day. Yet I still have to get up two to seven times a night to urinate. What can I do to reduce the frequency of urination? Author(s): O'Leary MP. Source: Harvard Health Letter / from Harvard Medical School. 2003 April; 28(6): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777237&dopt=Abstract

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Comparison of Saw Palmetto (extract and whole berry) and Cernitin on prostate growth in rats. Author(s): Talpur N, Echard B, Bagchi D, Bagchi M, Preuss HG. Source: Molecular and Cellular Biochemistry. 2003 August; 250(1-2): 21-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962139&dopt=Abstract

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Do saw palmetto extracts block human alpha1-adrenoceptor subtypes in vivo? Author(s): Goepel M, Dinh L, Mitchell A, Schafers RF, Rubben H, Michel MC. Source: The Prostate. 2001 February 15; 46(3): 226-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11170151&dopt=Abstract

•

Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. Author(s): Marks LS, Partin AW, Epstein JI, Tyler VE, Simon I, Macairan ML, Chan TL, Dorey FJ, Garris JB, Veltri RW, Santos PB, Stonebrook KA, deKernion JB. Source: The Journal of Urology. 2000 May; 163(5): 1451-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10751856&dopt=Abstract

•

Extracts from fruits of saw palmetto (Sabal serrulata) and roots of stinging nettle (Urtica dioica): viable alternatives in the medical treatment of benign prostatic hyperplasia and associated lower urinary tracts symptoms. Author(s): Koch E. Source: Planta Medica. 2001 August; 67(6): 489-500. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11509966&dopt=Abstract

•

Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature. Author(s): Cheema P, El-Mefty O, Jazieh AR.

Alternative Medicine 33

Source: Journal of Internal Medicine. 2001 August; 250(2): 167-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11489067&dopt=Abstract •

Long-term clinical and biologic effects of the lipidosterolic extract of Serenoa repens in patients with symptomatic benign prostatic hyperplasia. Author(s): Pytel YA, Vinarov A, Lopatkin N, Sivkov A, Gorilovsky L, Raynaud JP. Source: Adv Ther. 2002 November-December; 19(6): 297-306. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12665050&dopt=Abstract

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Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers. Author(s): Markowitz JS, Donovan JL, Devane CL, Taylor RM, Ruan Y, Wang JS, Chavin KD. Source: Clinical Pharmacology and Therapeutics. 2003 December; 74(6): 536-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14663456&dopt=Abstract

•

On call. Last week I received a mailing from a Canadian company that did not support American drugs like Hytrin and Proscar in dealing with enlarged prostates. There were about 30 testimonials in favor of its product. The company says that zinc is an essential ingredient to shrink the prostate. It further states the need for pyridoxine and certain amino acids, Serenoa, repens (saw palmetto), serrulata, Panax extract, and hydrangea extract. Comments from various European magazines are also cited. Author(s): Simon HB. Source: Harvard Men's Health Watch. 2000 April; 4(9): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10712767&dopt=Abstract

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Randomized trial of a combination of natural products (cernitin, saw palmetto, Bsitosterol, vitamin E) on symptoms of benign prostatic hyperplasia (BPH). Author(s): Preuss HG, Marcusen C, Regan J, Klimberg IW, Welebir TA, Jones WA. Source: International Urology and Nephrology. 2001; 33(2): 217-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12092634&dopt=Abstract

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Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Author(s): Gerber GS, Kuznetsov D, Johnson BC, Burstein JD. Source: Urology. 2001 December; 58(6): 960-4; Discussion 964-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11744467&dopt=Abstract

•

Review: St. John's wort, ginkgo, saw palmetto, and kava may be effective for some conditions. Author(s): Baime MJ.

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Source: Acp Journal Club. 2002 July-August; 137(1): 25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12093224&dopt=Abstract •

Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms. Author(s): Gerber GS, Zagaja GP, Bales GT, Chodak GW, Contreras BA. Source: Urology. 1998 June; 51(6): 1003-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9609640&dopt=Abstract

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Saw palmetto alters nuclear measurements reflecting DNA content in men with symptomatic BPH: evidence for a possible molecular mechanism. Author(s): Kaplan SA. Source: The Journal of Urology. 2003 July; 170(1): 340-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14567348&dopt=Abstract

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Saw palmetto alters nuclear measurements reflecting DNA content in men with symptomatic BPH: evidence for a possible molecular mechanism. Author(s): Veltri RW, Marks LS, Miller MC, Bales WD, Fan J, Macairan ML, Epstein JI, Partin AW. Source: Urology. 2002 October; 60(4): 617-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12385921&dopt=Abstract

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Saw palmetto berry extract inhibits cell growth and Cox-2 expression in prostatic cancer cells. Author(s): Goldmann WH, Sharma AL, Currier SJ, Johnston PD, Rana A, Sharma CP. Source: Cell Biology International. 2001; 25(11): 1117-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11913955&dopt=Abstract

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Saw palmetto extract: newest (and oldest) treatment alternative for men with symptomatic benign prostatic hyperplasia. Author(s): Marks LS, Tyler VE. Source: Urology. 1999 March; 53(3): 457-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10096366&dopt=Abstract

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Saw palmetto extracts for benign prostatic hyperplasia. Author(s): Segars LW. Source: The Journal of Family Practice. 1999 February; 48(2): 88-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10037530&dopt=Abstract

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Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. Author(s): Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C.

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Source: Jama : the Journal of the American Medical Association. 1998 November 11; 280(18): 1604-9. Erratum In: Jama 1999 February 10; 281(6): 515. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9820264&dopt=Abstract •

Saw palmetto extracts potently and noncompetitively inhibit human alpha1adrenoceptors in vitro. Author(s): Goepel M, Hecker U, Krege S, Rubben H, Michel MC. Source: The Prostate. 1999 February 15; 38(3): 208-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10068345&dopt=Abstract

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Saw palmetto for benign prostatic hyperplasia. Author(s): McKinney DE. Source: Jama : the Journal of the American Medical Association. 1999 May 12; 281(18): 1699. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10328068&dopt=Abstract

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Saw palmetto for BPH symptoms. Author(s): Knaus J. Source: Adv Nurse Pract. 2002 June; 10(6): 26-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12400357&dopt=Abstract

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Saw palmetto for BPH: a review of a meta-analysis. Author(s): Onega T. Source: Jaapa. 2002 May; 15(5): 59-60, 63-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12063819&dopt=Abstract

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Saw palmetto for prostate disorders. Author(s): Gordon AE, Shaughnessy AF. Source: American Family Physician. 2003 March 15; 67(6): 1281-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12674456&dopt=Abstract

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Saw palmetto for the treatment of men with lower urinary tract symptoms. Author(s): Gerber GS. Source: The Journal of Urology. 2000 May; 163(5): 1408-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10751846&dopt=Abstract

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Sensitization to saw palmetto and minoxidil in separate topical extemporaneous treatments for androgenetic alopecia. Author(s): Sinclair RD, Mallari RS, Tate B. Source: The Australasian Journal of Dermatology. 2002 November; 43(4): 311-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12423443&dopt=Abstract

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Serenoa repens for benign prostatic hyperplasia. Author(s): Wilt T, Ishani A, Mac Donald R. Source: Cochrane Database Syst Rev. 2002; (3): Cd001423. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12137626&dopt=Abstract

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That pesky prostate and the saw palmetto. Author(s): Powers JE. Source: S D J Med. 1997 December; 50(12): 453-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9433101&dopt=Abstract

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The clinical applications of Ginkgo biloba, St. John's wort, saw palmetto, and soy. Author(s): Glisson J, Crawford R, Street S. Source: The Nurse Practitioner. 1999 June; 24(6): 28, 31, 35-6 Passim; Quiz 47-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10431295&dopt=Abstract

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The Lipidosterolic Extract fromSerenoa repens Interferes with Prolactin Receptor Signal Transduction. Author(s): Vacher P, Prevarskaya N, Skryma R, Audy MC, Vacher AM, Odessa MF, Dufy B. Source: Journal of Biomedical Science. 1995 October; 2(4): 357-365. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11725073&dopt=Abstract

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The lipidosterolic extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a comparison of two dosage regimens. Author(s): Giannakopoulos X, Baltogiannis D, Giannakis D, Tasos A, Sofikitis N, Charalabopoulos K, Evangelou A. Source: Adv Ther. 2002 November-December; 19(6): 285-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12665049&dopt=Abstract

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The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Author(s): Ernst E. Source: Annals of Internal Medicine. 2002 January 1; 136(1): 42-53. Review. Erratum In: Ann Intern Med 2003 Jan 7; 138(1): 79. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11777363&dopt=Abstract

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Tissue effects of saw palmetto and finasteride: use of biopsy cores for in situ quantification of prostatic androgens. Author(s): Marks LS, Hess DL, Dorey FJ, Luz Macairan M, Cruz Santos PB, Tyler VE. Source: Urology. 2001 May; 57(5): 999-1005. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11337315&dopt=Abstract

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What is saw palmetto used for, and does it interact with any medications? Author(s): Gerber G. Source: Health News. 2000 June; 6(6): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10917733&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMD®Health: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to saw palmetto; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Alopecia Source: Integrative Medicine Communications; www.drkoop.com Benign Prostatic Hyperplasia Source: Healthnotes, Inc.; www.healthnotes.com Benign Prostatic Hyperplasia Source: Integrative Medicine Communications; www.drkoop.com

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Benign Prostatic Hyperplasia Alternative names: Prostate Enlargement Source: Prima Communications, Inc.www.personalhealthzone.com BPH Source: Integrative Medicine Communications; www.drkoop.com Hair Disorders Source: Integrative Medicine Communications; www.drkoop.com Hair Loss Source: Integrative Medicine Communications; www.drkoop.com Hirsuitism Source: Integrative Medicine Communications; www.drkoop.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Prostate Cancer Source: Healthnotes, Inc.; www.healthnotes.com Prostate Cancer Source: Integrative Medicine Communications; www.drkoop.com Prostate Enlargement Source: Integrative Medicine Communications; www.drkoop.com Prostate Infection Source: Integrative Medicine Communications; www.drkoop.com Prostatitis Source: Healthnotes, Inc.; www.healthnotes.com Prostatitis Source: Integrative Medicine Communications; www.drkoop.com Sexual Dysfunction Source: Integrative Medicine Communications; www.drkoop.com •

Homeopathy Sabal Serrulata Source: Healthnotes, Inc.; www.healthnotes.com

•

Herbs and Supplements Collinsonia Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

Alternative Medicine 39

Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Horsetail Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hydrangea Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Melaleuca Alternative names: Tea Tree Oil; Melaleuca alternifolia Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Nettle Alternative names: Urtica dioica Source: Healthnotes, Inc.; www.healthnotes.com Nettle Source: Prima Communications, Inc.www.personalhealthzone.com Nettle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10048,00.html Panax Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Pumpkin Alternative names: Cucurbita pepo, Cucurbita maxima Source: Healthnotes, Inc.; www.healthnotes.com Pygeum Alternative names: African Prune; Pygeum africanum Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Pygeum Source: Prima Communications, Inc.www.personalhealthzone.com Pygeum Africanum Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10052,00.html Sabal Serrulata Alternative names: Saw Palmetto Source: Integrative Medicine Communications; www.drkoop.com

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Saw Palmetto Alternative names: Serenoa serrulata, Serenoa repens, Sabal serrulata Source: Healthnotes, Inc.; www.healthnotes.com Saw Palmetto Alternative names: Sabal serrulata Source: Integrative Medicine Communications; www.drkoop.com Saw Palmetto Source: Prima Communications, Inc.www.personalhealthzone.com Saw Palmetto Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Saw Palmetto Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,819,00.html Serenoa Alternative names: Saw Palmetto; Serenoa serrulata & repens (Arecaceae) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Serenoa Repens Source: Integrative Medicine Communications; www.drkoop.com Sitosterol Source: Prima Communications, Inc.www.personalhealthzone.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. CLINICAL TRIALS AND SAW PALMETTO Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning saw palmetto.

Recent Trials on Saw Palmetto The following is a list of recent trials dedicated to saw palmetto.5 Further information on a trial is available at the Web site indicated. •

Saw Palmetto Extract in Benign Prostatic Hyperplasia Condition(s): Benign Prostatic Hyperplasia Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The purpose of this study is to test whether an extract of the saw palmetto plant is effective for relieving symptoms of Benign Prostatic Hyperplasia (BPH). Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00037154

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. 5

These are listed at www.ClinicalTrials.gov.

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The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “saw palmetto” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 5. PATENTS ON SAW PALMETTO Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.6 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “saw palmetto” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on saw palmetto, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Saw Palmetto By performing a patent search focusing on saw palmetto, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 6Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on saw palmetto: •

Breast enhancement system Inventor(s): Curry; Susan C. (2670 Chandler Ave., Suite 5, Las Vegas, NV 89120) Assignee(s): None Reported Patent Number: 6,673,366 Date filed: June 10, 2003 Abstract: A breast enhancement system for reducing the symptoms of PMS and/or noninvasive breast augmentation. The composition includes an amount of saw palmetto extract, an amount of soybean extract, an amount of pomegranate extract, an amount of wild yam extract, an amount of fennel seed, an amount of dong quai, an amount of blessed thistle, an amount of dandelion root and an amount of watercress. The composition is preferably distributed in an oral system, preferably in the form of a plurality of capsule, caplet, tablets, soft gelatin capsule or the like taken separately, orally administered on a daily basis. Excerpt(s): Not applicable to this application. The present invention relates generally to natural breast enhancement aides and more specifically it relates to a breast enhancement system for reducing the symptoms of PMS and/or non-invasive breast augmentation. Web site: http://www.delphion.com/details?pn=US06673366__

•

Breast-enhancing, herbal compositions and methods of using same Inventor(s): Ernest; Joseph Michael (Oceanside, CA), Smith; Allen (Encino, CA) Assignee(s): Vital Dynamics, Inc. (canoga Park, Ca) Patent Number: 6,200,594 Date filed: December 29, 1999 Abstract: Topical and oral compositions containing unique blends of certain herbs effectively enhance breasts in human females by strengthening connective tissues and encouraging the growth of new cells. The topical composition contains Saw Palmetto berry extract, Chaste Tree berry extract, Fenugreek seed extract, Fennel seed extract, Comfrey extract, White Willow Bark extract, Ma Huang extract, Black Cohosh extract, Guarana extract, Passion Flower extract, Bilberry extract, Horsetail extract and Cayenne extract. The oral composition is a dietary supplement system containing two diet supplement compositions. The first composition contains extracts of Blessed Thistle, Hops, Wild Yam, Fenugreek seed, Saw Palmetto berry, Chaste Tree berry, Fennel seed, Black Cohosh, Damiana, Dong Quai, Lycium Chinese Herb, Scullcap Concentrate, and Curcubita Pepo Pumpkin seed, as well as Methyl Sulfonyl Methane and Royal Jelly. The second composition contains extracts of Saw Palmetto berry, Chaste Tree berry, Black Cohosh, Fennel seed, Fenugreek seed, Lycium Chinese Herb, Scullcap Concentrate, and Curcubita Pepo Pumpkin seed, as well as Methyl Sulfonyl Methane and Royal Jelly. The topical composition, which is preferably in cream form, is topically applied to the breast area daily for a sufficient period of time. The oral system, preferably in the form of a plurality of capsules taken separately, is orally administered on a daily basis for a sufficient period, wherein capsules of the first composition are taken for a first period

Patents 45

and capsules of the second composition are taken for a subsequent second period. Most preferably, the topical and oral compositions are administered concurrently in a treatment regimen. The latter regimen provides a synergistic breast enhancement relative to the individual topical and oral treatments. Excerpt(s): The present invention relates to compositions and methods for enhancing breasts. More particularly, this invention relates to herbal topical and oral compositions and methods of using same to enhance breast appearance in women. An attractive bustline is important to many women. Unfortunately, as women age, lose weight or become inactive, their bustlines tend to become less firm and, therefore, less attractive. The strengthening or building up of biological tissue in the female human breast is a well known problem in physiotherapy. One medical approach uses surgical techniques, such as breast implant operations. Such approach has numerous disadvantages. For example, surgical operations are inherently dangerous and relatively expensive. Opting for use of a surgical breast implant carries with it not only the danger and expense involved in any surgical operation but also potential health dangers that may be associated with using a particular type of breast implant, namely, the silicone breast implant. Web site: http://www.delphion.com/details?pn=US06200594__ •

Composition and method for topical treatment of androgenic alopecia Inventor(s): Crandall; Wilson T. (Rte. 616, Jolly Hill, Ft. Defiance, VA 24437) Assignee(s): None Reported Patent Number: 6,333,057 Date filed: July 16, 1998 Abstract: This invention relates to the topical and oral treatment of hair loss, especially androgenic alopecia, by providing formulations that include anti-androgens, especially extracts of the saw palmetto plant, co-enzyme Q, and acetyl carnitine, and optionally stimulators of adenylate cyclase to stimulate hair growth, to increase the luster of hair, and to decrease hair graying. Excerpt(s): Androgenic alopecia is an autosomal disorder which begins in puberty in genetically disposed individuals. Androgenic alopecia is also known as hereditary baldness, male pattern baldness, and seborrheic alopecia and occurs in males and females. The disorder is heterogeneous and increased circulating androgens are not the only causative factor. Historically, patients with male androgenic alopecia present with frontal recession of the hairline, especially at the temples and vertex, and androgenetic frontal hairline (incipient regression of terminal hairs into shorter thin hairs of the intermediate and vellous type). Minoxidil, available since 1988, produces a maximum of only 40% cosmetic responses in selected patients with vertex balding who are young, recently diagnosed and display small areas of alopecia. The response to minoxidil is not seen for 4 to 10 months and treatment must be maintained or the hairline regresses. Saw palmetto is a small, creeping palm (Serenoa repens) of the southeastern United States, having palmately divided leaves with one-ribbed segments and black, one-seeded fruit. It is a native American tree of South Carolina and Georgia and extracts of this tree have been used successfully to treat benign prostatic hypertrophy. Extracts of saw palmetto act as a multi-site inhibitor of the hormone dihydrotestosterone (DHT) which is responsible for prostatic hypertrophy. Saw palmetto blocks approximately 50% of the binding of DHT to receptors in the prostate. It also blocks the uptake of DHT into the

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nucleus of prostatic cells, and strongly inhibits the action of the enzyme testosterone 5 alpha-reductase which reduces the conversion of testosterone to DHT. Web site: http://www.delphion.com/details?pn=US06333057__ •

Composition for promoting prostate health containing selenium and herbal extracts Inventor(s): Newmark; Thomas (704 Cordell Ct., St. Louis, MO 63132), Schulick; Paul (222 Kipling Rd., Brattleboro, VT 05301) Assignee(s): None Reported Patent Number: 6,261,607 Date filed: February 25, 2000 Abstract: An herbal composition which can help promote prostate health in men is prepared from saw palmetto, green tea, pumpkin seed oil, ginger, dual urtica root extracts, selenium, watermelon and rosemary. The composition contains therapeutically effective amounts of: supercritical extracts of saw palmetto, ginger, and rosemary, regular or supercritical extracts of green tea, pumpkin seed oil and urtica; selenium; and watermelon. In addition to promoting prostate health, the herbal composition of this invention normalizes urine flow and promotes healthy sexual function and performance. The composition also contains constituents which inhibit 5-lipoxygenase, thereby promoting normal prostate cell growth, and anti-aging constituents that inactivate free radicals, thereby providing antioxidant benefits. The composition is preferably administered orally or parenterally. Excerpt(s): This invention relates to herbal compositions. More particularly, this invention relates to an herbal composition which can be used to promote healthy prostate function in men. The present invention also relates to methods of using such compositions to promote prostate health. In men, the prostate gland is the source of several common disorders including prostatitis and benign prostatic hypertrophy (BPH), wherein the prostate gland becomes inflamed or enlarged. BPH can cause many uncomfortable and annoying symptoms including: difficulty in starting to urinate; increased urge to urinate; a weak or interrupted stream when urinating; a feeling that the bladder cannot be emptied completely; a feeling of decay when urination is started; a need to urinate often, especially at night; and frequent or continuous lower back pain. Drug therapies exist which can help offset some of the symptoms of BPH but these are associated with significant side effects such as, e.g., impotence. Web site: http://www.delphion.com/details?pn=US06261607__

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Compositions containing minoxidil and saw palmetto for treating baldness Inventor(s): Catalfo; Chris (Orlando, FL), Mussari; Fred (Melbourne, FL), Perry; Stephen H. (Longwood, FL) Assignee(s): Natural Science, Inc. (melbourne, Fl) Patent Number: 6,596,266 Date filed: February 20, 2001 Abstract: Compositions and/or formulations containing minoxidil as an active ingredient in combination with other active agents and/or enhancer agents (e.g., saw palmetto extract and nettle root extract) are provided. The compositions and/or

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formulations increase the hair growth capability of the composition. Also disclosed are methods of using the compositions to treat male patterned baldness and to stimulate hair growth on the scalp, including both the apex and frontal regions of the scalp. Excerpt(s): Androgenic alopecia is the single largest type of recognizable alopecia to affect both men (50%) and women (30%), primarily of Caucasian origin. Androgenic alopecia or common baldness represents 99 percent of all cases of hair loss (Brodland and Muller, 1991). The condition is characterized by the gradual conversion of terminal hair to short, wispy, colorless vellus hair. It is generally accepted that genetic hair loss arises from an inherited predisposition activated by circulating androgenic hormones. While many investigators have tried to isolate the causative androgen metabolite, no single molecule has emerged. For example, in comparative studies between non-balding controls, no significant difference between mean hormonal values or amounts has been detected. See Puolakka, 1980. This suggests that a sensitivity or receptivity to hormones at the cell binding sites within the dermal papilla is a possible factor. Several treatments are based on this theory using anti-androgens such as CPA (cyproterone acetate) in combination with ethinyl-estradiol and the aldosterone antagonist spironolactone, which, given in dosages from 75 to 100 mg per day has shown some benefit. See e.g., Rushton and Ramsay, 1992; Rushton et al. 1991. Most treatment modalities currently employed (such as hair transplantation) have been performed based on the theory that some hair follicles are genetically predisposed for sensitivity to androgens in the body. However, transplantation methods can be painful and expensive, often resulting in an undesirable "fake" appearance. No single treatment modality has proven completely or repeatably successful in inducing, maintaining and/or increasing hair growth. Web site: http://www.delphion.com/details?pn=US06596266__ •

Dietary supplement containing saw palmetto, pumpkin seed, and nettle root Inventor(s): Lam; Thanh Kevin (Monterey Park, CA) Assignee(s): Amway Corporation (ada, Mi) Patent Number: 6,241,987 Date filed: March 1, 1999 Abstract: A dietary supplement and method for supporting and maintaining normal prostrate gland function is described. The dietary supplement of the present invention provides a unique combination of herbal extracts including saw palmetto, pumpkin seed, and nettle root, which synergistically combine to help maintain prostrate gland health. In a preferred embodiment of the invention, the dietary supplement includes about 5% to about 25% by weight saw palmetto oil extract, about 12% to about 32% by weight pumpkin seed oil extract, and about 1% to about 21% by weight nettle root extract. Excerpt(s): The present invention relates to a dietary supplement for use in supporting and maintaining normal prostrate gland function. Specifically, the dietary supplement includes an effective amount of saw palmetto extract, pumpkin seed oil extract and nettle root extract. The use of plants or plant extracts in dietary supplements has long been used to prevent or control disorders of the human body. The prostrate gland is the source of several common disorders for men. These disorders include prostatitis and benign prostatic hyperplasia (BPH). BPH is a condition associated with aging which affects a large percentage of men over the age of fifty. The symptoms associated with BPH are many and varied. These symptoms include frequent, painful urination, an

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increased need to urinate, a need to urinate often, especially at night, difficulty in starting to urinate, and a weak or interrupted stream of urination, among others. A number of plants and plant extracts are known for alleviating the symptoms of BPH. U.S. Pat. No. 5,543,146 to Perez describes treatment of BPH with tablet compositions containing both pumpkin seed and saw palmetto extract. A German reference, W. Vahlensieck, Jr., et al., Drug Treatment of Benign Prostatic Hyperplasia, FORTSCHRMED., Nov. 10, 1996, at 407--11, also teaches the combination of pumpkin seed and saw palmetto. U.S. Pat. No. 4,886,665 to Kovacs describes the use of an oat extract and a nettle extract in a food supplement for the treatment or prevention of various disfunctions of the human body, including BPH. Web site: http://www.delphion.com/details?pn=US06241987__ •

Food supplement formulation Inventor(s): Green; Lonny S. (10825 Cherry Hill Dr., Glen Allen, VA 23059) Assignee(s): None Reported Patent Number: 6,555,142 Date filed: July 1, 2002 Abstract: A food supplement formulation comprises yi zhi ren, shan zhu yu, wu wei zi, ginseng, valerian root, passiflora incarnate, L-methionine, L-arginine, and a genderspecific complex selected from the group consisting of a mixture comprising betasitosteroi, saw palmetto, pollen extract, selenium, zinc, vitamin E, and lycopene, and a mixture comprising black cohosh, genistein, vitamin E, and cramp bark. Excerpt(s): The present invention relates generally to a food supplement formulation. More particularly, the invention is directed to a food supplement formulation which may additionally aid bladder control. Herbal and mineral formulations have been used as dietary supplements and natural medicaments for many years. In addition to providing compounds necessary to the human body for good nutrition, such formulations additionally may aid the body in dealing with a number of urinary tract maladies. In addition to desiring a supplement to the daily diet, many persons suffer from a condition known as "overactive bladder," wherein the patient has difficulty controlling urinary flow. Web site: http://www.delphion.com/details?pn=US06555142__

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Formulations for treating male pattern baldness containing Serenoa repens, Vitamin B6, Vitamin B3, zinc and L-Arginine Inventor(s): Bryant; Andrew Edward (Little Trewollack, St. Wenn, Bodmin, Cornwall PL30 5PL, GB) Assignee(s): None Reported Patent Number: 6,019,976 Date filed: March 25, 1998 Abstract: The invention relates to therapeutic formulations containing 75 to 85% by weight of a serenoa repens extract, 2 to 5% by weight of vitamin B6, 2 to 5% by weight of vitamin B3, 2 to 5% by weight of zinc salt, and 10 to 15% by weight of L-arginine. The

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therapeutic formulations can be used to treat male pattern baldness by topical application to the hair. Excerpt(s): This invention relates to therapeutic formulations and to the preparation and administering of such formulations. The invention has been developed initially in relation to the combating or alleviation of male pattern baldness, but is believed to have wider applications. The formulation includes an extract obtained from the fruits of the Saw Palmetto, also known as Serenoa repens. One method of obtaining this extract is described in French Patent Specification No. 2 480 754 and involves the use of a polar solvents in the presence of anti-oxidants and in an inert atmosphere. Another method of obtaining this extract is described in European Patent Specification No. 0 250 953 and involves the use of carbon dioxide as the solvent under high pressure conditions, for example, at pressures ranging from 100 to 350 bars and at temperatures ranging from 30.degree. C. to 50.degree. C. Web site: http://www.delphion.com/details?pn=US06019976__ •

Hair treatment system and kit for invigorating hair growth Inventor(s): Edwards; William Thomas (West Hollywood, CA) Assignee(s): Regenix Marketing Systems, Inc. (beverly Hills, Ca) Patent Number: 5,750,108 Date filed: March 31, 1997 Abstract: A method for hair treatment is disclosed wherein a first treatment solution comprising tea tree oil is periodically applied to the scalp for at least 10 days. Then, a second treatment solution comprising chlorine dioxide is periodically applied to the scalp, immediately followed by application of an acidic solution having an acidity effective to release the oxygen in the chlorine dioxide solution, for at least 1 month. Finally, a third treatment solution comprising saw palmetto berry extract is periodically applied to the scalp for at least 1 month. Also disclosed is a hair treatment kit comprising a first treatment solution comprising tea tree oil, a second treatment solution comprising chlorine dioxide, an acidic solution having a pH effective to release the oxygen from said chlorine dioxide in said second treatment solution, and a third treatment solution comprising saw palmetto berry extract. Excerpt(s): This invention relates to a method and a kit for invigorating hair growth. In particular, the invention relates to a three-step treatment system utilizing tea tree oil, chlorine dioxide and saw palmetto extract as operative ingredients. Humans typically have about 100,000 to 150,000 hairs on their scalps, and it is normal to lose about 50 to 150 hairs daily. The life of each hair is subject to a cycle, known as the pilar cycle. During the pilar cycle, hair forms, grows and falls out, before being replaced by a new hair shaft, which appears in the same follicle. The pilar cycle can be broken down into three successive phases: the anagen phase, the catagen phase and the telogen phase. During the anagen phase, the hair undergoes a period of active growth associated with an intensive metabolic activity in the bulb. The subsequent catagen phase is transitory and marked by a slowing-down of the mitotic activity. The final telogen phase corresponds to a period of rest for the follicle, with the hair being shed. Web site: http://www.delphion.com/details?pn=US05750108__

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Method of medical management for lower urinary tract symptoms and benign prostatic hyperplasia Inventor(s): Locke; D. Russell (Ocala, FL) Assignee(s): Starcor Pharmaceuticals, Inc. (ocala, Fl) Patent Number: 6,200,573 Date filed: January 20, 2000 Abstract: Disclosed is a method of medical management for men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH), involving combination therapy of an.alpha.sub.1 -adrenergic antagonist, i.e., terazosin in combination with a phytotherapeutic agent, Serenoa repens (saw palmetto) extract. The combination provides relief from both dynamic and mechanical obstructive effects of benign prostatic hyperplasia. Therapeutic compositions useful for such treatment and pharmaceuticalnutraceutical kits containing such compositions are disclosed. Excerpt(s): This invention relates to a novel and improved method of medical management for men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH), involving combination therapy of administering therapeutically effective amounts of an.alpha.sub.1 -adrenergic antagonist, i.e., terazosin in combination with a phytotherapeutic agent, Serenoa repens (saw palmetto) extract. Benign prostatic hyperplasia (BPH) is a common health related condition that affects many men as they age. Histologic changes that typify BPH are present in 50% of men by age 60 and approximately 90% by age 85 (Berry S J, Coffey D S, Walsh P C, Ewing L L. The development of human benign prostatic hyperplasia with age. J Urol. 1984; 132:474-479). BPH has a major impact on quality of life and exacts a heavy toll upon healthcare resources, including physicians, hospitals, and surgical facilities. In the United States, treatment of BPH exceeds $2 billion in costs, accounts for 1.7 million physician office visits, (Guess H A. Benign prostatic hyperplasia antecedents and natural history. Epidemiol Rev. 1992; 14:131-153) and results in more than 300,000 prostatectomies annually (McConnell J D, Barry M J, Bruskewitz R C. Benign Prostatic Hyperplasia. Rockville, Md.: Agency for Health Care Policy and Research, Public Health Service, US Dept of Health and Human Services; 1994. Clinical Practice Guideline No. 8, AHCPR publication 94-0582). Benign prostatic hyperplasia is a heterogeneous disorder shown in studies to be caused by hormonal factors, growth factors, stromal-epithelial interactions, and aging. It is a progressive condition, which results in increased frequency of urination, nocturia, a weak urine stream, hesitancy or delay in starting the urine flow and incomplete bladder emptying. Chronic consequences of BPH can include hypertrophy of bladder smooth muscle, a decompensated bladder, an increased incidence of urinary tract infection, urinary stone formation and renal failure. Web site: http://www.delphion.com/details?pn=US06200573__

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Pharmaceutical grade saw palmetto Inventor(s): Friedman; Elliot P. (Montecito, CA), Khwaja; Tasneem A. (Corona Del Mar, CA) Assignee(s): Pharmaprint Inc. (irvine, Ca), University of Southern California (los Angeles, Ca) Patent Number: 6,039,950 Date filed: October 23, 1997

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Abstract: The present invention relates generally to saw palmetto materials and methods for making such materials in medicinally useful and pharmaceutically acceptable forms. More particularly, the present invention relates to the use of compositional and activity fingerprints in the processing of saw palmetto materials to produce drugs which qualify as pharmaceutical grade compositions which are suitable for use in clinical or veterinary settings to treat and/or ameliorate diseases, disorders or conditions. Excerpt(s): The present invention relates generally to botanical materials and methods for transforming such materials into medicinally useful and pharmaceutically acceptable forms. More particularly, the present invention relates to the use of compositional and activity fingerprints in the processing of saw palmetto to produce botanical drugs which qualify as pharmaceutical grade compositions which are suitable for use in clinical settings to treat and/or ameliorate diseases, disorders and/or conditions. Pharmaceutical manufacturing is based on control over the composition and bioactivity for each manufactured batch. This standardization and control provides reproducible material in the predictable and consistent treatment of patients. Herbal medicines, produced from botanical materials, have presented a unique problem for manufacturers desiring the control, reproducibility, and standardization that are required of pharmaceuticals. This problem is primarily due to the plurality of components contained in an herbal medicine and the large variation in composition and potency due to the growing, harvesting and processing conditions of raw materials. Plants have been, and continue to be, the source of a wide variety of medicinal compounds. For centuries, various forms of botanically derived materials have been used to treat countless different ailments. The botanical materials have typically been in the form of powders made from one or more plants or plant parts or extracts derived from whole plants or selected plant parts. These powders and extracts are, for the most part, complex mixtures of both biologically active and biologically inactive compounds. Web site: http://www.delphion.com/details?pn=US06039950__ •

Use of a Serenoa repens extract for the production of a medicament to treat prostate cancer Inventor(s): Cousse; Henri (Pins Justaret, FR), Fabre; Pierre (Castres, FR), Raynaud; JeanPierre (Paris, FR) Assignee(s): Pierre Fabre Medicament (boulogne-billancourt, Fr) Patent Number: 6,599,540 Date filed: September 28, 2001 Abstract: The invention relates to the use of a lipido-sterolic Serenoa repens extract for the production of a medicament which is administered in an isolated manner or in an associated manner, in a simultaneous, separated or staggered manner, with prostatectomy, radiotherapy and/or hormonotherapy in order to prevent and/or treat prostate cancer. Excerpt(s): The present invention relates to the field of treating prostate cancer which, at the present time, is based on several therapeutic routes dependent on the degree of progress of the disease. The hormonal treatment of metastatic prostate cancer which has crossed the capsule currently relies mainly on several categories of medicinal products which act at different levels on the hypothalamo-gonad axis. The efficacy and limits of hormonal treatments are now more or less defined. These limits are set both by the side

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effects, in particular vascular effects for estrogens at high doses, and sexual, gastric and pulmonary effects for antiandrogens, and by the emergence of immediate or secondary resistance. The current attitude appears to be focused, at least at the initial phase of the treatment, on total androgenic blockage (inhibition of the testicular secretion of androgens and inhibition of the activity of the residual androgens on the target organ). Specifically, the absence of absolute certainty regarding the advantage of continuing this combination long term occasionally results in a complete androgenic blockage being preferred at the time of starting a treatment with an LHRH agonist, in order to prevent initial flare-ups with subsequent continuation of the agonist alone. Web site: http://www.delphion.com/details?pn=US06599540__

Patent Applications on Saw Palmetto As of December 2000, U.S. patent applications are open to public viewing.7 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to saw palmetto: •

Composition and method for treating non-bacterial prostatitis Inventor(s): Kastke, Floyd A.; (Los Angeles, CA) Correspondence: Robert J. Schaap; Suite 188; 21241 Ventura Boulevard; Woodland Hills; CA; 91364; US Patent Application Number: 20010025059 Date filed: January 9, 2001 Abstract: A composition and a method for treatment of prostate related dysfunction and, particularly, non-bacterial prostatitis and, even more particularly, non-bacterial chronic prostatitis. The composition primarily relies upon the use of a bioflavonoid and, particularly, that bioflavonoid known as quercetin. The quercetin is mixed with a proteolytic digestive enzyme protease, such as bromelin and papain, as the primary active ingredients. However, the composition may optionally and beneficially include other prostatitis affecting agents, such as zinc derived from zinc gluconate, cranberry, saw palmetto, as well as some other active and non-active ingredients. Excerpt(s): This application is a continuation-in-part of my co-pending U.S. provisional patent application Ser. No. 60,175,286, filed Jan. 10, 2000, for "Composition for Treating Non-Bacterial Prostatitis". The invention primarily relates to a composition and method for the treatment of non-bacterial prostatitis and, more particularly, to a composition and method for treating non-bacterial chronic prostatitis syndromes using bioflavonoids in a treatment composition and in a treatment method. Prostatitis is a name commonly used for a non-specific group of prostate related problems and is often characterized by prostatic pain, which may actually adopt the form of phantom symptomatic pain. At present, the cause for many of the forms of prostatitis is not fully known. As a result, there is frequently no known cure for non-bacterial chronic prostatitis, although there are several therapies of varying effectiveness, and usually limited effectiveness. These therapies are generally designed to address the issues of pain and discomfort as well as

7

This has been a common practice outside the United States prior to December 2000.

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the other symptoms arising from this condition of prostatitis, but are not specific to any effective cure or permanent treatment therefor. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Compositions and methods for treating baldness Inventor(s): Catalfo, Chris; (Orlando, FL), Mussari, Fred; (Melbourne, FL), Perry, Stephen H.; (Longwood, FL) Correspondence: Timothy H. Van Dyke; Bencen & Van Dyke, P.A.; 1630 Hillcrest Street; Orlando; FL; 32803; US Patent Application Number: 20020028257 Date filed: February 20, 2001 Abstract: Disclosed herein are novel compositions and/or formulations containing minoxidil as an active ingredient in combination with other active agents and/or enhancer agents (e.g., saw palmetto extract and nettle root extract) which increase the hair growth capability of the composition. Also disclosed are methods of using the novel compositions to treat male patterned baldness and to stimulate hair growth on the scalp, including both the apex and frontal regions of the scalp. Excerpt(s): The subject application claims the benefit under 35 USC.sctn. 119(e) of Provisional Application No. 60/183553 filed Feb. 18, 2000. Androgenic alopecia is the single largest type of recognizable alopecia to affect both men (50%) and women (30%), primarily of Caucasian origin. Androgenic alopecia or common baldness represents 99 percent of all cases of hair loss (Brodland and Muller, 1991). The condition is characterized by the gradual conversion of terminal hair to short, wispy, colorless vellus hair. It is generally accepted that genetic hair loss arises from an inherited predisposition activated by circulating androgenic hormones. While many investigators have tried to isolate the causative androgen metabolite, no single molecule has emerged. For example, in comparative studies between non-balding controls, no significant difference between mean hormonal values or amounts has been detected. See Puolakka, 1980. This suggests that a sensitivity or receptivity to hormones at the cell binding sites within the dermal papilla is a possible factor. Several treatments are based on this theory using anti-androgens such as CPA (cyproterone acetate) in combination with ethinyl-estradiol and the aldosterone antagonist spironolactone, which, given in dosages from 75 to 100 mg per day has shown some benefit. See e.g., Rushton and Ramsay, 1992; Rushton et al. 1991. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Compositions and treatment methods for benign prostatic hypertrophy Inventor(s): Hammerly, Milton; (Parker, CO) Correspondence: Christopher J. Whewell; Western Patent Group; 6020 Tonkowa Trail; Georgetown; TX; 78628; US Patent Application Number: 20010028897 Date filed: February 15, 2001 Abstract: Provided herein are medicinal compositions of matter that comprise an alpha1 adrenergic blocker in combination with an extract derived from the berries of the Saw

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Palmetto plant, and methods for their administration. The extract is typically obtained from the dried berries using extraction means known to those skilled in the art. Through use of the compositions of the invention, relaxation of the smooth muscles present in the prostate gland may be effected while simultaneously inhibiting glandular growth of the prostate thus providing a heretofore unobserved synergy in terms of relief to sufferers of benign prostatic hypertrophy. Excerpt(s): This application claims the benefit of U.S. Provisional Application Ser. No. 60/183,703 filed Feb. 18, 2000 the entire contents of which are herein incorporated by reference. This invention relates to a medicinal composition of matter comprising any one of known alpha-1 adrenergic blocking drugs in combination with Saw Palmetto. The compositions according to the invention are suitable for oral administration. Alternatively, the combinations of the invention may be administered by other means including without limitation intravenously, intramuscularly, subcutaneously, sublingually, buccally, and parenterally. Benign prostatic hypertrophy ("BPH") is a medical condition that affects nearly all men as they age. BHP is a condition characterized by a nodular enlargement of prostatic tissue resulting in obstruction of the urethra. The incidence of BPH is clearly age related. Based on an examination of autopsy specimens, a 30 percent incidence of benign hyperplasia was noted in the prostates of men aged 60-69, and a 100 percent incidence from men overa 90 (Randall and Hinman, 1983). This correlates with a 35 percent incidence of palpable prostatic enlargement during physical examination of men aged 60-69 Lytton, 1983). It is estimated that half of all men over 65 have some prostatic enlargement, and at least one third of these will have clinical symptoms of BPH. In vies of the continually increasing life span, the number of BPH patients and therefore the impact of this disease will continue to increase. Although BPH is currently treated primarily via surgical techniques, there is both clinical and experimental evidence to suggest that pharmacological management of this disease is possible and can delay or prevent the necessity of surgery in a significant percentage of patients. BPH is commonly associated with increased urinary frequency, decreased urine flow, and dribbling. Additionally, the condition frequently requires aging men to awaken on several occasions during the night to urinate. With respect to the pharmacological treatments available, the medical community currently recognizes one of two possible strategies for treating the symptoms of BPH. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and composition for reducing sebum secretion in mammals Inventor(s): Niazi, Sarfaraz; (Chicago, IL) Correspondence: Gerald T. Shekleton, ESQ.; Welsh & Katz, LTD.; 22nd Floor; 120 S. Riverside Plaza; Chicago; IL; 60606; US Patent Application Number: 20030054020 Date filed: September 7, 2001 Abstract: This invention relates to reducing sebum production on the skin using methods and compositions containing a surfactant, a chylomicron disrupter, a skin penetration enhancer, and an anti-androgenic compound. In a preferred embodiment, the composition contains the surfactant as a mixture of polyoxyethylene compounds and the anti-androgenic agent as a mixture of saw palmetto extract and nettle extract. Excerpt(s): This invention relates to cosmetic compositions and methods for reducing oily skin conditions in mammals by topical application of compositions containing a

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carrier, surfactants, chylomicron disrupters, skin penetration enhancers, and antiandrogenic compounds. Cosmetic products which improve the condition and appearance of skin are in great demand. Perhaps the most prevalent skin condition for which remedy is sought is excessive skin oiliness, particularly in the facial area. Excessive oiliness results from large amounts of sebum being secreted onto the skin surface. Sebum is a complex fatty mixture which is produced by cells of the sebaceous glands in the skin (sebocytes). Once produced, the sebum usually is secreted up hair follicles to the skin surface. Sometimes the secretion process is blocked and can lead to disorders such as acne. The primary lesion of acne is the comedo. The open comedo (blackhead) consists of a firm mass of keratin and sebum, which blocks and dilates the follicle pore. The upper portion of the blackhead is darkened by slow oxidative changes (not by dirt), and the lower portions are white. The closed comedo (whitehead), which is a collection of skin cells and sebum with the hair follicular opening blocked, are potentially the starting point of deep inflammatory lesions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods and compositions for the treatment of benign prostatic hypertrophy Inventor(s): Randhava, Sarabjit; (Evanston, IL), Randhava, Sikander; (Evanston, IL), Randhava, Surjit; (Evanston, IL) Correspondence: Katten Muchin Zavis Rosenman; Attention: Patent Administrator; Suite 1600; 525 West Monroe Street; Chicago; IL; 60661-3693; US Patent Application Number: 20030096009 Date filed: October 23, 2002 Abstract: This invention relates to a composition for use in treating benign prostatic hyperplasia including a saw palmetto extract provided in an oral controlled release formulation which allows release of active ingredients in the intestinal tract and which allows the maintenance of therapeutic levels of active agents in the bloodstream for prolonged periods of time. This invention also relates to a composition for improving the efficacy of a saw palmetto extract, a method of treating benign prostatic hypertrophy, and a method of improving the efficacy of a saw palmetto extract treatment. Excerpt(s): This invention relates to a composition for use in treating benign prostatic hyperplasia, which comprises saw palmetto extract contained in a controlled delivery system. The composition is preferably administered orally, uses a controlled delivery system to provide a targeted, extended release of the saw palmetto extract into the bloodstream. Many men over the age of fifty commonly experience a condition known as benign prostatic hyperplasia, or BPH. BPH affects as much as 40% of the male population over the age of seventy. The condition is commonly recognized as a swelling of the prostate gland. This problem gradually manifests itself in the form of a) frequent urination, b) small discharge volumes and "dribbling", and c) unsatisfying bladder evacuations. Waking up to urinate once or more each night is a typical sign of this problem. BPH is a chronic condition that tends to gradually worsen with age. The increased incidence of BPH in older men may be due to the fact that as men age, testosterone levels tend to decline and estrogen levels rise. In the process, testosterone metabolism takes a different pathway, and testosterone is converted to dihydrotestosterone (DHT), a potent male hormone that causes prostate enlargement. The actions of DHT can be limited by restricting the enzymatic production of DHT from testosterone and/or blocking the direct pharmacological action of DHT at the receptor

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level. Current therapies for BPH focus on limiting the actions of DHT, and include: pharmaceutical intervention with 5-.alpha.-reductase inhibitors such as finasteride (Proscar.RTM.); pharmacological intervention with.alpha.-adrenergic blockers, such as terazosin HCl (Hytrin.RTM.), and doxazosin mesylate (Cardura.RTM.); prostatectomy; and administration of saw palmetto extract. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Saw palmetto composition and associated methods Inventor(s): Gregg, Fred B. JR.; (Leesburg, FL) Correspondence: Christopher F. Regan; Allen, Dyer, Doppelt, Milbrath & Gilchrist, P.A.; P.O. Box 3791; Orlando; FL; 32802-3791; US Patent Application Number: 20020012712 Date filed: August 23, 2001 Abstract: A saw palmetto composition for nutritional supplementation, includes greater than about 0.2% saw palmetto sterols, and essentially no solvent residue. A method of extracting saw palmetto berries includes extracting by contacting ground saw palmetto berries with a substantially continuous flow of carbon dioxide at an extraction pressure of at least about 500 bar, and at a temperature of less than about 80.degree. C. to thereby dissolve saw palmetto compounds in the carbon dioxide.The method may further include separating the extracted saw palmetto compounds from the carbon dioxide into a plurality of fractions by passing the substantially continuous flow of carbon dioxide after extracting through a plurality of separations. A first separation of the plurality may have a predetermined first separation pressure lower than the extraction pressure, and a temperature sufficient to prevent the carbon dioxide from solidifying, and each subsequent separation may have a lower predetermined pressure than the preceding separation. Excerpt(s): This application claims priority from co-pending provisional application Ser. No. 60/166,584, which was filed on Nov. 19, 1999. The present invention relates to the field of nutritional supplements and, more particularly, to a composition comprising an extract of saw palmetto berries and a method for the extraction of saw palmetto berry components. Saw Palmetto (Serenoa repens) is a shrubby palm that grows only in the southeastern United States, and is most prolific on pine flatwoods in peninsular Florida and southern Georgia. The saw palmetto grows a seed stalk (spadix) in late spring, which flowers and then develops a hard green fruit about the size of a small olive. The fruit ripens in the summer, turning shades of yellow, orange and black. The ripe fruit is then harvested by hand during the late summer and early fall. Typical yields in harvestable areas range from a low of 200 lbs. to more than 1000 lbs. of berries per acre. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Topical preparation for treating acne and hirsutism Inventor(s): Goodman, David S.; (Naples, FL) Correspondence: Robert I. Pearlman, ESQ.; Riker, Danzig, Scherer, Hyland & Perretti Llp; Headquarters Plaza; One Speedwell Avenue; Morristown; NJ; 07962; US Patent Application Number: 20020155180 Date filed: March 13, 2002 Abstract: An improved method and preparation for the treatment of acne and hirsutism comprises topically applying an effective amount of a saw palmetto berry extract, and preferably one or more low irritability constituents that enhance penetration of the extract into hair follicle sebaceous glands. The low irritability penetration aid may be selected from the group consisting of adapalene, tretinoin, tretinoin gel microsponges, retinaldehyde, retinol, tazarotene, beta hydroxy acids (salicylic acid), azelaic acid, and alpha hydroxy acids (glycolic acid) as well as polyolprepolymer-2. Excerpt(s): This application is a Continuation-in-Part of U.S. Ser. No. 09/563,555 filed May 3, 2000 for the instant inventor. This invention relates to an improved preparation and method for treating both acne and hirsutism, or unwanted facial and body hair in women; and more particularly to a preparation comprising a topically active extract of saw palmetto berries, with one or more compounds which exhibit low irritability and enhance penetration of the extract into hair follicles and sebaceous glands. Acne is caused by a complex interaction of excessive sebum production colonization of hair follicles by Proprionibasterium acnes, and follicular plugging or comedone formation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Use of saw palmetto to prevent atherosclerosis Inventor(s): Goldberg, Michael E.; (Ivyland, PA), Weisman, Kenneth; (Newtown Square, PA) Correspondence: Caesar, Rivise, Bernstein,; Cohen & Pokotilow, LTD.; 12th Floor, Seven Penn Center; 1635 Market Street; Philadelphia; PA; 19103-2212; US Patent Application Number: 20010053391 Date filed: May 8, 2001 Abstract: A method of decreasing atherosclerosis and its complications including but not limited to myocardial infarction, stroke, and peripheral vascular disease comprising administering to a human or animal an amount of saw palmetto or Permixon containing saw palmetto sufficient to decrease atherosclerosis and its complications. Excerpt(s): This application claims the benefit of the filing date of May 09, 2000 of Provisional Patent Application Ser. No. 60/202,942. There are many steps in the biosynthesis and utilization by the tissues of testosterone. Testosterone is made mostly in the testicles. A lesser amount is made in the adrenals. Production is stimulated by secretion of GnRH or LHRH by the brain, which causes secretion of luteinizing hormone (LH) by the pituitary, which causes the testicles to make testosterone. Testosterone then flows into the blood stream and is absorbed by the target cells. Here it binds to a receptor and is transported into the cell and converted to dihydrotestosterone. This is bound and carried to the nucleus of the cell where it redirects cellular activity by turning on and off DNA. Hormonal manipulation is a term which refers to the reduction of testosterone or its effects by blocking any step in the above process in order to gain a

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desired effect. Until now the uses of hormonal manipulation include for example treating prostatic carcinoma, and treatment for baldness. For instance, leuprolide acetate is one of the compounds we previously discovered being effective in the prevention of such cardiac events. Leuprolide acetate is a synthetic nonapeptide of naturally occurring gonadotropin-releasing hormone (GnRH or LH-RH), the chemical name is 5-oxo-Lprolyl-L-histidyl-L-tryptophyl-L-seryl-L-tyrosyl-D-leucyl- -L-leucyl -L-arginyl-N-ethylL-prolinamide acetate salt sold under the trade name Lupron or Lupron Depot, as identified by U.S. Pat. No. 4,897,256, the entire disclosure in incorporated by reference herein, is known for use in the treatment of prostatic carcinoma. Leuprolide is known to decrease levels of LHRH, LH and Testosterone (a sex hormone). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with saw palmetto, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “saw palmetto” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on saw palmetto. You can also use this procedure to view pending patent applications concerning saw palmetto. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON SAW PALMETTO Overview This chapter provides bibliographic book references relating to saw palmetto. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on saw palmetto include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “saw palmetto” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on saw palmetto: •

PDR for Herbal Medicines. 1st ed Source: Montvale, NJ: Medical Economics Company. 1998. 1244 p. Contact: Available from Medical Economics Publishing Inc. P.O. Box 10689, Des Moines, IA 50336. (800) 922-0937. Fax (515) 284-6714. Website: www.medecbookstore.com. PRICE: $59.99. ISBN: 1563632926. Summary: Most of today's herbal remedies exhibit varying degrees of therapeutic value. Some, such as ginkgo, valerian, and saw palmetto, seem genuinely useful, while others, such as ephedra, tansy, and nightshade, can actually be dangerous. As the use of unfamiliar botanicals spreads, the need to steer patients toward the few truly useful preparations and warn them away from ineffective, dangerous alternatives is becoming an increasingly significant priority. This volume, from the publishers of Physicians Desk Reference, brings together the findings of the German Regulatory Authority's herbal watchdog agency (commonly caused Commission E). This agency conducted an

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intensive assessment of the peer-reviewed literature on some 300 common botanicals, weighing the quality of the clinical evidence and identifying the uses for which the herb can reasonably be considered effective. This reference book contains profiles of over 600 medicinal herbs. Each entry contains up to 9 standard sections: name(s), description, actions and pharmacology, indications and usage, contraindications, precautions and adverse reactions, overdosage, dosage, and literature. The entries have also been indexed by scientific and common name, indications, therapeutic category, and side effects. To assist in identification, the reference book includes a section of full-color plates of the plants included. The book concludes with a glossary of the specialized botanical nomenclature and other unfamiliar terminology, a list of poison control centers, and a list of drug information centers. Some of the herbs are listed for use for abdominal cramps or distress, acid indigestion, appetite stimulation, rectal bleeding, various bowel disorders, stomach cancer, cholelithiasis (gallstones), colic, colitis, constipation, dehydration, diarrhea, digestive disorders, dysentery, enteritis, anal fissure, flatulence (intestinal gas), gastritis, gastroenteritis, gastrointestinal disorders, gout, helminthiasis, hemorrhage, hemorrhoids, hepatitis, hypercholesterolemia, jaundice, liver and gall bladder complaints, liver disorders, malaria, nausea, abdominal pain, and vomiting.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “saw palmetto” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “saw palmetto” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “saw palmetto” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

DK Pocket Healers: Saw Palmetto: Hormone Enhancer - Safe and Effective Self-care for Impotence, Asthma and Bronchitis (DK Pocket Healers Healers) by Stephanie Pederson; ISBN: 0751331813; http://www.amazon.com/exec/obidos/ASIN/0751331813/icongroupinterna

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Frequently Asked Questions: All About Saw Palmetto and Prostate Health by MD Michael Janson, et al; ISBN: 0895299399; http://www.amazon.com/exec/obidos/ASIN/0895299399/icongroupinterna

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Healing Herbs-4 Vol.: Garlic Hawthorn Marigold & Saw Palmetto by Jill Rosemary Davies; ISBN: 1862047987; http://www.amazon.com/exec/obidos/ASIN/1862047987/icongroupinterna

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In a Nutshell: Saw Palmetto by Joseph F. Ryan, Jill Rosemary Davies; ISBN: 1862045569; http://www.amazon.com/exec/obidos/ASIN/1862045569/icongroupinterna

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Natural Care Library Saw Palmetto: Safe and Effective Self-Care for Impotence, Asthma, and Bronchitis by Stephanie Pedersen; ISBN: 0789453355; http://www.amazon.com/exec/obidos/ASIN/0789453355/icongroupinterna

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Saw Palmetto by Sarah Brewer; ISBN: 0722539606; http://www.amazon.com/exec/obidos/ASIN/0722539606/icongroupinterna

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Saw Palmetto for Men & Women: Herbal Healing for the Prostate, Urinary Tract, Immune System and More (Medicinal Herb Guide) by David Winston; ISBN: 1580172067; http://www.amazon.com/exec/obidos/ASIN/1580172067/icongroupinterna

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Saw Palmetto Nature's Prostate Healer: Natures Prostate Healer by Ray Sahelian; ISBN: 1575663007; http://www.amazon.com/exec/obidos/ASIN/1575663007/icongroupinterna

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Saw Palmetto: Premier Herb for Men's Health by David Winston; ISBN: 0879839414; http://www.amazon.com/exec/obidos/ASIN/0879839414/icongroupinterna

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Saw Palmetto: The Herb for Prostate Health by Christopher Hobbs, Stephen Brown; ISBN: 1883010462; http://www.amazon.com/exec/obidos/ASIN/1883010462/icongroupinterna

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Saw Palmetto: The Natural Choice for Prostate Health by Kate Gilbert Udall; ISBN: 1885670591; http://www.amazon.com/exec/obidos/ASIN/1885670591/icongroupinterna

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The Natural Pharmacist: Your Complete Guide to Saw Palmetto and the Prostate by Anna M. Barton (Author), Anna M. Barton; ISBN: 0761515593; http://www.amazon.com/exec/obidos/ASIN/0761515593/icongroupinterna

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User's Guide to Saw Palmetto & Men's Health: Learn What You Need to Know About Reducing Your Risk of Prostate Disease by Michael Janson, Jack Challem; ISBN: 159120030X; http://www.amazon.com/exec/obidos/ASIN/159120030X/icongroupinterna

Chapters on Saw Palmetto In order to find chapters that specifically relate to saw palmetto, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and saw palmetto using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “saw palmetto” (or synonyms) into the “For these words:” box.

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CHAPTER 7. PERIODICALS AND NEWS ON SAW PALMETTO Overview In this chapter, we suggest a number of news sources and present various periodicals that cover saw palmetto.

News Services and Press Releases One of the simplest ways of tracking press releases on saw palmetto is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “saw palmetto” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to saw palmetto. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “saw palmetto” (or synonyms). The following was recently listed in this archive for saw palmetto: •

Saw Palmetto may fight prostate cancer Source: Reuters Health eLine Date: December 13, 2000

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Saw palmetto berry extract inhibits prostate cancer cell growth in vitro Source: Reuters Industry Breifing Date: December 13, 2000

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Saw palmetto: don't be fooled by the label Source: Reuters Health eLine Date: August 25, 2000

•

Saw palmetto herbal blend safe for men with symptomatic BPH Source: Reuters Medical News Date: May 16, 2000 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “saw palmetto” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “saw palmetto” (or synonyms). If you know the name of a company that is relevant to saw palmetto, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.

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BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “saw palmetto” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “saw palmetto” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on saw palmetto: •

Enlarged Prostate Gland: Many Treatment Options Source: Mayo Clinic Health Letter. 19(4): 1-3. April 2001. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This health newsletter article discusses enlarged prostate gland (benign prostatic hyperplasia), a common problem that affects half of men in their 60s and close to 80 percent of men in their 80s. The prostate gland is located just below the bladder and surrounds the urethra, the tube that drains the bladder. This gland often enlarges with age and constricts the urethra, making it more difficult for urine to pass through. Signs and symptoms of benign prostatic hyperplasia (BPH) may include excessive urination at night, a weak urine stream, stopping and starting while urinating, a frequent urge to urinate, and a feeling that the bladder has not been emptied completely. Diagnosis includes a symptom questionnaire, a urine test to rule out infection, a prostate specific antigen (PSA) test, and a digital rectal exam (DRE) to rule out prostate cancer, and sometimes more tests including cystoscopy and urine flow tests. Generally, no treatment is required for mild BPH symptoms. Monitoring the situation and simple lifestyle changes may be all that is necessary. For men with moderate to severe symptoms, treatment options include oral medications, surgery, and minimally invasive techniques. Drug options include alpha blockers, finasteride, and plant extracts (including saw palmetto). Surgical treatments include transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), open prostatectomy (removal of the prostate), microwave and radiofrequency, laser therapy, and stents. One sidebar summarizes lifestyle changes that may be recommended to help men deal with symptoms of BPH. 1 figure. 1 table.

Academic Periodicals covering Saw Palmetto Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to saw palmetto. In addition to these sources, you can search for articles covering saw palmetto that have been published by

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any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute8: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

8

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.9 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:10 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

9

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 10 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway11 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.12 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “saw palmetto” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 88 See Details 91 1 46 226

HSTAT13 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.14 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.15 Simply search by “saw palmetto” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

11

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

12

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 13 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 14 15

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists16 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.17 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.18 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

16 Adapted 17

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 18 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on saw palmetto can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to saw palmetto. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to saw palmetto. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “saw palmetto”:

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Other guides Cancer Alternative Therapy http://www.nlm.nih.gov/medlineplus/canceralternativetherapy.html Dietary Supplements http://www.nlm.nih.gov/medlineplus/dietarysupplements.html Herbal Medicine http://www.nlm.nih.gov/medlineplus/herbalmedicine.html Prostate Diseases http://www.nlm.nih.gov/medlineplus/prostatediseases.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on saw palmetto. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Systolic Blood Pressure; Herbal Remedy Helps Prostate Patients Source: New York, NY: National Kidney Foundation. 1999. 2 p. Contact: Available from National Kidney Foundation, Inc. Medical Department, 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Fax: (212) 689-9261. E-mail: [email protected]. Website: www.kidney.org. PRICE: Full-text available online at no charge. Summary: New evidence from the Framingham Heart Study finds that the top number in a blood pressure reading (the systolic blood pressure) may not have been getting enough attention. Current treatment strategies have focused more on lowering the bottom number (diastolic pressure) in the patient's blood pressure reading. This fact sheet describes the results of the Framingham Heart Study and outlines the importance of blood pressure control as one strategy to prevent kidney disease. The fact sheet describes how blood pressure is measured and lifestyle changes that may help to reduce high blood pressure (hypertension). The reverse side of the fact sheet discusses the use of an herbal remedy, saw palmetto, to help patients with benign prostatic hyperplasia (BPH, enlarged prostate gland). The short article lists the symptoms of BPH and describes how saw palmetto may be utilized. Readers are encouraged to contact the National Kidney Foundation for more information.

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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to saw palmetto. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to saw palmetto. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with saw palmetto. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about saw palmetto. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at

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http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “saw palmetto” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “saw palmetto”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “saw palmetto” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “saw palmetto” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.19

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

19

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)20: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

20

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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SAW PALMETTO DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 5-alpha: Enzyme converting testosterone to dihydrotestosterone. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Cramps: Abdominal pain due to spasmodic contractions of the bowel. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acne Vulgaris: A chronic disorder of the pilosebaceous apparatus associated with an increase in sebum secretion. It is characterized by open comedones (blackheads), closed comedones (whiteheads), and pustular nodules. The cause is unknown, but heredity and age are predisposing factors. [NIH] Adenylate Cyclase: An enzyme of the lyase class that catalyzes the formation of cyclic AMP and pyrophosphate from ATP. EC 4.6.1.1. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] AFP: Alpha-fetoprotein. A protein normally produced by a developing fetus. AFP levels are usually undetectable in the blood of healthy nonpregnant adults. An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Aldosterone: (11 beta)-11,21-Dihydroxy-3,20-dioxopregn-4-en-18-al. A hormone secreted by

Dictionary 87

the adrenal cortex that functions in the regulation of electrolyte and water balance by increasing the renal retention of sodium and the excretion of potassium. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alopecia: Absence of hair from areas where it is normally present. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alpha-helix: One of the secondary element of protein. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Androgenic: Producing masculine characteristics. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antiandrogens: Drugs used to block the production or interfere with the action of male sex hormones. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign

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substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Arachidonate 12-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 12-hydroperoxyarachidonate (12-HPETE) which is itself rapidly converted by a peroxidase to 12-hydroxy-5,8,10,14-eicosatetraenoate (12-HETE). The 12-hydroperoxides are preferentially formed in platelets. EC 1.13.11.31. [NIH] Arachidonate 15-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 15-hydroperoxyarachidonate (15-HPETE) which is rapidly converted to 15-hydroxy5,8,11,13-eicosatetraenoate (15-HETE). The 15-hydroperoxides are preferentially formed in neutrophils and lymphocytes. EC 1.13.11.33. [NIH] Arachidonate Lipoxygenases: Enzymes catalyzing the oxidation of arachidonic acid to hydroperoxyarachidonates (HPETES). These products are then rapidly converted by a peroxidase to hydroxyeicosatetraenoic acids (HETES). The positional specificity of the enzyme reaction varies from tissue to tissue. The final lipoxygenase pathway leads to the leukotrienes. EC 1.13.11.- . [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU]

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ATP: ATP an abbreviation for adenosine triphosphate, a compound which serves as a carrier of energy for cells. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Autopsy: Postmortem examination of the body. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopsy specimen: Tissue removed from the body and examined under a microscope to determine whether disease is present. [NIH]

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Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Regions: Anatomical areas of the body. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate

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gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Chamomile: Common name for several daisy-like species native to Europe and Western Asia, now naturalized in the United States and Australia. The dried flower-heads of two species, Anthemis nobilis (Chamaemelum nobile) and Matricaria recutita, have specific use as herbs. They are administered as tea, extracts, tinctures, or ointments. Chamomile contains choline, coumarins, cyanogenic glycosides, flavonoids, salicylate derivatives, tannins, and volatile oils. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic prostatitis: Inflammation of the prostate gland, developing slowly and lasting a long time. [NIH] Chymopapain: A cysteine endopeptidase isolated from papaya latex. Preferential cleavage at glutamic and aspartic acid residues. EC 3.4.22.6. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH]

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Claudication: Limping or lameness. [EU] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Coculture: The culturing of normal cells or tissues with infected or latently infected cells or tissues of the same kind (From Dorland, 28th ed, entry for cocultivation). It also includes culturing of normal cells or tissues with other normal cells or tissues. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Comedo: A plug of keratin and sebum within the dilated orifice of a hair follicle, frequently containing the bacteria Propionibacterium acnes, Staphylococcus albus, and Pityrosporon ovale; called also blackhead. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with

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lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH]

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Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Cooperative group: A group of physicians, hospitals, or both formed to treat a large number of persons in the same way so that new treatment can be evaluated quickly. Clinical trials of new cancer treatments often require many more people than a single physician or hospital can care for. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Coumarins: Synthetic or naturally occurring substances related to coumarin, the deltalactone of coumarinic acid. Coumarin itself occurs in the tonka bean. The various coumarins have a wide range of proposed actions and uses including as anticoagulants, pharmaceutical aids, indicators and reagents, photoreactive substances, and antineoplastic agents. [NIH] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Criterion: A standard by which something may be judged. [EU] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyproterone: An anti-androgen that, in the form of its acetate, also has progestational properties. It is used in the treatment of hypersexuality in males, as a palliative in prostatic carcinoma, and, in combination with estrogen, for the therapy of severe acne and hirsutism in females. [NIH] Cyproterone Acetate: An agent with anti-androgen and progestational properties. It shows competitive binding with dihydrotestosterone at androgen receptor sites. [NIH] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it

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(phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Deoxyribonucleic: A polymer of subunits called deoxyribonucleotides which is the primary genetic material of a cell, the material equivalent to genetic information. [NIH] Deoxyribonucleic acid: A polymer of subunits called deoxyribonucleotides which is the primary genetic material of a cell, the material equivalent to genetic information. [NIH] Deoxyribonucleotides: A purine or pyrimidine base bonded to a deoxyribose containing a bond to a phosphate group. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic pressure: The lowest pressure to which blood pressure falls between contractions of the ventricles. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used

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for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] DNA Topoisomerase: An enzyme catalyzing ATP-independent breakage of single-stranded DNA, followed by passage and rejoining of another single-stranded DNA. This enzyme class brings about the conversion of one topological isomer of DNA into another, e.g., the relaxation of superhelical turns in DNA, the interconversion of simple and knotted rings of single-stranded DNA, and the intertwisting of single-stranded rings of complementary sequences. (From Enzyme Nomenclature, 1992) EC 5.99.1.2. [NIH] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU]

Dyspepsia: Impaired digestion, especially after eating. [NIH] Echinacea: A genus of perennial herbs used topically and internally. It contains echinacoside, glycosides, inulin, isobutyl amides, resin, and sesquiterpenes. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryogenesis: The process of embryo or embryoid formation, whether by sexual (zygotic) or asexual means. In asexual embryogenesis embryoids arise directly from the explant or on intermediary callus tissue. In some cases they arise from individual cells (somatic cell embryoge). [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph

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vessels, and the heart. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation of the intestinal mucosa of the small and large bowel. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermal Growth Factor: A 6 kD polypeptide growth factor initially discovered in mouse submaxillary glands. Human epidermal growth factor was originally isolated from urine based on its ability to inhibit gastric secretion and called urogastrone. epidermal growth factor exerts a wide variety of biological effects including the promotion of proliferation and differentiation of mesenchymal and epithelial cells. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Evacuation: An emptying, as of the bowels. [EU] Exhaustion: The feeling of weariness of mind and body. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extemporaneous: Compounded according to a physician's prescription; prepared when ordered; not ready-made. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture

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dishes adhere. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Facial: Of or pertaining to the face. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetoprotein: Transabdominal aspiration of fluid from the amniotic sac with a view to detecting increases of alpha-fetoprotein in maternal blood during pregnancy, as this is an important indicator of open neural tube defects in the fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibroblast Growth Factor: Peptide isolated from the pituitary gland and from the brain. It is a potent mitogen which stimulates growth of a variety of mesodermal cells including chondrocytes, granulosa, and endothelial cells. The peptide may be active in wound healing and animal limb regeneration. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Finasteride: An orally active testosterone 5-alpha-reductase inhibitor. It is used as a surgical alternative for treatment of benign prostatic hyperplasia. [NIH] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Follicles: Shafts through which hair grows. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

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Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genistein: An isoflavonoid derived from soy products. It inhibits protein-tyrosine kinase and topoisomerase-ii (dna topoisomerase (atp-hydrolysing)) activity and is used as an antineoplastic and antitumor agent. Experimentally, it has been shown to induce G2 phase arrest in human and murine cell lines. [NIH] Genital: Pertaining to the genitalia. [EU] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Ginger: Deciduous plant rich in volatile oil (oils, volatile). It is used as a flavoring agent and has many other uses both internally and topically. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]

Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadorelin: A decapeptide hormone released by the hypothalamus. It stimulates the synthesis and secretion of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. [NIH] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with

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formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Habitat: An area considered in terms of its environment, particularly as this determines the type and quality of the vegetation the area can carry. [NIH] Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helminthiasis: Infestation with parasitic worms of the helminth class. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Hirsutism: Excess hair in females and children with an adult male pattern of distribution. The concept does not include hypertrichosis, which is localized or generalized excess hair. [NIH]

Histology: The study of tissues and cells under a microscope. [NIH] Homogenate: A suspension of animal tissue that is ground in the all-glass "homogenizer" described by Potter and Elvehjem in 1936. [NIH]

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Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxy Acids: Organic compounds containing both the hydroxyl and carboxyl radicals. [NIH]

Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hypertrichosis: Localized or generalized excess hair. The concept does not include hirsutism, which is excess hair in females and children with an adult male pattern of distribution. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH]

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Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Information Centers: Facilities for collecting and organizing information. They may be specialized by subject field, type of source material, persons served, location, or type of services. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to

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fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involution: 1. A rolling or turning inward. 2. One of the movements involved in the gastrulation of many animals. 3. A retrograde change of the entire body or in a particular organ, as the retrograde changes in the female genital organs that result in normal size after delivery. 4. The progressive degeneration occurring naturally with advancing age, resulting in shrivelling of organs or tissues. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kava: Dried rhizome and roots of Piper methysticum, a shrub native to Oceania and known for its anti-anxiety and sedative properties. Heavy usage results in some adverse effects. It contains alkaloids, lactones, kawain, methysticin, mucilage, starch, and yangonin. Kava is also the name of the pungent beverage prepared from the plant's roots. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laser therapy: The use of an intensely powerful beam of light to kill cancer cells. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series,

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lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leuprolide: A potent and long acting analog of naturally occurring gonadotropin-releasing hormone (gonadorelin). Its action is similar to gonadorelin, which regulates the synthesis and release of pituitary gonadotropins. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Lipid: Fat. [NIH] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5lipoxygenase, arachidonate 12-lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [NIH]

Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lycopene: A red pigment found in tomatoes and some fruits. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe

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than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membranes: Thin layers of tissue which cover parts of the body, separate adjacent cavities, or connect adjacent structures. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH]

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Milk Thistle: The plant Silybum marianum in the family Asteraceae containing the bioflavonoid complex silymarin. For centuries this has been used traditionally to treat liver disease. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU]

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Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurotic: 1. Pertaining to or characterized by neurosis. 2. A person affected with a neurosis. [EU]

Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nocturia: Excessive urination at night. [EU] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oocytes: Female germ cells in stages between the prophase of the first maturation division and the completion of the second maturation division. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overactive bladder: A condition in which the patient experiences two or all three of the following conditions: [NIH] Overdosage: 1. The administration of an excessive dose. 2. The condition resulting from an excessive dose. [EU] Oxidants: Oxidizing agents or electron-accepting molecules in chemical reactions in which electrons are transferred from one molecule to another (oxidation-reduction). In vivo, it appears that phagocyte-generated oxidants function as tumor promoters or cocarcinogens rather than as complete carcinogens perhaps because of the high levels of endogenous antioxidant defenses. It is also thought that oxidative damage in joints may trigger the

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autoimmune response that characterizes the persistence of the rheumatoid disease process. [NIH]

Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Papain: A proteolytic enzyme obtained from Carica papaya. It is also the name used for a purified mixture of papain and chymopapain that is used as a topical enzymatic debriding agent. EC 3.4.22.2. [NIH] Papilla: A small nipple-shaped elevation. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perennial: Lasting through the year of for several years. [EU] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH]

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Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] Phagocyte: An immune system cell that can surround and kill microorganisms and remove dead cells. Phagocytes include macrophages. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physician Assistants: Persons academically trained, licensed, or credentialed to provide medical care under the supervision of a physician. The concept does not include nurses, but does include orthopedic assistants, surgeon's assistants, and assistants to other specialists. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Poison Control Centers: Facilities which provide information concerning poisons and treatment of poisoning in emergencies. [NIH]

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Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Pollen: The male fertilizing element of flowering plants analogous to sperm in animals. It is released from the anthers as yellow dust, to be carried by insect or other vectors, including wind, to the ovary (stigma) of other flowers to produce the embryo enclosed by the seed. The pollens of many plants are allergenic. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Progressive disease: Cancer that is increasing in scope or severity. [NIH] Promyelocytic leukemia: A type of acute myeloid leukemia, a quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. [NIH]

Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward

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opposite poles. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Prostatitis: Inflammation of the prostate. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protein-Tyrosine Kinase: An enzyme that catalyzes the phosphorylation of tyrosine residues in proteins with ATP or other nucleotides as phosphate donors. EC 2.7.1.112. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH]

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Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptivity: The condition of the reproductive organs of a female flower that permits effective pollination. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH]

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Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Residual Volume: The volume of air remaining in the lungs at the end of a maximal expiration. Common abbreviation is RV. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinaldehyde: A carotenoid constituent of visual pigments. It is the oxidized form of retinol which functions as the active component of the visual cycle. It is bound to the protein opsin forming the complex rhodopsin. When stimulated by visible light, the retinal component of the rhodopsin complex undergoes isomerization at the 11-position of the double bond to the cis-form; this is reversed in "dark" reactions to return to the native transconfiguration. [NIH] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU]

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Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rutin: 3-((6-O-(6-Deoxy-alpha-L-mannopyranosyl)-beta-D-glucopyranosyl)oxy)-2-(3,4dihydroxyphenyl)-5,7-dihydroxy-4H-1-benzopyran-4-one. Found in many plants, including buckwheat, tobacco, forsythia, hydrangea, pansies, etc. It has been used therapeutically to decrease capillary fragility. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Salicylic: A tuberculosis drug. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Scleroproteins: Simple proteins characterized by their insolubility and fibrous structure. Within the body, they perform a supportive or protective function. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Sebum: The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight

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78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Silymarin: A mixture of flavonoids extracted from seeds of the milk thistle, Silybum marianum. It consists primarily of three isomers: silicristin, silidianin, and silybin, its major component. Silymarin displays antioxidant and membrane stabilizing activity. It protects various tissues and organs against chemical injury, and shows potential as an antihepatoxic agent. [NIH] Sinclair: A special glue for applying extension in fractures. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin graft: Skin that is moved from one part of the body to another. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU]

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Spasmodic: Of the nature of a spasm. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Sperm: The fecundating fluid of the male. [NIH] Standard therapy: A currently accepted and widely used treatment for a certain type of cancer, based on the results of past research. [NIH] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulants: Any drug or agent which causes stimulation. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Submaxillary: Four to six lymph glands, located between the lower jaw and the submandibular salivary gland. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

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Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow. [NIH] Tea Tree Oil: Essential oil extracted from Melaleuca alternifolia (tea tree). It is used as a topical antimicrobial due to the presence of terpineol. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testicular: Pertaining to a testis. [EU] Testimonials: Information provided by individuals who claim to have been helped or cured by a particular product. The information provided lacks the necessary elements to be evaluated in a rigorous and scientific manner and is not used in the scientific literature. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thoracic: Having to do with the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH]

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Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Transurethral resection of the prostate: Surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. Also called TURP. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Tretinoin: An important regulator of gene expression, particularly during growth and development and in neoplasms. Retinoic acid derived from maternal vitamin A is essential for normal gene expression during embryonic development and either a deficiency or an excess can be teratogenic. It is also a topical dermatologic agent which is used in the treatment of psoriasis, acne vulgaris, and several other skin diseases. It has also been approved for use in promyelocytic leukemia. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other

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body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Urokinase: A drug that dissolves blood clots or prevents them from forming. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular

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nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Void: To urinate, empty the bladder. [NIH] Watchful waiting: Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called observation. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

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INDEX 5 5-alpha, 5, 16, 17, 31, 86, 98 A Abdomen, 86, 90, 96, 102, 104, 116 Abdominal, 60, 86, 92, 99, 108 Abdominal Cramps, 60, 86 Abdominal Pain, 60, 86, 99 Acne, 55, 57, 86, 94, 113, 118 Acne Vulgaris, 86, 118 Adenylate Cyclase, 45, 86 Adjuvant, 86, 99 Adrenal Cortex, 86, 87, 97, 110 Adrenergic, 3, 7, 15, 50, 53, 54, 56, 86, 96, 97 Adverse Effect, 4, 5, 6, 8, 30, 86, 103, 115 Affinity, 86, 115 AFP, 4, 86 Agonist, 52, 86 Aldosterone, 47, 53, 86 Algorithms, 87, 90 Alopecia, 26, 31, 35, 37, 45, 47, 53, 87 Alpha-1, 53, 54, 87, 96 Alpha-helix, 87, 103 Alternative medicine, 5, 31, 64, 87 Amino Acids, 25, 33, 87, 108, 110, 111, 117 Anal, 60, 87 Anal Fissure, 60, 87 Analog, 87, 104 Analogous, 87, 110, 118 Androgenic, 45, 47, 52, 53, 54, 55, 87 Androgens, 18, 26, 36, 45, 47, 52, 53, 86, 87 Anemia, 87, 104 Angiogenesis, 5, 87 Anorexia, 87, 99 Antagonism, 3, 87 Antiandrogens, 52, 87 Antibiotic, 87, 108 Antibody, 86, 87, 88, 92, 101, 102, 112, 116 Antigen, 4, 5, 8, 65, 86, 88, 93, 101, 102 Anti-inflammatory, 13, 88, 114 Antimicrobial, 88, 117 Antineoplastic, 88, 94, 99 Antioxidant, 46, 88, 107, 115 Anus, 87, 88, 90, 98, 113 Anxiety, 4, 88, 103 Apoptosis, 13, 19, 20, 88 Arachidonate 12-Lipoxygenase, 88, 104 Arachidonate 15-Lipoxygenase, 88, 104

Arachidonate Lipoxygenases, 88, 104 Arginine, 48, 88 Arterial, 88, 101, 111, 117 Arteries, 88, 90, 94, 105, 106 Assay, 13, 88 ATP, 86, 89, 96, 99, 111 Atrophy, 13, 89 Autopsy, 54, 89 B Back Pain, 46, 89 Bacteria, 87, 88, 89, 92, 96, 98, 119 Bacteriuria, 89, 119 Base, 89, 95, 103, 117 Bile, 89, 98, 103, 104, 116 Bile Ducts, 89, 98 Bile Pigments, 89, 103 Bilirubin, 89, 98, 101 Binding Sites, 47, 53, 89 Biological therapy, 89, 100 Biomarkers, 8, 89 Biopsy, 13, 26, 36, 89 Biopsy specimen, 13, 89 Biosynthesis, 57, 90 Biotechnology, 16, 64, 71, 90 Bladder, 10, 46, 48, 50, 55, 60, 65, 89, 90, 94, 102, 107, 111, 114, 119, 120 Bloating, 90, 102 Blood pressure, 76, 90, 95, 101, 106, 108, 115 Blood vessel, 87, 90, 96, 100, 103, 105, 108, 109, 115, 116, 118, 119 Body Fluids, 89, 90, 115, 119 Body Regions, 90, 92 Bone Marrow, 90, 101, 104, 110, 115, 116 Bowel, 60, 86, 87, 90, 95, 97, 102, 116 Bowel Movement, 90, 95, 116 Branch, 83, 90, 108, 116, 117 Breakdown, 90, 95, 98, 107 C Calculi, 90, 100 Callus, 90, 96 Capsules, 44, 90, 99 Carbon Dioxide, 49, 56, 90, 109, 113 Carcinogenic, 90, 116 Carcinogens, 90, 107 Carcinoma, 58, 90, 94 Cardiac, 58, 90, 97, 106, 116 Carnitine, 45, 90

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Case report, 24, 32, 91, 92 Cell Death, 88, 91, 106 Cell Division, 89, 91, 100, 106, 109, 110 Cell proliferation, 13, 19, 91 Cell Survival, 91, 100 Cellulose, 91, 109 Chamomile, 30, 91 Chlorine, 49, 91 Cholelithiasis, 60, 91 Cholesterol, 89, 91, 96, 98, 101, 116 Choline, 91 Chromatin, 88, 91, 107 Chronic, 4, 11, 13, 31, 50, 52, 55, 86, 89, 91, 96, 102, 103, 111, 116 Chronic prostatitis, 4, 52, 91 Chymopapain, 91, 108 CIS, 91, 113 Claudication, 4, 92 Clinical study, 92, 93 Clinical trial, 4, 7, 8, 9, 11, 12, 14, 15, 41, 42, 71, 92, 93, 94, 111, 112 Cloning, 90, 92 Coagulation, 30, 92 Cochlear, 92, 118, 119, 120 Cochlear Diseases, 92, 118 Coculture, 20, 92 Colic, 60, 92 Colitis, 60, 92 Collagen, 92, 98, 99 Combination Therapy, 50, 92 Comedo, 55, 92 Complement, 92, 93 Complementary and alternative medicine, 5, 13, 29, 30, 40, 93 Complementary medicine, 30, 93 Computational Biology, 71, 93 Concomitant, 11, 93 Conjugated, 93, 94 Connective Tissue, 44, 90, 92, 93, 99, 105 Connective Tissue Cells, 93 Consciousness, 93, 95 Constipation, 60, 93 Consumption, 93, 99, 113 Contamination, 30, 93 Contraindications, ii, 60, 93 Control group, 6, 93 Controlled clinical trial, 10, 93, 112 Controlled study, 12, 94 Cooperative group, 10, 94 Coronary, 94, 105, 106 Coronary Thrombosis, 94, 105, 106 Cortex, 94

Coumarins, 91, 94 Craniocerebral Trauma, 94, 118 Creatinine, 9, 94 Criterion, 11, 94 Curative, 94, 117 Cyclic, 86, 94 Cyproterone, 47, 53, 94 Cyproterone Acetate, 47, 53, 94 Cystoscopy, 65, 94 Cytochrome, 33, 94 Cytoplasm, 88, 94, 107 Cytotoxic, 20, 95, 112 D Data Collection, 10, 95 Databases, Bibliographic, 71, 95 Degenerative, 95, 100 Dehydration, 60, 95 Deletion, 88, 95 Dementia, 4, 95 Deoxyribonucleic, 31, 95 Deoxyribonucleic acid, 31, 95 Deoxyribonucleotides, 95 Dermal, 47, 53, 95 Diagnostic procedure, 43, 64, 95 Diarrhea, 60, 95 Diarrhoea, 95, 99 Diastole, 95 Diastolic, 76, 95, 101 Diastolic pressure, 76, 95, 101 Digestion, 89, 90, 95, 96, 102, 104, 116 Digestive system, 42, 95 Dihydrotestosterone, 5, 16, 45, 55, 57, 86, 94, 95, 113 Diploid, 95, 109 Direct, iii, 7, 14, 15, 55, 95, 113 Disease Progression, 8, 9, 95 DNA Topoisomerase, 96, 99 Doxazosin, 56, 96 Drug Interactions, 4, 29, 96 Duodenum, 89, 96, 116 Dyes, 96, 107 Dysentery, 60, 96 Dyspepsia, 96, 102 E Echinacea, 4, 26, 29, 30, 36, 96 Efficacy, 4, 6, 7, 9, 10, 11, 13, 15, 18, 20, 30, 51, 55, 96, 118 Electrocoagulation, 92, 96 Electrolyte, 87, 96, 110, 115 Electrons, 88, 89, 96, 103, 107, 108, 112 Embryo, 96, 102, 110 Embryogenesis, 26, 96

Index 123

Enamel, 96, 103 Endemic, 96, 104 Endothelial cell, 96, 98 Enhancer, 46, 53, 54, 60, 97 Enteritis, 60, 97 Enterocolitis, 97 Environmental Health, 70, 72, 97 Enzymatic, 55, 93, 97, 108, 113 Enzyme, 16, 19, 45, 46, 52, 86, 88, 96, 97, 99, 104, 105, 108, 109, 111, 113, 120 Epidermal, 18, 97, 105 Epidermal Growth Factor, 18, 97 Epidermis, 97, 103, 112 Epinephrine, 86, 97, 107 Epithelial, 5, 13, 50, 97, 100 Epithelial Cells, 97, 100 Epithelium, 5, 13, 97 Esophagus, 95, 97, 100, 116 Estradiol, 47, 53, 97 Estrogen, 55, 94, 97 Ethnic Groups, 10, 97 Evacuation, 93, 97 Exhaustion, 87, 97, 104 Expiration, 97, 113 Extemporaneous, 26, 35, 97 Extracellular, 93, 97, 98, 115 Extracellular Matrix, 93, 97, 98 Extraction, 54, 56, 98 F Facial, 55, 57, 98 Family Planning, 71, 98 Fat, 90, 98, 104, 114, 117 Fatty acids, 98, 104 Feces, 93, 98, 116 Fetoprotein, 86, 98 Fetus, 86, 98, 109 Fibrinogen, 98, 109 Fibroblast Growth Factor, 18, 98 Fibroblasts, 19, 93, 98 Finasteride, 4, 5, 6, 15, 16, 17, 26, 31, 36, 56, 65, 98 Flatulence, 60, 98 Flatus, 98 Follicles, 57, 98 Forearm, 90, 98 G Gallbladder, 86, 89, 95, 98 Gallstones, 60, 91, 98 Gamma Rays, 98, 112 Gas, 60, 90, 91, 98, 101, 102, 107 Gastric, 52, 91, 97, 98, 100 Gastrin, 98, 101

Gastritis, 60, 99 Gastroenteritis, 60, 99 Gastrointestinal, 60, 97, 98, 99, 104, 116, 119 Gastrointestinal tract, 98, 99, 119 Gelatin, 44, 99, 117 Gene, 90, 99, 118 Gene Expression, 99, 118 Genistein, 48, 99 Genital, 99, 103 Germ Cells, 99, 107, 117 Ginger, 30, 46, 99 Ginseng, 4, 26, 29, 30, 36, 39, 48, 99 Gland, 13, 46, 47, 65, 86, 99, 108, 109, 111, 114, 116 Glomerular, 99, 103, 113 Glutathione Peroxidase, 99, 115 Gonad, 51, 99 Gonadal, 99, 116 Gonadorelin, 99, 104 Gonadotropin, 58, 99, 104 Gout, 60, 99 Governing Board, 100, 110 Grade, 50, 51, 100 Graft, 100, 101 Growth, 5, 16, 25, 32, 34, 44, 45, 46, 47, 49, 50, 53, 54, 63, 87, 88, 91, 97, 98, 100, 105, 106, 109, 118 Growth factors, 5, 50, 100 H Habitat, 100 Haematoma, 100 Haemorrhage, 24, 32, 100 Hair follicles, 47, 55, 57, 100 Haploid, 100, 109 Health Status, 16, 100 Heartburn, 100, 102 Helminthiasis, 60, 100 Heme, 89, 94, 100 Hemorrhage, 60, 94, 96, 100, 112, 116 Hemorrhoids, 60, 100 Hepatitis, 60, 100 Hepatocytes, 100 Hereditary, 45, 99, 100 Hirsutism, 57, 94, 100, 101 Histology, 13, 100 Homogenate, 13, 100 Hormonal, 47, 50, 51, 53, 57, 89, 101 Hormone, 10, 13, 19, 45, 55, 57, 60, 86, 97, 98, 99, 101, 104, 110, 117 Host, 16, 101 Hydrogen, 89, 99, 101, 106, 108

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Hydrolysis, 101, 110, 111 Hydroxy Acids, 57, 101 Hyperbilirubinemia, 101, 103 Hypercholesterolemia, 60, 101 Hyperplasia, 4, 9, 20, 25, 48, 50, 54, 55, 65, 101 Hypertension, 30, 76, 96, 101, 102 Hyperthermia, 12, 101 Hypertrichosis, 100, 101 Hypertrophy, 19, 45, 46, 50, 53, 54, 55, 89, 101 Hyperuricemia, 99, 101 I Id, 27, 37, 77, 82, 84, 101 Immune response, 86, 88, 101, 116, 120 Immunization, 101, 110 Immunologic, 101, 112 Impairment, 101, 105 Impotence, 46, 60, 102 In situ, 26, 36, 102 In vitro, 3, 16, 35, 63, 102 In vivo, 32, 102, 107 Incision, 65, 102, 103, 111 Incontinence, 7, 8, 9, 10, 11, 15, 102 Indicative, 60, 102, 108, 119 Indigestion, 60, 102 Induction, 19, 87, 102 Infarction, 102 Infection, 8, 38, 65, 89, 99, 102, 104, 108, 116 Inflammation, 13, 86, 88, 91, 92, 96, 97, 99, 100, 102, 103, 111 Information Centers, 60, 102 Insight, 8, 11, 102 Intermittent, 4, 102 Interstitial, 102, 113 Intestinal, 55, 60, 97, 102 Intestine, 90, 97, 102, 103 Intoxication, 102, 120 Intracellular, 102, 110, 115 Intracranial Hypertension, 102, 118 Inulin, 96, 102 Invasive, 7, 8, 11, 12, 44, 65, 103 Involution, 13, 103 Ionizing, 103, 112 Irritants, 96, 103 Ischemia, 89, 103 J Jaundice, 60, 101, 103 Joint, 11, 103, 117 K Kava, 4, 26, 33, 36, 103

Kb, 70, 103 Keratin, 55, 92, 103, 114 Kidney Disease, 41, 42, 70, 76, 103 L Large Intestine, 95, 102, 103, 113, 115 Laser therapy, 65, 103 Latent, 103, 110 Lesion, 55, 103 Leucocyte, 87, 103 Leukocytes, 90, 104, 107 Leuprolide, 58, 104 Libido, 87, 104 Library Services, 82, 104 Ligament, 104, 111 Lipid, 18, 91, 104 Lipoxygenase, 46, 88, 104 Liver, 30, 60, 86, 89, 90, 95, 98, 100, 104, 106 Liver cancer, 86, 104 Localized, 100, 101, 102, 104, 109 Locomotion, 104, 109 Lumbar, 89, 104 Lycopene, 48, 104 Lymphatic, 102, 104, 105, 115 Lymphocyte, 88, 104 M Malaria, 60, 104 Malaria, Falciparum, 104, 105 Malaria, Vivax, 104 Malignant, 13, 88, 104, 105, 106, 112 Malnutrition, 89, 105 Manifest, 11, 105 Medicament, 51, 105, 117 MEDLINE, 71, 105 Melanocytes, 105 Melanoma, 16, 105 Membranes, 103, 105, 106, 113 Memory, 4, 87, 95, 105 Mental Disorders, 42, 105, 110 Mental Health, iv, 6, 42, 70, 72, 105, 110 Mesenchymal, 97, 105 Meta-Analysis, 6, 9, 35, 105 Metabolic disorder, 99, 105 Metabolite, 47, 53, 105 Metastasis, 105 Metastatic, 51, 105 Methionine, 48, 105, 117 MI, 85, 105 Milk Thistle, 30, 106, 115 Mitochondrial Swelling, 106 Mitosis, 88, 106 Mitotic, 49, 106

Index 125

Modification, 16, 106, 112 Molecular, 25, 32, 34, 71, 73, 90, 93, 98, 106, 109 Molecule, 47, 53, 88, 89, 93, 101, 106, 107, 108, 112 Monitor, 94, 106, 107 Motion Sickness, 106 Mucus, 96, 106 Myocardial infarction, 57, 94, 105, 106 Myocardium, 105, 106 N Nausea, 60, 99, 102, 106, 119 NCI, 1, 16, 42, 69, 91, 106 Necrosis, 20, 88, 102, 105, 106 Need, 3, 7, 12, 16, 25, 33, 46, 48, 59, 61, 65, 78, 106 Neoplasia, 106 Neoplasm, 13, 106 Neoplastic, 14, 106 Nephropathy, 30, 103, 107 Nerve, 86, 107, 119, 120 Networks, 12, 107 Neurogenic, 107, 119 Neurotic, 107, 119 Neutrophils, 18, 88, 104, 107 Nitrogen, 87, 107 Nocturia, 6, 10, 50, 107 Norepinephrine, 86, 107 Nuclear, 25, 34, 96, 98, 106, 107 Nucleus, 46, 57, 88, 91, 94, 98, 107, 110, 120 O Office Visits, 50, 107 Ointments, 91, 107 Oocytes, 31, 107 Opsin, 107, 113 Ovary, 97, 99, 107, 110 Overactive bladder, 48, 107 Overdosage, 60, 107 Oxidants, 49, 107 Oxidation, 88, 94, 99, 107, 108 Oxidation-Reduction, 107, 108 P Palliative, 94, 108, 117 Pancreas, 86, 89, 95, 108, 119 Pancreatic, 91, 108 Papain, 52, 108 Papilla, 47, 53, 108 Parasitic, 96, 100, 108 Pathogenesis, 9, 108 Pathologic, 88, 89, 94, 101, 108, 111 Pathologic Processes, 88, 108 Pathophysiology, 9, 108

Patient Education, 76, 80, 82, 85, 108 Pelvic, 11, 31, 108, 111 Penicillin, 87, 108 Peptide, 98, 103, 108, 110, 111 Perennial, 96, 108 Peripheral Vascular Disease, 57, 108 Petechiae, 100, 109 Phagocyte, 107, 109 Pharmaceutical Preparations, 91, 99, 109 Pharmacologic, 109, 118, 119 Photocoagulation, 92, 109 Physical Examination, 10, 54, 109 Physician Assistants, 6, 109 Physiologic, 86, 90, 103, 109, 112 Pigment, 89, 104, 105, 109 Pituitary Gland, 98, 99, 109 Placenta, 97, 109, 110 Plants, 47, 51, 60, 90, 91, 99, 102, 107, 109, 110, 114, 118 Plasma, 19, 98, 99, 109, 115 Plasmin, 109 Plasminogen, 19, 109 Plasminogen Activators, 109 Pleated, 103, 109 Poison Control Centers, 60, 109 Poisoning, 99, 102, 106, 109, 110 Pollen, 48, 110, 112 Polypeptide, 92, 97, 98, 109, 110 Polysaccharide, 88, 91, 110 Posterior, 87, 89, 108, 110 Potassium, 87, 110 Practicability, 110, 118 Practice Guidelines, 72, 110 Precursor, 91, 97, 107, 109, 110 Predisposition, 47, 53, 110 Primary Prevention, 16, 110 Progesterone, 110, 116 Progression, 7, 8, 9, 10, 14, 110 Progressive, 9, 50, 95, 100, 103, 106, 110, 113 Progressive disease, 9, 110 Promyelocytic leukemia, 110, 118 Prophase, 107, 110 Prostate gland, 46, 54, 55, 65, 76, 91, 111 Prostatectomy, 10, 51, 56, 65, 111 Prostatic Hyperplasia, 3, 4, 5, 6, 7, 8, 9, 10, 12, 13, 15, 16, 17, 18, 19, 20, 21, 24, 25, 26, 31, 32, 33, 34, 35, 36, 37, 38, 41, 47, 50, 55, 65, 76, 89, 98, 111 Prostatitis, 11, 31, 38, 46, 47, 52, 111 Protease, 52, 92, 111 Protein S, 90, 111

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Proteins, 87, 88, 91, 92, 103, 106, 107, 108, 109, 111, 114, 115, 118 Protein-Tyrosine Kinase, 99, 111 Proteolytic, 52, 87, 92, 98, 108, 109, 111 Protocol, 9, 10, 11, 12, 14, 111 Protozoa, 96, 111 Psoriasis, 111, 113, 118 Psychogenic, 111, 119 Puberty, 45, 111 Public Policy, 71, 111 Pulmonary, 52, 90, 91, 93, 111, 112, 117, 119 Pulmonary Artery, 90, 112, 119 Pulmonary Edema, 91, 112 Purpura, 100, 112 Q Quality of Life, 8, 9, 10, 15, 50, 112 Quercetin, 52, 112 R Radiation, 98, 101, 103, 112, 120 Radioactive, 101, 107, 112 Radioimmunotherapy, 112 Radiotherapy, 51, 112 Randomized, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 20, 25, 31, 33, 96, 112 Randomized clinical trial, 4, 13, 14, 15, 16, 112 Randomized Controlled Trials, 6, 112 Reagent, 91, 112 Receptivity, 47, 53, 112 Receptor, 3, 5, 7, 13, 36, 55, 57, 88, 94, 112 Rectal, 15, 60, 65, 113 Rectum, 88, 90, 95, 98, 102, 103, 111, 113, 117 Reductase, 3, 5, 7, 12, 16, 17, 18, 20, 31, 46, 56, 98, 113 Refer, 1, 92, 104, 112, 113 Regeneration, 26, 98, 113 Regimen, 11, 45, 96, 113 Reliability, 31, 113 Renal failure, 10, 50, 113 Reproductive system, 111, 113 Resection, 113, 118 Residual Volume, 10, 113 Respiration, 90, 106, 113 Retinal, 113 Retinaldehyde, 57, 113 Retinoids, 113 Retinol, 57, 113 Retrograde, 103, 113 Retropubic, 111, 114 Retrospective, 16, 114

Rheumatoid, 108, 114 Rigidity, 109, 114 Risk factor, 16, 114 Rutin, 112, 114 S Salicylate, 91, 114 Salicylic, 57, 114 Salivary, 95, 114, 116 Salivary glands, 95, 114 Saponins, 114, 116 Schizoid, 114, 120 Schizophrenia, 114, 120 Schizotypal Personality Disorder, 114, 120 Scleroproteins, 103, 114 Screening, 92, 114, 119 Scrotum, 114, 117 Sebaceous, 55, 57, 103, 114 Sebaceous gland, 55, 57, 103, 114 Sebum, 54, 55, 57, 86, 92, 114 Secretion, 52, 54, 55, 57, 86, 97, 99, 106, 114, 115 Sedative, 103, 114, 119 Sediment, 114, 119 Selenium, 46, 48, 114 Semen, 111, 115 Serum, 4, 8, 10, 92, 96, 99, 115 Sex Characteristics, 87, 111, 115, 117 Side effect, 4, 5, 10, 13, 15, 29, 30, 46, 52, 60, 86, 89, 101, 115, 118 Silymarin, 106, 115 Sinclair, 26, 35, 115 Skeletal, 87, 115 Skeleton, 103, 115 Skin graft, 115, 116 Skull, 94, 115, 117 Small intestine, 89, 96, 97, 101, 102, 115 Smooth muscle, 50, 54, 93, 115, 116 Social Environment, 112, 115 Sodium, 87, 99, 115 Solid tumor, 87, 115 Solvent, 49, 56, 115 Somatic, 26, 96, 106, 115 Spasmodic, 86, 116 Specialist, 77, 116 Species, 91, 97, 99, 104, 106, 108, 116, 118 Specificity, 21, 86, 88, 116 Sperm, 31, 87, 110, 116, 117 Standard therapy, 7, 116 Statistically significant, 5, 116 Stents, 12, 65, 116 Steroid, 5, 19, 114, 116 Stimulants, 99, 116

Index 127

Stomach, 5, 60, 86, 95, 97, 98, 99, 101, 106, 115, 116 Stool, 102, 103, 116, 117 Stress, 99, 106, 110, 116 Stroke, 42, 57, 70, 116 Stromal, 50, 116 Subacute, 102, 116 Subclinical, 102, 116 Submaxillary, 97, 116 Subspecies, 116 Substance P, 105, 114, 116 Sulfur, 105, 117 Supplementation, 56, 117 Suppositories, 99, 117 Suppression, 13, 117 Surfactant, 54, 117 Symphysis, 111, 117 Symptomatic, 5, 6, 8, 14, 16, 17, 20, 24, 25, 32, 33, 34, 52, 64, 117 Symptomatology, 6, 117 Synergistic, 45, 117 Systemic, 90, 97, 102, 117 Systolic, 76, 101, 117 Systolic blood pressure, 76, 117 T Tea Tree Oil, 39, 49, 117 Temporal, 11, 117 Tenesmus, 96, 117 Teratogenic, 117, 118 Testicles, 57, 114, 117 Testicular, 52, 117 Testimonials, 25, 33, 117 Testis, 97, 117 Testosterone, 5, 16, 19, 46, 55, 57, 86, 98, 113, 117 Therapeutics, 19, 33, 117 Thoracic, 89, 117 Threshold, 101, 117 Thrombolytic, 109, 118 Thrombosis, 111, 116, 118 Tinnitus, 4, 118, 120 Topical, 26, 35, 44, 45, 49, 54, 57, 108, 117, 118 Toxic, iv, 30, 115, 118 Toxicity, 96, 118 Toxicology, 72, 118 Toxins, 88, 102, 112, 118 Transfection, 90, 118 Transplantation, 47, 101, 118

Transurethral, 7, 65, 111, 118 Transurethral Resection of Prostate, 111, 118 Transurethral resection of the prostate, 7, 65, 118 Trauma, 106, 118 Treatment Outcome, 14, 118 Tretinoin, 57, 118 Tuberculosis, 93, 114, 118 Tumor marker, 89, 118 U Unconscious, 101, 119 Uremia, 113, 119 Ureters, 119 Urethra, 54, 65, 89, 111, 118, 119 Uric, 100, 101, 119 Urinalysis, 10, 119 Urinary Retention, 7, 8, 9, 10, 11, 15, 119 Urinary tract, 3, 6, 7, 9, 10, 11, 12, 13, 14, 24, 25, 26, 32, 33, 34, 35, 48, 50, 89, 119 Urinary tract infection, 7, 9, 10, 11, 50, 89, 119 Urinate, 32, 46, 48, 54, 55, 65, 119, 120 Urine, 6, 8, 9, 15, 46, 50, 54, 65, 89, 90, 94, 97, 102, 119 Urodynamic, 11, 25, 34, 119 Urokinase, 19, 119 V Vaccine, 86, 111, 119 Valerian, 29, 30, 48, 59, 119 Vascular, 52, 102, 109, 119 Vein, 107, 119 Venous, 100, 111, 119 Ventricle, 112, 117, 119 Vestibulocochlear Nerve, 118, 119, 120 Vestibulocochlear Nerve Diseases, 118, 120 Veterinary Medicine, 71, 120 Virus, 97, 120 Vitro, 120 Vivo, 120 Void, 8, 10, 15, 120 W Watchful waiting, 8, 11, 15, 120 Withdrawal, 6, 30, 120 Wound Healing, 98, 120 X X-ray, 98, 107, 112, 120

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