Bilateral Health Dictionary

Formerly known as adult respiratory distress syndrome. A form of acute respiratory failure in which a variety of di?erent disorders give rise to lung injury by what is thought to be a common pathway. The condition has a high mortality rate (about 70 per cent); it is a complex clinical problem in which a disproportionate immunological response plays a major role. (See IMMUNITY.)

The exact trigger is unknown, but it is thought that, whatever the stimulus, chemical mediators produced by cells of the immune system or elsewhere in the body spread and sustain an in?ammatory reaction. Cascade mechanisms with multiple interactions are provoked. CYTOTOXIC substances (which damage or kill cells) such as oxygen-free radicals and PROTEASE damage the alveolar capillary membranes (see ALVEOLUS). Once this happens, protein-rich ?uid leaks into the alveoli and interstitial spaces. SURFACTANT is also lost. This impairs the exchange of oxygen and carbon dioxide in the lungs and gives rise to the clinical and pathological picture of acute respiratory failure.

The typical patient with ARDS has rapidly worsening hypoxaemia (lack of oxygen in the blood), often requiring mechanical ventilation. There are all the signs of respiratory failure (see TACHYPNOEA; TACHYCARDIA; CYANOSIS), although the chest may be clear apart from a few crackles. Radiographs show bilateral, patchy, peripheral shadowing. Blood gases will show a low PaO2 (concentration of oxygen in arterial blood) and usually a high PaCO2 (concentration of carbon dioxide in arterial blood). The lungs are ‘sti?’ – they are less e?ective because of the loss of surfactant and the PULMONARY OEDEMA.

Causes The causes of ARDS may be broadly divided into the following:... acute respiratory distress syndrome (ards)

This is literally de?ned as ‘deprivation of the power of generation’. In practical terms this involves surgical removal of both OVARIES, or both testicles (see TESTICLE). Such an operation is most commonly associated with the treatment of malignant lesions. In women who have reached the menopause, bilateral oophorectomy is routinely performed during HYSTERECTOMY, especially in cases of uterine carcinoma, and is usually performed when removing an ovarian tumour or malignant cyst. It is essential that the surgeon discusses with a woman before an operation when it might prove bene?cial to remove her ovaries in addition to carrying out the main procedure. In men, orchidectomy is routine for testicular tumours, and is sometimes carried out when treating prostatic cancer.... castration

An undescended testis (see TESTICLE). The testes normally descend into the scrotum during the seventh month of gestation; until then, the testis is an abdominal organ. If the testes do not descend before the ?rst year of life, they usually remain undescended until puberty – and even then, descent is not achieved in some instances. Fertility is impaired when one testis is affected and is usually absent in the bilateral cases. The incidence of undescended testis in full-term children at birth is 3·5 per cent, falling to less than 2 per cent at one month and 0·7 per cent at one year. Because of the high risk of infertility, undescended testes should be brought down as early as possible and at the latest by the age of two. Sometimes medical treatment with HUMAN CHORIONIC GONADOTROPHIN is helpful but frequently surgical interference is necessary. This is the operation of orchidopexy.... cryptorchidism

A controversial but sometimes rapidly e?ective treatment for cases of severe DEPRESSION, particularly where psychotic features are present (see PSYCHOSIS), or in high-risk patients such as suicidal or post-partum patients. ECT is only indicated after antidepressants have been tried and shown to be ine?ective; the full procedure of treatment should be explained to the patient, whose consent must be obtained.

Before treatment, the patient will have been fasted for at least eight hours. After checking for any potential drug ALLERGY or interactions, the patient is given a general anaesthetic and muscle relaxants. Depending on the side of the patient’s dominance, either unilateral (on the side of the non-dominant hemisphere of the BRAIN) or bilateral (if dominance is uncertain,

e.g. in left-handed people) positioning of electrodes is used. Unilateral ECT has the advantage of being associated with less anterograde AMNESIA. When the current passes, the muscles will contract for approximately 10 seconds, with further tonic spasms lasting up to a minute. The patient should then be put in the COMA or recovery position and observed until fully conscious. Up to 12 treatments may be given over a month, improvement usually showing after the third session. Widely used at one time, the treatment is now given only rarely. It can be extremely frightening for patients and relatives and is not recommended for children.... electroconvulsive therapy (ect)

Absence or defects of the uterus

Rarely, the UTERUS may be completely absent as a result of abnormal development. In such patients secondary sexual development is normal but MENSTRUATION is absent (primary amennorhoea). The chromosomal make-up of the patient must be checked (see CHROMOSOMES; GENES): in a few cases the genotype is male (testicular feminisation syndrome). No treatment is available, although the woman should be counselled.

The uterus develops as two halves which fuse together. If the fusion is incomplete, a uterine SEPTUM results. Such patients with a double uterus (uterus didelphys) may have fertility problems which can be corrected by surgical removal of the uterine septum. Very rarely there may be two uteri with a double vagina.

The uterus of most women points forwards (anteversion) and bends forwards (ante?exion). However, about 25 per cent of women have a uterus which is pointed backwards (retroversion) and bent backwards (retro?exion). This is a normal variant and very rarely gives rise to any problems. If it does, the attitude of the uterus can be corrected by an operation called a ventrosuspension.

Endometritis The lining of the uterine cavity is called the ENDOMETRIUM. It is this layer that is partially shed cyclically in women of reproductive age giving rise to menstruation. Infection of the endometrium is called endometritis and usually occurs after a pregnancy or in association with the use of an intrauterine contraceptive device (IUCD – see CONTRACEPTION). The symptoms are usually of pain, bleeding and a fever. Treatment is with antibiotics. Unless the FALLOPIAN TUBES are involved and damaged, subsequent fertility is unaffected. Very rarely, the infection is caused by TUBERCULOSIS. Tuberculous endometritis may destroy the endometrium causing permanent amenorrhoea and sterility.

Menstrual disorders are common. Heavy periods (menorrhagia) are often caused by ?broids (see below) or adenomyosis (see below) or by anovulatory cycles. Anovulatory cycles result in the endometrium being subjected to unopposed oestrogen stimulation and occasionally undergoing hyperplasia. Treatment is with cyclical progestogens (see PROGESTOGEN) initially. If this form of treatment fails, endoscopic surgery to remove the endometrium may be successful. The endometrium may be removed using LASER (endometrial laser ablation) or electrocautery (transcervical resection of endometrium). Hysterectomy (see below) will cure the problem if endoscopic surgery fails. Adenomyosis is a condition in which endometrial tissue is found in the muscle layer (myometrium) of the uterus. It usually presents as heavy and painful periods, and occasionally pain during intercourse. Hysterectomy is usually required.

Oligomenorhoea (scanty or infrequent periods) may be caused by a variety of conditions including thyroid disease (see THYROID GLAND, DISEASES OF). It is most commonly associated with usage of the combined oral contraceptive pill. Once serious causes have been eliminated, the patient should be reassured. No treatment is necessary unless conception is desired, in which case the patient may require induction of ovulation.

Primary amenorrhoea means that the patient has never had a period. She should be investigated, although usually it is only due to an inexplicable delay in the onset of periods (delayed menarche) and not to any serious condition. Secondary amenorrhoea is the cessation of periods after menstruation has started. The most common cause is pregnancy. It may be also caused by endocrinological or hormonal problems, tuberculous endometritis, emotional problems and severe weight loss. The treatment of amenorrhoea depends on the cause.

Dysmenorrhoea, or painful periods, is the most common disorder; in most cases the cause is unknown, although the disorder may be due to excessive production of PROSTAGLANDINS.

Irregular menstruation (variations from the woman’s normal menstrual pattern or changes in the duration of bleeding or the amount) can be the result of a disturbance in the balance of OESTROGENS and PROGESTERONE hormone which between them regulate the cycle. For some time after the MENARCHE or before the MENOPAUSE, menstruation may be irregular. If irregularity occurs in a woman whose periods are normally regular, it may be due to unsuspected pregnancy, early miscarriage or to disorders in the uterus, OVARIES or pelvic cavity. The woman should seek medical advice.

Fibroids (leiomyomata) are benign tumours arising from the smooth muscle layer (myometrium) of the uterus. They are found in 80 per cent of women but only a small percentage give rise to any problems and may then require treatment. They may cause heavy periods and occasionally pain. Sometimes they present as a mass arising from the pelvis with pressure symptoms from the bladder or rectum. Although they can be shrunk medically using gonadorelin analogues, which raise the plasma concentrations of LUTEINISING HORMONE and FOLLICLE-STIMULATING HORMONE, this is not a long-term solution. In any case, ?broids only require treatment if they are large or enlarging, or if they cause symptoms. Treatment is either myomectomy (surgical removal) if fertility is to be retained, or a hysterectomy.

Uterine cancers tend to present after the age of 40 with abnormal bleeding (intermenstrual or postmenopausal bleeding). They are usually endometrial carcinomas. Eighty per cent present with early (Stage I) disease. Patients with operable cancers should be treated with total abdominal hysterectomy and bilateral excision of the ovaries and Fallopian tubes. Post-operative RADIOTHERAPY is usually given to those patients with adverse prognostic factors. Pre-operative radiotherapy is still given by some centres, although this practice is now regarded as outdated. PROGESTOGEN treatment may be extremely e?ective in cases of recurrence, but its value remains unproven when used as adjuvant treatment. In 2003 in England and Wales, more than 2,353 women died of uterine cancer.

Disorders of the cervix The cervix (neck of the womb) may produce an excessive discharge due to the presence of a cervical ectopy or ectropion. In both instances columnar epithelium – the layer of secreting cells – which usually lines the cervical canal is exposed on its surface. Asymptomatic patients do not require treatment. If treatment is required, cryocautery – local freezing of tissue – is usually e?ective.

Cervical smears are taken and examined in the laboratory to detect abnormal cells shed from the cervix. Its main purpose is to detect cervical intraepithelial neoplasia (CIN) – the presence of malignant cells in the surface tissue lining the cervix – since up to 40 per cent of women with this condition will develop cervical cancer if the CIN is left untreated. Women with abnormal smears should undergo colposcopy, a painless investigation using a low-powered microscope to inspect the cervix. If CIN is found, treatment consists of simply removing the area of abnormal skin, either using a diathermy loop or laser instrument.

Unfortunately, cervical cancer remains the most common of gynaecological cancers. The most common type is squamous cell carcinoma and around 4,000 new cases (all types) are diagnosed in England and Wales every year. As many as 50 per cent of the women affected may die from the disease within ?ve years. Cervical cancer is staged clinically in four bands according to how far it has extended, and treatment is determined by this staging. Stage I involves only the mucosal lining of the cervix and cone BIOPSY may be the best treatment in young women wanting children. In Stage IV the disease has spread beyond the cervix, uterus and pelvis to the URINARY BLADDER or RECTUM. For most women, radiotherapy or radical Wertheim’s hysterectomy – the latter being preferable for younger women – is the treatment of choice if the cancer is diagnosed early, both resulting in survival rates of ?ve years in 80 per cent of patients. Wertheim’s hysterectomy is a major operation in which the uterus, cervix, upper third of vagina and the tissue surrounding the cervix are removed together with the LYMPH NODES draining the area. The ovaries may be retained if desired. Patients with cervical cancer are treated by radiotherapy, either because they present too late for surgery or because the surgical skill to perform a radical hysterectomy is not available. These operations are best performed by gynaecological oncologists who are gynaecological surgeons specialising in the treatment of gynaecological tumours. The role of CHEMOTHERAPY in cervical and uterine cancer is still being evaluated.

Prolapse of the uterus is a disorder in which the organ drops from its normal situation down into the vagina. First-degree prolapse is a slight displacement of the uterus, second-degree a partial displacement and third-degree when the uterus can be seen outside the VULVA. It may be accompanied by a CYSTOCOELE (the bladder bulges into the front wall of the vagina), urethrocoele (the urethra bulges into the vagina) and rectocoele (the rectal wall bulges into the rear wall of the vagina). Prolapse most commonly occurs in middle-aged women who have had children, but the condition is much less common now than in the past when prenatal and obstetric care was poor, women had more pregnancies and their general health was poor. Treatment is with pelvic exercises, surgical repair of the vagina or hysterectomy. If the woman does not want or is not ?t for surgery, an internal support called a pessary can be ?tted – and changed periodically.

Vertical section of female reproductive tract (viewed from front) showing sites of common gynaecological disorders.

Hysterectomy Many serious conditions of the uterus have traditionally been treated by hysterectomy, or removal of the uterus. It remains a common surgical operation in the UK, but is being superseded in the treatment of some conditions, such as persistent MENORRHAGIA, with endometrial ablation – removal of the lining of the uterus using minimally invasive techniques, usually using an ENDOSCOPE and laser. Hysterectomy is done to treat ?broids, cancer of the uterus and cervix, menorrhagia, ENDOMETRIOSIS and sometimes for severely prolapsed uterus. Total hysterectomy is the usual type of operation: it involves the removal of the uterus and cervix and sometimes the ovaries. After hysterectomy a woman no longer menstruates and cannot become pregnant. If the ovaries have been removed as well and the woman had not reached the menopause, hormone replacement therapy (HRT – see MENOPAUSE) should be considered. Counselling helps the woman to recover from the operation which can be an emotionally challenging event for many.... uterus, diseases of

The prefix meaning 2 or twice, as in bilateral (2-sided).... bi-

Relating to, or situated on, one side.

“Bilateral” means “on both sides”.... lateral

(ARN) severe inflammation and necrosis of the retina associated with inflammation and blockage of retinal blood vessels, haemorrhage and death of retinal tissue, and retinal detachment. It may affect both eyes (bilateral acute retinal necrosis, BARN), and visual prognosis is poor. ARN is thought to be due to viral infection.... acute retinal necrosis

n. disease of the *tubulointerstitium of the kidney associated with chronic use of mixed analgesic preparations. Phenacetin, paracetamol, and salicylates have all been implicated. The condition is progressive and results in bilateral atrophy of the kidneys and chronic renal failure. In the early stages the condition is asymptomatic. The earliest clinical manifestations relate to disordered tubular function with impaired concentration and acidification of the urine.... analgesic nephropathy

n. failure to be aware of one’s disability, often resulting from right hemisphere brain damage. It is seen with a range of deficits, including *hemiplegia and *hemispatial neglect. A striking example is Anton’s syndrome, in which patients believe they can see normally despite being completely blind following severe bilateral damage to the visual cortex.... anosognosia

A group of disorders of the eye characterised by the intraocular pressure being so high as to damage the nerve ?bres in the retina and the optic nerve (see EYE) as it leaves the eye en route to the brain. The affected person suffers limitation of the ?eld of vision and on examination the optic disc can be seen to be cupped. The clinical signs depend on the rate and extent of rise in pressure.

Individuals most at risk have a family history of GLAUCOMA (especially among siblings), are myopic (short-sighted), or have diabetic or thyroid eye disease. People with a strong family history of the disease should have regular eye checks, including tonometry, from the age of 35 years.

Glaucoma is usually classi?ed as being either open-angle glaucoma or narrow-angle glaucoma.

Open-angle glaucoma is a chronic, slowly progressive, usually bilateral disorder. It occurs in one in 200 of people over 40 and accounts for 20 per cent of those registered blind in Great Britain. Symptoms are virtually non-existent until well into the disease, when the patient may experience visual problems. It is not painful. The characteristic ?ndings are that the intraocular pressure is raised (normal pressure is up to 21 mm Hg) causing cupping of the optic disc and a glaucomatous visual-?eld loss. The angle between the iris and the cornea remains open. Treatment is aimed at decreasing the intraocular pressure initially by drops, tablets and intravenous drug administration. Surgery may be required later. A trabeculectomy is an operation to create a channel through which ?uid can drain from the eye in a controlled fashion in order to bring the pressure down.

Narrow-angle glaucoma affects one in 1,000 people over 40 years of age and is more common in women. Symptoms may start with coloured haloes around street lights at night. These may then be followed by rapid onset of severe pain in and around the eye accompanied by a rapid fall in vision. One eye is usually affected ?rst; this alerts the surgeon so that action can be taken to prevent a similar attack in the other eye. Treatment must be started as an emergency with a topical beta blocker (see BETA-ADRENOCEPTOR-BLOCKING DRUGS) in eye drops with other drugs such as ADRENALINE or pilocarpine added as necessary. Dorzolamide, a topical anhydrase inhibitor, can also be used. ACETAZOLAMIDE, also an anhydrase inhibitor, can be given by mouth. In an emergency before surgery, MANNITOL can be given through an intravenous infusion; this is followed by surgery to prevent recurrence. Acute narrow-angle glaucoma occurs because the peripheral iris is pushed against the back of the cornea. This closes o? the angle between iris and cornea through which aqueous humour drains out of the eye. Since the aqueous humour cannot drain away, it builds up inside the eye causing a rapid increase in pressure.

Various types of LASER treatment – trabeculoplasty (‘burning’ the trabecular network); iridotomy (cutting holes to relieve pressure); and ciliary-body ablation by ‘burning’ – are sometimes used in preference to surgery.... glaucoma

The commonest deformity of the PALATE is cleft palate, which is a result of faulty embryonic development in which the two sides of the palate fail to fuse or only fuse in part. If the cleft extends the full length with bilateral clefts at the front of the MAXILLA, it may be accompanied by a cleft lip (also called hare-lip) and disruption in the development of the front teeth. About 1 in 500 babies is born with a cleft lip and 1 in 1,000 has a cleft palate. If the parents are affected, the risk is three times that of the normal population; if one child has a deformity, the risk for a subsequent child is higher. Associated abnormalities include tongue tie, malpositioning of the MANDIBLE and ?uid in the middle EAR.

Cleft palate and hare-lip should be recti?ed by operation, because both are a serious drawback to feeding in early life – while later, harelip is a great dis?gurement, and the voice may be affected. The lip may be dealt with at any time from the neonatal period to a few weeks, depending on the individual surgeon’s view of when the best result is likely to be achieved. Prior to operation, special techniques may be necessary to ensure adequate feeding such as the use of special teats in formula-fed babies. The closure of a large cleft in the palate is a more formidable operation and is better performed when the face has grown somewhat, perhaps at 6–12 months. The operations performed vary greatly in details, but all consist in paring the edges of the gap and drawing the soft parts together across it.

Further operations may be required over the years to improve the appearance of the nose and lip, to make sure that teeth are even, and to improve speech.

Parents of such children can obtain help and advice from the Cleft Lip and Palate Association (CLAPA).... palate, malformations of

a disorder, arising from bilateral occipito-parietal *strokes, characterized by inability to perceive the visual field as a whole (simultanagnosia), difficulty in fixating the eyes (oculomotor apraxia), and inability to move the hand to a specific object using vision (optic ataxia). [R. Balint (1874–1929), Hungarian neurologist]... balint’s syndrome

n. violent repetitive involuntary movements particularly involving the proximal limbs. They occur following bilateral damage to the *subthalamic nuclei of the basal ganglia, most commonly after stroke, haemorrhage, or trauma. In hemiballismus, only one side of the body is affected due to contralateral subthalamic dysfunction.... ballism

bilateral *acute retinal necrosis.... barn

n. surgical excision of the *cingulum, the part of the brain concerned with anger and depression. The procedure has occasionally been carried out as *psychosurgery for intractable mental illness, usually bilaterally. It is very rare in current psychiatric treatment.... cingulectomy

a fissure in the midline of the palate due to failure of the two sides to fuse in embryonic development. Only part of the palate may be affected, or the cleft may extend the full length with bilateral clefts at the front of the maxilla; it may be accompanied by a *cleft lip and disturbance of tooth formation. Cleft palates can be corrected by surgery.... cleft palate

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

a device similar to a *cochlear implant except that the electrode stimulates the auditory parts of the *brainstem rather than the cochlea. It is used to restore hearing of profoundly deaf people who have had damage to both auditory nerves and are hence unsuitable for cochlear implantation. It consists of an electrode that is permanently implanted on the surface of the brainstem. An external device with a microphone and an electronic processing unit pass information to the electrode using radio-frequency waves. The implant is powered by batteries in the external part of the device. It is most commonly used in patients with *neurofibromatosis type II who have had bilateral *vestibular schwannomas.... auditory brainstem implant

blood urea nitrogen: a measurement of nitrogen in the form of urea in the blood, usually reported as mg/dl, in common usage in the USA (each molecule of urea has two nitrogen atoms, each of molar mass 14 g/mol). Elsewhere, the concentration of urea in the serum is reported as mmol/L:

BUN or serum urea is used as a measure of kidney function but is less precise than the serum creatinine or estimates of glomerular filtration rate based on the serum creatinine (see eGFR). A disproportionate rise in blood urea nitrogen (or serum urea) compared with creatinine may be seen with volume depletion, cardiac failure, high protein diets, gastrointestinal bleeding, loss of muscle (the classic example is the bilateral amputee), and catabolic states associated with severe burns and fevers.... bun

a combination of *paraesthesia (pins and needles), numbness, and pain in the hand, usually affecting the thumb, index, and middle fingers and sometimes extending to the medial aspect of the fourth finger. The symptoms are usually worse at night, and in longstanding cases there may be weakness of grip due to wasting of the *thenar eminence of the thumb. It is caused by pressure on the median nerve as it passes through the wrist (see carpal tunnel), which may result from any continuous repetitive movements of the hand, such as keyboarding, or any condition causing local swelling. It is common in rheumatoid arthritis, myxoedema, pregnancy, and at the menopause, when it is more likely to be bilateral. Treatment is by splinting of the wrist, *NSAIDs, injection of a steroid, or – in severe cases – by surgical release of the nerve under local anaesthesia.... carpal tunnel syndrome

a disorder in which *keratitis and iridocyclitis (see uveitis) are associated with tinnitus, vertigo, and bilateral sensorineural deafness. [D. G. Cogan (1908–93), US ophthalmologist]... cogan’s syndrome

(dermoid) a benign tumour – a type of *teratoma – containing developmentally mature skin complete with hair follicles and sebaceous glands, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue, which may give rise to symptoms of thyrotoxicosis. It is usually found at sites marking the fusion of developing sections of the body in the embryo and is the most common benign ovarian tumour in girls and young women. Sometimes a dermoid cyst may develop after an injury. Treatment is complete surgical removal, preferably in one piece and without any spillage of cyst contents. Tumours in the skin are best removed by a plastic surgeon. Because of the risks of surgery and anaesthesia to pregnant women, it is usually considered more feasible to remove bilateral dermoid cysts of the ovaries discovered during pregnancy only if they grow beyond 6 cm in diameter. The procedure is usually performed through laparotomy or very carefully through laparoscopy and should preferably be done in the second trimester.... dermoid cyst

any developmental abnormalities resulting from anomalous metanephric differentiation (see metanephros). Most dysplastic kidneys are associated either with an abnormally located ureteral orifice or with urinary tract anomalies that are expected to produce unilateral, bilateral, or segmental urinary obstruction.... dysplastic kidneys

n. a bilateral symmetrical hypertrophy of the bones of the face and cranium, said to resemble the appearance of a lion’s head. It is a rare feature of untreated *Paget’s disease; the cause is unknown. Medical name: leontiasis ossea.... leontiasis

a condition in which an *ACTH-producing pituitary tumour expands after loss of negative *feedback following bilateral adrenalectomy for Cushing’s disease. (see Cushing’s syndrome) Hyperpigmentation due to excess pituitary MSH secretion is a prominent feature. Nelson’s syndrome has become rare because the standard treatment for Cushing’s disease is now surgical removal of the tumour; bilateral adrenalectomy is used only in extreme circumstances. [D. H. Nelson (1925–2009), US physician]... nelson’s syndrome

n. surgical removal of a testis. A radical orchidectomy, using an incision in the inguinal region, is performed for malignant tumours within the testis (usually germ-cell tumours, such as *seminoma or *teratoma). Orchidectomy may also be performed for *infarction of the testis. Removal of both testes (bilateral orchidectomy: see castration) causes sterility and reduces levels of testosterone by 90%, which is an effective treatment for advanced prostate cancer.... orchidectomy

a malignant tumour of the lining (*endometrium) of the uterus. Risk factors are nulliparity (never having given birth), obesity, and tamoxifen use as chemotherapy for breast cancer. The presenting symptom is usually *postmenopausal bleeding, but this cancer may present with postmenopausal discharge or *pyometra. The tumour invades the *myometrium and spreads down to the cervix and through the Fallopian tubes to the ovaries and peritoneal cavity and through the lymphatics to pelvic and aortic nodes. Prognosis depends on tumour differentiation, depth of myometrial invasion, extent of tumour spread, and involvement of retroperitoneal nodes. Treatment is laparoscopic abdominal *hysterectomy and bilateral *salpingo-oophorectomy, with *lymphadenectomy and radiotherapy if indicated.... endometrial cancer

n. the presence of fragments of endometrial tissue at sites in the pelvis outside the uterus or, rarely, throughout the body (e.g. in the lung, rectum, or umbilicus). It is thought to be caused by retrograde *menstruation. When the tissue has infiltrated the wall of the uterus (myometrium) the condition is known as adenomyosis. Symptoms vary, but typically include pelvic pain, severe *dysmenorrhoea, *dyspareunia, infertility, and a pelvic mass (or any combination of these). Medical treatment is aimed at suppressing ovulation using *gonadorelin analogues, combined oral contraceptives, or the intrauterine system (see IUS). High-dose progestogens suppress *gonadotrophins (FSH and LH), shrink implanted endometrial tissue, and reduce retrograde menstruation. They have a similar efficacy to other medical treatments, are cheaper, and have fewer side-effects than gonadorelin analogues. Surgical treatment may also be necessary, usually by laser or ablative therapy via the laparoscope. More radical surgical treatment in the form of a total hysterectomy and bilateral salpingo-oophorectomy is sometimes required.... endometriosis

(IPF) a serious interstitial lung disease, formerly called cryptogenic fibrosing alveolitis (see alveolitis). It is characterized by progressive fibrous scarring of the lung and increased numbers of inflammatory cells in the alveoli and surrounding tissues. The disease is usually diagnosed on clinical grounds on a basis of worsening breathlessness, inspiratory crackles at the lung bases on auscultation, clubbing of the fingers or toes, bilateral radiographic shadowing predominantly in the lower zones of the chest X-ray, subpleural *honeycomb change on CT scanning of the chest, and restrictive lung function on spirometry. It is also called usual interstitial pneumonia (UIP; see interstitial pneumonia), a term used by lung pathologists for the most common cellular pattern seen on biopsy. Treatment includes *pirfenidone, corticosteroids, and immunosuppressants.... idiopathic pulmonary fibrosis

n. either of two hereditary conditions inherited as autosomal *dominant traits and characterized by benign tumours growing from the fibrous coverings of nerves (see neurofibroma). In neurofibromatosis type I (von Recklinghausen’s disease), in which the abnormal gene is found on chromosome 17, numerous tumours affect the peripheral nerves. The tumours can be felt beneath the skin along the course of the nerves; they may become large, causing disfigurement, and rarely they become malignant, giving rise to neurofibrosarcomas. Pigmented patches on the skin (see café au lait spots) are commonly found and *Lisch nodules are present. Neurofibromatosis type II presents with bilateral *vestibular schwannomas (causing hearing loss) and *meningiomas. The abnormal gene is on chromosome 22.... neurofibromatosis

a sign of bilateral periorbital *haematoma associated with injury to the anterior cranial fossa, the front of the skull cavity that supports the frontal lobes of the brain. The name derives from its similarity in appearance to the black eye patches of a panda.... panda sign

(Eagle–Barrett syndrome) a hereditary condition, occurring exclusively in males, characterized by a deficiency of abdominal muscles, complex malformation of the urinary tract, and bilateral undescended testes. The lungs may be underdeveloped. The name derives from the typically wrinkled appearance of the skin over the abdomen.... prune belly syndrome

n. any of several straight muscles. The rectus muscles of the orbit are some of the extrinsic *eye muscles. Rectus abdominis is a long flat muscle that extends bilaterally along the entire length of the front of the abdomen. The rectus muscles acting together serve to bend the trunk forwards; acting separately they bend the body sideways. The rectus femoris forms part of the *quadriceps.... rectus

a benign bony growth that develops on the mandible on the side closest to the tongue. It is predominantly a bilateral condition.... torus mandibularis

n. 1. a surgical operation or any other process that induces *sterility in men or women. In women, hysterectomy and bilateral oophorectomy (surgical removal of both ovaries) are 100% effective and permanent. Alternatively, the Fallopian tubes may be removed (see salpingectomy) or divided and/or ligated. These operations can be performed through the abdomen or the vagina. The modern technique (tubal occlusion) is to occlude (close) permanently the inner (lower) half of the Fallopian tube through a *laparoscope. The occluding device is usually a clip (the Hulka-Clemens or Filshie clips) or a small plastic ring (Falope ring); *diathermy coagulation carries greater dangers (e.g. bowel burns) and is now little used. A more recent method is the use of a rapid-setting plastic introduced into the tubes through a hysteroscope (see hysteroscopy). Men are usually sterilized by *vasectomy. See also castration. 2. the process by which all types of microorganisms (including spores) are destroyed. This is achieved by the use of heat, radiation, chemicals, or filtration. See also autoclave.... sterilization