A

@ at. A accommodation; anode (anodal); anterior; axial; symbol for ampere and mass number. AAA ABDOMINAL AORTIC ANEURYSM. abatement a decrease in the severity 'LDSKUDJP of a pain or a symptom. abdomen the cavity between the    diaphragm and the pelvis, lined by a serous membrane, the peritoneum, and containing the stomach, intes-    tines, liver, gallbladder, spleen, pan- creas, kidneys, suprarenal glands,    ureters and bladder. For descriptive purposes, its area can be divided into nine regions (see Figure). Acute a. any 5LJKWK\SRFKRQGULDFUHJLRQ abdominal condition urgently requiring (SLJDVWULFUHJLRQ treatment, usually surgical. Pendulous /HIWK\SRFKRQGULDFUHJLRQ a. a condition in which the anterior 5LJKWOXPEDUUHJLRQ part of the abdominal wall hangs down 8PELOLFDOUHJLRQ over the pubis. Scaphoid (navicular) /HIWOXPEDUUHJLRQ a. a hollowing of the anterior wall so 5LJKWLOLDFIRVVD that it presents a concave rather than +\SRJDVWULFUHJLRQ convex contour. /HIWLOLDFIRVVD abdominal pertaining to the abdomen. A. aorta that part of the aorta below REGIONS OF THE ABDOMEN the diaphragm. A. aortic aneurysm a dilatation of the abdominal aorta. Men are most at risk and all men are delivery. The purpose is to determine invited for an AAA screening test at the equality of uterine size with the 65 years involving a simple ultrasound. calculated period of gestation and Also known as TRIPLE A screening. A. later in the pregnancy to determine the breathing deep breathing; hyperpnoea. position of the fetus. Postnatally the A. examination a systematic examina- examination is used to ascertain that tion of the abdomen by inspection, pal- the uterus is regaining its former non- pation and auscultation carried out by pregnant size and position. A. reflex midwives during pregnancy and after reflex contraction of abdominal wall abd 2

muscles observed when skin is lightly womb an embryo or fetus before it is stroked. A. section incision through capable of independent existence. the abdominal wall. A. thrust (formerly abortifacient an agent or drug that called the Heimlich manoeuvre) see may induce abortion. Appendix 2. abortion 1. premature cessation of a abdominoperineal pertaining to the normal process. 2. emptying of the abdomen and the perineum. A. exci- pregnant uterus before the end of the sion an operation performed through 24th week or a miscarriage (the pre- the abdomen and the perineum for ferred term). 3. the product of such an the excision of the rectum or bladder. abortion. Complete a. one in which Often done as a synchronized opera- the contents of the uterus are expelled tion by two surgeons, one working at intact. Criminal a. the termination of each approach. a pregnancy for reasons other than abdominoplasty also known as a those permitted by law (i.e., danger to tummy tuck, is a cosmetic surgery mental or physical health of mother or procedure to remove fat and excess child or family) and without medical loose skin to improve the shape of the approval. Incomplete a. one in which abdominal area. some part of the fetus or placenta is abduce to abduct or to draw away. retained in the uterus. Induced a. the abducent leading away from the intentional emptying of the uterus. Inev- midline. A. muscle the external rectus itable a. abortion where bleeding is muscle of the eye, which rotates it profuse and accompanied by pains, the outward. A. nerve the cranial nerve cervix is dilated and the contents of that supplies this muscle. the uterus can be felt. Missed a. one abductor a muscle that draws a limb where all signs of pregnancy disappear away from the midline of the body. The and later the uterus discharges a blood opposite of adductor. clot surrounding a shrivelled fetus, i.e., aberrant taking an unusual course. a carneous mole. Septic a. abortion Used of blood vessels and nerves. associated with infection. Therapeutic aberration deviation from the normal. (legal) a. one induced on medical In optics, failure to focus rays of light. advice because the continuance of the Mental a. mental disorder with a devi- pregnancy would involve risk to the life ation from linear or normal thinking. of the pregnant woman, or injury to ability the power to perform an act, the physical or mental health of the either mental or physical, with or pregnant woman or any existing chil- without training. A. test a test that dren of her family, greater than if the measures a person’s level of per- pregnancy were terminated; or because formance or estimates future perfor- there is a substantial risk that if the mance. Sometimes also known as an child were born it would suffer from intelligence test, achievement test or such physical or mental abnormalities aptitude test. Innate a. the ability with as to be seriously handicapped (1967 which a person is born. Abortion Act, as amended by the ablation removal or destruction, by Human Fertilization and Embryology Act surgical or radiological means, of neo- Amendments 1990 and 2008). Threat- plasms or other body tissue. ened a. the appearance of signs of abnormal varying from what is regular premature expulsion of the fetus; bleed- or usual. ing is slight, the cervix is closed. Tubal ABO system see BLOOD GROUPS. a. the termination of a tubal pregnancy abort 1. to terminate a process or caused by rupture of the uterine tube. disease before it has run its normal abrasion a superficial injury, where course. 2. to remove or expel from the the skin or mucous membrane is 3 acc

rubbed or torn, sometimes called a authority, drugs and other substances, graze. Corneal a. this can occur when e.g., solvents and equipment. the surface of the cornea has been abusive head injury commonly called removed, e.g., by a scratch or other shaken baby syndrome resulting in injury. traumatic brain injury in infants and abreaction the reliving of a painful young children. experience, with the release of acanthosis nigricans darkened, repressed emotion. thickened patches of skin that develop abruptio placentae premature around the groin, neck and axilla. detachment of the placenta, causing Patches can sometimes be itchy and maternal shock. may indicate underlying disease. abscess a collection of pus in a cavity. Acarus a genus of small mites. A. Caused by the disintegration and scabiei (former term for SARCOPTES replacement of tissue damaged by SCABIEI) the cause of scabies. mechanical, chemical or bacterial acataphasia loss of the ability to injury. Alveolar a. an abscess in a tooth express connected thought, resulting socket. Brodie’s a. a bone abscess, from a cerebral lesion. usually on the head of the tibia. Cold acceleration 1. An increase in the a. the result of chronic tubercular infec- speed or velocity of an object or reac- tion and so called because there are tion. 2. An increase in the fetal heart- few, if any, signs of inflammation. beat of at least 15 beats per minute Psoas a. a cold abscess that has over the baseline rate for at least 15 tracked down the psoas muscle from seconds. caries of the lumbar vertebrae. Sub- access to health care records there phrenic a. one situated under the are three pieces of legislation which diaphragm. govern access to patient health care absorbent 1. able to take in, or suck records. Patients (or in the case of up and incorporate. 2. a tissue structure deceased patients, their representative) involved in absorption. 3. a substance can apply for access to health care that absorbs or promotes absorption. records, unless it is considered that absorption 1. in physiology, the taking serious physical or mental harm to the up by suction of fluids or other sub- patient may result or where information stances by the tissues of the body. 2. would be disclosed relating to a third in psychology, great mental concen- party who has not consented. tration on a single object or activity. 3. accessory supplementary. A. nerve in radiology, uptake of radiation by body the 11th cranial nerve. It is made up tissues. of two portions: the cranial and the abstinence a refraining from the use spinal. of or indulgence in food, stimulants accident and emergency sometimes or coitus. A. syndrome withdrawal referred to as casualty, the emergency symptoms. department or trauma medicine. A abstract a brief, comprehensive setting for dealing with problems which summary of a research study or other require immediate attention and where academic report. patients can be directed or referred by abuse misuse, maltreatment, or exces- a general practitioner or the emergency sive use—may be physical, sexual, services. psychological or neglect. Can apply to acclimatization the ability of the body any group of people, e.g., the vulner- to adapt physiologically to changes in able, children, women, people with the environment. Taking exercise in a learning disabilities or the elderly. May hotter climate than the body is used also apply to the misuse of power, to will lead to increased sweating with acc 4

lower sodium levels in an attempt to a satisfactory level of organizational cool the body but which may lead to achievement. A. for Prior Experien- dehydration. Climbing, for example, at tial Learning (APEL) credit gained for a high altitude can produce altitude non-academic work (clinical or work sickness with low oxygen levels in the experience) that can be used to give blood, associated with increased credit to academic course work and cardiac output and respiratory effort. programmes of study in colleges and Athletes participating in sport events universities. A. for Prior Learning at international venues held in hot cli- abbreviated APL or APCL (accredita- mates or at high altitudes will require tion for prior certificated learning). A training to adapt to the physiological system used by academic institutions adjustments that will affect the athletic and other establishments to grant credit performance. for previous academic achievements. accommodation adjustment. In oph- Usually used to gain credit transfer thalmology, the term refers specifically between institutions leading to aca- to adjustment of the ciliary muscle, demic qualifications. which controls the shape of the lens. accretion growth. The accumulation Negative a. the ciliary muscle relaxes of deposits, e.g., of salts to form a and the lens becomes less convex, calculus in the bladder. In dentistry, giving long-distance vision. Positive a. the growth of tartar on the teeth. the ciliary muscle contracts and the acculturation the process by which lens becomes more convex, giving near a person absorbs the beliefs, values vision. and customs of another culture, usually accountable liable to be held respon- through direct contact, e.g., migrants sible for a course of action. A qualified resident in another country. nurse has a duty of care according to ACE inhibitors a group of drugs used law; in nursing, being accountable in the treatment of hypertension. Their refers to the responsibility the qualified name, angiotensin converting enzyme nurse takes for prescribing and initiating inhibitors, explains part of their mode nursing care. Nurses are accountable of action, although it is thought that to their patients, their peers and their some of their other actions may employing authority, according to the also be important in reducing blood Code for Nurses and Midwives. Reg- pressure. istered practitioners are accountable acet- combining form denoting acid. at all times for their actions, on or off From the Latin acetum, vinegar. duty and whether engaged in current acetabuloplasty an operation per- practice or not. Accountability is also formed to improve the depth and shape identified as one of the three founda- of the hip socket in correcting con- tions of public service. Everything done genital dislocation of the hip or in treat- by those who work in the NHS must ing osteoarthritis of the hip. be able to stand the test of parliamen- acetabulum the cup-like socket in the tary scrutiny, public judgements on innominate bone, in which the head of propriety and professional codes of the femur moves. conduct. acetate a salt of acetic acid. accreditation 1. to officially recognize acetoacetic acid diacetic acid. A someone as having particular status product of fat metabolism. It occurs in or being qualified to perform partic- excessive amounts in diabetes and ular activity. 2. An acknowledgement starvation, giving rise to acetone bodies of a person’s responsibility or achieve- in the urine. ment of something . 3. The granting acetonaemia the presence of acetone of approval to an institution that meet bodies in the blood. 5 aci acetone a colourless inflammable epiphysis and diaphysis of long bones. liquid with a characteristic odour. Growth is arrested resulting in short Traces are found in the blood and in stature. normal urine. A. bodies ketones found achromasia 1. lack of colour in the in the blood and urine of uncontrolled skin. 2. absence of normal reaction to diabetic patients and also in acute star- staining in a tissue or cell. vation as a result of the incomplete achromatopsia complete colour-blind- breakdown of fatty and amino acids. ness caused by disease or trauma. It acetonuria the presence of an excess may be congenital. quantity of acetone bodies in the urine, achylia absence of hydrochloric acid giving it a peculiar sweet smell. and enzymes in the gastric secretions. acetyl coenzyme A active form of A. gastrica a condition in which gastric acetic acid, to which carbohydrates, secretion is reduced or absent. fats and amino acids not needed for acid 1. sour or sharp in taste. 2. a protein synthesis are converted. substance which, when combined with acetylcholine a chemical transmit- an alkali, will form a salt. Any acid ter that is released by some nerve substance will turn blue litmus paper endings at the synapse between one red. Individual acids are given under neurone and the next or between a their specific names. A. alcohol-fast nerve ending and the effector organ it descriptive of stained bacteria that are supplies. These nerves are said to be resistant to decolourization by both acid cholinergic, e.g., the parasympathetic and alcohol. A.–base balance the nerves and the lower motor neurones normal ratio between the acid ions and to skeletal muscles. Acetylcholine the basic or alkaline ions required to is rapidly destroyed in the body by maintain the pH of the blood and body cholinesterase. fluids. Most of the body’s metabolic achalasia failure of relaxation of a processes produce acids as their end muscle sphincter causing dilatation of products, but a somewhat alkaline body the part above, e.g., of the oesophagus fluid is required as a medium for vital above the cardiac sphincter. cellular activities. Therefore chemical ache a dull continuous pain. exchanges of hydrogen ions must take Achilles Greek mythological hero who place continuously in order to maintain could be wounded only in the heel. A. a state of equilibrium. An optimal pH tendon tendo calcaneus, connecting (hydrogen ion concentration) between the soleus and gastrocnemius muscles 7.35 and 7.45 must be maintained; of the calf to the heel bone (os calcis). otherwise, the enzyme systems and Tapping the Achilles tendon normally other biochemical and metabolic activ- produces the Achilles reflex or ankle ities will not function normally. jerk. acidaemia abnormal acidity of the achlorhydria the absence of free blood, which contains an excess of hydrochloric acid in the stomach. May hydrogen ions in which the pH of the be found in pernicious anaemia, pel- blood falls below 7.35. lagra and gastric cancer. acidity 1. sourness or sharpness of acholia lack of secretion of bile. taste. 2. the state of being acid. acholuria deficiency or lack of bile in acidosis a pathological condition the urine. resulting from accumulation of acid or acholuric pertaining to acholuria. A. depletion of the alkaline reserve (bicar- jaundice jaundice without bile in the bonate content) in the blood and body urine. tissues, and characterized by increase achondroplasia an inherited condition in hydrogen ion concentration (decrease in which there is early union of the in pH to below 7.30). Metabolic a. aci 6

acidosis resulting from accumulation growing they can become large if not in the blood of ketoacids (derived from treated. Also known as vestibular fat metabolism) at the expense of bicar- schwannoma. bonate, thus diminishing the body’s acquired pertaining to disease, habits ability to neutralize acids. Occurs in or immunity developed after birth; not diabetic ketoacidosis, lactic acidosis inherited. and failure of renal tubules to reabsorb acquired immune deficiency syn- bicarbonate. Respiratory a. acidosis drome (AIDS) see AIDS. resulting from ventilatory impairment acrocephalia a malformation of the and subsequent retention of carbon head, in which the top is pointed. dioxide. Carbon dioxide accumulates acromegaly a chronic condition pro- in the blood and unites with water to ducing gradual enlargement of the form carbonic acid. Occurs with severe hands, feet, and bones of the head birth asphyxia and other respiratory and chest. Associated with overactivity conditions affecting the newborn and of the anterior lobe of the pituitary gland in adults with depression of the respi- in adults. ratory centre of the brain due to cere- acromioclavicular pertaining to the bral disease or drugs. joint between the acromion process of acidotic 1. pertaining to acidosis. 2. the scapula and the lateral aspect of a person suffering from acidosis. the clavicle. acinus a minute saccule or alveolus acromion the outward projection of of a compound gland, lined by secreting the spine of the scapula, forming the cells. The secreting portion of the point of the shoulder. mammary gland consists of acini. acroparaesthesia condition in which acme 1. the highest point. 2. the crisis pressure on the nerves of the brachial of a fever when the symptoms are fully plexus causes numbness, pain and developed. tingling of the hand and forearm. acne an inflammatory condition of acrophobia extreme or irrational fear the sebaceous glands in which black- of height. heads (comedones) are usually present acrosclerosis a combination of RAY- together with papules and pustules. A. NAUD’S DISEASE and scleroderma that keratitis inflammation of the cornea affects the hands, feet, face or chest. associated with acne rosacea. A. acrosome part of the head of a sper- rosacea a redness of the forehead, matozoon containing enzymes that nose and cheeks due to chronic dil- break down the cell membrane of the atation of the subcutaneous capillar- ovum and allow penetration. ies, which may become permanent ACTH adrenocorticotrophic hormone; with the formation of pustules in the corticotrophin. affected areas. A. vulgaris form that actin the protein of myofibrils respon- occurs commonly in adolescents and sible for contraction and relaxation of young adults, affecting the face, chest muscles. and back. actinic keratoses also known as acneiform resembling acne. SOLAR KERATOSES rough patches of skin acousma the hearing of imaginary caused by sun exposure over a pro- sounds. longed period of time. acoustic relating to sound or the actinodermatitis inflammation of the sense of hearing. A. neuroma a skin due to the action of ultraviolet or benign tumour of the brain. The X-rays. tumour grows on the acoustic nerve Actinomyces a genus of the actino- and can affect hearing and balance. bacteria class of bacteria which may Whilst the tumours are generally slow give rise to actinomycosis. 7 acu actinomycosis a rare chronic infective normal circumstances more potassium disease chiefly affecting the lung and ions are present within the cell and jaw, and more rarely the intestine and more sodium ions extracellularly. The pelvis. process of maintaining these normal action the accomplishment of an differences in electrolytic composition effect, whether mechanical or chemical, between the intracellular fluids is active or the effect so produced. A. research transport. The process differs from a method of undertaking social research simple diffusion or osmosis in that it that incorporates the researcher’s requires the expenditure of metabolic involvement as a direct and deliberate energy. part of the research, i.e., the researcher activities of daily living (ADL) those acts as a change agent. Cumulative activities usually performed in the a. the sudden and markedly increased course of a person’s normal daily action of a drug after administration of routine, such as eating, cleaning teeth, several doses. Reflex a. an involuntary washing and dressing: forms part of a response to a stimulus conveyed to the health assessment. nervous system and reflected to the activities of living (ALs) those activ- periphery, passing below the level of ities which meet the physical, psycho- consciousness (see also REFLEX). logical and social needs of the activator a substance, hormone or individual, e.g., eating, elimination, enzyme that stimulates a chemical communication, breathing, expressing change, although it may not take part sexuality, working, play, etc. in the change. In chemistry, a catalyst. activity theory describes a psycho- For example, yeast is the activator in social process whereby ageing people the process by which sugar is converted disengage from some activities of their into alcohol; the digestive secretions earlier life and replace these with other are activated by hormones to carry out hobbies and pastimes, according to normal digestion. their changing physical abilities and active causing change; energetic. A. economic situation. immunity an immunity in which indi- activity tolerance the amount of viduals have been stimulated to produce physical activity tolerated by a patient. their own antibodies. A. labour the It may be assessed in patients with normal progress of the birth process, cardiac or chronic respiratory disease. including uterine contractions, dilation Graded exercise, including walking, of the cervix to at least 3–4 cm and cycling and going up and down the descent of the fetus into the birth stairs, may be used to rebuild confi- canal. A. listening the act of alert, dence during the convalescent phase intentional hearing and demonstration after any serious illness or injury as of an interest in what a person has to an important part of any rehabilitation say through verbal signs, non-verbal programme. gestures and body language. A. move- actomyosin muscle protein complex; ments movements made by the patient, the myosin component acts as an as distinct from passive movements. enzyme which causes the release of A. principle the ingredient in a drug energy. that is primarily responsible for its ther- acuity sharpness. A. of hearing an apeutic action. A. transport the move- acute perception of sound. A. of vision ment of ions or molecules across the clear focusing ability. cell membranes and epithelial layers, acupressure a system of complemen- usually against a concentration gradi- tary medicine in which pressure is ent, resulting directly from the expen- applied to various points on the body diture of metabolic energy. Under to stimulate the innate self-healing acu 8

capacity of the individual. See ACUPUNC- changes in visual perception of colour TURE, SHIATSU. with prolonged stimulation. 2. adjust- acupuncture a Chinese medical ment of vision to degree of brightness system which aims to diagnose illness or colour tone of illumination. Dark a. and promote health by stimulating the adaptation of the eye to vision in body’s self-healing powers. The inser- reduced illumination. Light a. adapta- tion of special needles into specific tion of the eye to vision in bright illu- points along the ‘meridians’ of the body mination (photopia), with reduction in is used for the production of anaes- the concentration of the photosensitive thesia, the relief of pain and the treat- pigments of the eye. ment of certain conditions. addict a person exhibiting addiction. acute a term applied to a disease in addiction 1. the taking of drugs or which the attack is sudden, severe and alcohol leading to physiological and of short duration. A. respiratory dis- psychological dependence with a ten- tress syndrome (ARDS) a severe form dency to increase use. 2. the state of of acute lung function failure which being devoted to a particular activity occurs after an event such as trauma, or interest, e.g., gambling, exercise or inhalation of a toxic substance or septic computer games to the exclusion of shock. There is severe breathlessness the normal activities of daily living. See and a dangerous reduction in the supply DEPENDENCE and DRUG ADDICTION. of oxygen to the blood. A. stress dis- Addison’s disease T. Addison, British order an anxiety disorder that is usually physician, 1793–1860. Deficiency transient which occurs within 4 weeks disease of the suprarenal cortex. There following exposure or involvement to is wasting, brown pigmentation of the a traumatic event. The staff of the skin and extreme debility. Also known emergency services may be affected, as primary adrenal insufficiency or e.g., following a major road traffic hypo-adrenalism. incident. additives substances added to acyclic occurring independently of a improve, enhance or preserve some- natural cycle of events (such as the thing. Food a. used in the food industry menstrual cycle). to preserve and make the food look Adam’s apple the laryngeal promi- more attractive; these are given serial nence, a protrusion of the front of the numbers, e.g., E102 (tartrazine) E200 neck formed by the thyroid cartilage. (sorbic acid). Some additives may adamantine pertaining to the enamel produce an allergic reaction in some of the teeth. people and a few are thought to be adaptation 1. the process of modifi- implicated in behavioural problems in cation that a living organism undergoes children. when adjusting itself to new surround- adducent leading towards the midline. ings or circumstances. 2. a function A. muscle the medial rectus muscle of the stimulus to which the individual of the eye, which turns it inwards. is exposed and of the individual’s adductor a muscle that draws a limb accommodation to the situation. The towards the midline of the body. The adaptation response may relate to phys- opposite of abductor. iological needs, role, ‘self’ concept and adenine one of the purine bases found interdependence. 3. the process of in DNA. overcoming difficulties and adjusting adenitis inflammation of a gland, also to changing circumstances. 4. used in referred to as LYMPHADENITIS. ophthalmology to mean the adjustment adenoid small lumps of tissue at the of visual function according to the back of the nose, above the roof of the ambient illumination. Colour a. 1. mouth. Part of the immune system. 9 adr

Only present in children and by the age aditus an opening or passageway; of 7–8 years the adenoids start to often applied to that between the middle shrink. They disappear by adulthood. ear and the mastoid antrum. adenoidectomy the surgical removal adjustment in psychology, the ability of adenoid tissue from the nasopharynx. of a person to adapt to changing cir- adenoma a benign growth involving cumstances or environment. glandular tissue including the adrenal adjuvant 1. any treatment used in glands, the thyroid, prostate and pitu- conjunction with another to enhance itary glands. Whilst usually benign they its efficacy. 2. a substance adminis- can become cancerous. tered with a drug to enhance its effect. adenomyosis a condition in which the ADL activities of daily living. endometrium of the uterus breaks Adler’s theory A. Adler, Austrian psy- through the muscle wall of the uterus chiatrist, 1870–1937. The theory that usually resulting in painful and profuse neuroses develop as a compensation periods. for feelings of inferiority, either social adenopathy enlargement of any gland, or physical. especially those of the lymphatic adolescence the period between system. puberty and maturity. In the male, adenosine a nucleoside consisting of 14–25 years. In the female, 12–21 adenine and D-ribose (a pentose sugar). years. A. triphosphate (ATP) a compound adopt 1. to take a person, especially containing three phosphoric acids. It another’s child, into a legal relationship is present in all cells and serves as a as one’s own. 2. to choose to follow store for energy. a course of action. adenovirus a virus of the Adenovi- adoption the legal procedure by which ridae family. Many types have been a child is transferred from its natural isolated, some of which cause respi- parents to adopting parents. Regulated ratory tract infections, while others are by law, the child’s welfare is para- associated with conjunctivitis, epidemic mount. Local authorities offer advice keratoconjunctivitis or gastrointestinal and social work support and may act infection. as an adoption agency, and there are ADH antidiuretic hormone. Vasopressin. also private and charitable agencies adhesion union between two surfaces registered with the local authority. normally separated. Usually the result adrenal 1. near the kidneys. 2. a tri- of inflammation when fibrous tissue angular endocrine gland situated above forms, e.g., peritonitis may cause adhe- each kidney. sions between organs. A possible cause adrenalectomy surgical excision of of intestinal obstruction. an adrenal gland. adhesive capsulitis see FROZEN adrenaline a hormone secreted by the SHOULDER. medulla of the adrenal gland. Has an adipose of the nature of fat. Fatty. action similar to normal stimulation of adiposity the state of being too fat. the sympathetic nervous system: (a) Obesity. causing dilatation of the bronchioles; adiposogenital dystrophy a condi- (b) raising the blood pressure by con- tion occurring in adolescent boys with striction of surface vessels and stim- increased body fat accompanied by ulation of the cardiac output; (c) underdevelopment of the genitalia and releasing glycogen from the liver. It is altered secondary sexual characteristics therefore used to treat such conditions caused by damage to the HYPOTHALAMUS as asthma, collapse and hypoglycae- usually as a result of a tumour or infec- mia. It acts as a haemostat in local tion. Also known as FROHLICH’S SYNDROME. anaesthetics. adr 10 adrenergic pertaining to nerves that advanced life support (ALS) resus- release the chemical transmitter nor- citation techniques used during a adrenaline in order to stimulate the cardiac arrest that follows on from basic muscles and glands they supply. life support. They include defibrillation adrenocorticotrophin adrenocorti- and the administration of appropriate cotrophic hormone (ACTH); secreted by drugs. Paediatric advanced life support the anterior lobe of the pituitary body. (PALS) is a structured and algorithm Stimulates the adrenal cortex to method of life support for children with produce cortisol. See CORTICOTROPHIN. severe medical emergencies. See adrenogenital relating to both the Appendix 2. adrenal glands and the gonads. A. syn- advanced trauma life support drome a condition of masculinization (ALS) a set of protocols recom- caused by overactivity of the adrenal mended for use by doctors and para- cortex resulting in precocious puberty medics when dealing with seriously in the male infant and masculinization injured people at the scene of an acci- in the female. Both sexes are liable to dent. The immediate treatment of shock Addisonian crises. from reduced blood volume by the adrenolytic a drug that inhibits the infusion of fluids is an integral com- stimulation of the sympathetic nerves ponent of the life support regime. and the activity of adrenaline. advancement in surgery, an operation adsorbent a substance that has the to detach a tendon or muscle and reat- power of attracting gas or fluid to itself, tach it further forward. Used in the e.g., charcoal. treatment of strabismus and plastic adsorption the power of certain sub- surgery. stances to attach gases or other sub- adventitia the outer coat of an artery stances in solution to their surface and or vein. so concentrate them there. This is advocacy the process whereby a nurse made use of in chromatography. or health care professional provides a adult mature. A mature person. patient and/or the family with informa- adulteration addition of an impure, tion to enable them to make informed cheap or unnecessary ingredient decisions relating to the care situa- to cheat with, cheapen or falsify a tion. The nurse is then able to support preparation. the patient’s decision vis-à-vis other advance care planning discus- professionals and also to incorpo- sions about the wishes and prefer- rate the informed decisions into care ences for end of life care which are planning. documented and shared with per- A-EQUIP a model of clinical supervision mission with relevant agencies and for midwives. Abbreviation for advo- individuals. cating for education and quality advance decision sometimes also improvement. referred to as advanced decision to aeration supplying with air. Used to refuse treatment, advance directive or describe the oxygenation of blood which a living will is a written declaration takes place in the lungs. made by a mentally competent person, aerobe an organism that can live and which sets out their wishes with regard thrive only in the presence of oxygen. to life-prolonging medical interventions aerobic exercise physical exercises if they are incapacitated by an irrevers- for which the degree of effort is such ible disease or are terminally ill which that it can be maintained for long prevents them making their wishes periods without undue breathlessness. known to health professionals at the The aim of this form of exercising is time. See LIVING WILL. to increase the effectiveness of the 11 age

heart and lungs and the supply of afterpains the pains due to uterine oxygen to the tissues of the body. contraction after childbirth. aeropathy commonly called ‘the agammaglobulinaemia a condition bends’ (decompression sickness). in which there is a lack of gamma- aerophagy the excessive swallowing globulin in the blood. The patients of air. are therefore susceptible to infec- aerosol finely divided particles or drop- tions because of an inability to form lets. A. sprays used in medicine to antibodies. humidify air or oxygen, or for the aganglionosis see HIRSCHSPRUNG’S administration of drugs by inhalation. DISEASE. aetiology the science of the causes agar a gelatinous substance prepared of disease. from seaweed. Used as a culture afebrile without fever. medium for bacteria and as a laxative affect in psychiatry, the feeling expe- because it absorbs liquid from the rienced in connection with an emotion digestive tract and swells, so stimulat- or mood. ing peristalsis. affection 1. a morbid condition or age 1. the duration, or the measure of disease state. 2. a warm feeling for time, of the existence of a person or someone or something. object. 2. to undergo change as a result affective pertaining to the emotions of the passage of time. Chronological or moods. A. psychoses major mental a. the actual measure of time elapsed disorders in which there is grave dis- since a person’s birth. Gestational a. an turbance of the emotions. expression of age of a developing fetus, afferent conveying towards the centre. usually given in weeks. It is measured A. nerves the sensory nerve fibres that from the date of the mother’s last men- convey impulses from the periphery strual period, and so is approximately 2 towards the brain. A. paths or tracts weeks longer than time from concep- the course of the sensory nerves up tion. Mental a. the age level of intel- the spinal cord and through the brain. lectual ability of a person as gauged by A. vessels arterioles entering the glo- intelligence tests. Age-related macular merulus of the kidney, or lymphatics degeneration. See MACULA. entering a lymph gland. See EFFERENT. age-associated memory impair- affiliation the judicial decision about ment with age short-term memory the paternity of a child with a view to declines; most elderly people learn to the issue of a maintenance order. overcome and compensate for this affinity in chemistry, the attraction of deficit. However, for some it may be a two substances to each other, e.g., considerable problem in daily living. haemoglobin and oxygen. Memory loss associated with dementia afibrinogenaemia absence of fibrin- is often due to Alzheimer’s disease or ogen in the blood. The clotting mech- cerebral vascular disease. See DEMENTIA anism of the blood is impaired as a and ALZHEIMER’s DISEASE. result. age spots with increasing age skin African tick fever disease caused by blemishes appear; most commonly they a spirochaete, Borrelia duttonii. Trans- are seborrhoeic keratoses, which are mitted by ticks. See RELAPSING FEVER. brown or yellow and can occur any- afterbirth a lay expression used to where on the body. Also common with describe the placenta, cord and mem- increasing age are freckles, red pinpoint branes expelled after childbirth. blemishes on the trunk and solar ker- afterimage a visual impression that atoses due to overexposure to the remains briefly after the cessation of sun. Treatment is usually unnecessary sensory stimulation. except occasionally for solar keratoses age 12

which may eventually progress to skin cells, particularly a specific antibody cancer. formed in the blood in response to the ageing the structural changes that take presence of an invading agent. Agglu- place with time and are not caused by tinins are proteins (IMMUNOGLOBULIN) and accident or disease. Heredity is an function as part of the immune mech- important determinant of life expec- anism of the body. When the invading tancy, but factors such as smoking, an agents that bring about the production excessive intake of alcohol, obesity, of agglutinins are bacteria, the agglu- poor diet and insufficient exercise can tinins produced bring about agglutina- all contribute to physical and mental tion of the bacterial cells. deterioration. A. population as the agglutinogen any substance that, number of older people increase, the when present in the bloodstream, can demand for health care increases. cause the production of specific anti- Expectations for health care delivery bodies or agglutinins. and provision too are changing as aggregation the massing together of patients become increasingly knowl- materials, as in clumping. Familial a. edgeable about their health. the increased incidence of cases of a ageism the systematic discrimination disease in a family compared with that against people on the grounds of age, in control families. Platelet a. the based on stereotyping of the elderly as clumping together of platelets, which helpless, infirm, confused, requiring may be induced by a number of agents, health care and supportive social such as thrombin and collagen. services. aggression animosity or hostility Agenda for Change the grading and shown towards another person or pay system for NHS staff with the object as a response to opposition or exception of doctors, dentists and some frustration. very senior managers. agitation 1. shaking. 2. mental dis- agenesis failure of a structure to tress causing extreme restlessness. develop properly. aglutition difficulty in the act of swal- agent any substance or force capable lowing. Dysphagia. of producing a physical, chemical or agnosia an inability to recognize biological effect. Alkylating a. a cyto- objects because the sensory stimulus toxic preparation. Chelating a. a chem- cannot be interpreted, in spite of the ical compound that binds metal ions. presence of a normal sense organ. Wetting a. a substance that lowers the agonist the prime mover. A muscle surface tension of water and promotes opposed in action by another (the wetting. antagonist). agglutination collecting into clumps, agony extreme suffering, either mental particularly of cells suspended in a fluid or physical. and of bacteria affected by specific agoraphobia a fear of being in situ- immune serum. A. test a means of ations where escape might be difficult aiding diagnosis and identification of or help would not be available if things bacteria. If serum containing known go wrong. agglutinins comes into contact with agranulocyte a white blood cell the specific bacteria, clumping will without granules in its cytoplasm. take place (see WIDAL REACTION). Cross The term includes monocytes and a. a simple test to decide the group lymphocytes. to which blood belongs (see BLOOD agranulocytosis a condition in which GROUPS). there is a marked decrease or complete agglutinin any substance causing absence of granular leukocytes in the agglutination (clumping together) of blood, leaving the body defenceless 13 ala

against bacterial invasion. May result non-active nitrogen 79%; oxygen 21%, from: (a) the use of toxic drugs; (b) which supports life and combustion; irradiation. Characterized by a sore traces of neon, argon, hydrogen, etc.; throat, ulceration of the mouth and and carbon dioxide 0.03%, except in pyrexia. It may result in severe pros- expired air, when 6% is exhaled as a tration and death. result of diffusion that has taken place agraphia absence of the power of in the lungs. Air has weight and exerts expressing thought in writing. It arises pressure, which aids in syphonage from from a lack of muscular coordination body cavities. A.-bed a rubber mattress or as a result of motor dysfunction. inflated with air. A. embolism an embo- ague malaria. lism caused by air entering the circu- AHP allied health professional. latory system. A. hunger a form of AID artificial insemination of a woman dyspnoea in which there are deep with donor semen. sighing respirations, characteristic of AIDS acquired immunodeficiency syn- severe haemorrhage or acidosis. Resid- drome. The late symptomatic stage ual a. air remaining in the lungs after of chronic disease caused by human deep expiration. Stationary a. that immunodeficiency virus (HIV) infection retained in the lungs after normal expi- which progressively impairs the body’s ration. Supplemental a. the extra air cell-mediated immune responses to forced out of the lungs with expiratory infections and cancers. This results in effort. Tidal a. that which passes in serious ‘opportunistic infections’ caused and out of the lungs in normal respi- by microorganisms that do not usually ratory action. cause illness in people with a healthy airway 1. the passage by which the immune system, e.g., Pneumocystis air enters and leaves the lungs. 2. a jirovecii pneumonia (PCP), or cancers mechanical device (tube) used for such as Kaposi’s sarcoma (KS) and lym- securing unobstructed respiration phoma. Additionally, this late stage of during general anaesthesia or on other HIV disease is characterized by a high occasions when the patient is not ven- and rising level (viral load) of HIV and a tilating or exchanging gases properly. progressively decreasing number (less It may be passed through the mouth than 200 cells/mm3) of CD4+ T lym- or nose. The tube prevents a flaccid phocytes in the plasma. Prior to AIDS, tongue from resting against the pos- many HIV-infected people experience terior pharyngeal wall and causing a variety of recurrent signs and symp- obstruction of the airway (see Figure). toms, including lymphadenopathy, night akinesia loss of muscle power. sweats, diarrhoea, weight loss, malaise, This may be the result of a brain or oropharyngeal or vaginal candidiasis spinal cord lesion or, temporarily, of (thrush), and herpes zoster (shingles). anaesthesia. Formerly known as the AIDS-related akinetic relating to states or conditions complex, this stage is now generally where there is lack of movement. referred to as early symptomatic HIV alalia loss or impairment of the power disease (as opposed to AIDS which is of speech due to muscle paralysis or also known as late symptomatic HIV a cerebral lesion. disease). alacrima a deficiency or absence of AIH artificial insemination of a woman the secretion of tears. with her partner’s semen. alanine an amino acid formed by the ailment any minor disorder of the ingestion of dietary protein. A. trans- body. aminase (ALT) a transaminase found air a mixture of gases that make up in plasma and the liver which catalyses the earth’s atmosphere. It consists of the two parts of the alanine cycle. alb 14

or postural a. a non-pathological form that affects some individuals after pro- longed standing but disappears after bedrest for a few hours. alcohol a volatile liquid distilled from fermented saccharine liquids and forming the basis of wines and spirits. The official (British Pharma- copoeia) preparation of ethyl alcohol (ethanol) contains 95% alcohol and 5% water. Used: (a) as an antiseptic; (b) in the preparation of tinctures; (c) as a perspective for anatomical specimens. Taken internally, it acts as a temporary heart stimulant, and in large quantities as a depressant poison. It has some value as a food, 30 ml brandy produc- 7UDFKHD ing about 400 J. Absolute a. that which 3KDU\Q[ contains not more than 1% by weight of water. A.-fast pertaining to bacteria OROPHARYNGEAL AIRWAY that, once having been stained, are resistant to decolorization by alcohol. A. related disorders A variety of physical and mental disorders associated with prolonged and excessive consumption albinism a condition in which there is of alcohol including hepatitis, cirrhosis, congenital absence of pigment in the some cancers, e.g., of the oesophagus, skin, hair and eyes. It may be partial larynx and throat. Heavy alcohol con- or complete. sumption in pregnancy increases the albino a person affected with albinism. risk of miscarriage and fetal alcohol albumin 1. any protein that is soluble syndrome. Alcoholics are more likely in water and moderately concentrated to suffer from personality changes, salt solutions and is coagulable by heat, depression and to develop demen- e.g., egg white. 2. serum albumin; a tia. Many alcoholics suffer from a plasma protein, formed principally in poor diet and are prone to nutritional the liver and constituting about deficiency. See WERNICKE–KORSAKOFF four-sevenths of the 6%–8% protein SYNDROME. A. withdrawal syndrome concentration in the plasma. Albumin a group of symptoms that develop is a very important factor in regulating in a person suffering from alcohol- the exchange of water between the ism within 6–24 hours of taking the plasma and the interstitial compartment last drink of alcohol. The symptoms (space between the cells). A drop in include restlessness, tremors, loss of the amount of albumin in the plasma appetite, nausea, vomiting, insomnia, results in an increase in tissue fluid, disorientation, seizures and delirium which, if severe, becomes apparent as tremens. Treatment involves sedation, oedema. Albumin serves also as a improving nutrition, counselling and transport protein. social support. albuminuria the presence of albumin alcoholic 1. pertaining to alcohol. 2. in the urine, occurring e.g., in renal a person addicted to excessive, uncon- disease, in most feverish conditions and trolled alcohol consumption. This results sometimes in pregnancy. Orthostatic in loss of appetite and vitamin B 15 alk

deficiency, leading to peripheral neuritis alimentary relating to the system of with eye changes and cirrhosis of the nutrition. A. canal alimentary tract. The liver and to progressive deterioration passage through which the food in the personality. passes, from mouth to anus. A. system alcoholism the state of poisoning the alimentary tract together with the resulting from alcoholic addiction. liver and other organs concerned in aldosterone a compound, isolated digestion and absorption. A. tract ali- from the adrenal cortex, that aids the mentary canal. retention of sodium and the excretion alimentation the giving or receiving of potassium in the body, and by so of nourishment. The process of sup- doing aids the maintenance of electro- plying the patient’s need for nutrition. lyte balance. A. antagonists a group alkalaemia an increase in the alkali of drugs which block the action of content of the blood. See ALKALOSIS. aldosterone. alkali a substance capable of uniting aldosteronism an excess secretion with acids to form salts, and with fats of aldosterone caused by an adrenal and fatty acids to form soaps. Alkaline neoplasm. The serum potassium is low solutions turn red litmus paper blue. and the patient has hypertension and A. reserve the ability of the combined severe muscular weakness. buffer systems of the blood to neu- aleukaemia an acute condition in tralize acid. The pH of the blood is which there is an absence or deficiency normally slightly on the alkaline side, of white cells in the blood. between 7.35 and 7.45. The princi- Alexander technique F.M. Alexander, pal buffer in the blood is bicarbonate; Australian actor and physiotherapist, the alkali reserve is essentially rep- 1869–1955. A process of psychophys- resented by the plasma bicarbonate ical postural re-education. Body posture concentration. is believed to affect physical and psy- alkaline having the reactions of an chological wellbeing and the postural alkali. A. phosphatase an enzyme local- re-education process aims to assist ized on cell membranes that hydrolyses individuals in monitoring how they con- phosphate esters, liberating inorganic sciously use their bodies to promote phosphate, and has an optimal pH of good health. about 10.0. Serum alkaline phospha- alexia a form of aphasia in which there tase activity is elevated in obstructive is an inability to recognize written or jaundice and bone disease. printed words. Word blindness. alkalinity 1. the quality of being alka- algorithm a process or set of rules line. 2. the combining power of a base, used in calculations, e.g., of medica- expressed as the maximum number of tions, or for other problem solving. equivalents of acid with which it reacts Computer programs are the most famil- to form a salt. iar examples of algorithms in everyday alkaloid one of a group of active use. nitrogenous compounds that are alka- alienation a feeling of estrangement line in solution. They usually have a or separation from others or from self. bitter taste and are characterized by A symptom of schizophrenia. Suffer- powerful physiological activity. Exam- ers often believe that they are under ples are morphine, cocaine, atropine, the control of someone else. See quinine, nicotine and caffeine. The term DEPERSONALIZATION. is also applied to synthetic substances alignment the state of being arranged that have structures similar to plant in a line, i.e., in the correct anatomical alkaloids, such as procaine. position. alkalosis an increase in the alkali aliment food or nourishment. reserve in the blood. It may be alk 16

confirmed by estimation of the blood allograft an organ or tissue trans- carbon dioxide content and treated by planted from one person to another of giving normal saline or ammonium a dissimilar genotype but of the same chloride intravenously to encour- species. Non-viable a. skin, taken from age the excretion of bicarbonate by a cadaver, which cannot regenerate. the kidneys. Viable a. living tissue transplanted. See alkylating agent a drug that damages HOMOGRAFT. the deoxyribonucleic acid (DNA) mol- alloimmunization the immune ecule of the nucleus of the cell. Many response to donated blood, bone are nitrogen mustard preparations; they marrow or transplanted organ; rhe- are used in cancer chemotherapy. sus-negative pregnant women with all-or-none law principle that states a rhesus-positive fetus can become that in individual cardiac and skeletal alloimmunized following a sensitizing muscle fibres there are only two possi- event, e.g., antepartum haemorrhage or ble reactions to a stimulus: either there miscarriage, through the development is no reaction at all or there is a full of antibodies that target the foreign reaction, with no gradation of response material, causing haemolytic disease according to the strength of the stim- of the newborn. ulus. Whole muscles can grade their allopathy the practice of conventional response by increasing or decreasing medicine, i.e., with drugs having oppo- the number of fibres involved. site effects to the symptoms. allantois a membranous sac projecting alopecia baldness. Loss of hair. The from the ventral surface of the fetus cause of simple baldness is not yet fully in its early stages. It eventually helps understood, although it is known that to form the placenta. the tendency to become bald is limited allele allelomorph. One of a pair of almost entirely to males, runs in certain genes that occupy the same relative families and is more common in certain positions on homologous chromosomes racial groups than in others. Baldness is and produce different effects on the often associated with ageing. A. areata same process of development. hair loss in sharply defined areas, allelomorph allele. usually the scalp or beard. Cicatricial Allen Test is used to test the blood a., a. cicatrisata irreversible loss of supply to the hand, specifically the hair associated with scarring, usually patency of the radial and ulnar arteries. on the scalp. Also known as scarring It is performed prior to radial arterial alopecia. Male-pattern a. loss of scalp sampling or cannulation. hair, genetically determined and andro- allergen a substance that can produce gen-dependent, beginning with frontal an allergy or manifestation of an recession and progressing symmetri- immune response. cally to leave ultimately only a sparse allergic rhinitis a common condition peripheral rim of hair. where there is inflammation of the alpha the first letter of the Greek alpha- inside of the nose caused by an allergen bet, a. A. cells cells found in the islet such as pollen, dust, mould or animal of Langerhans in the pancreas. They skin. produce the hormone glucagon. A. allergy a hypersensitivity to some fetoprotein (AFP) a plasma protein foreign substances that are normally originating in the fetal liver and gastro- harmless but which produce a violent intestinal tract. The serum AFP level reaction in the patient. Asthma, hay is used to monitor the effectiveness fever, angioneurotic oedema, migraine of cancer treatment; the amniotic and some types of urticaria and eczema fluid AFP level is used in the prenatal are allergic states. See ANAPHYLAXIS. diagnosis of neural tube defects. A. 17 ami

receptors tissue receptors associated there is no cure for Alzheimer’s disease with the stimulation (contraction) of but medication is available to help smooth muscle. relieve some of the symptoms. Other alternative medicine a form of aspects of treatment are the provision medicine differing from conventional of appropriate health and social care, health care. Consists of a range of together with ongoing support for their treatments essentially based upon a families. holistic approach to health and wellbe- amalgam a compound of mercury and ing, including homeopathy, aromather- other metals. Dental a. now rarely used apy, hypnosis, acupuncture and others. for filling teeth. These therapies fall into three cate- amaurosis loss of vision, result- gories: touch and movement, medic- ing from a systemic cause without inal and psychological. Commonly damage to the eye. The visual loss called complementary therapies (see may be partial or complete, and is COMPLEMENTARY). usually temporary. altitude sickness condition caused ambidextrous equally skilful with by hypoxia that occurs as a result of either hand. lower oxygen pressure at high altitudes ambivalence the existence of contra- before acclimatization to the increased dictory emotional feelings towards an altitude. See ACCLIMATIZATION. object, commonly of love and hate for altruism a sense of unconditional another person. If these feelings occur concern for the welfare of others. to a marked degree they lead to psy- aluminium symbol Al. A silver-white chological disturbance. metal with a low specific gravity, com- amblyopia dimness of vision without pounds of which are astringent and any apparent lesion of the eye. Uncor- antiseptic. A. hydroxide compound rectable by optical means. used as an antacid in the treatment of ambulant able to walk. gastric conditions. ambulatory having the capacity to alveolar concerning an alveolus, or air walk. A. treatment or care health ser- sac of the lung. A. air air found in the vices provided on an outpatient or day alveoli. care basis. alveolitis inflammation of the alveoli. amelioration improvement of symp- Extrinsic allergic a. inflammation of toms; a lessening of the severity of a the alveoli caused by inhalation of an disease. antigen, such as pollen. amenorrhoea absence of menstrua- Alzheimer’s cells A. Alzheimer, tion. Primary a. the non-occurrence of German neurologist, 1864–1915. 1. the menses. Secondary a. the cessa- giant astrocytes with large prominent tion of the menses, after they have nuclei found in the brain in hepatolen- been established, owing to disease or ticular degeneration and hepatic comas. pregnancy. 2. degenerated astrocytes. ametropia defective vision. A general Alzheimer’s disease a progressive word applied to incorrect refraction. form of neuronal degeneration in the Ames Test a biological assay to assess brain and the most common cause of the mutagenic potential of chemical dementia in people of all ages. It is compounds. A positive test indicates more common in older than younger that the chemical is mutagenic and people and is not just a form of pre- therefore may act as a carcinogen, senile dementia, as was originally since cancer is often linked to mutation. thought. The degeneration of neurones amino acid a chemical compound is accompanied by changes in the containing both NH2 and COOH groups. brain’s biochemistry. At the moment, The end product of protein digestion. ami 18

Essential amino acids 8WHULQHZDOO 1 Threonine 2 Lysine 3 Methionine 4 Valine 5 Phenylalanine 6 Leucine 7 Tryptophan 8 Isoleucine 9 Histidine

Essential a. one required for replace- ment and growth but which cannot AMNIOCENTESIS be synthesized in the body in suffi- cient amounts and must be obtained in the diet (see Table). Histidine is also memory of events that have taken place essential in childhood. Non-essential since an injury or illness. Retrograde a. a. one necessary for proper growth a. loss of memory for events prior to but that can be synthesized in the an injury. It often applies to the time body and is not specifically required immediately preceding an accident. in the diet. amniocentesis the withdrawal of fluid aminoglycoside any of a group of from the uterus through the abdominal bacterial antibiotics, derived from wall by means of a syringe and needle various species of Streptomyces, that (see Figure) with guided ultrasound. It interfere with the function of bacte- is primarily used in the diagnosis of rial ribosomes. The aminoglycosides chromosome disorders in the fetus and include gentamicin, tobramycin, strep- in cases of hydramnios. Mothers who tomycin, tobramycin, amikacin, kana- are rhesus-negative should be given a mycin and neomycin. They are used to reduced dose of anti-D immunoglobulin treat infections caused by gram-neg- after the procedure to prevent them ative organisms and are classified as making antibodies. bactericidal agents because of their amniography radiography of the gravid interference with bacterial replication. uterus. All the aminoglycoside antibiotics are amnion the innermost membrane highly toxic, requiring monitoring of enveloping the fetus and enclosing the blood serum levels and careful obser- liquor amnii, or amniotic fluid. vation of the patient for early signs amniotic pertaining to the amnion. A. of toxicity, particularly ototoxicity and fluid the albuminous fluid contained in nephrotoxicity. the amniotic sac. Liquor amnii. amitosis multiplication of cells by amoeba a minute unicellular proto- simple division or fission. zoon. It is able to move by pushing out ammonia NH3. A naturally occurring parts of itself (called pseudopodia). compound of nitrogen and hydrogen Capable of reproduction by amitotic formed by the decomposition of proteins fission. Infection of the intestines by and amino acids. Converted into urea Entamoeba histolytica causes ‘amoebic by the liver. dysentery’. amnesia partial or complete loss of amoebiasis infection with amoeba, memory. Anterograde a. loss of particularly Entamoeba histolytica. 19 ana amoebic pertaining to, caused by, or amylopsin an enzyme found in the of the nature of an amoeba. A. abscess pancreas. Amylase. an abscess cavity of the liver resulting amylum [L.] starch. from liquefaction necrosis due to amyotonia atonic condition of the entrance of Entamoeba histolytica into muscles. the portal circulation in amoebiasis; anabolic relating to anabolism. A. amoebic abscesses may affect the lung, compound a substance that aids in brain and spleen. A. dysentery a form the repair of body tissue, particularly of dysentery caused by Entamoeba protein. Androgens may be used in this histolytica and spread by contaminated way. food, water and flies; called also amoe- anabolism the building up or synthesis biasis. Amoebic dysentery is mainly a of cell structure from digested food tropical disease but many cases occur materials. See METABOLISM. in temperate countries. Symptoms are anacidity decrease in normal acidity. diarrhoea, fatigue and intestinal bleed- anaclitic denoting the dependence of ing. Complications include involvement the infant on the mother or mother of the liver, liver abscess and pulmonary substitute for its sense of wellbeing. abscess. A. choice a psychoanalytical term for amoeboid resembling an amoeba in the adult selection of a loved one who structure or movement. closely resembles one’s mother (or amorphous without definite shape. another adult on whom one depended The term may be applied to fine as a child). A. depression severe and powdery particles, as opposed to progressive depression found in chil- crystals. dren who have lost their mothers and amphiarthrosis a form of joint in have not found a suitable substitute. which the bones are joined together anacrotism an abnormal pulse by fibrocartilage, e.g., the junctions of wave tracing embodying a secondary the vertebrae. expansion. amphoric pertaining to a bottle. Used anaemia deficiency in either quality to describe the sound sometimes heard or quantity of red corpuscles in the on auscultation over cavities in the blood that reduces the oxygen carrying lungs, which resembles that produced capacity of the blood, giving rise espe- by blowing across the mouth of a bottle. cially to symptoms of anoxaemia. There ampoule a small glass or plastic phial is pallor, breathlessness on exertion, in which sterile drugs of specified dose with palpitations, lassitude, headache, for injection are sealed. giddiness and often a history of poor ampulla the flask-like dilatation of a resistance to infection. Anaemia may canal, e.g., of a uterine tube. be due to many different causes. amputation surgical removal of a limb Increasingly, with the advent of elec- or other part of the body, e.g., the tronic cell counters, anaemia is now breast. classified according to the morpholog- amputee a person who has had one ical characteristics of the erythrocytes. or more limbs amputated. Aplastic a. the bone marrow is unable amylase an enzyme that reduces starch to produce red blood corpuscles. A rare to maltose. Found in saliva (ptyalin) and condition. Deficiency a. any type that pancreatic juice (amylopsin). is due to the lack of the necessary amyloid 1. pertaining to starch. 2. a factors for red cell formation, e.g., hor- waxy starch-like material that is a mones or vitamins. Haemolytic a. a complex protein forming in tissues and variety in which there is excessive organs leading to disturbance of func- destruction of red blood corpuscles tion, called amyloidosis. caused by antibody formation in the ana 20

blood (see RHESUS FACTOR), by drugs or freezing with ethyl chloride or by topical by severe toxaemia, as in extensive application. Spinal a. injection of burns. Iron-deficiency a. the most anaesthetic agent into the spinal sub- common type of anaemia, due to a arachnoid space. lack of absorbable iron in the diet. It anaesthetic a drug causing may also be due to excessive or chronic anaesthesia. blood loss, or to poor absorption of anaesthetist a person who is medi- dietary iron. Macrocytic a. a type in cally qualified to administer an anaes- which the cells are larger than normal; thetic and in the techniques of life present in pernicious anaemia. Micro- support for the critically ill or injured. cytic a. a variety in which the cells are anal pertaining to the anus. A. eroti- smaller than normal, as in iron defi- cism sexual pleasure derived from anal ciency. Pernicious a. a variety caused functions. A. fissure see FISSURE. A. by the inability of the stomach to fistula see FISTULA. A. stage the second secrete the intrinsic factor necessary stage of a child’s psychosexual devel- for the absorption of vitamin B12 from opment, characterized by the child’s the diet. Sickle-cell a. a hereditary sensual interest in the anal area and haemolytic anaemia seen most com- the passing or retention of faeces. monly in people living in or originating analeptic a drug that stimulates the from the Caribbean islands, Africa, Asia, central nervous system. the Middle East and the Mediterranean. analgesia insensibility to pain, espe- The red blood cells are sickle-shaped. cially the relief of pain without causing Splenic a. a congenital, familial disease unconsciousness. Patient-controlled in which the red blood cells are fragile a. a preset dose of analgesic, which and easily broken down. the patient controls according to need. anaerobe a microorganism that can In-built safety measures prevent acci- live and thrive in the absence of free dental overdose. oxygen. These organisms are found in analgesic 1. relating to analgesia. 2. body cavities or wounds where the a remedy that relieves pain. A. cocktail oxygen tension is very low. Examples an individualized mixture of drugs used are the bacilli of tetanus and gas to control pain. gangrene. analogue 1. an organ with a different anaesthesia loss of feeling or sen- structure and origin to but the same sation in a part or in the whole of the function as another one. 2. a compound body, usually induced by drugs. Basal with a similar structure to another but a. basal narcosis. Loss of conscious- differing in respect of a particular ness, although supplemental drugs element. have to be given to ensure complete analysis 1. the act of determining the anaesthesia. Epidural a. injection into component parts of a substance. 2. in the extradural space between the ver- psychiatry, a method of trying to under- tebral spines and beneath the ligamen- stand the complex mental processes, tum flavum. General a. unconsciousness experiences and relationships with other produced by inhalation or injection of individuals or groups of individuals to a drug. Inhalation a. drugs or gas are determine the reasons for an individ- administered by a face mask or endo- ual’s behaviour. A. of covariance tracheal tube to cause general anaes- (ANCOVA) a statistic that measures thesia. Intravenous a. unconsciousness differences among group means and is produced by the introduction of a uses a statistical technique to equate drug into a vein. Local a. local anal- the groups under study in relation to gesia. Nerve conduction is blocked by another given variable. A. of variance injection of a local anaesthetic, or by (ANOVA) a statistic that tests whether 21 ang

groups differ from each other, rather The main sources are unrefined cereals than testing each pair of means sep- and pork. Vitamin B1. arately. ANOVA considers the variation aneurysm a local dilatation of a blood among all groups. vessel, usually an artery. Atheroscle- anaphase part of the process of rosis is responsible for most arterial mitosis or meiosis. aneurysms; any injury to the arterial anaphylaxis anaphylactic shock. A wall can predispose to the formation severe reaction, often fatal, occurring of a sac. Smoking is the strongest risk in response to drugs, e.g., penicillin, factor in developing aortic aneurysm . but also to bee stings and food allergy, The pressure of blood causes it to e.g., nuts, in sensitive individuals. The increase in size and rupture is likely. symptoms are severe dyspnoea, rapid Surgery, either open or endovascular, pulse, profuse sweating and collapse. can prevent rupture, see ABDOMINAL anaplasia a change in the character AORTIC ANEURYSM. Dissecting a. a con- of cells, seen in tumour tissue. dition in which a tear occurs in the anarthria inability to articulate speech aortic lining when the middle coat is sounds owing to a brain lesion or necrosed and blood gets between the damage to peripheral nerves innervating layers, stripping them apart. Fusiform articulatory muscles. a. a spindle-shaped arterial aneurysm. anastomosis 1. in surgery, any arti- Saccular a. a dilatation of only a part ficial connection of two hollow struc- of the circumference of an artery. tures, e.g., gastroenterostomy. 2. in angina a tight strangling sensation or anatomy, the joining of the branches pain. A. cruris intermittent claudication. of two blood vessels. Severe pain in the leg after walking. anatomy the science of the structure A. pectoris cardiac pain that occurs of the body. on exertion owing to insufficient blood Ancylostoma hookworm. A genus of supply to the heart muscles. Vincent’s nematode roundworms which may a. infection and ulceration of the tonsils inhabit the duodenum and cause by a spirochaete, Borrelia vincentii, and extreme anaemia and malnutrition. A. a bacillus, Bacillus fusiformis. duodenale a hookworm very wide- angiocardiography radiological exam- spread in tropical and subtropical areas. ination of the heart and large blood androgen one of a group of hormones vessels by means of cardiac catheter- secreted by the testes and adrenal ization and an opaque contrast medium. cortex. They are steroids which can be angiography radiological examination synthesized and produce the secondary of the blood vessels using an opaque male characteristics and the building contrast medium. up of protein tissue. A. insensitivity angioma a benign tumour composed syndrome (AIS) a rare genetic condition of dilated blood vessels. that affects the development of a child’s angioedema a type of reaction; most genitals and reproductive organs. commonly caused by an allergy, char- android resembling a man. A. pelvis acterized by well-defined swellings or a female pelvis shaped like a male weals of sudden and rapid onset in the pelvis with a wedge-shaped entrance skin, throat, mouth, eyes and other and narrow anterior segment. areas. Fatal oedema of the glottis may anergy 1. specific immunological tol- occur resulting in a medical emergency. erance in which T cells fail to respond See OEDEMA. normally. The state can be reversed. angioplasty surgery of a narrowed 2. tiredness, lethargy, lack of energy. artery to promote the normal flow of aneurine thiamin. An essential vitamin blood. Balloon a. technique in which involved in carbohydrate metabolism. a catheter with an elastic, flexible ang 22

(balloon-like) tip that can be inflated measured by a Doppler ultrasound to widen the narrowed blood vessel, probe to that measured at the brachial e.g., in the heart. Usually a stent is artery to quantify the degree of arterial inserted to keep the artery open. Stents occlusion in the leg. Forms an important have now been developed coated in part of a leg ulcer assessment regard- slow-release drugs that reduce further ing the patient’s suitability for com- risk of arterial narrowing. See STENT. pression bandaging. angiosarcoma a malignant vascular ankyloblepharon adhesions and scar growth. tissue on the ciliary borders of the angiospasm a spasmodic contraction eyelids, giving the eye a distorted of an artery, causing cramping of the appearance. muscles. ankylosing spondylitis a long-term angiotensin a substance that raises condition in which there is inflammation the blood pressure. It is a polypeptide of the spine and other areas of the produced by the action of renin on body leading to back pain and stiffness, plasma globulins. Hypertensin. pain and swelling of other parts of the anhidrosis marked deficiency in the body and extreme tiredness. The cause secretion of sweat. is unknown but there may be a genetic anhidrotic an agent that decreases link. perspiration. An adiaphoretic. ankylosis consolidation, immobility and anhydraemia deficiency of water in stiffness of a joint as a result of disease. the blood. annular ring-shaped. aniline a chemical compound derived anoci-association the exclusion of from coal tar, used for making anti- pain, fear and shock in surgical oper- septic dyes. It is an important cause ations, brought about by means of local of serious industrial poisoning and anaesthesia and basal narcosis. methaemoglobinaemia. anodyne 1. pain-relieving or relaxing. anima 1. the soul. 2. Jung’s term for 2. a drug or other treatment that the unconscious, or inner being, of the relieves pain. individual, as opposed to the personality anomaly considerable variation from presented to the world (persona). In normal. Jungian psychoanalysis, the more fem- anomie a feeling of hopelessness and inine soul or feminine component of a lack of purpose. man’s personality. Anopheles a genus of mosquito. Many anion a negatively charged ion which are carriers of the malarial parasite and travels towards the anode, e.g., chloride infect humans by their bite. Other − 2− (Cl ), carbonate (CO3 ). See CATION. species transmit filariasis. aniridia lack of part or the whole of anophthalmia congenital absence of the iris. a seeing eye. anisocoria inequality of diameter anorexia loss of appetite for food. A. of the pupils of the two eyes. nervosa a condition in which there is anisocytosis inequality in the size of complete lack of appetite, with extreme the red blood cells. emaciation. It is owing to psychological anisometropia a marked difference causes and most commonly occurs in in the refractive power of the two eyes. young women with poor self esteem ankle the joint between the leg and and fear of obesity associated with a foot, formed by the tibia and fibula distorted body image, leading them to articulating with the talus. perceive themselves as fat and to take ankle-brachial pressure index extreme forms of dietary control in order (ABPI) The measurement of the ratio to lose weight. of systolic blood pressure at the ankle anosmia loss of the sense of smell. 23 ant anovular applied to the absence of anthrax an acute, notifiable, infectious ovulation. Usually refers to uterine disease due to Bacillus anthracis, bleeding when there has been no ovu- acquired through contact with infected lation, the result of taking contraceptive animals or their by-products. A world- pills. wide zoonosis, anthrax is now very anoxaemia complete lack of oxygen uncommon in the UK. in the blood. anthropoid resembling a human. A. anoxia lack of oxygen to an organ or pelvis female pelvis in which the tissue. anteroposterior diameter exceeds the antacid a substance neutralizing transverse diameter. acidity, particularly of the gastric juices. anthropology the study of human antagonist 1. a muscle that has an beings that focuses on origins, historical opposite action to another, e.g., the and cultural development, and races. biceps to the triceps. 2. in pharmacol- Cultural a. that branch of anthropology ogy, a drug that inhibits the action of that is concerned with individuals and another drug or enzyme, e.g., metho- their relationship to others and to their trexate is a folic acid antagonist. 3. in environment. Medical a. biocultural dentistry, a tooth in one jaw opposing discipline concerned with both the bio- one in the other jaw. logical and sociocultural aspects of anteflexion a bending forward, as of human behaviour, and the ways in the body of the uterus. See RETROFLEXION. which the two interact to influence antenatal before birth. A. care care health and disease. Physical a. that provided by midwives, GPs and obste- branch of anthropology that concerns tricians during pregnancy to ensure that the physical and evolutionary charac- the fetal and maternal health are sat- teristics of human beings. isfactory. Deviations from normal can anthropometry the science that deals be detected and treated early. The with the comparative measurement of mother can be prepared for labour and parts of the human body, such as parenthood and health education height, weight, body fat, etc. offered. anti-D immunoglobulin anti-rhesus antepartum shortly before birth, i.e., antibody which is given by intramus- in the last 3 months of pregnancy. A. cular injection to a rhesus-negative haemorrhage bleeding occurring before woman within 72 hours of delivery of parturition. See PLACENTA PRAEVIA. her infant or following termination of anterior situated at or facing towards her pregnancy, miscarriage or invasive the front. The opposite of posterior. A. investigations such as amniocentesis, capsule the anterior covering of the to prevent haemolytic disease of the lens of the eye. A. chamber of the eye newborn in the next pregnancy. Anti-D the space between the cornea in front is also available to all rhesus-negative and the iris and lens behind. women as antenatal prophylaxis. See anterograde extending or moving RHESUS FACTOR. forwards. anti-inflammatory a drug that anteversion the forward tilting of an reduces or acts against inflammation. organ, e.g., the normal position of the May belong to one of several groups. uterus. See RETROVERSION. antibacterial a substance that anthelmintic (anthelminthic) 1. destroys or suppresses the growth destructive to worms. 2. an agent of bacteria. destructive to worms. antibiotic substances (e.g., penicil- anthracosis a disease of the lungs, lin), produced by certain bacteria and caused by inhalation of coal dust. A fungi, that prevent the growth of, or form of pneumoconiosis. ‘Miner’s lung’. destroy, other bacteria. A. resistance ant 24

the evolution and survival, as a result other conditions in which convulsions of worldwide antibiotic misuse, of occur. bacteria undergoing the process of antidepressant one of a group of natural selection, despite the use drugs which elevate mood, often dimin- of antibiotics to which they were once ish anxiety and increase coping sensitive. behaviour. Tricyclic antidepressants and antibody also known as immunoglob- selective serotonin uptake inhibitors are ulin, an antibody is one of a group of the most commonly used in treatment these glycoprotein molecules found of depression. These drugs are usually either on the cell surface of B lympho- successful in relieving the symptoms cytes (membrane antibody) where they of depression, but may take 2–3 weeks act as antigen receptors, or produced before any improvement is noted. Anti- and secreted by B lymphocytes that depressant drugs are not addictive, but have been stimulated and transformed abrupt withdrawal may result in physical by an antigen into plasma cells. symptoms and should be avoided. Secreted antibodies are found in blood, Monoamine oxidase inhibitors (MAOIs) serum and in other body fluids and are used in the treatment of panic dis- tissues. Antibodies react and combine orders and bipolar depression. with specific antigens during humoral anti-discriminatory practice the immune responses, forming immune professional policies, practice and pro- complexes. Antibodies are an important visions that actively seek to reduce component of acquired (learned) immu- institutional discrimination experienced nity. There are five different types, or by individuals and groups, particularly classes of antibody, each named by on the grounds of age, race, gender, the abbreviation for immunoglobulin (Ig) disability, social class or sexual orien- and a letter of the alphabet, i.e., IgM, tation. Anti-discriminatory practice can IgG, IgA, IgD, IgE. IgG (also called gam- utilize particular the Equalities Act 2010 ma-globulin) is the most abundant of to challenge discrimination. the five classes of antibody and is the antidiuretic a substance that reduces major immunoglobulin in the secondary the volume of urine excreted. A. humoral immune response. hormone (ADH) a hormone which is anticholinergic a drug that inhibits secreted by the posterior pituitary the action of acetylcholine. gland. Vasopressin. anticholinesterase an enzyme that antidote an agent that counteracts the inhibits the action of the enzyme ace- effect of a poison. tylcholinesterase, thereby potentiating antiembolic against embolism. Anti- the action of acetylcholine at postsyn- embolic hose/stockings are worn to aptic receptors in the parasympathetic prevent the formation or decrease the nervous system, thus allowing return risk of deep vein thrombosis, especially of normal muscle contraction. in patients after surgery or those con- anticoagulant a substance that pre- fined to bed. vents or delays the blood from clotting, antiemetic a drug that prevents or e.g., warfarin. New anticoagulants are overcomes nausea and vomiting. available and are becoming increasingly antifungal a preparation effective in more common, e.g., rivaroxaban, dab- treating fungal infections. igatran which require less frequent antigen any substance, bacterial or blood monitoring. otherwise, which in suitable conditions anticonvulsant a substance that will can stimulate the production of an arrest or prevent convulsions. Anticon- immune response. vulsant drugs such as phenytoin are antihaemophilic see COAGULATION used in the treatment of epilepsy and FACTOR CONCENTRATE. 25 aor antihistamine any one of a group of been infected with the identified drugs which block the tissue receptors organism. for histamine. They are used to treat antisocial against society. A. allergic conditions, e.g., drug rashes, behaviour in psychiatry, the refusal of hay fever and serum sickness, and an individual to accept the normal obli- include promethazine. gations and restraints imposed by the antihypertensive 1. effective against community upon its members. hypertension. 2. an agent that reduces antispasmodic any measure used to high blood pressure. prevent or relieve the occurrence of antimalarial against malaria. Drugs muscle spasm. that are used both in the treatment of antitoxin a substance produced by the an attack and for prophylaxis. All vis- body cells as a reaction to invasion by itors to malarial countries should take bacteria, which neutralizes their toxins. preventative antimalarial drugs. Expert See IMMUNITY. advice should be sought regarding the antitussive 1. effective against cough. appropriate drug and dose. See MALARIA. 2. an agent that suppresses coughing. antimetabolite one of a group of antivenin an antitoxic serum to neu- chemical compounds which prevent the tralize the poison injected by the bite effective utilization of the corresponding of a snake or insect. metabolite, and interfere with normal antiviral 1. acting against viruses. 2. growth or cell mitosis if the process a drug that is effective against viruses requires that metabolite. causing disease, e.g., aciclovir. antineoplastic effective against the antrum a cavity in bone. Mastoid a. multiplication of malignant cells. the tympanic antrum, which is an antiperistalsis contrary contractions air-conditioning cavity in the mastoid which propel the contents of the intes- portion of the temporal bone. Maxillary tines backwards and upwards. a. antrum of Highmore. The air sinus antiperspirant a substance applied in the upper jawbone. to the body as a lotion, cream or spray anuria cessation of the secretion of to reduce sweating. Use can sometimes urine. result in irritation especially if the skin anus the extremity of the alimentary is broken. canal, through which the faeces are antiphospholipid syndrome discharged. Imperforate a. one where (APS) also known as Hughes syn- there is no opening because of a con- drome. An immune disorder causing genital defect. increased risk of blood clots. anxiety a chronic state of tension, antipruritic an external application or which affects both mind and body. A. drug that relieves itching. neurosis see NEUROSIS. antipyretic an agent that reduces anxiolytic a substance, such as diaz- fever. epam or pentobarbital, used for relief antisepsis the prevention of infection of anxiety. Anxiolytics may quickly by destroying or arresting the growth cause dependence and are not suitable of harmful microorganisms. for long-term administration. antiseptic 1. preventing sepsis. 2. any aorta the large artery rising out of the substance that inhibits the growth of left ventricle of the heart and supplying bacteria, in contrast to a germicide, blood to all the body. Abdominal a. which kills bacteria outright. that part of the artery lying in the antiserum animal or human blood abdomen. Arch of the a. the curve of serum which contains antibodies to the artery over the heart. Thoracic a. infective organisms or to their toxins. that part which passes through the The serum donor must have previously chest. aor 26 aortic pertaining to the aorta. A. heart the end closing the left ventricle. incompetence owing to previous A. of the lung the extreme upper part inflammation the aortic valve has of the organ. become fibrosed and is unable to close Apgar score V. Apgar, American completely, thus allowing backward flow anaesthetist, 1909–1974. A system of blood (a. regurgitation) into the left used in the assessment of the newborn: ventricle during diastole. A. stenosis reflex irritability and colour. The Apgar a narrowing of the aortic valve. A. valve score is assessed 1 minute after birth the valve between the left ventricle of and again at 5 minutes. Most healthy the heart and the ascending aorta, infants score 9 at birth. A score below which prevents the backward flow of 7 would indicate cause for concern (see blood through the artery. Table). aortography radiographic examination APEL see ACCREDITATION. of the aorta. A radio-opaque contrast APH antepartum haemorrhage. medium is injected into the blood to aphagia loss of the power to swallow. render visible lesions of the aorta or aphakia absence of the lens of the its main branches. eye. Aphacia. APACHE abbreviation for Acute Phys- aphasia a communication disorder iology And Chronic Health Evaluation. owing to brain damage; characterized A classification system for indicating by complete or partial disturbance of severity of illness in intensive care language comprehension, formulation patients. or expression. Partial disturbance is apathy an appearance of indifference, also called dysphasia. Broca’s a. dis- with no response to stimuli or display order in which verbal output is impaired, of emotion. often owing to STROKE, and in which aperient a drug that produces an verbal communication may be affected action of the bowels. A laxative. as well. Speech is slow and laboured aperistalsis lack of peristaltic move- and writing is often impaired. Devel- ment of the intestines. opmental a. a childhood failure to Apert’s syndrome E. Apert, French acquire normal language when deaf- paediatrician, 1868–1940. A congenital ness, learning difficulties, motor dis- abnormality in which there is fusion at ability or severe emotional disturbance birth of all the cranial sutures, in addi- are not causes. tion to syndactyly (webbed fingers). aphonia inability to produce sound. apex the top or pointed end of a cone- The cause may be organic disease of shaped structure. A. beat the beat of the larynx or may be purely functional. the heart against the chest wall which aphrodisiac a drug which excites can be felt during systole. A. of the sexual desire.

Apgar score Sign Score 0 1 2 Appearance Blue/pale Body pink, extremities blue Pink Pulse rate Absent Below 100 Above 100 Grimace None Grimace (on stimulation) Cries Activity Limp Some (flexion of extremities) Active Respiration Absent Weak cry, hypoventilation Strong cry 27 apr aphthae small ulcers surrounded by appendicitis inflammation of the ver- erythema on the inside of the mouth miform appendix. (aphthous ulcers). appendix a supplementary or depen- apical pertaining to the apex of a dent part. A. epiploicae small tag-like structure. structures of peritoneum containing fat, apicectomy excision of the root of a which are scattered over the surface tooth. Root resection. of the large intestine, especially the APL see ACCREDITATION. transverse colon. Vermiform a. a worm- aplasia incomplete development of like tube with a blind end, projecting an organ or tissue or absence of from the caecum in the right iliac growth. region. It may be from 2.5 to 15 cm aplastic without power of develop- long. ment. A. anaemia see ANAEMIA. apperception conscious reception and apnoea cessation of respiration. A. recognition of a sensory stimulus. mattress a mattress designed to sound appetite the desire for food. It is stim- an alarm if the infant lying on it ceases ulated by the sight, smell or thought breathing. A. monitor designed to give of food, and accompanied by the flow an audible signal when a certain period of saliva in the mouth and gastric juice of apnoea has occurred. A. of prema- in the stomach. The stomach wall also turity apnoeic periods occurring in the receives an extra blood supply in prepa- respiration of newborn infants in whom ration for its digestive activity. Appetite the respiratory centre is immature or is psychological, dependent on memory depressed. Cardiac a. the temporary and associations, as compared with cessation of breathing caused by a hunger, which is physiologically aroused reduction of the carbon dioxide tension by the body’s need for food. Appetite in the blood, as seen in Cheyne–Stokes can be discouraged by unattractive respiration. Sleep a. transient attacks food, surroundings or company, and of failure of autonomic control of res- by emotional states such as anxiety, piration, becoming more pronounced irritation, anger and fear. during sleep. apposition the bringing into contact apocrine pertaining to modified sweat of two structures, e.g., fragments of glands that develop in hair follicles, bone in setting a fracture. such as are mainly found in the axillary, appraisal a formal review, usually pubic and perineal areas. annually, of a health care professional’s aponeurosis a sheet of tendon-like performance by a trained appraiser in tissue which connects some muscles order to provide feedback on past per- to the parts that they move. formance, identifying progress made apophysis a prominence or excres- and together agreeing future goals and cence, usually of a bone. objectives. apoplexy a sudden fit of insensibility, apprehension a feeling of dread or usually caused by rupture of a cerebral fear. blood vessel or its occlusion by a blood approved name the non-proprietary clot producing coma and paralysis of or generic name for a drug. The one side of the body. Rarely used term approved name should always be used for a stroke. in prescribing except where the bio- apparition a hallucinatory vision, availability may vary between brands. usually the phantom appearance of a apraxia the inability to perform correct person. A spectre. movements because of a brain lesion appendectomy appendicectomy. and not because of sensory impair- appendicectomy removal of the ver- ment or loss of muscle power in the miform appendix. limbs. Oral a. inability to perform APT 28

volitional movements of the tongue arginine an essential amino acid pro- and lips in the absence of paralysis duced by the digestion of protein. It or paresis. Involuntary movements may, forms a link in the excretion of nitrogen, however, be observed, e.g., patients being hydrolysed by the enzyme may purse their lips in order to blow out arginase. a match. Argyll Robertson pupil D. Argyll aptitude the natural ability or capacity Robertson, British ophthalmologist, to acquire mental and physical skills. 1837–1909. See PUPIL. A. test the evaluation of a person’s Arnold–Chiari malformation J. ability for learning certain skills or car- Arnold, German pathologist, 1835– rying out specific tasks. 1915; H. Chiari, German pathologist, apyrexia the absence of fever. 1851–1916. Herniation of the cere- aqua [L.] water. A. destillata distilled bellum and elongation of the medulla water. oblongata; occurs in hydrocephalus aqueduct a canal for the passage of associated with spina bifida. Also fluid. A. of Sylvius the canal connecting known as CHIARI MALFORMATION. the third and fourth ventricles of the aromatherapy the therapeutic use of brain. specially prepared essential or aromatic aqueous watery. A. humour the fluid oils obtained from the different parts filling the anterior and posterior cham- of plants, including the flowers, leaves, bers of the eye. seeds, wood, roots and bark. The oils Arachis a genus of leguminous plants may be diluted for use in massage, used in various preparations such as baths or infusions. earwax softeners and skin medications. arousal a state of alertness and arachnodactyly abnormally long and increased response to stimuli. thin fingers and toes. A congenital arrector pili a small muscle attached condition. to the hair follicle of the skin. When arachnoid 1. resembling a spider’s contracted it causes the hair to become web. 2. a web-like membrane covering erect, producing the appearance known the central nervous system between as gooseflesh. the dura and pia mater. arrest a cessation or stopping. Cardiac arborization the branching termi- a. cessation of ventricular contractions. nations of many nerve fibres and Developmental a. discontinuation of a processes. child’s mental or physical development arbovirus one of a large group of at a certain stage. Respiratory a. ces- viruses transmitted by insect vectors sation of breathing. See Appendix 2. (arthropod-borne), e.g., mosquitoes, arrhenoblastoma a rare ovarian sandflies or ticks. The diseases caused tumour that secretes male hormones include many types of encephalitis, also and causes virilization. yellow, dengue, sandfly and Rift Valley arrhythmia variation from the normal fevers. rhythm, e.g., in the heart’s action. arcus [L.] bow, arch. A. senilis an Sinus a. an abnormal pulse rhythm due opaque circle appearing round the edge to disturbance of the sinoatrial node, of the cornea in old age. causing quickening of the heart on ARDS acute respiratory distress inspiration and slowing on expiration. syndrome. art therapy the use of the creative areola 1. a space in connective tissue. arts as a medium to encourage patients 2. a ring of pigmentation, e.g., that to express their feelings when unable surrounding the nipple. to do so verbally. arginase an enzyme of the liver that artefact something that is man-made splits arginine into urea and ornithine. or introduced artificially. 29 art arterial blood gases (ABGs) nor- in general constitute the major cause mally present in arterial blood include of chronic disability in the UK. Acute oxygen, carbon dioxide and nitrogen. rheumatic a. rheumatic fever. Osteo- Measurements of the partial pressures a. (DJD) a degenerative condition of oxygen and carbon dioxide together attacking the articular cartilage and with the blood’s pH provide important aggravated by an impaired blood information on the oxygen saturation supply, previous injury or overweight, of the haemoglobin and acid–base mainly affecting weight-bearing joints state of the blood indicating the ade- and causing pain. Rheumatoid a. quacy of ventilation in critical care a chronic inflammation, usually of situations. unknown origin. The disease is pro- arteriectomy the removal of a portion gressive and incapacitating, owing to of artery wall, usually followed by anas- the resulting ankylosis and deformity of tomosis or a replacement graft. See the bones. Usually affects the elderly. ARTERIOPLASTY. A juvenile form is known as STILL’S arteriography radiography of arteries DISEASE. after the injection of a radio-opaque arthroclasia the breaking down of contrast medium. adhesions in a joint to produce freer arterioplasty the reconstruction of an movement. artery by means of replacement or arthrodesis the fixation of a movable plastic surgery. joint by surgical operation. arteriosclerosis a gradual loss of arthrography the examination of a elasticity in the walls of arteries due joint by means of X-rays. An opaque to thickening and calcification. It is contrast medium may be used. accompanied by high blood pressure, arthrogryposis 1. a congenital abnor- and precedes the degeneration of inter- mality in which fibrous ankylosis of nal organs associated with old age or some or all of the joints in the limbs chronic disease. occurs. 2. a tetanus spasm. arteriotomy an incision or puncture arthroplasty plastic surgery for the into an artery. reorganization of a joint. Charnley’s a. arteriovenous both arterial and see MCKEE FARRAR a. Cup a. reconstruc- venous; pertaining to both artery and tion of the articular surface, which is vein, e.g., an arteriovenous aneurysm, then covered by a vitallium cup. Exci- fistula or shunt for haemodialysis. sion a. excision of the joint surfaces arteritis inflammation of an artery. affected, so that the gap thus formed Giant cell a. a variety of polyarteritis then fills with fibrous tissue or muscle. resulting in partial or complete occlu- Girdlestone a. an excision arthroplasty sion of a number of arteries. The carotid of the hip. McKee Farrar a. replace- arteries are often involved. Temporal ment of both the head and the socket a. occlusion of the extracranial arteries, of the femur; Charnley’s a. is similar. particularly the carotid arteries. Replacement a. partial removal of the artery a tube of muscle and elastic head of the femur and its replacement fibres, lined with endothelium, which by a metal prosthesis. distributes blood from the heart to the arthroscope an endoscope for exam- capillaries throughout the body. ining the interior of a joint. arthralgia neuralgic pains in a joint. arthroscopy keyhole surgery used to arthrectomy excision of a joint. diagnose and treat joint problems. arthritis inflammation of one or articular pertaining to a joint. more joints. Movement in the joint articulation 1. a junction of two or is restricted, with pain and swelling. more bones. 2. the enunciation of Arthritis and the rheumatic diseases words. art 30 artificial not natural. A. feeding 1. inhalation of asbestos fibres causing the giving of food other than by placing scarring of the lung tissue. It results it directly in the mouth. It may be pro- in breathlessness and leads to respi- vided via the mouth, using an oesoph- ratory failure. It may be latent for many ageal tube; the food may be introduced years. See MESOTHELIOMA. into the stomach through a fine tube ascariasis the condition in which via the nostril (the nasal route); an roundworms are found in the gastro- opening through the abdominal wall intestinal tract. Treatment is with into the stomach (i.e., a gastrostomy) anthelmintic drugs to eliminate the may allow direct introduction; or food infestation. may be injected intravenously (see PAR- ascites free fluid in the peritoneal ENTERAL). 2. in reference to the feeding cavity. It may be the result of local of infants, giving food other than human inflammation or venous obstruction, or milk. A. insemination the insertion of be part of a generalized oedema. sperm into the uterus by means of ascorbic acid vitamin C. This acid is syringe and cannula instead of coitus. found in many vegetables and fruits The husband’s, partner’s or donor and is an essential dietary constituent semen may be used. A. kidney a dial- for humans. Vitamin C is destroyed by ysis machine to remove unwanted heat and deteriorates during storage. waste materials from the patient with It is necessary for connective tissue acute or chronic renal failure. See HAE- and collagen fibre synthesis and pro- MODIALYSIS. A. respiration a means of motes the healing of wounds. Defi- resuscitation from asphyxia. A. tears ciency causes scurvy. sterile solutions designed to maintain asepsis freedom from pathogenic the moisture of the cornea when the microorganisms. latter is abnormally dry due to inade- aseptic free from sepsis. A. technique quate tear production. Methylcellulose a method of carrying out sterile pro- is a common ingredient. cedures so that there is the minimum arytenoid resembling the mouth of a risk of introducing infection. Achieved pitcher. A. cartilages two cartilages of by the sterility of equipment and a non- the larynx; their function is to regulate touch technique. the tension of the vocal cords attached asexual without sex. A. reproduction to them. the production of new individuals asbestos a fibrous non-combustible without sexual union, e.g., by cell divi- silicate of magnesium and calcium that sion or budding. is a good non-conductor of heat. There asparaginase an enzyme that catal- are three types of asbestos fibre— yses the deamination of asparagine; white, brown and blue—that were used as an antineoplastic agent against widely used in the building industry. cancers, e.g., acute lymphocytic leu- White fibre was the most commonly kaemia, in which the malignant cells used and blue and brown fibres the require exogenous asparagine for most dangerous to health. In many protein synthesis. countries there are now strict regu- aspartame a synthetic compound lations controlling the use of asbes- of two amino acids (L-aspartyl-L- tos (which has declined), including its phenylalanine methyl ester) used as a removal from buildings. Contact with low-calorie sweetener. It is 180 times asbestos over a prolonged period may as sweet as sucrose (table sugar); the result in asbestosis, bronchial and amount equal in sweetness to a tea- laryngeal cancer and mesothelioma. spoon of sugar contains 0.1 calorie asbestosis a form of pneumoconiosis (4.2 J). Aspartame does not promote (chronic lung disease), due to the the formation of dental caries. It 31 ass

should be avoided by patients with from an adult or child who is legally phenylketonuria. incompetent to consent. aspartate transaminase (AST) an assertiveness a form of behaviour enzyme released when the liver or characterized by a confident declaration muscles are damaged. Levels of AST or affirmation of a statement without are measured as markers of liver need of proof. To assert oneself is to health. compel recognition of one’s rights or aspect that part of a surface facing position without either aggressively in a particular direction. Dorsal a. that transgressing the rights of another and facing and seen from the back. Ventral assuming a position of dominance, or a. that facing and seen from the front. submissively permitting another to deny aspergillosis a bronchopulmonary one’s rights or rightful position. A. disease in which the mucous mem- training instruction and practice in brane is attacked by the fungus techniques for dealing with interper- Aspergillus. sonal conflicts and threatening situa- Aspergillus a genus of fungi. A. fumi- tions in an assertive manner, avoiding gatus a common cause of aspergillosis, the extremes of aggressive and sub- found in soil and manure. missive behaviour. aspermia absence of sperm. assessment 1. the critical analysis asphyxia a deficiency of oxygen in the and valuation or judgement of the status blood and an increase in carbon dioxide or quality of a particular condition, sit- in the blood and tissues. Symptoms uation or other subject of appraisal. In include irregular and disturbed respi- the nursing process, assessment rations, or a complete absence of involves the gathering of information breathing, and pallor or cyanosis. about the health status of the patient/ Asphyxia may occur whenever there is client, analysis and synthesis of the an interruption in the normal exchange data, and the making of a clinical of oxygen and carbon dioxide between nursing judgement. The outcome of the the lungs and the outside air. Common nursing assessment is the establish- causes are drowning, electric shock, ment of a nursing DIAGNOSIS, the iden- lodging of a foreign body in the air tification of the nursing problems and passages, inhalation of smoke and poi- establishing a nursing care plan. 2. an sonous gases and trauma to or disease examination set by an examining of the lungs or air passages. Treatment authority to test a candidate’s skills includes immediate remedy of the sit- and knowledge. uation (see RESPIRATION (ARTIFICIAL) and assimilation the process of transform- Appendix 2) and removal of the under- ing food so that it can be absorbed lying cause whenever possible. and utilized as nourishment by the aspiration 1. the act of inhaling. 2. tissues of the body. the drawing off of fluid from a cavity association coordination of function by means of suction. of similar parts. A. fibres nerve fibres assault unlawful personal attack or linking different areas of the brain. A. trespass upon another person including of ideas a mental impression in which threatening words. a thought or any sensory impulse will assay a quantitative examination to call to mind another object or idea con- determine the amount of a particular nected in some way with the former. constituent of a mixture, or of the bio- Free a. a method employed in psycho- logical or pharmacological potency of analysis in which the patient is encour- a drug. aged to express freely whatever comes assent agreement to undergo medical to mind. By this method material that care and treatment that is obtained is in the unconscious can be recalled. ass 32 associative play a form of play in focus on the retina is then not a point which a group of children participate but a diffuse and indistinct area. May in similar activities without formal orga- be congenital or acquired. nization or direction. astringent an agent causing contrac- asthenia lack of energy or strength. tion of organic tissues, thereby check- Debility. Loss of tone. ing secretions, e.g., silver nitrate. asthenic description of a type of body astrocytoma a malignant tumour of build: a pale, lean, narrowly built person the brain or spinal cord. It is slow- with poor muscle development. growing. A glioma. asthenopia eye strain likely to arise asymmetry inequality in size or shape in long-sighted people when continual of two normally similar structures or effort of accommodation is required for of two halves of a structure normally close work. the same. asthma paroxysmal dyspnoea charac- asymptomatic without symptoms. terized by wheezing and difficulty in asynergy lack of coordination of struc- expiration. The illness often commences tures which normally act in harmony. in childhood but can commence at any asystole absence of heartbeat. Cardiac age and in about half of the children arrest. affected it may be outgrown. Bronchial at risk whereby an individual or pop- a. attacks of dyspnoea in which there ulation may be vulnerable to a particular is wheezing and difficulty in expiration disease, hazard or injury. At risk situ- due to muscular spasm of the bronchi. ations are those involving possible The attacks may be precipitated by problems that may be preventable with hypersensitivity to foreign substances, appropriate intervention, or, if they air pollution, exertion or infection, or should occur, treatment. associated with emotional upsets. There ataraxia a state of detached serenity is often a family history of asthma or with depression of mental faculties or other allergic condition. Management impairment of consciousness. involves avoidance of known allergens ataxia, ataxy failure of muscle coor- and treatment is with bronchodilators dination resulting in irregular jerky with or without corticosteroids, usually movements, and unsteadiness in stand- via an aerosol. Other drug therapies ing and walking from a disorder of the used include sodium cromoglycate controlling mechanisms in the brain, useful in preventing exercise-induced or from inadequate input to the brain asthma and inhaled anticholinergic from joints and muscles. Hereditary a. drugs may also be used to assist bron- Friedreich’s ataxia. chodilation. An asthmatic person with atelectasis a collapsed or airless state an acute attack that does not respond of the lung, which may be acute or to initial drug therapy should be referred chronic and may involve all or part of to hospital for immediate assessment the lung: (a) from imperfect expansion and treatment. Cardiac a. attacks of of pulmonary alveoli at birth (congenital dyspnoea and palpitation, arising most a.); (b) as the result of disease or injury. often at night, associated with left-sided atheroma an abnormal mass of fatty heart failure and pulmonary congestion. or lipid material with a fibrous covering, Treatment is with diuretic therapy. existing as a discrete, raised plaque astigmatism inequality of the refrac- within the intima of an artery. tive power of an eye, due to curvature atherosclerosis a condition in which of its corneal meridians. The curve the fatty degenerative plaques of ath- across the front of the eye from side eroma are accompanied by arterioscle- to side is not quite the same as the rosis, a narrowing and hardening of curve from above downwards. The the vessels. 33 aty athetosis a recurring series of slow, impulses. A. valves the bicuspid and writhing movements of the hands, tricuspid valve on the left and right usually affecting people with cerebral sides of the heart, respectively. palsy. atrium pl. atria. 1. a cavity, entrance Athlete’s foot a fungal infection or passage. 2. one of the two upper between the toes, easily transmitted chambers of the heart. Formerly called to other people. See TINEA. auricle. atlas the first cervical vertebra, artic- atrophy wasting of any part of the ulating with the occipital bone of the body, owing to degeneration of the skull. cells, from disuse, or lack of nourish- atmosphere 1. the gases that sur- ment or nerve supply. Progressive round the earth, extending to an altitude muscular a. a rare form of motor of 16 km. 2. the air or climate of a neurone disease with degeneration of particular place, e.g., a smoking atmo- the lower motor neurones with wasting sphere. 3. mental or moral environ- of muscle tissue. ment, tone or mood. atropine an alkaloid which inhibits atomizer an instrument by which a respiratory and gastric secretions, liquid is divided to form a fine spray relaxes muscle spasm and dilates the or vapour (nebulizer). pupil. atony lack of tone, e.g., in the muscle attack an episode or onset of illness. detrusor of the bladder resulting in A. rate number of cases of a disease incontinence. in a particular group, e.g., a school, atopy a state of hypersensitivity to over a given period, related to the pop- certain antigens. There is an inherited ulation of that group. Transient isch- tendency that includes asthma, eczema aemic a. brief attack (a few hours or and hay fever. less) of cerebral dysfunction of vascular ATP adenosine triphosphate. origin, with STROKE-like symptoms, atresia absence of a natural opening without lasting neurological deficit. or tubular structure, e.g., of the anus attention deficit syndrome a dis- or vagina; usually a congenital order of childhood characterized by malformation. marked failure of attention, impulsive- atrial relating to the atrium. A. fibril- ness and increased motor activity. lation overstimulation of the atrial walls Affects more boys than girls. Treatment so that many areas of excitation arise involves medication, behaviour therapy and the atrioventricular node is bom- and social support. Also known as barded with impulses, many of which attention deficit hyperactivity disorder it cannot transmit, resulting in a highly (ADHD). irregular pulse. A. flutter rapid regular attenuation a bacteriological process action of the atria. The atrioventricular by which organisms are rendered less node transmits alternative impulses or virulent by culture in artificial media one in three or four. The atrial rate is through many generations, exposure usually about 300 beats per minute. to light, air, etc.; it is used for vaccine A. septal defect the non-closure preparations. of the foramen ovale at the time of attitude 1. a posture or position of birth, giving rise to a congenital heart the body; in obstetrics, the relation of defect. the various parts of the fetal body to atrioventricular pertaining to the one another. 2. a pattern of mental atrium and ventricle. A. bundle see views established by cumulative prior BUNDLE OF HIS. A. node a node of neu- experience. rogenic tissue situated between the atypical irregular; not conforming to atrium and ventricle and transmitting type. aud 34 audiogram a graph produced by an interviews and surveys of patients and audiometer. families. audiologist an allied health profes- auditory relating to the ear or to the sional specializing in audiology, who sense of hearing. provides services that include: (a) eval- aura the premonition, peculiar to an uation of hearing function to detect individual, which often precedes an hearing impairment and, if there is a epileptic fit. hearing disorder, to determine the ana- aural referring to the ear. tomical site involved and the cause of auricle 1. the external portion of the the disorder; (b) selection of appropriate ear. 2. obsolete term for the atrium. hearing aids; and (c) training in lip auriscope an instrument for examining reading, hearing aid use and mainte- the drum of the ear. An otoscope. nance of normal speech. auscultation examining the internal audiology the science concerned organs by listening to the sounds that with the sense of hearing, especially they give out. In direct or immediate the evaluation and measurement of a. the ear is placed directly against the impaired hearing and the rehabilita- body. In mediate a. a stethoscope is tion of those with impaired hearing. used. audiometer an instrument for testing autism neurodevelopment disorder hearing, whereby the threshold of the characterized by impaired social inter- patient’s hearing can be measured. actions, verbal and non-verbal com- audit systematic review and eval- munication and restricted and repetitive uation of records and other data to behaviour. Infantile a. failure of a child determine the quality of the services to relate to people and situations, or products provided in a given sit- leading to complete withdrawal into a uation. A. trail the process in which world of private fantasies. careful documentation of the research autistic pertaining to autism. process makes it possible for students autistic spectrum disorder also and other researchers to understand known as autism spectrum disorder. how any particular finding was reached. A range of conditions which encompass Medical a. the systematic critical anal- the previous diagnosis of autism, ysis of the quality of medical treatment Asperger’s syndrome, pervasive devel- and care, including the procedures for opmental disorder and childhood dis- diagnosis and treatment, the use of integrative disorder. resources, outcomes and the resul- autoagglutination 1. clumping or tant quality of life for the patient. agglutination of cells by an individual’s Nursing a. an evaluation of structure, own serum, as in autohaemagglutina- process and outcome as a measure- tion. Autoagglutination occurring at low ment of the quality of nursing care. temperatures is called cold agglutina- Concurrent audits are conducted at tion. 2. agglutination of particulate the time the care is being provided antigens, e.g., bacteria, in the absence to clients/patients. They may be con- of specific antigens. ducted by means of observation and autoantibody an antibody formed in interview of clients/patients, review response to and reacting against the of open charts, or conferences with individual’s own tissues. groups of consumers and providers autoantigen a tissue constituent that of nursing care. Retrospective audits stimulates production of autoantibodies are conducted after the patient’s in the organism in which it occurs. discharge. Methods include the autoclave a steam-heated sterilizing study of closed patient’s charts and apparatus in which the temperature is nursing care plans, questionnaires, raised by reducing the air pressure 35 ave

inside; steam is injected under pres- sounds via sensors placed on the sure, bringing about efficient steriliza- infant’s head. Those infants who fail tion of instruments and dishes treated to respond to this test are referred for in this way. a full auditory diagnostic assessment. autodigestion dissolution of tissue by automatic performed without the influ- its own secretions. Autolysis. ence of the will. autoeroticism sexual pleasure derived automatism performance of non-reflex from self-stimulation of erogenous acts without apparent volition, and of zones (the mouth, the anus, the genitals which the patient may have no memory and the skin). See MASTURBATION. afterwards, as in somnambulism. autogenic therapy a complementary Post-epileptic a. automatic acts fol- therapy combining self-hypnosis and lowing an epileptic fit. relaxation. autonomic self-governing. A. nervous autogenous generated within the system the sympathetic and parasym- body and not acquired from external pathetic nerves that control involun- sources. tary muscles and glandular secretion, autograft the transfer of skin or other over which there is no conscious tissue from one part of the body to control. another to repair some deficiency. autonomy the right of personal autoimmune disease condition in freedom of action, which is regarded which the body develops antibodies to as one of the hallmarks of a profession. its own tissues, e.g., in autoimmune autoplasty 1. replacement of missing thyroiditis (Hashimoto’s disease). tissue by grafting a healthy section from autoimmunization the formation of another part of the body. 2. in psycho- antibodies against the individual’s own analysis, instinctive modification within tissue. the psychic systems in adaptation to autoinfection self-infection, trans- reality. ferred from one part of the body to autopsy postmortem examination of a another by fingers, towels, etc. body to determine the cause of death. autoinoculation inoculation with a autosome any chromosome other than microorganism from the body itself. the sex chromosomes. In humans there autointoxication poisoning by toxins are 22 pairs of autosomes and one generated within the body itself. pair of sex chromosomes. autologous related to self; belonging autosuggestion suggestion arising in to the same organism. A. blood trans- one’s self. Uncritical acceptance of an fusion (ABT) the patient donates blood idea arising in the individual’s own before elective surgery for transfusion mind. postoperatively. ABT may also be autotransfusion reinfusion of a obtained as a blood salvage procedure patient’s own blood. during operation or postoperatively. autotransplantation transfer of tissue Avoids cross-matching, compatibility from one part of the body to another and transfusion infection problems. part. autolysis a breaking up of living avascular not vascular. Bloodless. A. tissues, e.g., as may occur if pancreatic necrosis death of bone owing to defi- ferments escape into surrounding cient blood supply, usually following tissues. It also occurs after death. an injury. automated auditory brainstem average 1. the value or score that is response (AABR) one of two typical of a group. The result is obtained hearing tests in the Newborn Hearing by adding several amounts together and Screening Programme that records then dividing the total by the number of brain activity in response to clicking amounts. Sometimes also referred to ave 36

as the mean. 2. A colloquial term used an individual seeks to escape or to mean ‘usual’ or ‘ordinary’. avoid certain situations, feelings or aversion intense dislike. A. therapy a conflicts. method of treating addictions by asso- avulsion the tearing away of one part ciating the craving for what is addictive from another. Phrenic a. a tearing away with painful or unpleasant stimuli. It is of the phrenic nerve. It paralyses the rarely used. diaphragm on the affected side. avian influenza commonly known axilla an armpit. as bird flu, a disease of poultry and axiom a statement or proposition that other birds caused by strains of the can be accepted without evidence as influenza virus that can occasionally it is obviously true. infect people who are in close contact axis 1. a line through the centre of a with infected birds. The severity of the structure. 2. the second cervical ver- disease depends upon the strain of the tebra. See PLANES. virus involved; the strain caused by the axon the process of a nerve cell along H5N1 virus is particularly virulent. At which electrical impulses travel. The the present time, normal influenza vac- nerve fibre. cines do not protect against the H5N1 axonotmesis nerve injury character- virus. See ORTHOMYXOVIRUS and swine ized by disruption of the axon and influenza. myelin sheath but with preservation of aviation medicine the medical spe- the connective tissue fragments, result- ciality concerned with the effects of air ing in degeneration of the axon distal travel and with the causes and treat- to the injury site; regeneration of the ment of health problems that may occur axon is spontaneous. in flight. azoospermia absence of spermatozoa avitaminosis a condition resulting from in the semen. an insufficiency of vitamins in the diet. azygos something that is unpaired. A deficiency disease. azygous vein an unpaired vein that avoidance a conscious or uncon- ascends the posterior mediastinum and scious defence mechanism whereby enters the superior vena cava.