The meaning of the symbols of definition seen in a dream.

A failure of the adaptive mechanisms of an organism to counteract adequately, normally or appropriately to stimuli and stresses to which the organism is subjected, resulting in a disturbance in the function or structure of some part of the organism. This definition emphasizes that disease is multifactorial and may be prevented or treated by changing any or a combination of the factors. Disease is a very elusive and difficult concept to define, being largely socially defined. Thus, criminality and drug dependence are presently seen by some as diseases, when they were previously considered to be moral or legal problems.... disease

All forms of illness in which psychological, emotional or behavioural disturbances are the dominating feature. The term is relative and variable in different cultures, schools of thought and definitions. It includes a wide range of types and severities.... mental illness

A variety of chronic symptoms and physical findings that occur in some persons who are infected with HIV, but do not meet the Centres for Disease Control’s definition of AIDS. Symptoms may include chronic swollen glands, recurrent fevers, unintentional weight loss, chronic diarrhoea, lethargy, minor alterations of the immune system (less severe than those that occur in AIDS), and oral thrush. ARC may or may not develop into AIDS.... aids-related complex

Literally, substances meant to oppose depressions or sadness, and generally heterocyclic types such as Elavil, MAO inhibitors like phenelzine, or lithium carbonate. This category of substances formerly included stuff like amphetamines and other stimulants. Our only plants that could fit the current definition would be Hypericum, Peganum and perhaps Oplopanax.... antidepressant

A geographic area defined and served by a health programme or institution, such as a hospital or community health centre, which is delineated on the basis of such factors as population distribution, natural geographic boundaries, and transportation accessibility. By definition, all residents of the area needing the services of the programme are usually eligible for them, although eligibility may also depend on additional criteria.... catchment area

Clinical information, excluding information about treatment and intervention. Clinical information that does not record an intervention is by nature a clinical observation. The observer may be the patient or related person (information about symptoms, family history, occupation or lifestyle) or a health care professional (information about physical signs, measurements, properties observed or diagnoses). While information about the nature of a planned or performed treatment is excluded by the definition, clinical observations may be recorded on the results of a treatment, on progress during the course of a treatment, or on the result of a treatment.... clinical observation

An attribute or rule that serves as a basis for evaluation, definition or classification of something; an evaluation standard.... criterion

Usually defined as the passage of three or more liquid motions within 24 hours. However, for exclusivelybreast-fed infants this may not be satisfactory and the definition is usually based upon what the mother considers to be diarrhoea.... diarrhoea

Conventionally defined as beginning with the first 24-hour period that meets the definition of diarrhoea and ending with the last diarrhoeal day that is followed by at least two consecutive days that do not meet the definition of diarrhoea.... diarrhoeal episode

A group of cases of a specific disease or illness clearly in excess of what one would normally expect in a particular geographic area. There is no absolute criterion for using the term epidemic; as standards and expectations change, so might the definition of an epidemic, e.g. an epidemic of violence.... epidemic

The absence of psychiatric disorders or traits. It can be influenced by biological, environmental, emotional and cultural factors. This term is highly variable in definition, depending on time and place.... mental health

A widely agreed upon and generally accepted set of terms and definitions constituting a core of data acquired for e.g. assessment purposes.... minimum data set

A substance that depresses central nervous system function, bringing sleep and lessening pain. By definition, narcotics can be toxic in excess.... narcotic

Cases that differ substantially from the average case in a particular area. For example, a hospital admission requiring either substantially more expense or a much longer length of stay than average. See also Statistical section for related definition.... outlier

A minimum income level below which a person is officially considered to lack adequate subsistence and to be living in poverty. Poverty statistics are based on definitions developed by individual countries or constituencies.... poverty level / line

Definition:– “A substance or combination of substances presented for treating or preventing disease; or with a view to making a medical diagnosis or to restoring, correcting or modifying physiological functions.” (Directive EC 65/65)

Take medicines as instructed by the practitioner. Never take the contents of unlabelled bottles or cartons. Never share prescribed medicines with other people. Never transfer medicines from one container to another. Keep all medicines out of the reach of children. ... medicine

n. the basic *SI unit of electric current. It is equal to the current flowing through a conductor of resistance 1 ohm when a potential difference of 1 volt is applied between its ends. The formal definition of the ampere is the current that when passed through two parallel conductors of infinite length and negligible cross section, placed 1 metre apart in a vacuum, produces a force of 2 × 10?7 newton per metre between them. Symbol: A.... ampere

The extent to which a measurement, test or study measures what it purports to measure. There are various types of validity: construct validity: The degree to which an instrument measures the characteristic being investigated; the extent to which the conceptual definition matches the operational definition. content validity: Verification that the method of measurement actually measures what it is expected to measure, covering all areas under investigation reasonably and thoroughly. criterion validity: Verification that the instrument correlates with external criteria of the phenomenon under study, either concurrently or predictively. external validity: The extent to which study results can be generalized beyond the sample used in the study. face validity: A type of content validity, determining the suitability of a given instrument as a source of data on the subject under investigation, using commonsense criteria. internal validity: the extent to which the effects detected in a study are truly caused by the treatment or exposure in the study sample, rather than being due to other biasing effects of extraneous variables.... validity

Injury by exposure to damp and cold. Small babies and emaciated elderly people may not generate sufficient heat in wintry weather.

Causes: fatigue, poor physical condition, inadequate nutrition.

Symptoms: death-like cold on surface of abdomen and under armpits, arrested pulse, slow breathing, partial loss of consciousness, blue puffy skin, stumbling, hallucinations, function of vital organs slows down.

A Glasgow survey shows cases are usually due to “the person dying of something else, drinks or drugs, or low thyroid function”. Cold induces platelet agglutination which is a hazard for sufferers of thrombosis and heart disease. Even short exposures in the elderly with atheroma (see definition) are a hazard. Preventative: Garlic.

To thin down thick blood: Nettle tea. Lemons.

Treatment. Circulatory stimulants. Under no circumstances should sedatives, antidepressants or tranquillisers be given. More than a few drops of alcohol increases heat loss and worsens the condition. Alternatives. Life Drops: 5-10 drops in cup of tea.

Cayenne pepper on food. Composition powder or essence.

Camphor drops rapidly dispel the shivering reaction. All these open surface blood vessels and promote a vigorous circulation.

Teas: Chamomile, Balm, Yarrow.

Diet. Hot meals, hot drinks, adequate protein as well as carbohydrates. No alcohol. Oats warms the blood. Oatmeal porridge is indicated for people habitually cold. One teaspoon honey thrice daily in tea or other hot drink.

Wear a hat; nightcap at night. Electric blanket. Sleep in well-heated room. Wear thick wool underclothing. Serious cases admitted to Intensive Care Unit. ... hypothermia

Overpowering desire to sleep at any time of the day and in any situation. Psychiatrists believe it to be an escape mechanism, a form of hysteria. Seems to run in families. Official definition favours a neurologic brain disorder rather than a psychogenic disorder which has its origin in the mind. May be mis-diagnosed and treated as schizophrenic with antipsychotic drugs.

Symptoms. Tired and apathetic. Muscle weakness. May hear voices and have terrifying hallucinations. Causes may be emotional, autotoxaemic, psychic disturbance or spirit possession.

Treatment. Central nervous system stimulants, antidepressants.

Alternatives. Ginkgo, Siberian Ginseng, Camphor, Horseradish, Prickly Ash bark, Gotu Kola, Kola. Yerbe mate tea.

Tablets/capsules. Prickly Ash, Thuja, Ginseng, Gotu Kola.

Formula. Ginkgo 2; Prickly Ash 1; Ginseng 1. Doses – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or honey, thrice daily. Practitioner. Ephedra – 1 teaspoon to each cup boiling water; half-1 cup at bedtime. Ephedrine.

Note: Researchers have discovered a “biologic marker for the disease – an antigen called HLA.DR2 found in almost 100 per cent of narcoleptic patients”. The antigen appears in only 25 per cent of the general population. This unusual finding may also be evidence that the immune system is somehow involved in the onset of narcolepsy. (American Family Physician, July 1988) ... narcolepsy

A distinct system of healing – a philosophy, science art and practice which seeks to promote health by stimulating the body’s inherent power to regain harmony and balance. It regards as self- evident laws:

(1) only nature heals, providing it is given the opportunity to do so;

(2) let food be your medicine and medicine your food; (3) disease is an expression of purification; and

(4) all disease is one.

The philosophy of Naturopathy is based upon two basic principles. The first principle is that the body possesses the power to heal itself through its internal vitality and intelligence. All the practitioner does is to create the most favourable conditions to stimulate and enhance this healing power of nature.

In 1964 a Naturopathic Commission drafted a definition of Nature Cure and defined the therapies of dietetics, fasting, structural adjustments, hydrotherapy, natural hygiene and psychotherapy to be of primary importance.

Naturopathy enlists the aid of water, light, air, diet and manipulation. Mechanical factors to be rectified are spinal mal-alignments and muscular tensions due to occupational or postural causes. Address: British College of Naturopathy and Osteopathy, 6 Netherhall Gardens, London NW3 5RR. Tel 071-435-8728.

See also: BASTYR COLLEGE OF NATUROPATHIC MEDICINE. ... naturopathy

a US term for a health condition that severely affects an individual’s physical, mental, social, or economic wellbeing, lasts for an extended period of time, and (usually) requires very expensive treatment. In practice, the definition varies from government agency to agency and from employer to employer. The definition may focus specifically on the economic burden, the time lost from work, the seriousness of the condition, or a combination of these.... catastrophic illness

n. a substantial long-term restriction of functional ability or activity as a result of *impairment of the body or mind. Most modern definitions of disability, including that supplied by the World Health Organization, recognize that it is a complex condition that includes a social dimension. In other words, an individual’s experience of being disabled may in part reflect social and environmental factors that deny opportunities and full participation in society. See also handicap.... disability

“There is a large body of opinion to support the belief that a herb that has, without ill-effects, been used for centuries and capable of producing convincing results, is to be regarded as safe and effective.” (BHMA) Claims for efficacy are based on traditional use and inclusion in herbals and pharmacopoeias over many years. Their prescription may be prefixed by: “For symptomatic relief of . . .” or “An aid in the treatment of . . .”

To establish efficacy of treatment for a named specific disease by herbs, the DHSS requires scientific data presented to the Regulatory authorities for consideration and approval.

A product is not considered a herbal remedy if its active principle(s) have been isolated and concentrated, as in the case of digitalis from the Foxglove. (MAL 2. Guidance notes)

A herbal product is one in which all active ingredients are of herbal origin. Products that contain both herbal and non-vegetable substances are not considered herbal remedies: i.e. Yellow Dock combined with Potassium Iodide.

The British Government supports freedom of the individual to make an informed choice of the type of therapy he or she wishes to use and has affirmed its policy not to restrict the general availability of herbal remedies. Provided products are safe and are not promoted by exaggerated claims, the future of herbal products is not at risk. A doctor with knowledge and experience of herbal medicine may prescribe them if he considers that they are a necessary part of treatment for his patient.

Herbalism is aimed at gently activating the body’s defence mechanisms so as to enable it to heal itself. There is a strong emphasis on preventative treatment. In the main, herbal remedies are used to relieve symptoms of self-limiting conditions. They are usually regarded as safe, effective, well-tolerated and with no toxicity from normal use. Some herbal medicines are not advised for children under 12 years except as advised by a manufacturer on a label or under the supervision of a qualified practitioner.

World Health Organisation Guidelines

The assessment of Herbal Medicines are regarded as:–

Finished, labelled medicinal products that contain as active ingredients aerial or underground parts of plants, or other plant material, or combinations thereof, whether in the crude state or as plant preparations. Plant material includes juices, gums, fatty oils, essential oils, and any other substances of this nature. Herbal medicines may contain excipients in addition to the active ingredients. Medicines containing plant material combined with chemically defined active substances, including chemically defined, isolated constituents of plants, are not considered to be herbal medicines.

Exceptionally, in some countries herbal medicines may also contain, by tradition, natural organic or inorganic active ingredients which are not of plant origin.

The past decade has seen a significant increase in the use of herbal medicines. As a result of WHO’s promotion of traditional medicine, countries have been seeking the assistance of WHO in identifying safe and effective herbal medicines for use in national health care systems. In 1989, one of the many resolutions adopted by the World Health Assembly in support of national traditional medicine programmes drew attention to herbal medicines as being of great importance to the health of individuals and communities (WHA 42.43). There was also an earlier resolution (WHA 22.54) on pharmaceutical production in developing countries; this called on the Director-General to provide assistance to the health authorities of Member States to ensure that the drugs used are those most appropriate to local circumstances, that they are rationally used, and that the requirements for their use are assessed as accurately as possible. Moreover, the Declaration of Alma-Ata in 1978 provided for inter alia, the accommodation of proven traditional remedies in national drug policies and regulatory measures. In developed countries, the resurgence of interest in herbal medicines has been due to the preference of many consumers for products of natural origin. In addition, manufactured herbal medicines from their countries of origin often follow in the wake of migrants from countries where traditional medicines play an important role.

In both developed and developing countries, consumers and health care providers need to be supplied with up-to-date and authoritative information on the beneficial properties, and possible harmful effects, of all herbal medicines.

The Fourth International Conference of Drug Regulatory Authorities, held in Tokyo in 1986, organised a workshop on the regulation of herbal medicines moving in international commerce. Another workshop on the same subject was held as part of the Fifth International Conference of Drug Regulatory Authorities, held in Paris in 1989. Both workshops confined their considerations to the commercial exploitation of traditional medicines through over-the-counter labelled products. The Paris meeting concluded that the World Health Organisation should consider preparing model guidelines containing basic elements of legislation designed to assist those countries who might wish to develop appropriate legislation and registration.

The objective of these guidelines, therefore, is to define basic criteria for the evaluation of quality, safety, and efficacy of herbal medicines and thereby to assist national regulatory authorities, scientific organisations, and manufacturers to undertake an assessment of the documentation/submission/dossiers in respect of such products. As a general rule in this assessment, traditional experience means that long-term use as well as the medical, historical and ethnological background of those products shall be taken into account. Depending on the history of the country the definition of long-term use may vary but would be at least several decades. Therefore the assessment shall take into account a description in the medical/pharmaceutical literature or similar sources, or a documentation of knowledge on the application of a herbal medicine without a clearly defined time limitation. Marketing authorisations for similar products should be taken into account. (Report of Consultation; draft Guidelines for the Assessment of Herbal Medicines. World Health Organisation (WHO) Munich, Germany, June 1991) ... herbal medicine

n. according to the official definition of the World Health Organization, a state of complete physical, mental, and social wellbeing, not merely the absence of disease or infirmity. Others question whether defining it as an ideal state truly expresses either its practical dynamics or its philosophical complexity.... health

n. the view that ethical judgments are solely or mainly determined by the cultural, social, or psychological perspectives of those making them. In medical ethics, this often takes the form of cultural relativism, whereby it is assumed that because health-care traditions and practices vary, so too must definitions of what constitutes good practice. Compare Kantian ethics.... relativism

An enabling Act allowing subsequent definitive statutory instruments to be issued at the discretion of the Medicines Control Agency. The Act controls all aspects of the sale of medicines in the United Kingdom; with no exceptions.

Medicines fall into three categories: POM (Prescription Only Medicines), P (Pharmacy Only), and OTC (Over The Counter). POM and P medicines must be prescribed by a registered medical practitioner and dispensed by a pharmacist. P medicines can be sold only by a registered pharmacist. Health stores are concerned with the OTC products, the sale of which is governed by S.I. Medicines General Sales List, Order 1980, No 1922.

All medicines and substances used as medicine bearing a medicinal claim on label or advertising material must be licenced. Without a licence it is not lawful for any person, in his business, to manufacture, sell, supply, export, or import into the United Kingdom any medicinal products unless some exemption is provided in the Act or subsequent regulations. The prefix ML, followed by the Manufacturer’s number must appear on the label together with the product licence number prefixed by the capitals PL. For example, if any person other than a pharmacist sells a medicinal product which claims to relieve indigestion or headache, but the label of which bears no licence number, that shopkeeper (and the manufacturer) will be breaking the law.

All foods are exempt from licencing provided no claims are made of medicinal benefits.

A special licence (manufacturer’s) is required by any person who manufactures or assembles a medicinal product. (Section 8) He must hold a Product Licence for every product he manufactures unless some special exemption is provided by the Act. He may of course act to the order of the product licence holder. (Section 23)

“Manufacture” means any process carried on in the course of making a product but does not include dissolving or dispersing the product in, or diluting or mixing it with some other substance used as a vehicle for the purpose of administering it. It includes the mixture of two or more medicinal products.

“Assembly” means enclosing a medicinal product in a container which is labelled before the product is sold or supplied, or, where the product is already enclosed in a container in which it is supplied, labelling the container before the product is sold or supplied in it. (Section 132)

From the practitioner’s point of view, herbal medicines are exempt from the Act and no licence is required.

The consulting herbalist in private practice who compounds his own preparations from medicinal substances may apply to the Medicines Control Agency, 1 Nine Elms Lane, London SW8 5NQ for a manufacturer’s licence to authorise mixture and assembly, for administration to their patients after he has been requested in their presence to use his own judgement as to treatment required. Products thus sold, will be without any written recommendation and not advertised in any way.

The “assembly” aspect of his licence refers to his ability to buy in bulk, repackage and label. Where he uses prepackaged products and does not open the packet, or relabel, a licence is not required. He will not be able to use terms, “Stomach mixture”, “Nerve mixture”, etc, implying cure of a specific condition.

It is necessary for the practitioner to have a personal consultation with his patient before making his prescription. Subsequent treatment may be supplied by a third person or by post at the discretion of the practitioner.

A licence is required where one or more non-herbal ingredients (such as potassium iodide, sodium citrate, etc) are included. Dispensing non-herbal remedies constitutes “manufacture” for which a licence is required. (MAL 24 (3))

The main thing the licensing authority looks for before granting a licence is evidence of safety. The manufacturers’ premises must be licenced. A wholesaler or distributor, also, must have a licence.

Where a product is covered by a Product Licence certain medicinal claims may be made. Where claims are made, the Act requires a warning to appear on the label worded: “If you think you have the disease to which this product refers, consult a registered medical practitioner before taking this product. If you are already receiving medical treatment, tell your doctor you are also taking this product.” (SI 41, s.5)

Labels of all medicines, tablets, etc, must carry the words: “Keep out of the reach of children”.

Under the Act it is illegal for medicines to be offered for sale for cancer, diabetes, epilepsy, glaucoma, kidney disease, locomotor ataxy, paralysis, sexually transmitted diseases and tuberculosis; these diseases to be treated by a registered medical practitioner only.

Definition of a herbal remedy. A “herbal remedy” is a medicinal product consisting of a substance produced by subjecting a plant or plants to drying, crushing or any other process, or of a mixture whose sole ingredients are two or more substances so produced, or of a mixture whose sole ingredients are one or more substances so produced and water or some other inert substances. (Section 132)

No licence is required for the sale, supply, manufacture or assembly of any such herbal remedy in the course of a business in which the person carrying on the business sells or supplies the remedy for administration to a particular person after being requested by or on behalf of that person, and in that person’s presence, to use his own judgement as to the treatment required. The person carrying on the business must be the occupier of the premises where the manufacture or assembly takes place and must be able to close them so as to exclude the public. (Section 12 (1))

No licence is required for the sale, supply, manufacture or assembly of those herbal remedies where the process to which the plant or plants are subjected consists only of drying, crushing or comminuting and the remedy is sold or supplied under a designation which only specifies the plant or plants and the process and does not apply any other name to the remedy; and without any written recommendation (whether by means of a labelled container or package or a leaflet or in any other way) as to the use of the remedy. (Section 12 (2)) This exemption does not apply to imported products. Except where a herbal product is supplied for a medicinal use, legally it is not even a medicinal product.

The 1968 Act has been a great step forward in the history of herbal medicine, The British Herbal Medicine Association and the National Institute of Medical Herbalists fought and won many special concessions. In years following the Act standards rose sharply. Practitioners enjoy a measure of recognition, with power to manufacture and dispense their own medicines and issue official certificates for incapacitation for work.

See: BRITISH HERBAL MEDICINE ASSOCIATION. NATIONAL INSTITUTE OF MEDICAL HERBALISTS. ... medicine’s act, 1968. 

A rare condition in which a child is unable to relate to people and situations. Autism is more common in boys. It is by definition evident before the age of 30 months and is usually apparent in the 1st year of life. The precise causes of autism are unknown. Often, autistic children seem normal for the 1st few months of life before becoming increasingly unresponsive to parents or other stimuli. Extreme resistance to change of any kind is an important feature. The child reacts with distress to alteration in routine or interference with activities. Rituals develop in play, and there is often attachment to unusual objects or obsession with one particular idea. Delay in speaking is common and most autistic children have a low IQ. Behavioural abnormalities may include rocking, selfinjury, screaming fits, and hyperactivity. Despite these symptoms, appearance and muscular coordination are normal. Some autistic people have an isolated special skill, such as an outstanding rote memory or musical ability.

There is no effective treatment for autism, which is lifelong. Special schooling, support and counselling for families, and sometimes behaviour therapy can be helpful. Medication is useful only for specific problems, such as hyperactivity. The majority of autistic people need special, sometimes institutional, care.... autism

Inability to see. Definitions of blindness and partial sight vary. In the , blindness is defined as a corrected visual acuity of 3/60 or less in the better eye, or a visual field of no more than 20 degrees in the better eye. Blindness may result from injury to, or disease or degeneration of, the eyeball; the optic nerve or nerve pathways connecting the eye to the brain; or the brain itself. Clouding of the cornea may result from Sjögren’s syndrome, vitamin A deficiency, chemical damage, infections, and injury. Corneal ulcers can cause blindness due to scarring of the cornea. Uveitis and cataracts are other common causes of blindness. Diabetes mellitus, hypertension, or injury can all cause bleeding into the cavity of the eyeball and subsequent loss of vision. Bleeding into the fluid in front of the lens (hyphaema) or behind the lens (vitreous haemorrhage) can also result in loss of vision. Other conditions that may cause blindness include glaucoma; retinal artery occlusion or retinal vein occlusion; age-related macular degeneration; retinopathy; retinal detachment; tumours such as retinoblastoma and malignant melanoma of the eye; and retinal haemorrhage.

Loss of vision may be due to nerve conduction problems. These problems may be the result of pressure caused by a tumour; reduced blood supply to the optic nerve; optic neuritis; or toxic or nutritional deficiencies. Blindness can result if there is pressure on the visual cortex from a brain tumour or brain haemorrhage, or if the blood supply to the cortex is reduced following a stroke.

Treatment depends on the underlying cause. If the loss of vision cannot be corrected, the patient may then be registered as legally blind or partially sighted. (See also eye; vision, loss of.)... blindness

A term covering a range of conditions in which there is progressive impairment of the structure and function of part of the body. The definition excludes conditions due to inflammation, infection, altered immune responses, chemical or physical damage, or cancerous change.

The number of specialized cells or structures in the organ affected is usually reduced, and cells are replaced by connective tissue or scar tissue.

Degenerative nervous system disorders include Alzheimer’s disease, motor neuron disease, Huntington’s disease, and Parkinson’s disease. Degenerative disorders of the eye include Leber’s optic atrophy and senile macular degeneration. Degenerative disorders of the joints include osteoarthritis.

Some hardening of the arteries seems to be a feature of aging.

In some people, degenerative changes in the muscle coat of arteries are unusually severe and calcium deposits may be seen on X-rays (as in Monckeberg’s sclerosis, a type of arteriosclerosis).

Several degenerative disorders, such as the muscular dystrophies, are now known to be genetic.... degenerative disorders

n. poor sight, not due to any detectable disease of the eyeball or visual system, known colloquially as lazy eye. In practice this strict definition is not always obeyed. For example, in toxic amblyopia, caused by tobacco, alcohol, certain other drugs, and vitamin deficiency, there is a disorder of the *optic nerve. The commonest type is amblyopia ex anopsia, in which factors such as squint (see strabismus), cataract, and other abnormalities of the optics of the eye (see refraction) impair its normal use in early childhood by preventing the formation of a clear image on the retina. This in turn leads to a cortical visual impairment.... amblyopia

(in Britain) an Act providing for the identification and care of those suffering from a chronic or degenerative disease for which there is no cure and which can be only partially alleviated by treatment. Such people are usually distinguished from the elderly who may also suffer from chronic diseases. It is the responsibility of local authorities to identify those with such problems and to ensure that services are available to meet their needs. Identification can be difficult because of the lack of a clear and agreed definition of what constitutes a disability of such severity as to warrant inclusion in such a register.... chronic sick and disabled persons act 1970

n. an invasive endoscopic procedure for examining the interior of the colon and the terminal ileum. A colonoscope is a flexible, steerable telescopic instrument that houses a high-definition digital video camera to allow direct visualization of the colonic mucosa. It is inserted into the anus and guided around the loops of the large bowel to the caecum and terminal ileum. Its progress may be aided by using an external *3-D magnetic imager (e.g. ScopeGuide). It is possible to obtain biopsies for microscopic examination using flexible forceps passed through the colonoscope (diagnostic colonoscopy) and to remove polyps, dilate strictures with endoscopic balloons, or insert self-expandable metal stents (SEMS) into benign or malignant strictures (therapeutic colonoscopy).... colonoscopy

n. an illuminated optical endoscope used to inspect the interior of the gullet (oesophagus), stomach, and duodenum. For many years these were rigid or semi-rigid instruments affording only limited views, but their modern counterparts are flexible instruments that house advanced digital systems to allow high-definition imaging of the oesophagus, stomach, and the proximal segments of the duodenum. Biopsies can be taken of visualized areas of mucosal abnormality, and therapeutic procedures (e.g. to stop a bleeding ulcer, remove a polyp, insert a *gastrostomy, dilate a stricture, or insert a self-expandable metal stent) may be performed. As the same instruments can usually be introduced into the duodenum they are also known as gastroduodenoscopes or oesophagogastroduodenoscopes. —gastroscopy n.... gastroscope

any sexual behaviour regarded as abnormal by society. The deviation may relate to the sexual object (as in *fetishism) or the activity engaged in (for example, *paedophilia, sadism, and exhibitionism). The activity is sexually pleasurable.

The definition of what is normal varies with different cultures and over time, and treatment is appropriate only when the deviation causes suffering. For this reason the term sexual variation is now sometimes preferred. Some people may find that *counselling helps them to adjust to their deviation. Others may wish for treatment to change the deviation: *aversion therapy may be used, also *conditioning normal sexual fantasies to pleasurable behaviour. The only helpful effect of drugs is to reduce sexual drive generally.... sexual deviation

(intrauterine fetal death) n. birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception. Under the Stillbirth (Definition) Act 1992, there is a legal obligation to notify all stillbirths to the appropriate authority. The number of such births expressed per 1000 births (live and still) is known as the stillbirth rate. In legal terms, viability is deemed to start at the 24th week of pregnancy and a fetus born dead before this time is known as a *miscarriage or *abortion. However, some fetuses born alive before the 24th week may now survive as a result of improved perinatal care. See also confidential enquiries.... stillbirth