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You are here:: About Roche; > Glossary

Glossary

Starting with A for "ACE inhibitor" and continuing through to Y for "Yolk Sac Tumour", we give you succinct explanations for scientific and medical terms in clear and simple words.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

C-reactive protein (CRP)

a protein produced by the liver that is normally present in trace amounts in the blood serum but is elevated during episodes of inflammation

Calciferols

also known as vitamin D or anti-rickets vitamin

Name for the fat-soluble active substances which are related to steroids and which regulate calcium and phosphate balance. The most important calciferols are ergocalciferol (vitamin D2), which comes from plants, and cholecalciferol (vitamin D3), which comes from animals. They are formed by UV irradiation of vitamin precursors. The biologically active form of this vitamin is the hormone calcitriol, which is formed in the liver and kidneys.

Biochemical Function
Regulation of calcium and phosphate balance in the intestine, by increasing calcium and phosphate uptake, in the kidneys, by increasing calcium and phosphate re-absorption, and in the bones, by mineralisation and by mobilising calcium and phosphates. Acts together with parathormone and calcitonin.

Occurrence
Calciferols are contained in food, mostly food of animal origin, such as fish liver oil and fish. There are low levels in meat, egg yolk, milk and milk products. Califerols also occur in avocados. The daily requirement for adults is about 5 mg. For healthy people who spend enough time in the sun, the quantity formed in the body is adequate. Intake in food is only important in critical conditions, related to the climate, way of life or skin pigmentation. Calciferol deficiency in children can lead to severe disturbances in the mineralisation of the skeletal system, including problems in the formation of solid bones and rickets. If the calciferol intake of adults is not enough or the exposure to UV light is inadequate, this can lead to osteomalacia.

Problems as a result of excessively high vitamin intake (hypervitaminosis) are rare. They occur when the daily intake is greater than 25 mg. The symptoms are loss of appetite, nausea, marked increase in urine excretion, decalcification of the bones and increased levels of calcium in blood plasma. In extreme cases there can be deposition of calcium in blood vessels, heart, lungs and kidneys.

calcimimetic

a drug that mimics calcium that is used to lower parathyroid hormone levels

Calcitonin

Also known as thyreocalcitonin

A hormone which is formed in the so-called C cells of the thyroid. Its release is proportional to the concentration of calcium in plasma.

Actions
Calcitonin causes the rapid and short-term reduction in calcium and phosphate concentrations and thus acts in opposition to parathormone. During growth, calcitonin predominantly inhibits the activity of osteoclasts, which break down bone. In adults, it increases the incorporation of calcium into osteoid and predominantly affects the kidneys and intestines (increased excretion of calcium, phosphate and sodium ions).

Clinical uses
For osteodystrophia deformans and osteoporosis.

Side-effects
Hot spells, gastrointestinal problems.

Calcitriol

1-alpha, 25-Dihydroxycholecalciferol

Calcitriol is a hormone for calcium and phosphate metabolism. It is produced in the liver and kidney (from vitamin D). Together with parathormone and calcitonin, calcitriol regulates the absorption of calcium through the formation of a calcium-binding protein in the intestinal mucous membrane. The normal concentration in blood serum is 80-180 pmol/l.

Clinical Uses
Conditions with calcium deficiency (e.g. renal osteopathy and osteoporosis).

Calcitriol deficiency

see Vitamin D deficiency

Calcium

Chemical element, symbol Ca. A soft silver-white and shining metal which is unstable in air and which reacts violently with oxygen and water. In man, calcium is predominantly stored in bone tissue. The calcium content is ca. 1.5% of body weight and is normally kept within narrow limits by the interactions between the hormones calcitriol, calcitonin and parathormone. In serum, calcium is present to about 55% as the functionally important ionised form, Ca++. About 40% is protein bound and about 5% bound to organic acids. If the blood is acidified as a result of disturbances in the body's acid-base balance and there is an excess of acid (acidosis), this leads to an increase in ionised calcium in the blood. Conversely, an excess of base (alkalosis) leads to a decrease in ionised calcium.

Functions
The important functions related to calcium include blood coagulation, the normal excitability of nerve and muscle tissue and the development of tension in muscles. Calcium also has supportive functions as a component of bones and teeth. Potassium, magnesium and phosphate ions partially oppose the actions of calcium.

Presence in food
Milk and milk products are foods which are particularly rich in calcium, but so are some types of vegetable, including broccoli, spinach and kale. The daily requirement for an adult is about 800-1000 mg.

Symptoms of deficiency
Muscular spasm, loss of calcium phosphate from the bones, osteoporosis as a result of dietary imbalance, disturbances in absorption when there is vitamin D deficiency or hormonal disturbance.

Clinical uses
Calcium salts in combination with other substances for osteoporosis.

Calcium antagonists

also known as calcium channel blockers

Substances which inhibit the flow of calcium into cells and consequently the so-called electromechanical coupling of muscular work.

Actions
Calcium antagonists reduce the tension in vessel musculature, leading to widening of the vessels. They also reduce contraction of heart muscle and oxygen consumption

Uses
Alone or in combination with organic nitrates and beta-receptor blockers, in the prevention and therapy of angina pectoris, for high blood pressure (hypertension) and coronary heart disease. Certain calcium antagonists are also used for cardiac arrythmias.

Contraindications
Some forms of cardiac arrythmia, severe hypertension, fresh myocardial infarction.

Side-effects
Attacks of reddening of the skin, with a feeling of heat, headache, deposition of water, particularly in the skin, gastrointestinal problems, giddiness, marked drop in blood pressure, symptoms like angina pectoris, reduction in heart rate and others.

Calcium channel blockers

see calcium antagonists

Calorie

Accepted symbol cal; no longer recognised unit of warmth. The valid unit is the Joule (1 cal =4.187 J).

Calorie-free diet

also known as hunger cure

Long term total fasting, during which only fluid, salt, trace elements and vitamins are taken.

Use
To decrease overweight and metabolic balance. During a long fast not only depot fat, but also protein (e.g. as muscle mass) is broken down. The calorie-free diet is regarded as out-dated.

Cancer

The general medical term for a malignant growth (tumour). The main distinction is between carcinoma, which is a malignant growth of skin and mucous membrane cells (epithelial cells) and sarcoma, which is a malignant growth of supportive and connective tissue, muscles, vessel cells and blood cells.

Cancer Frequency

First occurrence of malignant growths. Estimates are based on data including those from the legal incorporated health insurances, the data in the cancer registers of individual federal states and professional societies.

Cancer of the Neck of the Womb

Also cervical cancer
Malignant tumour of the womb which originates in the uppermost cell layer of the mucous membrane of the womb. A distinction is made between cervical os carcinoma (at the mouth of the womb) and cervical cavity carcinoma (neck of the womb).

Occurrence: Cervical cancer is the second most frequent female genital carcinoma, after uterus carcinoma. Various types of papillovirus play a role in causing the disease (cf. Viruses, Oncogenic).

Symptoms and Clinical Course: Symptoms only develop from a certain tumour size, particularly when the tumour breaks up: irregular loss of blood, watery flesh coloured bloody effusion from the vagina, bleeding on contact (after sexual intercourse or a gynaecological examination); Pain normally only develops after the border between the organs has been passed and the tumour has broken into other organs (bladder, intestine, ureter, pelvic vessels and nerves). Metastases are spread relatively early through the lymph vessels in the connective tissue space next to the womb and in the pelvic lymph nodes. The urinary vessels are often encapsulated and constricted and there can be urinary congestion, renal failure and uraemia, which is often the cause of death; metastasis through the blood vessels occur relatively late and rarely (liver, lungs, pelvis, spinal column).

Diagnosis: Early recognition from regular cancer screening tests. Tissue samples are taken if there is suspected carcinoma of the cervical cavity. Every woman aged over 20 should be examined annually by a gynaecologist, who takes a smear for cytological investigation.

Therapy: Surgery. Only sections of the womb should be removed if the stage is early or if children are desired. If children are not desired or if the disease is severe, the total womb is removed (hysterectomy), perhaps including the connective tissue space round the womb (parametrium) and more, depending on the state of the disease and relapses. Chemotherapy or tumour irradiation may be necessary before the operation to reduce the size of the tumour.

Prognosis: If cervical carcinoma is treated early, the 5-year survival rate is almost 100% (stage I), but sinks to 8% if the diagnosis is too late (stage IV).

Cancer Precursors

See Precancerosis.

Cancer Register

A special disease register in which the number of cases of cancer in the population is anonymously registered. The register is used for the scientific registration and investigation of the frequency, dangerousness and clinical course of cancer. The collection can also be used by doctors for the collection of information about different forms of cancer, for help in diagnosis and as a basis for the standardisation of the naming and classification of tumours. A third task of a cancer register is the so-called clinical aftercare register. This records the patients who were examined and treated in the area of a hospital or cancer centre and ensures reliable aftercare. The cancer register is normally kept so that is can fulfil all three tasks.

Cancer Syndromes, Familial

Genetically related increased frequency of tumour disease in one family. One example of this is neurofibromatosis.

Cancer, Breast

see Carcinoma, Mammary.

Cancer, Occupational

Name for a cancer which is accepted as an occupational disease. Usually caused by carcinogenic dusts (e.g. asbestos), dangerous substances (e.g. aromatic amines and chemistry workers) or ionising radiation (e.g. X-rays).

Cancer, Screening Tests

Screening tests for men and women for the early recognition of specific forms of cancer, particularly cancer of the neck of the womb, breast cancer, colorectal carcinoma, prostate cancer, skin cancer. Cancer screening tests are recommended for women from age 20 and for men from age 40. The tests should be carried out each year.

Cancer, Skin

Malignant growth originating in the skin. The tumours are classified on the basis of the cells from which they originate: e.g. tumours from skin cells (melanoma, basalioma), tumours of the muscles (leiomyosarcoma) and tumours of fat tissue (liposarcoma).

Candidoses

also Candida mycoses, older names are soor or thrush.
Infections from a fungus of the genus Candida, which frequently attacks the skin and/or the mucous membrane. If the immune system of a patient is weakened, fungal infections of internal organs may develop, particularly in the respiratory tract.
Diagnosis: The appearance of the affected skin and mucous membrane is typical. There is mostly a whitish coating of the mucous membrane or reddening and scaling of the external skin. Skin and mucous membrane samples may be taken and examined under the microscope. If there is a suspicion that organs have been attacked, fungi can be cultured from appropriate material, e.g. bronchial mucus, blood etc..
Therapy: with drugs, so-called antimycotics

Candidosis

also known as candida mycosis or soor mycosis

Candidosis is a collective term for infections with blastomycetes of the genus candida.

Forms
1. Infection of the skin and mucous membranes (external genitalia, mouth, nose and throat, gastrointestinal tract); 2. infection of the skin and mucous membranes which is favoured by factors such as type 2 diabetes, type 1 diabetes, humid surroundings, pregnancy, immune deficiency, severe disease, antibiotic treatment or alcoholism; 3. Candidosis of internal organs, particularly in the respiratory tract, heart, brain or kidneys, in individuals with immune deficiency.

Diagnosis
Typical appearance of the skin with pea-sized nodules and pustules on the edge of the focus of infection; detection under the microscope and in culture.

Cane sugar

see saccharose

capillaries

the smallest blood vessels in the circulatory system

Caput Medusae

Also Medusa Head.
Dilatation of the veins round the navel. The veins then become clearly visible. Caput medusae develops when draining of blood is disturbed within the abdominal cavity, e.g. during portal hypertension or liver cirrhosis, as shunt circulation of the blood may develop.

Carbohydrate metabolism

In the animal, this means the conversion and metabolism of absorbed or native carbohydrates. In green plants carbohydrates are also produced by photosynthesis, which is based on the action of sun light on carbon dioxide and water. During digestion, digestible carbohydrates in food are split by enzymes (amylases, disaccharidases) in the cells of the mucous membrane of the small intestine into monosaccharides. These are released into the circulation and are thus transported into the cells, where metabolic energy is extracted. Blood glucose concentrations remain constant (70-115 mg/dl), which is vital for cells which require a lot of energy or with poor oxygen supply. Glucose is quantitatively the most important monosaccharide in carbohydrate metabolism and is taken up by cells in muscle and fat tissue.

Metabolic pathways
On the one hand, glucose is the basis for glycolysis, the break down of glucose to form energy. On the other hand, it is used for glycogenesis, which is the assembly of the storage carbohydrate glycogen when there is an excess of glucose. The hormone insulin decreases the concentration of glucose in blood by increasing its cellular uptake. The hormones glucagon and adrenaline increase the availability of glucose and raise blood sugar.

Carbohydrate metabolism is perturbed in, for example, diabetes mellitus.

Carbohydrate unit

Abbreviation CU

Calculation unit or accessory parameter in calculating diet for type 2 diabetes or type 1 diabetes. 1 CU corresponds to 12 g of carbohydrates which raise blood sugar. Alternatively, one carbohydrate unit is the quantity of food in grams which contains 12 g of carbohydrate. This could be 25 g wholemeal bread, 80 g bananas or a quarter of a litre of buttermilk.

Carbohydrates

Also known as saccharides

Carbohydrates include sugars which are made up of one or more sugar units (e.g. glucose, saccharose), or out of many units, such as starch and cellulose. Cf. monosaccharides, disaccharides, oligosaccharides, polysaccharides, roughage

Functions
1. Basic nutrients, which are stored in plants as starch and inulin, and in animals as glykogen; 2. structural components of plants (e.g. cellulose) and animals (e.g. chitin); also present in the extracellular matrix (glycosaminoglycans); 3. component of glycoproteins (proteins with carbohydrate part) and glycolipids.

Biosynthesis
In plants carbohydrates are formed in the leaves by photosynthesis, which is the formation of carbohydrates from carbon dioxide and water as the result of irradiation. In animals glucose is formed by gluconeogenesis. Cf. carbohydrate metabolism.

Carcinogenesis

Also Cancerogenesis or Generation of Cancer
Carcinogenesis describes the generation of malignant tumours, in which various factors participate, including carcinogenic substances, hormones, viruses (see Viruses, oncogenic), genetic susceptibility or immune defects. The generation of a malignant tumour is though to occur in three phases, the trigger phase, the latency phase, which can last 15-20 years and during which the tumour cells grow, and the third phase, the clinical diagnosis of the tumour. The subsequent clinical course for malignant tumours is that they grow into other regions of the body and metastasise (see Metastasis).
Malignant growth is favoured by certain factors, including the type and duration of action of the carcinogenic substances, other carcinogenic substances and the specific individual characteristics.

carcinogenic

causing cancer

Carcinoid

Malignant tumour which originates from certain hormone-producing cells and which usually grows very slowly. Carcinoids mostly occur in the gastrointestinal tract (85% of cases, most often in the appendix), more rarely in the bronchi (10% of cases) or in the pancreas or ovaries (5% of cases).

Symptoms: The tumour and its metastases can produce certain substances, such as serotonin, and these can lead to a so-called carcinoid syndrome in about 6% of cases. These are attacks in which the upper body and the limbs redden and the patient suffers from hot flushes, diarrhoea etc..

Diagnosis: Detection of serotonin the blood or its degradation products in urine, ultrasound investigation, enteroscopy, scintigraphy (X-ray examination with the help of radioactive substances).

Therapy: The tumour is surgically removed. With advanced tumours, alpha-interferon and chemotherapy can be used. The chemotherapy can be locally restricted to liver metastases.

Prognosis: The 5-year survival rate is still 20-65%, even if the liver is colonised by metastases.

Carcinoma

Malignant tumour which originates from the cells which cover the internal and external surfaces (epithelium). The following forms are distinguished, depending on the origin of the cells and their degree of differentiation:
1. Squamous cell carcinoma, which originates from the external skin and the mucous membrane
2. Adenocarcinoma, originating from the gland cells
3. Undifferentiated carcinoma, for which no statement can be made about the tissue of origin
A further classification is based on the content of connective tissue, i.e. on the ratio between tumour tissue and connective tissue
Carcinoma spreads by growing into or spreading into neighbouring tissue, organs or organ systems through the lymph nodes or through metastases.

Carcinoma of the Hypopharynx

This is a malignant tumour which is situated at the transition between the throat and the larynx and which is also called external carcinoma of the larynx. The tumour mostly occurs between the ages of 50 and 70 and men are much more frequently affected than women (4:1). Causes are thought to include consumption of alcohol and tobacco.

Symptoms: The symptoms of the tumour include pain on one side which extends to the ear, problems in swallowing, hoarseness, sputum with bloody streaks and swelling of the lymph nodes on the lower jaw.

Diagnosis: Pharyngoscopy, perhaps with a microscope, and computer tomography are used for diagnosis.

Therapy: If there are not yet any remote metastases (see Metastases), the therapy consists of the operative removal of the larynx, the lower portions of the throat and a neck dissection. Combined radiotherapy and chemotherapy are performed if the tumour is extensive.

Prognosis: When the diagnosis is made, distant metastases are present in 10% of cases (liver, lung, skeleton). The 5-year survival rate (see Survival Rate) is about 20%. Cf. Carcinoma of the Larynx.

Carcinoma of the Islet Cells

Very rare malignant tumour which originates in the cells in the pancreas which produce insulin. Islet cell carcinoma develops from a benign precursor form, the so-called insulinoma. The tumour cells of the insulinoma produce uncontrolled quantities of insulin. This lowers the levels of blood sugar and this can lead to symptoms of hypoglycaemia (sugar deficiency), including sweating, palpitations, reduced states of consciousness.

Carcinoma of the Larynx

Most frequent malignant tumour in the area of the neck, which occurs predominantly in men of at least 50 years of age (men: women, 5:1).

Causes: There is a close correlation with the inhalation of tobacco smoke and consumption of alcohol, particularly in combination. The tumours develop from precancerous precursor forms (so-called laryngeal precancerosis).

Classification: 1. Tumours above the glottis (supraglottal, ca. 30% of cases); 2. Tumours in the area of the glottis (glottal, ca. 60% of cases); 3. Tumours below the glottis (subglottal, rare). Extension over all three stages is also possible (so-called transglottal tumour).

Symptoms: The main symptom in glottal laryngeal carcinoma is hoarseness. The main symptoms in supraglottal laryngeal carcinoma are a feeling of the presence of a foreign body and problems in swallowing.

Diagnosis: Endoscopy of the larynx (laryngoscopy), taking of tissue samples and their microscopic examination, examination of the mobility of the vocal chords by stroboscopic light (larnygostroboscopy), computer tomography (CT), magnetic resonance tomography (MRT).

Therapy: The laryngeal carcinoma is removed by operation. Depending on the spread of the tumour, the vocal chords (chordectomy) and either parts or all of the larynx (neck dissection*) may be removed. Radiotherapy may be performed after the operation.

Prognosis: The prognosis for glottal carcinoma is favourable, as this is usually diagnosed early, as hoarseness rapidly develops, and metastases have then rarely formed. The prognosis of supraglottal carcinoma is poorer, as metastases in the surrounding lymph nodes are formed more rapidly.

Carcinoma of the Lip

Malignant tumour of the lip, which mostly develops on the lower lip. The development is favoured by ultraviolet radiation and by tobacco smoke, particularly in pipe smokers. If small tumours (less than 2 cm in diameter) are removed by operation, the 5-year survival rate is about 90%.

Carcinoma of the Oral Cavity

Most frequent malignant tumour in the head and neck region. The tumour may lie, for example, in the bed of the mouth, on the edge of the tongue, in certain parts of the jawbone, in the palate or on the cheek.

Symptoms: Restricted white changes in the mucous membrane (leukoplakia) can be an early stage of carcinoma of the oral cavity. In cases of advanced carcinoma of the oral cavity, the jaw may break without great external force. There may also be bleeding and loss of sensitivity in the mouth, paralysis, secretion of bloody saliva, etc..

Occurrence: Particularly in young men, rare in women, who tend to be older.

Diagnosis: Inspection of the oral cavity, including those area which are difficult to see, palpation of the mouth and jaw, testing the nerves (feeling and movement), test of saliva flow, test of jaw joint, X-ray investigation of jawbone, ultrasound investigation of lymph ducts and lymph nodes and of the stomach and X-ray investigation of the lung, to look for metastases.

Therapy: Operative removal of the tumour, together with lymph drainage ducts (Neck dissection), if this is not possible, combined chemotherapy and radiotherapy.

Prognosis: The prognosis is good if the tumour is recognised at an early stage and operated on and there are no metastases. An average of 60% of patients for all stages of the diseases is free of symptoms after five years.

Carcinoma, Anal

Malignant tumour which originates from certain cells (epithelial cells) on the edge of the anus or the anal canal. This tumour rapidly forms metastases in the surrounding lymph nodes, and in the lymph nodes in the groin and in the ileac bone.

Frequency: General frequency: about 0.5 cases per 100,000 population. The tumour occurs more frequently after 60 years of age. 1-3% of all tumours of the lower intestine are anal carcinoma.

Symptoms: Itching, faecal incontinence, pain and bleeding develop relatively late.

Diagnosis: Inspection and palpation of the anal region, an examination with a rectoscope is carried out (rectoscopy). A rectoscope is a tube-shaped instrument with a camera and which can grasp and take samples. Ultrasound, X-rays (computer tomography, magnetic resonance tomography).

Treatment: Combined radiotherapy and chemotherapy. It may be possible to remove small tumours without metastases by operation. Large tumours can be reduced in size by operation and then treated with radiation and chemotherapy.

Prognosis: After 5 years, 85-100% of all patients are still living.
Cf. Carcinoma, Colorectal.

Carcinoma, Bladder

Malignant tumour which originates from the superficial cells of the bladder mucous membrane
Occurrence: Predominantly after 60 years of age. More frequent in men than in women (men : women=3:1)

Causes:
1. Aromatic amines: chemical substances which are used in industry to make azo dyes. They are also contained in cosmetics and can be absorbed with cigarette smoke and some drugs. Cf. Occupational Cancer.
2. Chronic inflammation of the bladder

Symptoms: Blood in the urine, with or without pain, passing water is more difficult and painful or more frequent and painful, pain in the region of the groin, urinary congestion (stasis)

Stages: The classification of the stages depends on how deep the tumour has penetrated and on the presence of metastases, cf. TNM Classification.

Diagnosis: Palpation of the bladder, laboratory tests on the urine, ultrasound investigation of the bladder, cystoscopy (examination of the bladder by mirror), tissue sampling and examination, computer tomography.

Therapy: Superficial tumours can be removed by operation by inserting a surgical instrument through the urethra (transurethral resection). If the tumour is deeper, the whole bladder and the surrounding lymph nodes are removed (radical cystectomy). For superficial tumours, also stimulation of the immune system with tuberculosis vaccine (immune therapy), to reduce the rate of recurrence. Application of chemotherapeutic drugs (see chemotherapy) into the bladder, also radiotherapy and chemotherapy for tumours which have penetrated more deeply.

Prospects of cure: Depending on stage, depth of penetration, type of tumour cells and therapy, 5-year survival rate for deep bladder carcinoma without distant metastases and after radical cystectomy is 45%.

Carcinoma, C-cell

also medullary thyroid carcinoma.
Malignant tumour originating from specific cells in the thyroid which produce hormones. The thyroid C-cells produce the hormone calcitonin, which is involved in the regulation of calcium balance. The cells of C-cell carcinoma produce calcitonin in an unregulated fashion and in large quantities, which can lead to deficiency of calcium in the blood.

Occurrence. Can be hereditary or can occur spontaneously without a hereditary component. Sometimes occurs together with other tumours of the hormone system (e.g. tumours of the adrenals or pancreas).

Diagnosis: Imaging procedures: Ultrasound investigation of the thyroid, computer tomography, magnetic resonance tomography, somatostatin receptor scintigraphy (test performed with radioactive substances). Laboratory tests: Determination of calcitonin and CEA (carcinoembryomic antigen, which is a protein which is produced by cancer cells).

Therapy: Operation as soon as possible.

Prophylaxis: Genetic tests on family members and possibly removal of the thyroid if there are genetic changes.

Carcinoma, Chorionic

Also malignant chorionic epithelioma
This is a malignant tumour which originates in the placenta or, more broadly, in the germ cells. The tumour penetrates into the surrounding tissues and destroys them. This opens blood vessels, into which the tumour grows, so that there is a marked tendency for bleeding to occur. Chorionic carcinoma frequently develops early metastases in the lungs and vagina.

Localisation: Particularly in the womb after births or miscarriages and changes in the placenta (bladder mole). Also in the Fallopian tubes, ovaries and outside the female genitals (chest). In men in the testicles or chest.

Symptoms: When localised in the womb, this organ is enlarged, possibly bleeding. Symptoms can arise from distant metastases.

Diagnosis: The disease is diagnosed by determining the concentration of hormone in the blood (HCG concentration) and by microscopic examination of the tissue from scraping the womb (when the tumour is in the womb).

Therapy: The treatment is by operative removal combined with chemotherapy.
The 5-year survival rate is above 50%.

Carcinoma, Colorectal

Malignant tumour in the area of the colon or rectum, which originates from a group of cells which coat the intestine (epithelial cells),

Occurrence: Occurs more frequently in women than in men, mostly between 60 and 70 years of age. Hereditary colorectal carcinoma may occur earlier. Colorectal carcinoma is more frequent in industrial countries, which is a result of fatty nutrition with low levels of ballast. It is also more frequent in patients with ulcerative colitis or with intestinal inflammation from radioactive radiation. Cf. Anal Carcinoma.

Localisation: 62% of tumours or in the rectal area, 20% in the lower section of the colon and the remaining 18% in the rest of the colon.

Classification:
1. Dukes classification
2. TNM classification.

Metastasis Formation (colonisation by daughter tumours, see Metastasis): 1. Metastases are first formed in the liver and then in the lungs, as a result of transmission through the blood vessels. 2. At a relatively late stage in the clinical course of the disease, metastases can colonise neighbouring lymph nodes through the lymph vessels.

Symptoms: Blood in the faeces which may be either directly visible or occult (cf. Blood, Occult). Also wind, intestinal seizures, anaemia, loss of weight, changes in customary bowel movements, alternation between diarrhoea and constipation, sometimes palpable swelling in the abdominal region.

Diagnosis: Palpable changes can be found by examining the rectum with the finger. Faecal blood is either visible or can be detected with a rapid test (Gujak test), during cancer screening tests. Other methods of investigation include enteroscopy, ultrasound investigation, X-ray of the intestine after an enema of contrast medium, perhaps computer tomography. The clinical course of the disease can be evaluated by measuring the tumour antigen CEA (abbreviation for carcinoembronal antigen).

Therapy: The precursors of colorectal carcinoma (polyps) and very early carcinoma, without indications for metastases, can be removed by endoscopy. The therapy of advanced tumours is the operative removal of the affected section of the intestine (cf. Colectomy). The treatment for hereditary rectal carcinoma is an early removal of the whole rectum. In patients with advanced carcinoma, radiotherapy and/or chemotherapy can be used to reduce the size of the tumour before the operation, which improves the chances that the operation will be successful. Chemotherapy* is performed after the operation. If it is not possible to remove the tumour operatively, a bypass or an artificial intestinal outlet must be created, so that stool passage is possible.

After-care: Regular follow-ups, as 50-80% of the relapses occur within 2 years.

Prognosis: The survival rate depends on the spread of the tumour: Dukes A: 5 year survival, 90-100% of patients; Dukes B: 5 year survival 65-90% of patients; Dukes C: 5 year survival 25-70% of patients; Dukes D: 5 year survival less than 6% of patients.

Carcinoma, Endometrial

Malignant tumour of the inner cell layer of the womb. See Carcinoma of the Body of the Womb.

Carcinoma, Fistula

A fistula carcinoma is a malignant tumour which originates in the cells which cover the wall of a fistula (epithelial tissue). Fistulas connect body cavities or hollow organs to each other or to the surface of the body.

Carcinoma, Gallbladder

Malignant tumour which originates in the cells which coat the gallbladder, most frequently in the neck of the gallbladder. Mostly occurs from age 60 and particularly frequently in women. Metastases frequently arise in the liver and peritoneum. One possible cause which is discussed is gall stones and chronic inflammation of the gallbladder.

Symptoms: Symptoms usually only occur when the disease is advanced. The cancer is occasionally found by chance when the patient suffers from gallbladder inflammation. Palpation of the upper abdomen is often not painful. Icterus (see jaundice) and loss of weight can also be observed. The size of the liver may increase if there are liver metastases.

Diagnosis: The disease is detected by an ultrasound investigation, x-ray techniques (computer tomography, specific X-ray imaging of the gall ducts, ERC) or by gastroscopy.

Therapy: In the early stage, complete removal of the gallbladder, possibly part of the liver as well.

Prognosis: The general prognosis for the disease is poor, as the operations mostly only increase the quality of life, but do not cure the condition.

Carcinoma, Intestinal

Malignant tumour which originates in the cells which coat the intestine (epithelial cells). Most frequent malignant tumour of the intestine.
Forms: Mostly colorectal carcinoma, more rarely anal carcinoma or malignant tumour of the small intestine.

Cardiac arrythmia

Name for all changes in the activity of the heart which are characterised by irregular excitation, changes from normal heart rate (60-100 beats/min) or an abnormal sequence of the individual actions of the heart. Classification is on the basis of the heart rate (bradycardial for low, tachycardial for high heart rate), the localisation or the mode of origin.

Causes
Changes in the system of the heart for conducting excitation, as a result of heart disease, abnormal electrolyte concentrations, vegetative or psychosomatic abnormalities, drugs (particularly cardiac glycosides and psychotropic drugs), poisons, hormonal disturbances (particularly of the thyroid), accidents with electricity or injuries to the heart (rare). Cardiac arrythmias are also frequent in healthy people (particularly children, adolescents and sportsmen).

Symptoms
Cardiac arrythmias often have no symptoms. They are often felt as palpitations, racing of the heart or missed beats (mostly extrasystoles). With corresponding underlying disease, symptoms of disturbances in cerebral perfusion, coronary insufficiency (angina pectoris, myocardial infarction) and heart failure, shock and cardiac thromboembolisms may develop.

Cardiac glycosides

A name for a substances of similar chemical structure which have certain actions on the heart and which occur in various plants, such as species of digitalis, strophanthus, scilla and convallaria and also in certain toads.

Actions
Increase the strength of heart muscle and the cardiac output, reduce heart rate. This increases the efficiency of the cardiac pump when heart failure is present. Among the individual cardiac glycosides there are great differences in onset of action, duration of action and loss of action. What they all have in common is the small difference between the desired drug effect and the dose for intoxication (narrow therapeutic window). Dose adjustment must therefore be careful and individualised.

Uses
In heart failure and in certain sorts of heart failure

Side-effects
Signs of intoxication such as vomiting, visual problems, widening of the pupils, hallucinations and cardiac arrythmias, which may be fatal.

Cardiac hypertrophy

Increase in the size of the heart as a result of an increase in the thickness of the muscular fibres in one or all sections of the heart

Causes
Either without known reason or as a result of a pathological and long-term stress, particularly in patients with in-born heart defects, raised peripheral resistance (e.g. in high blood pressure or arteriosclerosis), increased pressure in the pulmonary circulation, long-term increase in the cardiac output (e.g. when thyroid function is excessive).

cardiac output

the amount of blood pumped by the heart each minute

Cardiac output per minute

also known as heart-time volume or minute volume

The volume of blood which is expelled from the left ventricle of the heart in one minute. Heart minute volume = beat volume x number of beats per minute. The Cardiac output per minute for healthy individuals at rest is 4.5 to 5 l/min.

cardio-renal-anemia syndrome

a combination of congestive heart failure, renal failure and anemia occurring in patients with chronic kidney disease; each of these conditions occurs as a complication of the others

Cardiomyopathy

also known as myocardiopathy

Name for all diseases of the heart muscles which are not caused by coronary sclerosis, diseases of the pericardium, arterial hypertension, high blood pressure in the pulmonary circulation or in-born heart defect.

Classification
According to the changes in the heart's muscular tissue, e.g. a) Hypertrophic cardiomyopathy: progressive increase in the thickness (hypertrophy) of individual or all wall layers of heart muscle, particularly the left ventricle. This leads to reduced filling of the ventricle during relaxation (diastole), although the function of the heart during tension development (systole) is (initially) normal. Symptoms: Shortage of breath, angina pectoris, palpitations, short loss of consciousness, often heart murmurs. A markedly upwards apex beat is typical. Therapy: beta-receptor blockers, calcium antagonists. Prognosis: restricted life expectancy (acute cardiac arrythmias). Both sporadic forms and familial forms have been described. b) Congestive (dilatative) cardiomyopathy: most frequently occurring form of cardiomyopathy, which occurs particularly in men. The size of the ventricles increases, although the heart musculature does not become thicker. The cardiac output is reduced. Symptoms: heart failure, cardiac arrythmias, sometimes arterial embolism, arising from a blood clot in the heart. Therapy: Drug treatment of heart failure, drugs to reduce blood coagulation.

Diagnosis
Echocardiography, heart catheterisation (sometimes with biopsy), X-ray of the abdominal organs, electrocardiography

cardiovascular disease

a general term for medical conditions that affect the heart and blood vessels

Cardiovascular diseases

Definition

General collective term for pathological disturbances in the functions of the heart and circulation. Cardiovascular diseases include high blood pressure (hypertension), so-called hardening of the arteries (arteriosclerosis), occlusive arterial diseases, varicose veins (cf. varicosis) and other diseases which affect the heart. These include poor perfusion of the coronary vessels (coronary insufficiency, coronary heart disease) with acute forms such as angina pectoris and myocardial infarction and inadequate strength of the heart muscle (cf. left heart failure) and rare diseases of the heart muscle (cf. cardiomyopathy).

Causes

Cardiovascular diseases include numerous quite distinct conditions. Arteriosclerosis supports the development of perfusion problems, thrombosis and other conditions. Its causes are not definitely known. Numerous toxins and diseases have been suggested to cause or support the development of arteriosclerosis. These include high blood pressure (hypertension), high blood fat (particularly hypercholesterolaemia), diabetes mellitus (type 2 diabetes, type 1 diabetes, nicotine, antigen-antibody complexes, inflammation, low tissue levels of oxygen, psychological stress, age and family background. High blood pressure may be related to poor nutrition, hormonal disturbance, treatment with certain drugs or other causes. Acute arterial occlusion is mostly caused by thrombosis or an embolism. Coronary insufficiency is the result of coronary sclerosis and can lead to angina pectoris or even myocardial infarction. It is triggered by critically deficient perfusion, which is the result of occlusion of a coronary artery by a blood clot (thrombus). So-called varicose veins often result from in-born weakness in connective tissue or a failure of the venous valves.
Risk factors for many cardiovascular diseases include overweight, diabetes mellitus (type 2 diabetes, type 1 diabetes), imbalanced and fatty nutrition and lack of exercise.

Symptoms

High blood pressure is often accompanied by non-specific symptoms of very variable degree, including giddiness, headache and visual problems. The initial clinical course is often free of symptoms until these arise as the result of organ damage, particularly early development of arteriosclerosis, with coronary heart disease and other conditions. Arteriosclerosis is mostly observed as ischaemia and other secondary diseases. The symptoms of arteriosclerosis are sudden chest pains which spread and are frequently accompanied by a feeling of constriction. In a myocardial infarction these symptoms last longer and are more severe.

Diagnosis

Diagnoses can be made on the basis of specific symptoms, although additional diagnostic procedures are available for many cardiovascular diseases, such as (direct) or (indirect) measurement of blood pressure, electrocardiography, X-ray imaging of blood vessels (angiography) and ultrasound diagnosis.

Therapy

A change in the way of life is mostly recommended. Aside from this, both drug treatment and operations are used for cardiovascular diseases, depending on their type and severity. The treatment of underlying disease is always of first importance. Hypertension and arteriosclerosis are among the cardiovascular diseases which are dangerous and which entail the long-term risk of acute complications. High blood pressure can partially be normalised by salt reduction, normalisation of body weight, reduction in so-called stressors and endurance sports, such as cycling, swimming and jogging. This way of life also protects against formation or development of arteriosclerosis.

Prevention

Risk factors should be avoided, such as nicotine, continuous lack of exercise, unbalanced fatty nutrition and overweight. Overweight should be reduced.

Catarrh

see rhinitis

catheter

in terms of dialysis, a tube that is inserted into a vessel for the purpose of accessing the bloodstream

CD4+ Cells

see T-helper cells.

CD4/CD8 ratio

Ratio of the helper cells (CD4+ T-lymphocytes or T4-helper cells) to the suppressor cells (CD8+ T-lymphocytes or T8-suppressor cells) in blood. The normal value lies between 1.21 and 3.05. The CD4/CD8 ratio is of particular value in assessing the course and prognosis of HIV disease.

CD8+ Cells

see T-suppressor cells*.

Cell Membrane

The cell membrane is the closed but partially permeable outer limit of the cell. It guarantees contact to other cells, for example in metabolism and the mutual recognition of cells of the same type. The antigenic properties (see antigen) and the receptors of the cell are also localised on the cell membrane.

Cell plasma

see Cytoplasm.

Cellobiose

Disaccharide from two connected molecules of glucose. Cellobiose is a building block of the plant carbohydrate cellulose.

Cellulitis

also known as cellulite

Colloquial expression for non-inflammatory changes in the collagen and elastic fibres in the connective tissue under the skin, which is particularly recognisable in overweight women round the thighs and hips.

Symptoms
Mattress phenomenon (net-like superficial pattern ) and orange peel skin (funnel-shaped retractions).

Prevention and Treatment
Weight reduction and physical training

Cellulose

Polysaccharides from cellobiose, which consists of two glucose molecules (see glucose). Occurs in plants as a structural polysaccharide with high stability. It can be metabolised by intestinal bacteria, although this only occurs in the large intestine in man. Cellulose is therefore of only limited nutritional value. Cf. roughage.

cerebrovascular accident

interruption of the blood supply to an area of the brain, resulting in injury or death of brain tissue and associated neurological symptoms; also known as a stroke

Chain of Infection

The chain of infection describes the routes of transmission of the pathogens of infectious disease.

Forms:
I. Homogenous Chain of Infection
In this, the pathogen is transmitted between warm blooded animals. A distinction is made between chains of infection which are restricted to one type of warm blooded animal and chains of infection in which transmission from animal to man takes place. Examples of the first type are droplet and contact infections, which are transmitted as smear infections, as venereal diseases, through the placenta or by the physician.

II. Heterogenous Chain of Infection:
In this case, transmission to warm blooded animals occurs by insects or arachnids (spiders).
Here too a distinction is made between diseases which are restricted to a single type of warm blooded animal and diseases which can be transmitted from one type of warm blooded animal to another (animal-animal, animal-man, man-man).

Chemotherapy

Use of drugs which damage pathogens (bacteria, viruses, fungi) and tumour cells by inhibiting their metabolism, which should occur as selectively as possible. In cancer therapy, a distinction is made between so-called adjuvant chemotherapy after an operation or radiotherapy* and neoadjuvant chemotherapy, which is used before a planned operation or radiotherapy to damage a tumour or metastasis or to reduce the tumour mass.

Chitin

Chitin is a linear carbohydrate (polysaccharide) which contains nitrogen and which is similar to cellulose. It is built up of molecules of D-N-acetylglucosamine and forms the hard external skeleton of insects and crustaceans. It also occurs in the cell walls of fungi.

Cholesterin

see cholesterol

Cholesterol

Cholesterol occurs in animal tissue as a component of cell membranes and lipoproteins. It is a natural fatty substance which is taken up in food and also produced in the body, to about 50 % with a balanced diet. Cholesterol is the starting material for the biosynthesis of some hormones, such as sex hormones, bile acids and calciferols. The cholesterol contained in animal food, particularly in fat and egg yolk, is bound in lipoproteins for transport in the body and esterified with fatty acids or eliminated in bile.chylomicrons are small lipoprotein particles with a high proportion of fat and which are formed directly in the intestine. Otherwise cholesterol is transported in the blood in various types of lipoprotein (LDL, VLDL, IDL and HDL).

Biosynthesis
Cholesterol is formed in the liver and in the intestinal mucous membrane from acetyl-CoA , which can for example be formed during the breakdown of fats.

Significance as risk factor
1. The risk of suffering from arteriosclerosis is particularly raised by deposition of cholesterol in a certain form (LDL) on the walls of the blood vessels. This used to be wrongly known as hardening of the arteries. In contrast, cholesterol in another form (HDL) is believed to reduce the risk of arteriosclerosis. 2. Cholesterol is frequently found in gall stones as crystals. 3. Cholesterol is stored in large quantities in cells and organs in patients suffering from lipogranulomatosis. Cf. hypercholesterolaemia, hypocholesterolaemia and hyperlipoproteinaemia.

Chromium

Chemical element, symbol Cr, non-noble heavy metal, trace element. Chromium is a component of the glucose tolerance factor and an important substance (cofactor) for the reaction of the hormone insulin with the insulin receptors on cell membranes. Sources of chromium include meat, beer yeast, cheese, wholemeal products and honey. Chromium deficiency can lead to reduced glucose tolerance, increased insulin concentrations and increased blood sugar (hyperglycaemia).

Chromosomes

So-called hereditary bodies; visible bearers of genetic information, thread- or loop-shaped components of the cell nucleus. Genes (hereditary units) are arranged in series on the chromosomes. Each chromosome is present in two copies ("diploid chromosomes") in the fertilised egg cell and in other body cells. The exceptions are the sex chromosomes. Male human beings have one X and one Y chromosome and human females two X chromosomes. In the germ cells (egg cells and sperm) there is only one copy of each chromosome ("haploid chromosomes"). Chromosomes consist mostly of deoxyribonucleic acid (DNA) and the proteins of the cell nucleus (histones). They have the ability to duplicate themselves in an identical fashion, so that after cell division (mitosis) both daughter cells have the identical number of chromosomes. So-called reductive division (meiosis) only occurs in the formation of the germ cells and the number of chromosomes is reduced from diploid to haploid. The number of chromosomes depends on the animal species. Human beings have 23 pairs of chromosomes, making 46 chromosomes in diploid cells.

chronic obstructive pulmonary disease (COPD)

general term for lung diseases such as emphysema or chronic bronchitis; characterised by chronic irreversible airway obstruction that results in slowed breathing and excess mucus production, leading to frequent coughing; usually caused by smoking

Chylomicrons

Lipoprotein particles of low density (less than 0.95 g/ml, average 180-500 nm) with a high proportion of fat (98-99.5 %). Chylomicrons are formed in the intestinal mucosa and reach the blood through the lymph system. They transport triglycerides taken up in food. They are broken down by the enzyme lipoprotein lipase to chylomicron residues, which are precursors of the lipoproteins formed in the liver (VLDL and HDL). Cf. hyperlipoproteinaemias

Circulation of the blood

A flow system for blood which consists of arteries, veins and capillaries and which serves body tissue. Blood flows from the right atrium of the heart into the right heart chamber (ventricle), which pumps it into the aorta pulmonalis (lung artery), which has both right and left branches. Gas exchange, the uptake of oxygen and release of carbon dioxide, occurs in the capillaries of the lung. Blood enriched with oxygen then flows into the left atrium, which completes the minor or pulmonary circulation. The blood then passes into the left chamber, which pumps it into the aorta (the largest artery) and its branches. Oxygen is released and carbon dioxide taken up by blood in the capillary system of organs and tissue and then the blood returns through the veins to the right atrium. This completes the systemic circulation.

Cirrhosis of the Liver

see Liver Cirrhosis.

Citrate cycle

also known as the citric acid cycle, tricarboxylic acid cycle or the Krebs cycle

Cyclic sequence of chemical reactions in cellular metabolism, which may for example be coupled to glycolysis. Its functions include the breakdown of carbohydrates, aminoacids and fatty acids, for the production of energy and the synthesis of intermediary products for biosynthetic reactions. The citrate cycle produces molecules which enter the so-called respiratory chain for further energy production.

Civilisation diseases

Collective term for diseases which are becoming more common in industrial countries and which arise from lack of physical activity or false nutrition. Examples of civilisation diseases which are related to nutrition include metabolic diseases (e.g. overweight, type 2 diabetes, fatty liver, gall and kidney stones, gout), caries, parodontosis, diseases of the locomotoric system, diseases of the digestive tract (e.g. constipation, liver, gallbladder, pancreatic and intestinal diseases), blood vessel disease (e.g. arteriosclerosis, myocardial infarct, stroke and thrombosis), weakening of the immune system and some forms of cancer.

Claudication test

Initial functional test for disturbances of perfusion of the legs in occlusive arterial diseases. At fixed speed (e.g. 80 paces per minute) the distance is measured until exercise pain develops, for example on a tread-mill.

Clay shovellers' disease

also known as clay shovellers' fracture

Clay Shovellers' Fracture is caused by continuous and unusual stress to the muscles of the back, for instance by unusually hard shovelling work, and involves avulsion (tearing away), usually of the seventh cervical vertebra or of the spinous process of the first thoracic vertebra. Bone fracture is mostly in the form of a fatigue fracture, with displacement of the bone fragments as a result of muscular tension.

Clay shovellers' fracture

see Clay shovellers' disease

Clinical urine tests

Determination of colour, reaction (pH) and density of fresh midstream urine, including microscopic examination of the urine sediment and the measurement of conventional clinical chemistry values (e.g. glucose, proteins, bilirubin, haemoglobin, ketone bodies). This is mostly done as a rapid test with a test strip. The result of the clinical urine test is the so-called urine status.

Closed-fist stress test

Test for disturbances in perfusion in the area of the arms and hands as a result of arterial occlusive diseases. The arm is raised and the hand is closed to a fist and then opened 60 times within 2 minutes. If perfusion is inadequate, the palm and fingers turn pale, either diffusely or in patches. Reactive blood repletion and refilling of the veins in the suspended arm are delayed.

Cockcroft-Gault equation

one of several equations used to estimate kidney function in adults based on the serum creatinine concentration and patient age, gender and weight; this equation estimates creatinine clearance, which reflects glomerular filtration rate

Cold, Russian

The so-called "Russian cold" was a large wave of influenza in the years 1889-1892. Cf. pandemic.

Colds

Inflammation of the respiratory tract and middle ear which often occurs after chilling. Not to be confused with influenza!

Causes
Mostly virus infection, (particularly with rhinovirus) after a drop in local perfusion and immune defence.

Treatment
Drug treatment: symptomatic:
1. Nose drops; 2. Inhalation with camomile extract, brine (mineral water containing salt) or ethereal oils; 3. With children, cold ointments can be rubbed in; 4. Antibiotic treatment for otitis media or paranasal sinus inflammation.

Traditional treatments: 1. With acute symptoms like flu, rest, including bed rest; 2. Little food, or food which is easy to digest and which contains much carbohydrate; 3. Regular bowel movements, perhaps with laxatives; 4. The effect of fever is in principle positive. If necessary, temperature can be reduced with wet packs; 5. Cold baths with plant additives can soothe, relax and support sleep; 6. Treatment of inflamed mucous membranes with ethereal oils, depending on the localisation, steam inhalation for the head, rinsing of the mouth or gargling; also local warmth, e.g. with infrared or short wave radiation.

Prevention
Avoidance of overheated rooms, dry air, and stress; adequate supply of vitamins, particularly of vitamin C (ascorbic acid).

Comments
Never treat with nose drops for more than 14 days, because of the danger of chronic rhinopathy (narrowing of the nose, with restriction to breathing, damage to the mucous membrane, problems in smelling, calcification of the blood vessels).

Colectomy

Operative removal of the whole colon (subtotal colectomy) or of the colon and rectum (total colectomy). After this, the free ends of the intestine are joined together (anastomosis) or an artificial intestinal outlet (Anus praeternaturalis) is created.

Forms:
1. Segment resection: removal of a small section of the colon
2. Right hemicolectomy: removal of the first ascending part of the colon, including a small section of the small intestine
3. Resection of the transverse colon: removal of the middle straight section of the colon (transverse colon)
4. Left hemicolectomy: removal of the posterior, descending section of the colon
5. Right or left extended hemicolectomy
6. Sigma resection: removal of the final section of the colon

Indication: for carcinoma of the colon (see colorectal carcinoma), ulcerative colitis, hereditary diseases of the colon in which multiple benign or malignant tumour of the colon occur (familial adenomatous polyposis).

Colon Cancer

Tumour disease of the colon. A distinction is made between benign tumours, such as polyps, and malignant colon tumours.
cf. Intestinal Tumour, Colon Carcinoma.

Colon Carcinoma

See Colorectal Carcinoma.

Combination Therapy

In a combination therapy, either several drugs are used at the same time, or formulation are used which already consist of two or more drugs.
The aim is to improve the action or to reduce the side effects. It is mostly necessary to use combination therapy in particularly severe infections with partially resistant infective agents, for example in tuberculosis and in HIV infections.

Combination Vaccines

Also known as multiple vaccines

Vaccine (see vaccines) for the simultaneous immunisation against several infectious diseases, to make the recommended protective vaccination easier, e.g. measles, mumps, German measles vaccine. Cf. vaccine, polyvalent.

Complement System

This is a system of proteins which are activated in sequence in an infection, to inactivate the intruding foreign material, either by breaking up the foreign cell or by activating other defence cells.

complete blood count

a laboratory test that determines the number of white and red blood cells and platelets, hemoglobin and hematocrit, as well as other values that reflect the overall health of blood; also known as a full blood count

Computer tomography

Abbreviation CT

X-Ray diagnostic and computer-based imaging procedure. A narrow fan-shaped beam is produced with an X-ray tube and a special filter system. This is attenuated (weakened) to various degrees by the structures present in the layer of the patient who is irradiated. The signal from this attenuated X-ray beam is detected with an array of multiple detectors and electronically processed. During computer tomography, the system of tube and detectors rotates together round the middle of the circular measurement field. In this way, many different projections of the same layer are produced and processed in the computer to an image which depicts the distribution of the attenuation values in the irradiated body layer. CT images have much better contrast resolution but poorer structural and form resolution than conventional X-rays. CT is particularly useful in the detection of restricted and diffuse morphological changes, such as tumours, metastases and abscesses. It complements ultrasound diagnosis, conventional X-ray diagnosis and nuclear spin tomography.

congenital

inherited, inborn, acquired in the uterus or at birth

congestive heart failure

a condition in which the heart is unable to maintain adequate circulation of blood in the tissues of the body

Congestive Jaundice

Jaundice (see Icterus) which occurs in liver congestion, as a consequence of obstruction to draining of blood from the liver.

Constipation

see obstipation

Constipation

also known as obstipation

Collective term for conditions which are characterised by few bowel movements (fewer than three times a week) and necessary intense pressure during these movements.

Causes
1. The most frequent form is decellerated intestinal passage and is particularly frequent in women. The cause is mostly unclear. Constipation occurs during diabetes mellitus, underfunction of the thyroid or adrenals, pregnancy or drug treatment (e.g. opiates, diuretics, calcium preparations). 2. Rectoanal obstruction (occlusion in the area of the rectum or anus): a) processes which lead to constriction in the lower large intestine and anal channel (e.g. tumour, inflammation, scars); b) functional obstruction: prolapse of the internal wall of the colon, anism (paradoxical contraction of the external sphincter when pressing); c) neurogenic disease: Multiple sclerosis, Parkinson's syndrome, stroke, diabetes mellitus.

Therapy
Intake of roughage, milk sugar (lactulose), laxatives or drugs which stimulate intestinal mobility.

Contraception, hormonal

Method of contraception which was introduced in 1960 and which involves regular treatment with oestrogen and/or gestagen according to a standard scheme. Depending on the type of hormone and the dosage, the mechanism of action is based not only on inhibition of ovulation, but also on changes in the mucus of the womb neck, so that sperm migration is made more difficult or impossible. Changes in the mucus membrane of the womb make it more difficult for the fertilised egg cell to become embedded. If hormonal treatment is interrupted every 21 days, cyclical bleeding which resembles menstruation takes place.

Drug side-effects
The tendency to form blood clots (thrombosis) is increased, particularly in women who smoke. Other problems are an increase in weight (see overweight), oedema, nausea, vomiting, headache and psychiatric symptoms. An increase in blood pressure is rare.

Coreceptor

Protein molecule on the surface of cells which makes it possible for the HI virus to penetrate. The main receptor through which the virus penetrates into the cell is the so-called CD4 receptor. Most coreceptors are normally docking sites for substances which are important for inflammatory reactions.

Cori Cycle

also known as the glucose-lactate cycle

During intense muscular work, glucose is released from muscular glycogen (starch) by glycolysis, which is metabolised to form pyruvate. At low levels of oxygen, this is fermented to form lactate. Lactate reaches the liver through the circulation and is here either totally oxidised or used for gluconeogenesis. As a result of the Cori cycle, the liver takes over part of the metabolic work of the muscle.

Coronary angiography

X-Ray imaging of the coronary arteries (see angiography.

Uses
To distinguish between different sorts of coronary sclerosis, for the localisation of constrictions of coronary arteries and imagining of shunts in coronary heart disease, particularly before cardiological surgery. PTCA and thrombolysis are possible at the same time.

Coronary angioplasty

see PTCA

Coronary heart disease

also known as stenosing coronary sclerosis or ischaemic heart disease

A disease with different causes, which is characterised from the start by inadequate perfusion of the coronary arteries (primary coronary insufficiency). The most frequent cause is arteriosclerosis of the large coronary arteries or a disease of the small coronary arteries (see microangiopathy, small vessel disease), more rarely also spasm of the coronary vessels (Prinzmetal angina).

Forms
1. Coronary heart disease without signs of disease (so-called silent ischaemia); 2. Coronary Heart Disease as angina pectoris, myocardial infarction, left heart failure, cardiac arrythmias or sudden heart death.

Risk Factors
Nicotine consumption, high blood pressure (hypertension), high concentration of blood fats (particularly high LDL-cholesterol), low HDL-cholesterol, high lipoprotein A, diabetes mellitus (type 2 diabetes, type 1 diabetes), overweight, raised concentrations of fibrinogen (blood coagulation factor), lack of exercise, psychological stress

Diagnosis
Electrocardiography at rest, exercise and long-term electrocardiography, stress echocardiography (ultrasound investigation of the heart during stress; cf. echocardiography), myocardial scintigraphy (investigation of the heart muscle with a radioactive substance), coronary angiography (heart catheter investigation)

Therapy
1. Drug therapy, e.g. organic nitrates, calcium antagonists, beta-receptor blockers, acetylsalicylic acid; 2. Reopening of constricted or occluded vessels: coronary angioplasty (expansion with a balloon catheter), sometimes combined with stent implantation (insertion of a tube shaped wire construction to keep the vessel open); surgical peeling of an occluded coronary artery, aortocoronary bypass ( surgical connection of the aorta and coronary vessels, bypassing the occluded stretches); 3. Heart transplantation.

Coronary insufficiency

Insufficient perfusion of the coronary arteries. There is an imbalance between the requirements of the heart muscle for nutrients which provide energy and oxygen and what is actually available.

Forms
1. Primary coronary insufficiency is mostly the result of constriction of the coronary vessels, particularly as the result of arteriosclerosis or from spasm or inflammation. The clinical course is latent and chronic and is not evident for a long time. There is reduced ability to increase coronary perfusion during exercise, loss of heart muscle due to lack of oxygen-rich blood and increasing heart failure. Acute coronary insufficiency leads to a lack of oxygen rich blood in heart muscle (heart muscle ischaemia, angina pectoris). Under some circumstances, for instances if the vessels are occluded by arteriosclerosis, this may lead to the death of heart muscle (myocardial infarction). The clinical presentation of primary coronary insufficiency is coronary heart disease. 2. secondary or functional coronary insufficiency means reduced perfusion of the coronary vessels as a result of excessively low blood oxygen, from excessively low blood pressure in the coronary arteries (in certain heart defects or shock), from abnormalities in the flow properties of blood or from increased requirement for blood, for instance when heart muscle tissue increases. Changes in the coronary vessels do not occur here.

Coronary sclerosis

Arteriosclerosis of the coronary arteries, with constriction or occlusion of the vessels. Coronary sclerosis is the most frequent cause of primary coronary insufficiency and thus of coronary heart disease.

Corticosteroids

Group of steroid hormones which are formed in the adrenal cortex. Three groups of corticosteroids are distinguished, depending on their exact site of production in the adrenal cortex: 1. Mineral corticosteroids, including the important natural hormones aldosterone and desoxycorticosterone. These act on the water balance in the kidney. 2. Glucocorticoids, including the three important natural hormones cortisol, cortisone and corticosterone. These fulfil important functions in carbohydrate metabolism, by stimulating the production of glucose (gluconeogenesis) and starch (glycogen). 3. Sex hormones: androgens and oestrogens, which are however not exclusively formed in the adrenal cortex.

Cortisol

Cortisol is a hormone which is formed in the adrenal cortex and is one of the glucocorticoids. It counteracts the effects of insulin. It increases the production of glucose in the body (gluconeogenesis), raises blood sugar (hyperglycaemia) and increases protein breakdown.

Cough

Forced breathing out, against the vocal chords in the larynx, which are initially closed and then suddenly opened. Cough is an essential protective reflex, which is released by the irritation of receptors in the windpipe and bronchi.

Forms
1. Productive cough in which mucus is transported out; 2. Unproductive, dry cough, so-called hacking cough.

Treatment
1. In principle, the treatment of cough is the treatment of the underlying disease (e.g. influenza); 2. In addition, drugs to suppress cough should be used for unproductive and exhausting cough; 3. Traditional medicine offers a variety of herbs; cold compresses are a home remedy and have a soothing and suppressive effect.

Comment
A further diagnostic investigation must be carried out if the cough continues, or if the sputum contains pus or is bloody.

Cough fracture

(Serial) rib fracture caused by intense coughing, particularly with marked osteoporosis or osteolysis.

Coxarthrosis

also known as Arthrosis deformans coxae

Arthrosis of one or both hip joints. Fully developed only in age (Malum coxae senile).

Causes
1. Long term imbalance between stress and resistance to stress (e.g. in overweight); 2. congenital malposition of the hip joints; 3. injury (e.g. femoral neck fracture); 4. disturbances in perfusion or metabolism, gout, diabetes mellitus, alcohol abuse; 5. inflammation.

Symptoms
Coxarthrosis can be very painful. Restrictions in function develop, which may lead to an absolutely stiff joint (ankylosis).

Diagnosis and therapy
See arthrosis

creatinine

a waste product derived primarily from metabolism in muscle

creatinine clearance

the volume of plasma cleared of creatinine in one minute

Creutzfeldt-Jakob disease

a rare, fatal neurological disease caused by misfolded proteins (prions) that accumulate and damage brain tissue; this disease is similar to mad cow disease

Cross-Resistance

Resistance of infective agents to a certain drug which leads to resistance to another drug.

CSE inhibitors

see lipid sinkers

Abbreviation for computer tomography

Abbreviation for carbohydrate unit

Cyclamate

Cyclamates are sodium or calcium salts of N-cyclohexylsulphaminic acid and are used as calorie-free sweeteners and substitutes for carbohydrate in diabetes mellitus, sometimes in combination with saccharine at a ratio of 10 to 1.

cysteine

a sulphur-containing amino acid (C3H7NO2S) occurring in many proteins in the body that plays a role in conferring protein stability through disulphide bridging; can be synthesised in the body

Cytokines

The cytokines are proteins which are formed and excreted by many types of cell and which change the behaviour or properties of other cells (cf. Lymphokines).

Cytomegaly

also CMV infection
The clinical picture of cytomegaly arises from infection of the organism with the cytomegaly virus. There are usually no symptoms in individuals with a healthy immune system. In contrast, the infection may be severe (for example with involvement of the liver, lungs and central nervous system) or even fatal in babies and in patients with a weakened immune system, for example during HIV infection or in cancer. The disease can frequently be recognised by examining the reflective properties of the back of the eye (fundus) (predominantly in HIV patients). The virus itself can be detected in body secretions or in tissue. The diagnosis can also be based on the detection of virus antigens or nucleic acid (cf. polymerase chain reaction).
To prevent the disease, individuals who are not infected with the cytomegaly virus should never receive blood or organs from infected patients. It may be possible to moderate the course of the disease and the death rate with specific antibodies. The disease can be treated as required with antibiotics (virostatic drugs).

Cytoplasm

also protoplasm, cell plasma
This is the substance of all living cells which is enclosed by the cell membrane.It includes aqueous solutions of proteins, fats (lipids), sugar (carbohydrates), mineral salts, trace elements and a variety of inclusion bodies of various sizes, such as vesicles and cell organisms.

Cytostatic Drugs

Drugs which prevent or delay cell growth, particularly cell division. Cytostatic drugs only act on cells which are growing, not those in the resting stage. Cytostatic drugs are used in tumour therapy (see chemotherapy), as tumour cells are not subject to normal physiological growth controls and divide more rapidly than do normal cells. They are therefore more sensitive to the drugs than are healthy normal cells.

Glossary entries: Roche and Walter de Gruyter, Berlin

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