DSM-IV
D
form in the tooth socket after a difficult
extraction, such as removal of a wisdom
tooth (see
impaction, dental
) .
The clot
itself may become infected, or infection
may already have been present before
extraction. The inflamed socket appears
dry, and exposed bone is often visible.
The socket is irrigated to remove
debris and may then be coated w ith an
anti-inflammatory paste. The infection
usually clears up w ithin a few days.
DSM-IV
The fourth edition of the Diagnostic and
Statistical Manual of Mental Disorders,
published by the American Psychiatric
Association. It classifies psychiatric illnes-
ses and is widely used in other countries.
dTaP/IPV
A combined vaccine, introduced in 2004,
that provides immunity against
diphthe-
ria
(in a low dose),
tetanus
,
pertussis
(whooping cough), and
poliomyelitis
.
It
is given to children aged three to five
years as part of the childhood im m uni-
zation programme. (See
Typical childhood
immunization schedule
,
p.414.)
DTaP/IPV/Hib
A combined vaccine, introduced in 2004,
that provides immunity against
diphthe-
ria
,
tetanus
,
pertussis
(whooping cough),
poliomyelitis
,
and
Hib
.
In this vaccine
(and in the
dTaP/IPV
vaccine), the polio
and pertussis parts have been altered to
minimize the risk of adverse effects.
HOW IT IS DONE
The injection is given in three doses to
infants at two, three, and four months
of age, so that they are protected as soon
as possible. (Meningitis C vaccination is
given at the same time.) The childhood
immunization schedule also includes a
preschool booster (see
dTaP/IPV
) ,
and a
further diphtheria, tetanus, and polio
booster before leaving school. (See
Typical
childhood immunization schedule
,
p.414.)
PROTECTION
The vaccine provides a very high level
of im m unity to diphtheria, tetanus,
pertussis, polio, and H ib infections.
POSSIBLE ADVERSE EFFECTS
DTaP/IPV/Hib is less likely to cause re-
actions than the older vaccines. Any side
effects are usually m ild and tend to
occur w ithin 12-24 hours. They include
a slightly raised temperature, irritability
and fretfulness, and a small lump, red-
ness, and swelling at the injection site.
Severe side effects are very rare.
The vaccine should not be given to chil-
dren who have reacted severely to a
preceding dose or to the old DTP vac-
cine, or to children who could have a
severe reaction to
neomycin
,
streptomycin
,
or polymyxin B (see
polymyxins
) ,
w hich
may exist in the vaccine in trace amounts.
DTP vaccine
An injection providing immunity against
diphtheria
,
pertussis
(whooping cough),
and
tetanus
.
In 2004, the DTP vaccine
was replaced, in the UK, by the
dTaP/IPV
and
DTaP/IPV/Hib
vaccines.
dual personality
See
multiple personality
.
Dubin-Johnson syndrome
An inherited disorder that is caused by
an autosomal recessive genetic trait (see
genetic disorders
) .
Dubin-Johnson syn-
drome is characterized by long-standing,
m ild
jaundice
(yellowing of the skin and
the whites of the eyes), w hich may not
become
apparent
until
puberty
or
adulthood. There is an abnormality in
the transportation of
bilirubin
(the main
pigment found in bile) from the
liver
to
the
biliary system
,
w hich
causes
the
bilirubin to accumulate in the liver.
No specific treatment
is
available.
Affected people are advised to avoid
drinking alcohol, and to avoid taking a
range of medications that are processed
by the liver, for example
oral contracep-
tives
.
Genetic counselling
may be offered
to prospective parents who have a fami-
ly history of Dubin-Johnson syndrome.
Duchenne’s dystrophy
The most common and severe form of
muscular dystrophy
.
duct
A tube or a tube-like passage leading
from a gland to allow the flow of
fluids, such as the tear ducts.
ductal carcinoma
Any
carcinoma
(a cancerous
tumour
arising from cells in an organ’s surface
layer or its lining membrane) of a duct
(a tube or tube-like passage leading
from a
gland
).
Examples of ducts that are most fre-
quently affected by carcinomas are the
pancreatic duct (see
pancreas
)
and the
m ilk ducts in the female
breast
.
Ductal
carcinomas of the breast that have not
yet spread into the breast tissue can
usually be cured by surgery.
Duke’s classification
A
staging
system for
carcinomas
(cancer-
ous tumours arising from cells in an
organ’s surface layer or lining mem-
brane)
in the
lower
gastrointestinal
tract. Carcinomas of the
colon
(the main
part of the large intestine) or
rectum
(the muscular tube that connects the
large intestine to the anus) are classi-
fied according to this system.
dumbness
See
mutism
.
dumping syndrome
Symptoms that include sweating, faint-
ing, and palpitations due to the rapid
passage of food from the stomach into
the intestine. Dum ping syndrome (also
known as rapid gastric emptying) is
uncommon but mainly affects people
w ho have had a
gastrectomy
(surgical
removal of the stomach).
Symptoms may occur within about
3 0 minutes of eating (early dumping)
or after 90-120 minutes (late dump-
ing). Some very anxious people may
experience the symptoms of dumping
even though their stomach is intact.
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