CHAPTER 23			INDEXING PRINCIPLES FOR CATEGORY C 
 
	(DISEASES) 
 
 

23.1		Category C is the MeSH category for disease terms. The terms are  
 
arranged in two ways: by type of disease (e.g., infections, neoplasms,  
congenital diseases) and by system (e.g., cardiovascular diseases,  
gastrointestinal diseases, endocrine diseases). 
 

23.2		The Tree Structure given below shows the specific coverage of  
diseases in Category C. 
 
C1	BACTERIAL AND FUNGAL DISEASES 
C2	VIRUS DISEASES 
C3	PARASITIC DISEASES 
C4	NEOPLASMS 
C5	MUSCULOSKELETAL DISEASES 
C6	DIGESTIVE SYSTEM DISEASES 
C7	STOMATOGNATHIC DISEASES 
C8	RESPIRATORY TRACT DISEASES 
C9	OTORHINOLARYNGOLOGIC DISEASES 
C10	NERVOUS SYSTEM DISEASES 
C11	EYE DISEASES 
C12	UROLOGIC AND MALE GENITAL DISEASES 
C13	FEMALE GENITAL DISEASES AND PREGNANCY COMPLICATIONS 
C14	CARDIOVASCULAR DISEASES 
C15	HEMIC AND LYMPHATIC DISEASES 
C16	NEONATAL DISEASES AND ABNORMALITIES 
C17	SKIN DISEASES 
C18	NUTRITIONAL AND METABOLIC DISEASES 
C19	ENDOCRINE DISEASES 
C20	IMMUNOLOGIC DISEASES 
C21	INJURY, OCCUPATIONAL DISEASES,  POISONING 
C22	ANIMAL DISEASES 
C23	SYMPTOMS AND GENERAL PATHOLOGY 
 

23.3		The subheadings available for use with Category C terms are: 
/blood				/microbiology 
/blood supply (C4 only)			/mortality 
/cerebrospinal fluid		/nursing 
/chemically induced		/parasitology 
/chemistry (C4 only)		/pathology 
/classification			/physiopathology 
/complications			/prevention & control 
/congenital			/psychology 
/diagnosis			/radiography 
/diet therapy			/radionuclide imaging 
/drug therapy			/radiotherapy 
/economics			/rehabilitation 
/embryology			/secondary (C4 only) 
/enzymology			/secretion (C4 only) 
/epidemiology			/surgery 
/ethnology			/therapy 
/etiology			/transmission (C1-3 only) 
/genetics			/ultrasonography 
/history			/ultrastructure (C4 only) 
/immunology			/urine 
/metabolism			/veterinary 
				/virology 
 

23.3.1	A few "tissue-oriented" subheadings have been assigned only to  
Category C4, the tree containing neoplasms (tumors, cancers and cysts);  
neoplasms can be viewed as tissue in addition to being thought of as diseases,  
so the additional subheadings are permitted. See Chapter 24 for a discussion of  
neoplasms. 
 

23.3.2	The subheading /transmission is an AQ only for Categories C1-3  
(the infectious diseases). It is reserved for transmission of diseases caused by  
microorganisms or parasitic organisms; genetic transmission is covered instead  
by the subheading /genetics. See section 23.22+. 
 

23.3.3	Each subheading is discussed specifically in Chapter 19, so  
the correct use of every subheading allowed with disease terms will not be  
covered in this chapter. 
  

23.4		The categorization of "disease" in MeSH is very broad, including not  
only what are generally thought of as "diseases" or "disorders", but also such  
concepts as "abnormalities", "injuries", "poisoning" and "addiction", and many  
pathologic descriptions such as "hypertrophy", "metaplasia" and "necrosis".   
 

23.4.1	The word "lesion" is often used by authors and can mean many  
things depending on the article. An indexer must not consider the word  
synonymous with "injury" or "cancer" unless proven to be so in the article;  
usually a "lesion" will be indexed as a "disease" or as the /pathology of the  
involved organ. 
 

23.5		The main heading DISEASE exists in MeSH but its use is restricted to  
articles on the disease process in general as opposed to health. Use the heading  
DISEASE for articles such as: "The stages of illness" or "Disease, the physician  
and society". 
 

23.5.1	Few subheadings are permitted with the general heading DISEASE  
(only /classification, /ethnology, /etiology, /psychology, and /transmission).  
For any article which seems to require another subheading on the term DISEASE,  
index only any other aspect studied; users of Index Medicus will be looking at  
their particular aspect of interest, not at DISEASE. 
 
Adaptation to disease. 
		DISEASE / * psychol 
		* ADAPTATION, PSYCHOLOGICAL 
 
But: Blood hormone levels in disease. 
		HORMONES / * blood 
		(Not: * DISEASE) 
 

23.5.2	If an indexer wants to use one of the following Category C  
subheadings with the general term DISEASE, its main heading equivalent should be  
used instead. 
 
DISEASE / diag		=DIAGNOSIS 
DISEASE / diet ther	=DIET THERAPY 
DISEASE / drug ther	=DRUG THERAPY 
DISEASE / econ		=ECONOMICS, MEDICAL 
DISEASE / epidemiol	=MORBIDITY or EPIDEMIOLOGY 
DISEASE / genet		=HEREDITARY DISEASES		 
DISEASE / immunol	=IMMUNITY or IMMUNOLOGY 
DISEASE / mortal	=MORTALITY 
DISEASE / nurs		=NURSING CARE 
DISEASE / pathol	=PATHOLOGY 
DISEASE / prev		=PREVENTIVE MEDICINE 
DISEASE / radiogr	=RADIOGRAPHY 
DISEASE / radionuclide	=RADIONUCLIDE IMAGING 
DISEASE / radiother	=RADIOTHERAPY 
DISEASE / rehabil	=REHABILITATION 
DISEASE / surg		=SURGICAL PROCEDURES, OPERATIVE 
DISEASE / ther		=THERAPEUTICS or a specific 
DISEASE / ultrasonogr	=ULTRASONOGRAPHY 
DISEASE / vet		=ANIMAL DISEASES or VETERINARY MEDICINE 
 

23.6		MeSH has some headings which are annotated to allow their use either  
for a specialty or for diseases within its province; these terms usually include  
the word MEDICINE. For instance, AVIATION MEDICINE can mean the specialty or the  
medical aspects of aviation. Other specialty terms, such as MILITARY MEDICINE,  
are to be used only for the specialty itself; the indexer must check the  
annotation before using a specialty heading for a disease. 
 

23.7		The many types of disease terms available in MeSH are shown below. 
 
Pre-coordinated organ-diseases terms: 
BRAIN DISEASES 
STOMACH DISEASES 
Infection terms: 
	Pre-coordinated general terms: 
BACTERIAL INFECTIONS 
VIRUS DISEASES 
	Pre-coordinated specific terms: 
STREPTOCOCCAL INFECTIONS 
ADENOVIRUS INFECTIONS 
	Historical or classical terms: 
PLAGUE 
BOTULISM 
YELLOW FEVER 
Terms in which the organism is inherent: 
TUBERCULOSIS for Mycobacterium tuberculosis infection 
TRYPANOSOMIASIS for Trypanosoma infection	 
Terms in which the organism and organ are inherent: 
TUBERCULOSIS, PULMONARY 
AMEBIASIS, HEPATIC 
STAPHYLOCOCCAL SCALDED SKIN SYNDROME 
Neoplasm terms: 
Pre-coordinated organ-neoplasms terms: 
BRAIN NEOPLASMS 
STOMACH NEOPLASMS 
Histological types of neoplasms: 
ASTROCYTOMA 
ADENOCARCINOMA 
Inflammatory disease terms (usually end in -ITIS): 
ENCEPHALITIS 
GASTRITIS 
PNEUMONIA 
Terms for specific diseases: 
ENCEPHALOMALACIA 
PYLORIC STENOSIS 
Syndromes: 
Eponymous syndromes: 
BASSEN-KORNZWEIG SYNDROME 
LAURENCE-MOON-BIEDL SYNDROME 
Descriptive syndromes: 
NAIL-PATELLA SYNDROME 
SEA-BLUE HISTIOCYTE SYNDROME 
Animal diseases: 
Pre-coordinated animal-diseases: 
CAT DISEASES 
DOG DISEASES 
Species-specific diseases: 
MASTITIS, BOVINE 
NAIROBI SHEEP DISEASE  
 

23.8		Index a disease as specifically as possible. An article on coronary  
disease is indexed as CORONARY DISEASE, not HEART DISEASES. An article on lung  
cancer is indexed as LUNG NEOPLASMS, not RESPIRATORY TRACT NEOPLASMS nor LUNG  
DISEASES. 
 

23.8.1		When many diseases are discussed in an article, however, it  
may not be possible to index each without using too much depth. The "rule of  
three" permits the indexing of up to three related terms; if more than three  
related terms are to be indexed, they should usually be covered by a single,  
more general term which is chosen by consulting the Trees. 
 
For example, in an article about the drug therapy of celiac disease, lactose  
intolerance, intestinal lipodystrophy, short bowel syndrome, and Crohn disease,  
the indexer may need to index several drugs as well as the diseases, and  
possibly also the complications caused by the diseases and the drugs. If each  
disease and each drug were indexed as well as all the complications, too many  
terms would be used, so the indexer must group in the following manner: 
 
CELIAC DISEASE, LACTOSE INTOLERANCE, SHORT BOWEL SYNDROME and LIPODYSTROPHY,  
INTESTINAL are treed under MALABSORPTION SYNDROMES, so that term can be used  
instead of indexing four terms. 
 
If for some reason there is still too much depth (as in a priority 3 journal),  
MALABSORPTION SYNDROMES and CROHN DISEASE can be grouped with the still more  
general term INTESTINAL DISEASES. 
 

23.8.2		Even when there are not too many terms, there may be too many  
IM terms. In general, we do not make more than five terms IM if a grouping  
procedure can be followed to choose an IM term which covers three or more  
related main concepts. The specific terms may still be indexed NIM if there is  
not too much depth. 
 
ATPase levels in heart mitochondria in congestive cardiomyopathy, aortic  
subvalvular stenosis, endomyocardial fibrosis, and myocarditis. 
MITOCHONDRIA, HEART / * enzymol 
ATPASE / * anal 
CARDIOMYOPATHY, CONGESTIVE / enzymol 
AORTIC SUBVALVULAR STENOSIS / enzymol 
ENDOMYOCARDIAL FIBROSIS / enzymol 
MYOCARDITIS / enzymol 
MYOCARDIAL DISEASES / * enzymol 
 
Note that MYOCARDIAL DISEASES is the most specific term which groups all the  
related concepts; HEART DISEASES is also available but is less specific. 
 

23.9		Always use the most specific pre-coordinated disease term available  
rather than combining two terms. 
 
Index SALMONELLA INFECTIONS, 
 not SALMONELLA + INFECTIONS 
 not SALMONELLA + BACTERIAL INFECTIONS 
 
Index AORTIC ANEURYSM, 
 not AORTA + ANEURYSM 
 not AORTIC DISEASES + ANEURYSM 
 

23.10		MeSH contains many terms which refer to systemic diseases. When  
indexing an article about one of those diseases in a specific organ, coordinate  
the systemic disease term (IM) with the pre-coordinated organ-diseases term  
(IM), not the organ term. Use the same subheading(s) on both terms. 
 
Immunology of pulmonary amyloidosis. 
AMYLOIDOSIS / * immunol 
LUNG DISEASES / * immunol 
 

23.10.1	Similarly, when indexing any disease in which the article is about a  
more specific organ or location than indicated by the disease term, the disease  
term for the specific organ or location should be added as a coordinate. Both  
terms should be made IM, and the same subheading(s) should be used on both. 
 
Epidemiology of spinal osteoporosis. 
OSTEOPOROSIS / * epidemiol 
SPINAL DISEASES / * epidemiol 
 
Complications of colonic hemorrhage. 
GASTROINTESTINAL HEMORRHAGE / * compl 
COLONIC DISEASES / * compl 
 

23.11		When a pre-coordinated organ-diseases concept does not exist in  
MeSH, index the organ (IM) and add the most specific corresponding Category C  
term available, but make it NIM. 
 
"Cystic duct diseases" is indexed as	 
* CYSTIC DUCT 
  BILE DUCT DISEASES 
 
MeSH does not have a term to cover "cystic duct diseases", so * CYSTIC DUCT must  
be indexed. Then the indexer must check the Trees to see what term CYSTIC DUCT  
is indented under; in this case BILE DUCTS. Since MeSH has the term BILE DUCT  
DISEASES, that term is added NIM. (If BILE DUCT DISEASES had not been available,  
the Trees would have been consulted for the term under which BILE DUCTS is  
treed, and the corresponding disease term for that anatomical part would have  
been used as the NIM coordinate.)     
 

23.11.1	Since AQs are different for organs and diseases, it may not be  
possible to use a subheading on the organ when a pre-coordinated organ-diseases  
term does not exist for it; however, if a subheading applies to the organ and is  
an AQ, it should be used. 
 
Radiography of cystic duct diseases. 
CYSTIC DUCT / * radiogr 
BILE DUCT DISEASES / radiogr 
 
Drug therapy of cystic duct diseases. 
* CYSTIC DUCT 
BILE DUCT DISEASES / drug ther 
  
Ultrasonography of the pancreatic ducts in cystic duct diseases. 
(No imaging of the cystic duct) 
* CYSTIC DUCT 
BILE DUCT DISEASES / ultrasonogr 
PANCREATIC DUCTS / * ultrasonogr 
 

23.11.2	If an article is about a specific disease for which a MeSH term  
exists as an indention under the general organ-diseases term, that specific  
disease term should be indexed IM in coordination with the term for the more  
specific organ, and the general organ-diseases term should not be indexed at  
all. 
 
Cystic duct cholangitis. 
* CYSTIC DUCT 
* CHOLANGITIS 
Not: BILE DUCT DISEASES 
 

23.11.3	There are some locational terms which MeSH has annotated "coord NIM  
with (a disease term) IM"; the decision has been made that these specific sites  
are relatively unimportant.  When indexing a disease in such a location, do not  
follow the rule given in 23.11 but use the instructions in the annotation,  
making the location NIM with the disease term IM. 
 
Radiography in diseases of the internal carotid artery. 
CAROTID ARTERY DISEASES / * radiogr 
CAROTID ARTERY, INTERNAL / radiogr 
 

23.11.4	If a pre-coordinated organ-diseases heading does not exist in MeSH,  
do not attempt to achieve the concept of "disease" by using the subheadings  
/pathology or /physiopathology on the organ.  These subheadings are not  
synonymous with "disease"; /pathology is a description of non-normal tissue and  
/physiopathology is descriptive of non-normal function (see sections 19.8.52 and  
19.8.55).  To index a "disease" concept when the specific term is not available,  
follow the instructions given above. 
 
The previous sections discussed indexing policies for diseases in general. The  
rest of Chapter 23 will be devoted to policies for specific concepts. The brief  
Table of Contents below shows the coverage in individual sections of the  
chapter. 
 
 
23.12			Infections 
23.13			Inflammation 
23.14			Pathological processes 
23.15			/pathology 
23.16			Acute and chronic disease 
23.17			Pain 
23.18			Postoperative complications 
23.19			Fistulas 
23.20			Abnormalities 
23.21			Congenital diseases 
23.22			Hereditary diseases and  /genetics 
23.23			Injuries 
23.24			Drug hypersensitivity 
23.25			Deficiency diseases 
23.26			Syndromes 
23.27			Physiological processes vs. disease 
23.28			/physiopathology vs. /blood 
23.29			Hematology 
23.30			Serology 
23.31			Enzymes 
23.32			/etiology 
23.33			Veterinary diseases 
23.34			Pregnancy complications 
 

23.12		An infection is a disease caused by an organism. Infections are  
among the most common diseases we index.      
 
Authors sometimes use the term "infectious disease"; this may mean INFECTION in  
general, a specific infection, or COMMUNICABLE DISEASES. Check the text of the  
article itself for the meaning in a given instance. 
 

23.12.1	MeSH has many infection terms in Categories C1-C3; section 23.7  
shows the types of infection terms available. 
 

23.12.2	For the rules on how to index infections, see sections 22.12 through  
22.18. 
 

23.12.3	When an infection occurs in a specific organ, the pre-coordinated  
organ-diseases term must be indexed as well as the term for the infection  
itself. The subheading /microbiology or /parasitology on the organ-diseases term  
shows the origin of the disease. Any other subheading required for the subject  
of the article will probably be used on both the infection term and the organ- 
diseases term. 
 
Systemic Staphylococcus epidermidis infection. 
* STAPHYLOCOCCUS EPIDERMIDIS 
* STAPHYLOCOCCAL INFECTIONS 
 
Staphylococcus epidermidis infection of the adrenal glands. 
* STAPHYLOCOCCUS EPIDERMIDIS 
* STAPHYLOCOCCAL INFECTIONS 
ADRENAL GLAND DISEASES / * microbiol 
 
Drug therapy of Staphylococcus epidermidis infection of the adrenal glands. 
* STAPHYLOCOCCUS EPIDERMIDIS 
STAPHYLOCCAL INFECTIONS / * drug ther 
ADRENAL GLAND DISEASES / * drug ther / microbiol 
  

23.12.4	If the infection occurs in an organ for which there is no pre- 
coordinated organ-diseases term available, the rules given in section 23.11  
should be followed. Again the subheadings /microbiology or /parasitology can be  
used. 
 
Klebsiella pneumoniae infection of the cystic duct.  
* KLEBSIELLA PNEUMONIAE 
* KLEBSIELLA INFECTIONS 
CYSTIC DUCT / * microbiol 
BILE DUCT DISEASES / microbiol (note: NIM) 
 

23.12.5	MeSH contains the following pre-coordinated general "system- 
infection" terms.	 
EYE INFECTIONS, BACTERIAL  (also FUNGAL, 
PARASITIC, and VIRAL) 
INTESTINAL DISEASES, PARASITIC 
 
When indexing an infection caused by a specific organism in an organ located in  
one of these systems, if the infection term is not indented under one of the  
general terms, the general term should be added as a coordinate to the specific  
infection and specific organ-diseases term. This saves the searcher who wants  
articles on any infection anywhere in the system from having to search for all  
possible infections and specific organ-diseases.  
 
Epidemiology of enterovirus infections of the uvea. 
ENTEROVIRUS INFECTIONS / * epidemiol 
UVEAL DISEASES / * epidemiol / microbiol 
EYE INFECTIONS, VIRAL / * epidemiol 
 

23.13		The term INFLAMMATION is used for general articles on the  
inflammatory process. MeSH contains many terms for inflammations of specific  
organs, usually expressed by a Greek root for the organ with the suffix -ITIS.  
Each organ for which there is an inflammation term available is annotated with  
that information at the organ term. If no inflammation term exists for the organ  
being studied, index IM the pre-coordinated organ-diseases term (or the organ  
itself if no disease term exists) and add INFLAMMATION as an NIM coordinate. 
 
Stomach inflammation 		= * GASTRITIS  
Inflammation of the mouth		= * STOMATITIS 
Cecitis				= * CECAL DISEASES 
				INFLAMMATION	 
				(No inflammation term is  
				is available for the cecum 
 
 

23.13.1	Many inflammatory diseases are caused by an infection of the organ;  
in such cases index the inflammation term with the subheading /microbiology or  
/parasitology, coordinated with the pre-coordinated organism-infections term. Do  
not use the subheading /complications on the organism-infections term, because  
the inflammation is not really a complication; it is a symptom of the infection  
occurring in that organ and thus is merely a more specific term than the organ- 
diseases term which would be used otherwise. (Do not assume that an infection in  
an organ is inflammatory unless stated so in the article; use the pre- 
coordinated organ-diseases term rather than an -ITIS term unless there is proof  
of inflammation.) 
 
Staphylococcal pancreatitis. 
PANCREATITIS / * microbiol 
* STAPHYLOCOCCAL INFECTIONS 
(Not: STAPHYLOCOCCAL INFECTIONS / * compl) 
 

23.13.2	If an inflammation is caused by tuberculosis, coordinate the -ITIS  
term with the most specific pre-coordinated TUBERCULOSIS term available. 
 
Tuberculous endocarditis. 
* TUBERCULOSIS, CARDIOVASCULAR 
ENDOCARDITIS, BACTERIAL / * microbiol 
 
Tuberculous duodenitis. 
* TUBERCULOSIS, GASTROINTESTINAL 
DUODENITIS / * microbiol 
 

23.14		MeSH contains many terms in Category C23 treed under PATHOLOGICAL  
PROCESSES (NON MESH);  these are descriptive of what an organ or tissue looks  
like.  Each of the terms is annotated with the correct indexing, since different  
terms have different coordinations.  In the sections below, examples are given  
of each type of indexing. 
 

23.14.1	TORSION and ULCER are two of the terms annotated to be indexed NIM  
in coordination with the pre-coordinated organ-diseases term (IM). However, the  
annotation for TORSION says to use no qualifiers, while the annotation for ULCER  
does not have this restriction. 
 
Surgery for uterine torsion. 
UTERINE DISEASES / * surg 
TORSION 
 

23.14.2	INFARCTION and NEOVASCULARIZATION are two of the terms annotated to  
be indexed in coordination with the organ / * blood supply, not a pre- 
coordinated organ-disease term.  However, NEOVASCULARIZATION is annotated that  
it can be IM or NIM, depending on the article, whereas INFARCTION must be IM.  
 
Therapy of liver infarction. 
LIVER / * blood supply 
INFARCTION / * ther 
(Not:  LIVER DISEASES / * ther)   
 

23.14.3	NECROSIS and HYPERPLASIA are two of the terms annotated to be  
indexed NIM in coordination with the organ / * pathology rather than a pre- 
coordinated organ-diseases term.  However, the annotation for NECROSIS says to  
use no qualifiers, while the annotation for HYPERPLASIA does not have this  
restriction. 
 
Detection of focal nodular hyperplasia of the liver. 
LIVER / * pathol 
HYPERPLASIA / diag 
(Not:  LIVER DISEASES / * diag) 
 

23.15		For any article discussing the pathology of an organ in a disease,  
index the organ even if it is the organ normally affected by the disease.  Do  
not, however, index the organ merely because it is inherent in the disease if it  
is not discussed. 
 
Lung pathology in pulmonary tuberculosis. 
LUNG / * pathol 
TUBERCULOSIS, PULMONARY / * pathol 
 
Pathology of pulmonary tuberculosis. 
TUBERCULOSIS, PULMONARY / * pathol 
(Not:  LUNG / pathol, either IM or NIM, unless the lung is especially discussed;   
the author may discuss many organs affected by the disease) 
 

23.16		ACUTE DISEASE and CHRONIC DISEASE are MeSH terms used primarily as  
NIM coordinates with a specific disease term indexed IM. 
 

23.16.1	Index ACUTE DISEASE or CHRONIC DISEASE as IM concepts only when the  
general concept of acuteness or chronicity is the point of the article,  
irrespective of any specific disease. When either of these terms is made IM, the  
following subheadings may be used with it: /classification, /economics,  
/epidemiology, /mortality, /nursing, /psychology, /rehabilitation, /therapy. 
 
The psychology of chronic disease. 
CHRONIC DISEASE / * psychol 
 

23.16.2	An article on a specific acute or chronic disease should be indexed  
as the specific disease, coordinated with ACUTE DISEASE or CHRONIC DISEASE. In  
such a case (far more common than the general article shown in 23.16.1), the  
coordinate term must be NIM and no qualifier may be used with it. 
 
Therapy of acute pancreatitis. 
PANCREATITIS / * ther 
ACUTE DISEASE 
 

23.16.3	Do not attempt to qualify every disease as acute or chronic; the  
acuteness or chronicity must be the point of the article (and even then, the  
terms must be NIM in reference to a specific disease). 
 

23.16.4	The term CRITICAL ILLNESS is also available, and should be indexed  
in the same manner as ACUTE DISEASE and CHRONIC DISEASE (IM for general articles  
with the same limited set of subheadings allowed, NIM as a coordinate with no  
qualifiers). However, it is far less likely that a specific disease will be  
discussed as "critical", so this term will not be used as frequently as the  
others. It may well be that the term will be used primarily for general articles  
on critical illness, irrespective of any specific disease. 
 

23.17		Articles on pain in general will be indexed as PAIN (IM) with any  
subheadings required. Such articles will probably discuss the physiopathological  
mechanisms of pain, its psychology, etc. irrespective of an organ. 
 

23.17.1	If the pain process in a specific disease is especially discussed,  
PAIN may be indexed but will probably be NIM. The subheading on the specific  
disease may be /complications, but /physiopathology is probably better if the  
pain process is discussed. 
 
 

23.18		POSTOPERATIVE COMPLICATIONS and its indentions are conditions  
affecting patients who have undergone surgery; they may or may not be directly  
related to the surgery. 
 
INTRAOPERATIVE COMPLICATIONS is also available in MeSH and should be indexed by  
the same rules as POSTOPERATIVE COMPLICATIONS, but intraoperative complications  
are seen less frequently so the following examples all refer to postoperative  
complications.  
 

23.18.1	If a complication follows surgery but is unrelated to the specific  
surgical procedure, index the complication (IM), add POSTOPERATIVE COMPLICATIONS  
(IM), and add the type of surgery, but do not use /adverse effects on the  
surgical procedure. 
 
Postoperative pneumonia. 
PNEUMONIA / * etiol 
* POSTOPERATIVE COMPLICATIONS 
 
Postoperative pneumonia in cholecystectomy. 
PNEUMONIA / * etiol 
* POSTOPERATIVE COMPLICATIONS 
* CHOLECYSTECTOMY 
 
If the complication term is indented under POSTOPERATIVE COMPLICATIONS, the more  
general term should not be indexed. 
 
Epidemiology of postoperative surgical shock in hepatectomy. 
SHOCK, SURGICAL / * epidemiol 
* HEPATECTOMY 
 

23.18.2	If a postoperative complication is a direct result of a surgical  
procedure, and the procedure is a MeSH term, index the procedure with the  
subheading / * adverse effects and do not add POSTOPERATIVE COMPLICATIONS. 
 
Postoperative hepatic coma in portacaval anastomosis. 
HEPATIC COMA / * etiol 
PORTACAVAL ANASTOMOSIS / * adv eff 
 
Many postoperative complications which are direct results of specific procedures  
are available in MeSH as indentions under POSTOPERATIVE COMPLICATIONS. These  
should be indexed without adding the procedure as well, unless the procedure is  
discussed. 
 
Etiology of postgastrectomy syndromes. 
POSTGASTRECTOMY SYNDROMES / * etiol 
 
But: A new gastrectomy technique to prevent postgastrectomy syndromes. 
GASTRECTOMY / * methods 
POSTGASTRECTOMY SYNDROMES / * prev 
 

23.18.3	If a postoperative complication is a direct result of a surgical  
procedure but no MeSH heading exists for the procedure, index POSTOPERATIVE  
COMPLICATIONS (IM) in coordination with the complication (unless, of course, it  
is an indention under POSTOPERATIVE COMPLICATIONS). 
 
Postoperative cerebral hemorrhage in brain surgery. 
CEREBRAL HEMORRHAGE / * etiol 
* POSTOPERATIVE COMPLICATIONS 
BRAIN / * surg 
 

23.18.4	If a postoperative complication is a direct result of a surgical  
procedure, and the procedure is a MeSH term but no term exists for the  
complication, POSTOPERATIVE COMPLICATIONS may be indexed if subheadings are  
needed for the complication, but it must be made NIM because / * adverse effects  
has been used with the specific procedure. (This is similar to the policy on  
main heading-subheading duplicates, section 19.7.4.) 
 
Ultrasound and radiographic imaging of bile leaks caused by cholecystectomy. 
CHOLECYSTECTOMY / * adv eff 
* BILE     
POSTOPERATIVE COMPLICATIONS / ultrasonogr / radiogr 
 

23.18.5	If a complication is a direct result of a surgical procedure, and  
the procedure is a MeSH term, but the intraoperative appearance of the  
complication is being discussed as well as the postoperative appearance,  
INTRAOPERATIVE COMPLICATIONS and POSTOPERATIVE COMPLICATIONS may be added but  
again should be made NIM because / * adverse effects has been used with the  
procedure. 
 
Intraoperative and postoperative arrhythmias in heart surgery. 
HEART SURGERY / * adv eff 
ARRHYTHMIA / * etiol 
POSTOPERATIVE COMPLICATIONS 
INTRAOPERATIVE COMPLICATIONS 
 

23.19		A fistula is an abnormal passage between two or more internal organs  
or from an internal organ to the body surface. Fistulas are of various origins:  
congenital, traumatic, post-infection. 
 
There are many pre-coordinated specific organ-fistula and general system-fistula  
headings available in MeSH. 
 

23.19.1	If the fistula can be adequately indexed by one of the pre- 
coordinated specific organ-fistula headings, use that. 
 
			Stomach fistula = 	* GASTRIC FISTULA 
 
			Vaginal fistula =	* VAGINAL FISTULA 
 

23.19.2	If no pre-coordinated organ-fistula term exists for the specific  
organ, but there is a more general system-fistula term available, index it and  
coordinate with the pre-coordinated organ-diseases term for the specific organ,  
making both IM. 
 
Renal fistula = 		* URINARY FISTULA 
				* KIDNEY DISEASES 
 
Parotid fistula = 	* PAROTID DISEASES 
				* SALIVARY GLAND FISTULA	 
 

23.19.3	If no pre-coordinated organ-fistula term is  
available for the specific organ, and no general system-fistula term exists  
either, index the pre-coordinated organ-diseases term and coordinate with  
FISTULA, making both IM. 
 
		Tracheal fistula =	* TRACHEAL DISEASES 
					* FISTULA 
 
		Ovarian fistula =	* OVARIAN DISEASES 
					* FISTULA 
 

23.19.4	If no pre-coordinated organ-fistula or system-fistula term is  
available for the specific organ or area, and no pre-coordinated organ-diseases  
term is available either, index the organ or area and coordinate with FISTULA,  
making both IM. If a more general system-diseases term is available, it should  
be added NIM, following the rules given in section 23.11. 
 
Perineal fistula = 	* PERINEUM 
			* FISTULA 
 
Scrotal fistula =		* SCROTUM 
			* FISTULA 
			GENITAL DISEASES, MALE (NIM) 
 
 

23.19.5	When indexing a fistula, each element must be covered in turn,  
independently. Do not use /complications on the elements of a fistula. 
 
Surgery of a gastroduodenocolonic fistula. 
GASTRIC FISTULA / * surg 
INTESTINAL FISTULA / * surg 
DUODENAL DISEASES / * surg 
COLONIC DISEASES / * surg 
 

23.19.6	An ARTERIOVENOUS FISTULA (also called arteriovenous aneurysm) or an  
ARTERIO-ARTERIAL FISTULA should be indexed in coordination with with the terms  
for the specific vessels involved (IM). As with organs, if a pre-coordinated  
vessel-diseases term exists in MeSH, use it rather than just the term for the  
vessel. 
 
Congenital aortocaval fistula. 
 AORTIC DISEASES / * congen 
 VENAE CAVAE / * abnorm 
 ARTERIOVENOUS FISTULA / * congen 
 
Radiography of a pulmonary arteriovenous aneurysm. 
PULMONARY ARTERY / * radiogr 
PULMONARY VEINS / * radiogr 
ARTERIOVENOUS FISTULA / * radiogr 
 

23.19.6.1	If a heading does not exist for the specific blood vessel, or if the  
vessel is not specified by the author, index the term for the organ or area with  
the subheading / * blood supply and add the appropriate FISTULA term. 
 
Arterioarterial fistulas of the leg. 
LEG / * blood supply 
* ARTERIO-ARTERIAL FISTULA 
 

23.19.6.2	There are two headings which must be distinguished from the term  
ARTERIOVENOUS FISTULA. 
 
ARTERIOVENOUS ANASTOMOSIS is a Category A term referring to the normal  
anatomical connection between an artery and a vein. 
 
An ARTERIOVENOUS SHUNT, SURGICAL (sometimes called a surgical anastomosis) is  
created surgically; it should be coordinated with /surgery on the specific  
artery and vein. 
 

23.19.7	Sometimes a fistula is created artificially in order to study the  
physiology of an organ. If the fistula is discussed, index the organ with the  
subheading / * physiology, add the same organ with / surgery (NIM) and add  
FISTULA or an indention (NIM only with no subheading, since the article is not  
about the disease concept). In most cases, such a technique is third-tier and  
need not be indexed. 
 

23.20		The concept of "abnormality" in MeSH refers to an inborn structural  
anomaly of a body part. Category C16 contains many terms for abnormalities; the  
abnormalities terms in this tree fall into two groups: pre-coordinated organ- 
abnormalities terms (MOUTH ABNORMALITIES, CORONARY VESSEL ANOMALIES, etc.) and  
specific abnormality terms (CLEFT PALATE, SPINA BIFIDA, etc.).  
 

23.20.1	If a MeSH term does not exist for the specific abnormality discussed  
in an article, index the organ or area with the subheading /abnormalities (see  
section 19.8.1). If the article requires a subheading which cannot be used on  
the organ or area, the term ABNORMALITIES or a specific may be indexed with the  
subheading desired, but must be made NIM (see section 19.7.4). 
 
Surgery of uterine abnormalities. 
UTERUS / * surg / * abnorm 
 
Epidemiology of abnormalities of the uterus. 
UTERUS / * abnorm 
ABNORMALITIES / epidemiol 
 

23.20.2	ABNORMALITIES, MULTIPLE should be indexed when an article discusses  
the existence of more than one abnormality in a patient. Do not routinely use  
the subheading /complications on each abnormality; the addition of the term  
ABNORMALITIES, MULTIPLE indicates that the abnormalities coexist, so only the  
subheadings required to cover the subject of the article need to be indexed.  
Different subheadings may be used on different terms. If a subheading applies to  
more than one of the abnormalities, it may also be used with the term  
ABNORMALITIES, MULTIPLE. 
 
Surgery of esophageal atresia and intestinal anomalies in a child with a  
radiographically demonstrated heart deformity. 
ESOPHAGEAL ATRESIA / * surg  
INTESTINES / * surg / * abnorm 
ABNORMALITIES, MULTIPLE / * surg 
HEART DEFECTS, CONGENITAL / * radiogr 
 

23.20.2.1	Some recurring groupings of multiple abnormalities have been given  
SYNDROME names (see section 23.26+). When indexing an article about such a  
grouping called a syndrome by the author, use the term for the syndrome if in  
MeSH and do not add ABNORMALITIES, MULTIPLE if the term is indented under it. If  
no MeSH term exists for the syndrome, index the abnormalities and add both  
SYNDROME (NIM) and ABNORMALITIES, MULTIPLE (IM), since there are many syndromes  
which are not comprised of abnormalities, and many groupings of abnormalities  
which have not been designated as syndromes. 
 
 

23.20.3	ABNORMALITIES, DRUG-INDUCED are deformities in offspring caused by  
chemical compounds taken by or given to the mother when she was pregnant. Index  
drug- or chemically-induced abnormalities using the abnormality term with the  
subheading / * chemically induced, the term for the compound with the subheading  
/ * adverse effects, and * ABNORMALITIES, DRUG-INDUCED. 
 
Cleft palate from anticonvulsant therapy during pregnancy. 
ANTICONVULSANTS / * adv eff  
CLEFT PALATE / * chem ind 
* ABNORMALITIES, DRUG-INDUCED 
EPILEPSY / * drug ther 
PREGNANCY COMPLICATIONS / * drug ther 
 

23.20.3.1	The term TERATOGENS is also available in MeSH, but is used primarily  
for toxicology studies in which the ability of a chemical to act as a teratogen  
is studied prospectively; retrospective studies looking at deformities which  
resulted from therapeutic or diagnostic techniques will probably be indexed as  
ABNORMALITIES, DRUG-INDUCED. 
 
Studies of the teratogenic effect of hydrocortisone in rats. 
HYDROCORTISONE / * tox 
TERATOGENS / * tox 
RATS (check tag) 
ANIMAL (check tag) 
 

23.20.4	ABNORMALITIES, RADIATION-INDUCED are abnormalities in offspring  
caused by prenatal irradiation. Index a radiation-induced abnormality using the  
term for the abnormality with the subheading / * etiology, the specific type of  
radiation (unless x-rays; see section 19.8.60) with the subheading / * adverse  
effects (if allowed), and * ABNORMALITIES, RADIATION-INDUCED. 
 
Microcephaly caused by background radiation. 
MICROCEPHALY / * etiol 
BACKGROUND RADIATION / * adv eff 
* ABNORMALITIES, RADIATION-INDUCED  
 

23.20.5	When an article discusses an abnormality in a newborn infant, the  
check tag INFANT, NEWBORN must be checked. If the article is about an  
abnormality in an older patient, the check tag INFANT, NEWBORN should not be  
checked, only the age at which the patient is seen. 
 

23.20.6	Do not confuse abnormalities with congenital diseases. Although it  
is true that all abnormalities are congenital by MeSH definition,  the  
subheading /abnormalities and the terms indented under ABNORMALITIES in Category  
C16 refer to morphological deviations from normal structure. When a title says  
"congenital", check to see whether the article is about a congenital disease, or  
whether a structural "abnormality" is meant. 
 

23.21		Index congenital diseases using one of the disease terms indented  
under INFANT, NEWBORN, DISEASES. If the term used is not indented there, index  
it with the subheading /congenital (see 19.8.18). 
 

23.21.1	When an article discusses a congenital disease in a newborn infant,  
the check tag INFANT, NEWBORN must be checked even if the disease is indented  
under INFANT, NEWBORN, DISEASES. If the article is about a congenital disease in  
an older patient, do not check INFANT, NEWBORN, only the age at which the  
patient is seen. 
 

23.21.2	Do not confuse diseases of neonates with congenital diseases. It is  
possible for an infant to develop a disease within the first month of life (the  
limits of the check tag INFANT, NEWBORN) without having been born with the  
disease. 
 
"Congenital" means "existing at birth" or acquired at birth. It is not  
necessarily a synonym for "neonatal". When a title says "neonatal", check to see  
if the disease was indeed present at birth before indexing it as /congenital. 
 
Neonatal staph infections from contamination in hospital nurseries. 
STAPHYLOCOCCAL INFECTIONS / * transm 
CROSS INFECTION / * transm 
* NURSERIES, HOSPITAL 
INFANT, NEWBORN (check tag) 
 

23.21.3	When a newborn infant develops signs of a disease which were not  
visible at birth, but the disease itself is unlikely to have developed in the  
brief period after birth, it is correct to index the disease as having been  
congenital. 
 
Intestinal obstruction in a 5-day-old infant resulting from an undisclosed  
peritoneal tumor. 
PERITONEAL NEOPLASMS / * congen / compl 
INTESTINAL OBSTRUCTION / * etiol 
INFANT, NEWBORN (check tag) 
 

23.21.4	When indexing articles about congenital diseases, abnormalities, or  
other diseases in the neonatal period, do not add the term INFANT, NEWBORN,  
DISEASES as a coordinate, merely check the tag INFANT, NEWBORN. The term INFANT,  
NEWBORN, DISEASES is annotated "GEN only", so it should be reserved for articles  
on unspecified diseases in the neonatal period. 
 
Since diseases in premature infants are more unusual and devastating, the term  
INFANT, PREMATURE, DISEASES is annotated to be an IM concept. Use it as a  
coordinate for any disease in a premature infant (except those indented under  
it), making it IM with the same subheadings. Add the term INFANT, PREMATURE (NIM  
with no subheading). 
 

23.22		Index familial (hereditary) diseases using the disease term with the  
subheading /genetics (see 19.8.34). 
 
Ultrastructure of the X chromosome in X-linked muscular dystrophy.  
X CHROMOSOME / * ultrastruct 
MUSCULAR DYSTROPHY / * genet 
* LINKAGE 
 
Familial platelet disorders. 
BLOOD PLATELET DISORDERS / * genet 
 

23.22.1	Familial diseases which are not hereditary should be indexed with  
the term FAMILY HEALTH (NIM for articles on a specific disease in a family, as  
opposed to the concept in general). 
 
A family with measles from sleeping in the same room. 
MEASLES / * transm 
* HOUSING 
FAMILY HEALTH 
 

23.22.2	There is a main heading HEREDITARY DISEASES, but it is reserved for  
general articles on hereditary or familial diseases. Do not use it as a  
coordinate for a disease indexed with the subheading /genetics. 
 
Gout as a hereditary disease. 
GOUT / * genet 
(Not: * HEREDITARY DISEASES) 
 
Incidence of hereditary diseases in the United States. 
HEREDITARY DISEASES / * epidemiol 
INCIDENCE 
UNITED STATES / epidemiol 
 

23.22.3	Do not confuse /genetics with /congenital. A congenital disease may  
or may not be hereditary. Conversely, a hereditary disease need not necessarily  
be present at birth; Huntington chorea is hereditary, but the disease does not  
develop until adulthood.   
 

23.22.4	An additional use of the subheading /genetics is for studies of the  
genetic aspects of any disease, whether or not hereditary.   
 
Chromosome aberrations in various types of leukemia. 
LEUKEMIA / * genet 
* CHROMOSOME ABERRATIONS 
 
 

23.23		MeSH contains many terms for various wounds and injuries in Category  
C21. If, however, the term for the specific injury is not available, index the  
term for the organ or area with the subheading /injuries (see 19.8.38). 
 
Surgery of arm injuries. 
ARM INJURIES / * surg 
 
Surgery of kidney trauma. 
KIDNEY / * inj / * surg 
 

23.23.1	When indexing an organ or area with the subheading /injuries, if the  
injury requires a subheading which cannot be used on the organ or area, WOUNDS  
AND INJURIES or an indention may be added with the subheadings desired but must  
be made NIM (see 19.7.4). 
 
Preventing injuries to the fibula. 
FIBULA / * inj 
LEG INJURIES / prev 
(Not: WOUNDS AND INJURIES / prev) 
 
But: Radiography of fibular injuries. 
FIBULA / * inj / * radiogr 
(Not: LEG INJURIES / radiogr) 
 

23.23.2	Many of the terms in Category C21 should be coordinated with the  
specific organ/injuries or pre-coordinated organ-injuries term.  
 
Incidence of fractures of the finger. 
FRACTURES / * epidemiol 
FINGER INJURIES / * epidemiol 
INCIDENCE 
 
Radiographic diagnosis of an elbow dislocation. 
DISLOCATIONS / * radiogr 
ELBOW JOINT / * inj / * radiogr 
 
 

23.24		The MeSH term DRUG HYPERSENSITIVITY means "drug allergy"; do not use  
it for "sensitivity" meaning how well a patient responds to a drug, or whether  
side effects develop.  
 
Allergy to the calcium channel blocker nifedipine. 
NIFEDIPINE  / * adv eff 
CALCIUM CHANNEL BLOCKERS / * adv eff 
DRUG HYPERSENSITIVITY / * etiol 
 
But: Overdose from extreme sensitivity to nifedipine. 
NIFEDIPINE  / * pois 
CALCIUM CHANNEL BLOCKERS / * pois 
OVERDOSE / etiol 
(Not: DRUG HYPERSENSITIVITY / * compl) 
 

23.24.1	Do not use DRUG HYPERSENSITIVITY for allergies to all terms from  
Category D; save it for allergy to "drugs" in the conventional sense  
(penicillin, aspirin, etc.).  Allergies to various metals and other non-drug  
substances in Category D like DENTIFRICES, CELLOPHANE, SILICONES, etc. should be  
indexed merely as HYPERSENSITIVITY or a specific, with the subheading /etiology. 
 
Pulmonary allergic response to the glycopeptide vancomycin. 
VANCOMYCIN / * adv eff 
ANTIBIOTICS, GLYCOPEPTIDE / * adv eff 
DRUG HYPERSENSITIVITY / * etiol 
RESPIRATORY HYPERSENSITIVITY / * chem ind 
 
Formaldehyde hypersensitivity in people living in houses with certain types of  
wood paneling. 
FORMALDEHYDE / * adv eff 
CONSTRUCTION MATERIALS / * adv eff 
HYPERSENSITIVITY / * etiol 
 

23.24.2	Other terms available for use when indexing allergies to compounds  
from Category D include: 
ANAPHYLAXIS: a severe immediate hypersensitivity 
reaction caused by exposure to an antigen (such as a drug or biological product)  
in a previously sensitized individual. If caused by a drug, index  
ANAPHYLAXIS/chemically induced and coordinate with DRUG HYPERSENSITIVITY, but  
not if caused by a vaccine, toxin or other biological product. 
DRUG ERUPTIONS: any skin disease (not necessarily 
inflammatory) caused by a drug administered internally or externally. If the  
latter, coordinate with DERMATITIS, ALLERGIC CONTACT. 
DERMATITIS, ALLERGIC CONTACT: any allergic skin 
disease (not necessarily inflammatory) caused by a drug, any other Category D  
term, or factor such as plants or insects, coming in contact with the skin. If  
caused by a cutaneously administered drug, coordinate with DRUG ERUPTIONS. 
DERMATITIS, OCCUPATIONAL: any skin disease (not 
necessarily inflammatory) caused by any allergen or irritant in a work  
environment. If discussed, coordinate with DERMATITIS, ALLERGIC CONTACT or  
DERMATITIS, IRRITANT.  
		MULTIPLE CHEMICAL SENSITIVITY: a type of 
hypersensitivity usually to occupational or environmental chemicals and often  
affecting multiple organs. The specific chemicals are seldom at issue. If  
discussed, consider adding an appropriate occupational or environmental term  
such as ENVIRONMENTAL (or OCCUPATIONAL) EXPOSURE or OCCUPATIONAL DISEASES.  If a  
specific chemical is discussed, index it IM or NIM. 
 

23.25		The term DEFICIENCY DISEASES is available in MeSH but should be made  
IM only when indexing articles on deficiency diseases in general, irrespective  
of any specific substance.   
 
Occurrence of deficiency diseases in Calcutta. 
DEFICIENCY DISEASES / * epidemiol 
INDIA / epidemiol 
 
Deficiency of a specific dietary substance or endogenous compound should be  
indexed with a pre-coordinated substance-deficiency term if one is available in  
MeSH, or with the subheading /deficiency on the term for the substance (see  
19.8.21).  However, if a disease subheading is needed when /defic is indexed  
with a specific dietary substance, DEFICIENCY DISEASES may be added with the  
subheading desired, NIM only (see section 19.7.4).   
 
Diagnosis of potassium deficiency. 
POTASSIUM DEFICIENCY / * diag 
 
Selenium deficiency. 
SELENIUM / * defic 
 
Diagnosis of selenium deficiency.  
SELENIUM / * defic 
DEFICIENCY DISEASES / diag 
 
Since DEFICIENCY DISEASES is treed under NUTRITION DISORDERS, do not add  
DEFICIENCY DISEASES as a coordinate when indexing /defic with an endogenous  
substance.  Although DEFICIENCY DISEASES is restricted to dietary deficiencies,  
deficiencies of many endogenous compounds result in specific diseases which are  
available in MeSH.  Sections 23.25.1 to 23.25.3.1 discuss some types of diseases  
resulting from deficiencies of various endogenous compounds. 
 

23.25.1	Deficiencies of many enzymes result in inborn errors of metabolism,  
so a specific heading treed under METABOLISM, INBORN ERRORS may be applicable.   
Whether to index only the enzyme with the subheading /defic, only the inborn  
error of metabolism which results, or both, depends upon the slant of the  
article.  If the article is only about the fact that there is an enzyme  
deficiency, index only the enzyme with the subheading /defic;  if the article is  
only about the disease which results, index only the disease;  if the article is  
about both aspects, index both.     
 
Detecting iduronidase deficiency as a confirmatory test in patients with  
suspected Scheie's syndrome. 
IDURONIDASE / * defic 
SCHEIE'S SYNDROME / * diag 
* ENZYME TESTS 
 
 

23.25.2	Deficiency of any of the immunologic components of the blood often  
results in a disease treed under IMMUNOLOGIC DEFICIENCY SYNDROMES, and  
deficiency of one of the blood coagulation factors usually results in one of the  
BLOOD COAGULATION DISORDERS or a disease treed under EMBOLISM AND THROMBOSIS  
(NON MESH). 
 
Therapy of IgM deficiency. 
IGM / * defic 
DYSGAMMAGLOBULINEMIA / * ther 
 
Hereditary deficiency of antithrombin III.  
(The author describes how the patient suffers recurring thromboembolism.) 
ANTITHROMBIN III / * defic 
THROMBOEMBOLISM / * genet 
RECURRENCE 
 

23.25.3	Deficiency of hormones usually results in endocrine disorders, most  
of which are available in Category C19.  As with enzymes, the indexer must make  
the determination whether the disease is relevant or whether the article really  
is just about the deficiency. 
 
For example, although THYROID HORMONES / * defic is allowable in MeSH, the  
indexer should check carefully to see if HYPOTHYROIDISM might not be a better  
way to cover the substance of the article. 
 

23.25.3.1	A specific disease caused by a hormone deficiency is DIABETES  
MELLITUS, caused by a deficiency of or resistance to the hormone insulin. 
 
MeSH contains many terms for specific types of diabetes and its complications.   
When indexing one of the types of complications, it is not necessary to use  
/etiology on the pre-coordinated term, as the term itself implies that it  
results from diabetes.  It also is not necessary to add DIABETES  
MELLITUS/complications, just any specific type of diabetes. 
 
Incidence of paresthesias in insulin-dependent diabetes. 
DIABETES MELLITUS, INSULIN-DEPENDENT / * compl 
PARESTHESIA / * epidemiol / etiol		 
DIABETIC NEUROPATHIES / * epidemiol 
INCIDENCE  
(Not: DIABETIC NEUROPATHIES / etiol) 
 
Incidence of diabetic foot. 
DIABETIC FOOT / * epidemiol 
INCIDENCE 
(Not: DIABETIC FOOT / etiol) 
(Not: DIABETES MELLITUS / compl) 
 

23.26		Syndromes are characteristic groupings of diseases. Dorland's  
Illustrated Medical Dictionary defines a syndrome as "a set of symptoms which  
occur together; ... a symptom complex". 
 
MeSH contains two types of syndrome terms, the eponymous syndromes (those  
containing a personal name, like CUSHING'S SYNDROME) and the descriptive  
syndromes (in which the name of the syndrome describes its characteristics, like  
PRUNE BELLY SYNDROME).  
 

23.26.1	To index a syndrome, always look for the term in MeSH first. Check  
the text carefully; the same syndrome may be called different names by different  
authors. In addition, the same author (or another with the same last name) may  
have identified more than one syndrome, so be sure that if a syndrome term is  
available in MeSH, it refers to the syndrome being described in the article. For  
example, MeSH has the term BERNARD-SOULIER SYNDROME (a platelet disorder), and  
also BERNARD'S SYNDROME see HORNER'S SYNDROME (caused by paralysis of the  
cervical sympathetic nerves). 
 

23.26.2	When no MeSH term exists for the specific syndrome described in an  
article, index the dominant features of the syndrome as described by the author  
(usually no more than three or so), and add the heading SYNDROME (NIM with no  
subheading). 
 

23.26.2.1	To decide which component(s) of the syndrome to make IM, favor the  
specialty of the journal or the author; if the syndrome has renal elements and  
the article is in a nephrology journal, the kidney aspects will usually be IM  
and the others NIM. 
 

23.26.2.2	Do not routinely add the subheading /complications to each of the  
components of a syndrome, since the addition of the term SYNDROME shows that the  
diseases indexed are part of the constellation of symptoms making up the  
syndrome. Index only the subheadings needed to cover the subject of the article  
(/surgery, /pathology, etc.). Different subheadings may be used on different  
components. 
 

23.26.2.3	A convenient tool for the indexing of syndromes which are not  
available as MeSH terms is Jablonski's Dictionary of Syndromes & Eponymic  
Diseases, 2nd Edition, by Stanley Jablonski. 
 

23.26.3	The term SYNDROME should only be indexed IM for articles about  
syndromes in general, such as "Nomenclature for syndromes". 
 

23.26.4	On occasion an author uses the word "syndrome" in a facetious,  
literary, pseudo-medical or humorous context: "the only child syndrome", "the  
holier-than-thou syndrome", etc.  
 
Sometimes such articles are out of scope and should not be indexed at all, and  
sometimes they should be indexed as WIT AND HUMOR, but there may be medical  
elements described; if the MeSH concept of "syndrome" applies, the term SYNDROME  
may be indexed. 
 

23.27		MeSH contains many terms for physiologic states, with corresponding  
disease terms available for extreme variants of more or less permanent nature.  
For example, BODY TEMPERATURE is available, but so are HYPERTHERMIA and  
HYPOTHERMIA. 
 

23.27.1	When an author uses a term which corresponds to one of the disease  
headings, the indexer must examine the text to determine if a disease state  
actually exists; if not, the term for the physiologic process should be indexed  
instead of the disease. 
 
The hypertensive effects of angiotensin in rats.  
(The author is studying the pharmacology of the drug.) 
ANGIOTENSIN / * pharmacol 
BLOOD PRESSURE / * drug eff 
STIMULATION, CHEMICAL 
 
Hypertension as a side effect of sympathomimetic therapy. 
SYMPATHOMIMETICS / * adv eff 
HYPERTENSION / * chem ind 
 

23.27.2	In many articles on a disease state, the researchers also study the  
physiologic process (perhaps to see if treatment is being effective). Whether or  
not to index both aspects depends upon how important both are. 
 
Heart rate changes in procainamide treatment of tachycardia. 
TACHYCARDIA / * drug ther / physiopathol 
PROCAINAMIDE / * ther use / pharmacol 
ANTI-ARRHYTHMIA AGENTS / * ther use / pharmacol 
HEART RATE / * drug eff 
 
Procainamide treatment of tachycardia.  
(Heart rate  studied as a method of seeing effectiveness.) 
TACHYCARDIA / * drug ther 
PROCAINAMIDE / * ther use 
ANTI-ARRHYTHMIA AGENTS / * ther use  
 
 

23.28		Terms such as HEMODYNAMICS, BLOOD PRESSURE, BLOOD CIRCULATION, etc.  
refer to the movement of blood through the blood vessels, caused by the pumping  
action of the heart. They have nothing to do with blood as a substance, so each  
of these terms has been annotated to tell the indexer to use /physiopathology  
rather than /blood on any disease in which these concepts are studied. 
 

23.29		The hematologic aspects of a disease, however, should be coordinated  
with the subheading /blood on the disease; such concepts include substances in  
the blood, the physical chemistry of the blood (such as BLOOD VISCOSITY), blood  
cells, blood coagulation, etc. Terms in this area about which an indexer might  
be unsure have been annotated to use /blood on the disease. 
 

23.30		Serology (despite its name, which sounds as though it would mean  
/blood) usually refers to some aspect of immunology, so the serological aspects  
of disease in addition to the immunological aspects should be indexed as the  
/immunology of the disease.  
 

23.30.1	Serodiagnosis, however, refers to diagnosis of a disease by the  
measurement of some immune compound such as an antibody; the correct subheading  
on the disease will be /diagnosis. 
 

23.30.2	Seroepidemiology refers to the study of the epidemiology of a  
disease by determining the number of people who have antibodies to it. The  
correct subheading on the disease will be /epidemiology, and a common coordinate  
term will be SEROEPIDEMIOLOGIC METHODS (NIM with the specific disease IM). 
 

23.31		Enzyme activities are often studied in disease states. Index such  
articles as the /metabolism of the enzyme, coordinated with the /enzymology of  
the organ and disease. If the enzyme activity is measured in a specific body  
fluid such as the blood, use that more specific subheading with the enzyme term,  
but still use /enzymology with the disease, not the body fluid subheading. 
 
Liver catalase activity in gout. 
GOUT / * enzymol 
LIVER / * enzymol 
CATALASE / * metab 
 
Blood catalase activity in gout. 
GOUT / * enzymol 
CATALASE / * blood 
 

23.32		Various aspects of the /etiology of a disease can be indexed more  
specifically (see the Subheading Trees, Figure 19.5). 
 

23.32.1	The microbial, viral or parasitic etiology of a disease should be  
indexed as the /microbiology, /virology, or /parasitology of the disease,  
respectively. (These subheadings are also used for studies of  microorganisms or  
parasites in a disease when the organisms do not cause the disease.) 
 
Enterovirus-induced myocarditis. 
MYOCARDITIS / * virol 
* ENTEROVIRUS INFECTIONS 
 
Demonstration of Toxoplasma gondii in the liver of patients with AIDS. 
AIDS / * parasitol 
LIVER / * parasitol 
TOXOPLASMA GONDII / * isol 
 
 

23.32.2	A disease caused by a drug or chemical should be indexed with the  
subheading /chemically induced; the subheading on the chemical will usually be  
/adverse effects, / poisoning, or /toxicity.  
 
As discussed in section 25.11.2, however, when the disease is deliberately  
induced as an experimental model, no subheading is used on the chemical, and the  
chemical is usually an NIM concept. 
 

23.32.3	Studies of the prenatal factors leading to the development of a  
disease should be indexed as the /embryology of the disease. Quite frequently,  
this aspect is studied in patients with abnormalities. 
 
The embryonal origin of cleft palate. 
CLEFT PALATE / * embryol 
 

23.32.3.1	When a pregnant woman is exposed to chemicals, microorganisms,  
radiation, etc. resulting in a disease or any other effects in the offspring  
(not necessarily visible at birth), the term PRENATAL EXPOSURE DELAYED EFFECTS  
should be used; whether the subheading /embryology is also used with the disease  
depends upon the amount of discussion devoted to the embryologic period. 
 
Cognition disorders  in adolescents caused by maternal treatment with  
anticonvulsants during pregnancy. 
(No discussion of the embryologic period) 
COGNITION DISORDERS / * chem ind 
* PRENATAL EXPOSURE DELAYED EFFECTS 
ANTICONVULSANTS / * adv eff 
EPILEPSY / * drug ther 
PREGNANCY COMPLICATIONS / * drug ther 
ADOLESCENT (check tag) 
FEMALE (check tag) 
HUMAN (check tag) 
PREGNANCY (check tag) 
 
As discussed in section 23.20.3, any inborn structural anomaly caused by a drug  
or chemical should be indexed as ABNORMALITIES, DRUG-INDUCED, not PRENATAL  
EXPOSURE DELAYED EFFECTS. 
  

23.32.4	An etiologic subheading restricted to use with infections is  
/transmission. It thus refers strictly to transmission by organisms, not  
hereditary transmission (see section 23.22+). 
 
Transmission of leishmaniasis from a bite by Phlebotomus. 
LEISHMANIASIS / * transm 
INSECT BITES / * compl 
* INSECT VECTORS 
* PHLEBOTOMUS 
 

23.32.5	The hereditary etiology of a disease should be indexed with the  
subheading /genetics. See section 23.22+. 
 

23.33 		Index veterinary diseases (not animal models) with all of the  
following: the disease term with the subheading /veterinary (IM), the pre- 
coordinated animal-diseases heading if in MeSH (IM), the animal term (NIM or a  
check tag), and the check tag ANIMAL. 
 
Liver diseases in cattle. 
LIVER DISEASES / * vet 
* CATTLE DISEASES 
CATTLE (check tag) 
ANIMAL (check tag) 
 

23.33.1	In most cases, some aspect of the veterinary disease will be  
discussed; the subheading needed for that aspect is made IM on the pre- 
coordinated animal-diseases term, but must be NIM on the term for the disease  
itself, since /veterinary is always made IM. 
 
Liver metabolism in bovine liver diseases. 
LIVER DISEASES / * vet / metab 
CATTLE DISEASES / * metab 
LIVER / * metab 
CATTLE (check tag) 
ANIMAL (check tag) 
 

23.33.2	If no pre-coordinated animal-diseases term exists for the specific  
animal, make the animal itself IM, using a subheading if one is applicable to  
the article and is an AQ for animal terms. 
 
Fluid therapy of kidney diseases in minks. 
KIDNEY DISEASES / * vet / ther 
* MINK 
FLUID THERAPY / * vet 
ANIMAL (check tag) 
 
Microbiology of kidney diseases in minks. 
KIDNEY DISEASES / * vet / microbiol 
MINK / * microbiol 
ANIMAL (check tag) 
 

23.33.3	Do not use /veterinary with any term from Category C22, as these are  
the ANIMAL DISEASES. When indexing any heading from this category treed under a  
specific pre-coordinated animal-diseases term, the animal-diseases term should  
not be indexed, only the term for the animal (NIM or as a check tag). 
 
Epidemiology of bovine mastitis. 
MASTITIS, BOVINE / * epidemiol 
CATTLE (check tag) 
ANIMAL (check tag) 
FEMALE (check tag) 
(Not: CATTLE DISEASES / * epidemiol, because MASTITIS, BOVINE is an indention  
under it) 
 

23.33.4	Do not use /complications on any general animal-diseases term (such  
as SHEEP DISEASES).  Since a complication of a sheep disease (or a coexisting  
sheep disease) is another sheep disease, MeSH has not allowed /complications as  
an AQ for any such term. 
 
Coexisting muscle and joint diseases in race horses. 
MUSCULAR DISEASES / * vet / compl 
JOINT DISEASES / * vet / compl 
* HORSE DISEASES 
HORSES (NIM) 
ANIMAL (check tag) 
(Not:  HORSE DISEASES / * compl) 
 

23.33.5	The subheadings /injuries and /abnormalities are AQs for higher  
animals in Category B2.  When indexing a veterinary abnormality or injury that  
is available as a MeSH heading, use /veterinary on the heading and coordinate  
with /inj or /abnorm on the animal rather than using the pre-coordinated animal- 
diseases term. 
 
Femoral fractures in four foals. 
FEMORAL FRACTURES / * vet 
HORSES / * inj 
ANIMAL (check tag) 
(Not:  * HORSE DISEASES) 
 

23.33.5.1	However, if an injury or abnormality causes a disease, the animal- 
diseases term must be added as a coordinate for that disease. 
 
Syncope in cattle with Arnold-Chiari deformities. 
ARNOLD-CHIARI DEFORMITY / * vet / compl 
CATTLE / * abnorm 
SYNCOPE / * vet / etiol 
CATTLE DISEASES / * etiol 
ANIMAL (check tag) 
 

23.33.6	Another AQ for higher animals in Category B2 is /surgery, which is  
also, of course, an AQ for the pre-coordinated animal-diseases terms.  Most of  
the articles we see are on surgery for disease, and in these instances /surg  
should be used on the animal-diseases term, with no qualifier on the animal term  
added NIM or as a check tag. 
 
Surgical treatment of infertility in a ewe. 
INFERTILITY, FEMALE / * vet / surg		 
SHEEP DISEASES / * surg 
SHEEP (NIM, no subheading) 
ANIMAL (check tag) 
FEMALE (check tag) 
CASE REPORT (check tag) 
 
Use /surg on the animal term in the following instances: 
 

23.33.6.1	Surgery in healthy animals: 
 
New methods for spaying cats. 
CASTRATION, FEMALE / * vet / methods 
CATS / * surg 
FEMALE (check tag) 
ANIMAL (check tag) 
 

23.33.6.2	Surgery where no animal disease is especially discussed: 
 
Spinal fusion in dogs. 
DOGS / * surg 
SPINAL FUSION / * vet 
ANIMAL (check tag) 
 

23.33.6.3	Surgery for abnormalities or injuries: 
 
Surgical correction of congenital heart defects in cattle. 
HEART DEFECTS, CONGENITAL / * vet / surg 
CATTLE / * abnorm / * surg 
ANIMAL (check tag) 
 

23.33.6.4	Surgery where there is no specific pre-coordinated animal-diseases  
term available in MeSH so the animal is added IM too: 
 
Surgical treatment of a liver abscess in a rhesus monkey. 
LIVER ABSCESS / * vet / surg 
MONKEY, RHESUS / * surg 
MONKEY DISEASES / * surg 
ANIMAL (check tag) 
CASE REPORT (check tag) 
 

23.33.7	Other subheadings which are AQs for animals in Category B2 but also  
for animal-diseases terms are:  /blood, /csf, /embryol, /genet, /immunol,  
/metab, /microbiol, /parasitol, /psychol, and /urine, and /virol. 
 
As with /surg, these should be used on the animal term for articles on studies  
in normal animals, where no disease is discussed, in animals with abnormalities  
or injuries, and where MeSH has provided no pre-coordinated specific animal- 
diseases term.  In all other cases, use the subheading on the animal-diseases  
term.  
 
Changes in erythrocyte deformability in heart enlargement in broiler chickens. 
* ERYTHROCYTE DEFORMABILITY 
HEART ENLARGEMENT / * vet / blood 
CHICKENS / * blood 
POULTRY DISEASES / * blood 
ANIMAL (check tag) 
 
Genetic eye defects in the dog. 
EYE ABNORMALITIES / * vet / genet 
DOGS / * abnorm / * genet 
ANIMAL (check tag) 
 
But:  Lipid metabolism in Sarcocystis infection in swine. 
SARCOCYSTOSIS / * vet / metab 
SWINE DISEASES / * metab 
SWINE (NIM, no subheading) 
ANIMAL (check tag) 
 

23.33.8	It may be hard to determine whether a disease in an animal is a  
veterinary disease or is being viewed as a model, in which case the veterinary  
aspects are ignored.  Pregnant sheep, for example, may be used as models of  
human pregnancy, so an article on intrauterine growth retardation in sheep may  
or may not require the subheading /veterinary and the addition of SHEEP  
DISEASES.  The indexer must read the introduction carefully to see the author's  
emphasis.  The author's affiliation may also be a guide;  in the article  
mentioned above, if the author were from a department of veterinary medicine the  
emphasis might be on the sheep as sheep, whereas if the author were from a  
department of obstetrics, the sheep might be models. 
 

23.33.9	Do not consider as a disease the infection or infestation of an  
animal lower than vertebrates in the evolutionary scale.  Use only the term for  
the animal, not a disease term.    
 
Nematode infestations of grasshoppers. 
GRASSHOPPERS / * parasitol 
* NEMATODES 
(Not:  NEMATODE INFECTIONS / * vet) 
 
 
 

23.34		PREGNANCY COMPLICATIONS and its indentions are used for articles on  
disease states occurring during pregnancy.  The diseases do not have to be  
caused by the pregnancy;  many articles discuss the care of women who have pre- 
existing conditions but become pregnant. 
 

23.34.1	For any article about a disease in a pregnant woman, index the  
disease (IM) and coordinate with the term PREGNANCY COMPLICATIONS (IM).  Use the  
same subheading on both terms, if allowed.  Do NOT use /compl on the disease,  
because /compl is used for two coexisting diseases and pregnancy itself is not  
considered a disease.  (If, however, the woman has two diseases, /compl may be  
used for the coexistence of the diseases.)  Check the tags FEMALE and PREGNANCY  
(for indexers working online, the computer will automatically add these check  
tags when the term PREGNANCY COMPLICATIONS is indexed).  
 
	Treatment options for Graves' disease complicating pregnancy. 
				GRAVES' DISEASE / * ther 
				PREGNANCY COMPLICATIONS / * ther 
				HUMAN (check tag) 
				FEMALE (check tag) 
				PREGNANCY (check tag) 
 

23.34.2	If MeSH contains a term for the disease which is indented under the  
term PREGNANCY COMPLICATIONS, index it and do not add the more general term. 
 
Pregnancy in phenylketonuria; dietary treatment aimed at normalizing maternal  
plasma phenylalanine concentrations. 
				PHENYLKETONURIA, MATERNAL / * diet ther / * blood 
				PHENYLALANINE / * blood 
				HUMAN (check tag) 
				FEMALE (check tag) 
				PREGNANCY (check tag) 
				Not:  PREGNANCY COMPLICATIONS / * diet ther / * blood 
 

23.34.3	Indented under the term PREGNANCY COMPLICATIONS are five more  
specific, but still relatively general, types of complications:  PREGNANCY  
COMPLICATIONS, CARDIOVASCULAR 
		PREGNANCY COMPLICATIONS, HEMATOLOGIC 
		PREGNANCY COMPLICATIONS, INFECTIOUS 
		PREGNANCY COMPLICATIONS, NEOPLASTIC 
		PREGNANCY COMPLICATIONS, PARASITIC 
 
		If the disease being indexed is a cardiovascular, hematologic,  
infectious, neoplastic, or parasitic disease, index the disease and coordinate  
it with one of these more specific terms rather than the general term PREGNANCY  
COMPLICATIONS. 
 
The function of the hemostatic system in pregnant women with iron deficiency  
anemia. 
				PREGNANCY COMPLICATIONS, HEMATOLOGIC / * blood 
				ANEMIA, IRON-DEFICIENCY / * blood 
				* HEMOSTASIS 
				HUMAN (check tag) 
				FEMALE (check tag) 
				PREGNANCY (check tag) 
 

23.34.4	The MeSH heading ABORTION is also indented under PREGNANCY  
COMPLICATIONS.  It should be reserved for articles on so-called "spontaneous  
abortion" or "miscarriage", not the deliberately-induced procedure. 
 
Long-term psychological sequelae of spontaneous abortion. 
				ABORTION / * psychol 
 

23.34.4.1	Articles on abortion procedures are indexed as ABORTION, INDUCED or  
an indention, or as ABORTION, CRIMINAL. Do not use ABORTION.  
 
Psychological responses to various abortion procedures. 
				ABORTION, INDUCED / * psychol / methods 
 

23.34.4.2	ABORTION, HABITUAL (frequently referred to as "recurrent abortion")  
is an indention under ABORTION and thus must not be used for "repeat abortions"  
as a method of birth control.  The latter must be indexed as one of the abortion  
procedure terms in Category E. 
 

23.34.5	At times an indexer must index an article on a disease in a pregnant  
woman which causes an abnormality or disease in her fetus or baby.  In such  
cases, index the pregnancy complication aspects as above, probably with no  
subheading.  (Do not use /compl, which should be reserved for complications in  
the same person.)  Add the term for the disease or abnormality in the baby,  
using the subheading /embryol (which is indented under /etiol and is defined as  
"embryologic factors contributing to postnatal disorders"). 
 
Maternal diabetes leading to microcephaly in the infant. 
				* PREGNANCY IN DIABETES 
				MICROCEPHALY / * embryol 
				PREGNANCY (check tag) 
				HUMAN (check tag) 
				FEMALE (check tag) 
				INFANT, NEWBORN (check tag) 
 

23.34.6	LABOR COMPLICATIONS and its indentions are indexed in the same way  
as PREGNANCY COMPLICATIONS. 
 
	Pneumomediastinum in labor. 
				* PNEUMOMEDIASTINUM 
				* LABOR COMPLICATIONS 
				HUMAN (check tag) 
				FEMALE (check tag) 
				PREGNANCY (check tag) 
 
	Prevention of uterine rupture in labor. 
				UTERINE RUPTURE / * prev 
				HUMAN (check tag) 
				FEMALE (check tag) 
				PREGNANCY (check tag) 
	Not: LABOR COMPLICATIONS / * prev because UTERINE RUPTURE is treed under  
LABOR COMPLICATIONS 
 

23.34.7	PUERPERAL DISORDERS and its indentions are diseases occurring in the  
postpartum period.  They are indexed the same way as PREGNANCY COMPLICATIONS,  
but since the woman is no longer pregnant, the check tag PREGNANCY should not be  
indexed and will not be added automatically by the computer.   
 
	Prevalence of puerperal psychoses. 
				PSYCHOSES / * epidemiol 
				PUERPERAL DISORDERS / * epidemiol 
				PREVALENCE 
				HUMAN (check tag) 
				FEMALE (check tag) 
				Not:  PREGNANCY (check tag) 
 

23.34.8	FETAL DISEASES and its indentions are diseases which occur in the  
unborn baby as opposed to the pregnant mother.  FETAL DISEASES is indexed like  
PREGNANCY COMPLICATIONS (in coordination with the disease, using the same  
subheadings), but the check tags for the mother should not be indexed unless  
something about the mother is discussed enough to be indexed.  For indexers  
working online, the computer will not automatically check FEMALE and PREGNANCY  
when FETAL DISEASES is indexed.  The two examples below show the types of  
articles in which the maternal aspects do not need to be indexed or checked  
versus those in which they should be indexed and checked. 
 
	Atrial natriuretic factor blood concentrations in anemic fetuses. 
				ATRIAL NATRIURETIC FACTOR / * blood 
				ANEMIA / * blood 
				FETAL DISEASES / * blood 
				HUMAN (check tag) 
				Not: FEMALE (check tag) 
				Not: PREGNANCY (check tag) 
 
	Streptococcus group B infections in pregnant women and their unborn  
babies. 
				* STREPTOCOCCUS GROUP B 
				* STREPTOCOCCAL INFECTIONS 
				* PREGNANCY COMPLICATIONS, INFECTIOUS 
				* FETAL DISEASES 
				HUMAN (check tag) 
				FEMALE (check tag) 
				PREGNANCY (check tag) 
 

23.34.8.1	The term PRENATAL DIAGNOSIS is available as well.  Not all articles  
indexed with PRENATAL DIAGNOSIS also need the term FETAL DISEASES;  index FETAL  
DISEASES only if the article discusses the fetal aspect (for example, diagnosing  
the disease during the fetal period so that treatment can occur prior to birth).   
If the emphasis of the article is really what happens after the baby is born, do  
not add FETAL DISEASES. 
 
	Diagnosis and surgical management of fetal neuroblastoma. 
				FETAL DISEASES / * diag / * surg 
				NEUROBLASTOMA / * diag  / * surg 
				* PRENATAL DIAGNOSIS 
				HUMAN (check tag) 
 
	Maternal serum inhibin levels in the prenatal diagnosis of Down syndrome. 
				INHIBIN / * blood 
				PRENATAL DIAGNOSIS / * methods 
				DOWN SYNDROME / * diag  
				HUMAN (check tag) 
				FEMALE (check tag) 
				PREGNANCY (check tag) 
				Not:  FETAL DISEASES / * diag