Liver Biopsy - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

IVER IOPSY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N...

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IVER IOPSY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Liver Biopsy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00668-5 1. Liver Biopsy-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on liver biopsy. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON LIVER BIOPSY ............................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Liver Biopsy .................................................................................. 7 The National Library of Medicine: PubMed ................................................................................ 30 CHAPTER 2. NUTRITION AND LIVER BIOPSY .................................................................................. 75 Overview...................................................................................................................................... 75 Finding Nutrition Studies on Liver Biopsy ................................................................................. 75 Federal Resources on Nutrition ................................................................................................... 76 Additional Web Resources ........................................................................................................... 77 CHAPTER 3. PATENTS ON LIVER BIOPSY ......................................................................................... 79 Overview...................................................................................................................................... 79 Patents on Liver Biopsy ............................................................................................................... 79 Patent Applications on Liver Biopsy ........................................................................................... 81 Keeping Current .......................................................................................................................... 82 CHAPTER 4. BOOKS ON LIVER BIOPSY ............................................................................................ 83 Overview...................................................................................................................................... 83 Book Summaries: Federal Agencies.............................................................................................. 83 Book Summaries: Online Booksellers........................................................................................... 85 Chapters on Liver Biopsy ............................................................................................................. 86 CHAPTER 5. MULTIMEDIA ON LIVER BIOPSY .................................................................................. 97 Overview...................................................................................................................................... 97 Video Recordings ......................................................................................................................... 97 CHAPTER 6. PERIODICALS AND NEWS ON LIVER BIOPSY ............................................................... 99 Overview...................................................................................................................................... 99 News Services and Press Releases................................................................................................ 99 Newsletter Articles .................................................................................................................... 100 Academic Periodicals covering Liver Biopsy.............................................................................. 102 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 105 Overview.................................................................................................................................... 105 NIH Guidelines.......................................................................................................................... 105 NIH Databases........................................................................................................................... 107 Other Commercial Databases..................................................................................................... 109 APPENDIX B. PATIENT RESOURCES ............................................................................................... 111 Overview.................................................................................................................................... 111 Patient Guideline Sources.......................................................................................................... 111 Finding Associations.................................................................................................................. 114 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 117 Overview.................................................................................................................................... 117 Preparation................................................................................................................................. 117 Finding a Local Medical Library................................................................................................ 117 Medical Libraries in the U.S. and Canada ................................................................................. 117 ONLINE GLOSSARIES................................................................................................................ 123 Online Dictionary Directories ................................................................................................... 124 LIVER BIOPSY DICTIONARY ................................................................................................... 125 INDEX .............................................................................................................................................. 177

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with liver biopsy is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about liver biopsy, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to liver biopsy, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on liver biopsy. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to liver biopsy, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on liver biopsy. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON LIVER BIOPSY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on liver biopsy.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and liver biopsy, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “liver biopsy” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Survey of Current Liver Biopsy Practice Patterns Source: Journal of Clinical Gastroenterology. 35(1): 86-88. July 2002. Contact: Available from Lippincott Williams and Wilkins, Inc. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2300. Summary: Although the hepatitis C epidemic has increased the proportion of Hepatology in general gastroenterology practice, many clinicians express concern regarding the risks of percutaneous liver biopsy. This article reports on a survey of clinicians regarding their current liver biopsy practice patterns. The authors sent a questionnaire about liver biopsy practices to members of the Duke University Digestive Epidemiological Studies Consortium. The response rate was 112 of 157 physicians (71 percent). Nearly a third (29.5 percent, 33 physicians) reported that they do not perform

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liver biopsies. Reasons cited for not performing biopsies included concern about risks (72.7 percent), low reimbursement (66.7 percent), and logistical issues with space and recovery time (45.4 percent). Routine practice was biopsy without ultrasound in 53.2 percent, ultrasound marking by a radiologist or technician at the time of biopsy in 24.0 percent, previous ultrasound marking in 17.7 percent, and ultrasound marking by the gastroenterologist in 5.1 percent. For patients with hepatitis C, 76.8 percent of clinicians perform routine biopsies before treatment. The authors conclude that new approaches, especially in training programs, may be necessary to make clinicians more comfortable with this procedure. 3 tables. 19 references. •

Practice Guidelines for Liver Biopsy Source: Canadian Journal of Gastroenterology. 14(6): 481-482. June 2000. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Fax (905) 829-4799. E-mail: [email protected]. Summary: Histological assessment of the liver by using biopsy remains important in the diagnosis and follow up of acute and chronic hepatic (liver) disease. This article offers practice guidelines for liver biopsy, as established by the Canadian Association of Gastroenterology (CAG). Liver biopsies may be obtained blind, i.e., by clinical estimation of organ location; by using radiological guidance with computerized tomography or ultrasound; via the transvenous (through the jugular or femoral veins) route in patients with contraindications to percutaneous (through the skin) biopsy; or via direct vision, surgically or laparoscopically in certain situations. The authors list the indications for liver biopsy and note that the prebiopsy workup of a patient should include informed consent, including an explanation of the risks of the procedure and the laboratory test results that can be obtained from the biopsy. Postbiopsy management should include a recording by the physician performing the biopsy of how many 'passes' were made, any medications administered, and any apparent complications. Contraindications to percutaneous liver biopsy include an uncooperative patient, impaired coagulation, severe uncorrected anemia, significant ascites, infection in the path of the needle, suspected extrahepatic biliary obstruction of high grade, cholangitis, echinococcal cysts, no safe unobstructed access route to biopsy, leukemia and myelofibrosis, and uremia. The authors conclude that with strict attention to the indications and contraindications, liver biopsy can be regarded as a safe and useful procedure. 2 references.

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Liver Biopsy and Nursing Intervention Source: Gastroenterology Nursing. 17(1): 17-19. August 1994. Summary: In this article, the authors present recommendations for nurses responsible for providing patient care for liver biopsy procedures. The authors stress that the nurse's role in the gastrointestinal (GI) department includes pre-and post-procedure planning, assistance during the procedure, patient and family education, and emotional support. Topics include preparation for the procedure, including a review of the equipment; the procedure itself; recovery; complications; and discharge. The authors focus on the important role of the nurse, noting that an educated, organized, and confident assistant can promote a trusting relationship between patient and physician. 3 references. (AA-M).

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Role of Liver Biopsy in Chronic Hepatitis C Source: Hepatology. 36(5 Supplemental 1): S152-S160. November 2002.

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Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: The report of the 1997 National Institutes of Health (NIH) Consensus Development Conference on hepatitis C endorse pretreatment liver biopsy. This article reviews the role of liver biopsy in chronic hepatitis C, addressing whether liver histology helps determine the urgency of, and predicts the likelihood of response to, antiviral therapy; and if surrogate markers can supplant histological assessment. Because the rate of progression of chronic hepatitis C is influenced by baseline histological grade or stage, patients can be stratified into those with moderate to severe hepatitis, who merit imminent therapy, and those with mild hepatitis, in whom therapy can be postponed until more effective or tolerable treatments become available. Less advanced baseline histology has been shown to be an independent predictor of responsiveness to antiviral therapy. Although the predictive value of biopsy is insufficient to withhold therapy from patients with advanced fibrosis, baseline biopsy helps gauge expectations for the outcome of therapy. Reports have been published recently suggesting that laboratory markers can predict distinctions between low-grade fibrosis and therapy-indicating septal fibrosis or cirrhosis (scarring). These indices, however, are insufficiently reliable to predict histological distinctions in populations with varying prevalence of fibrosis or cirrhosis or to provide anything more than broad qualitative distinctions, far short of the potential information in a liver biopsy. For most patients, the value of pretreatment liver biopsy outweighs its risks, provides information about the urgency of treatment, and should be retained. The authors call for studies to identify noninvasive laboratory markers of histological activity and stage, especially genetic predictors of accelerated disease progression. 5 tables. 59 references. •

How Long Should Patients Be Under Observation After Liver Biopsy? Source: Gastroenterology and Endoscopy News. p. 32. December 1999. Contact: Available from McMahon Publishing Group. 545 West 45th Street, 8th Floor, New York, NY 10036. (212) 957-5300. Website: www.gastroendonews.com. Summary: This brief news article reports on a recent research finding that for patients who have just undergone liver biopsy, three hours of observation is adequate, unless the patient has a low platelet count (less than 100,000). The authors also found that the length of post biopsy observation has no significant effect on the number of emergency room (ER) visits, admission rate, or incidence of complications. Patients with low platelet counts, as well as patients older than 40 years and those who have high bilirubin levels, should be observed for longer periods, as these groups are at higher risk for admission to the hospital. The study included 1,007 consecutive outpatients who underwent liver biopsy.

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Ambulatory Liver Biopsy Source: HMO Practice. 5(1): 9-10. January-February 1991. Summary: This report describes the result of ambulatory liver biopsies on 21 patients at the Rutgers Community Health Plan. All biopsies were performed in a standard treatment room in a free standing ambulatory care center. The author contends that ambulatory liver biopsy performed on an outpatient basis is a simple, safe procedure that reduces costs and saves physician time. 9 references.

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Role of Liver Biopsy in Management of Chronic Hepatitis C: A Systematic Review Source: Hepatology. 36(5 Supplemental 1): S161-S172. November 2002. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: This review article considers two topics pertinent to the need for pretreatment liver biopsy in patients with chronic hepatitis C: how liver biopsy results predict treatment outcomes; and how well biochemical blood tests and serological measures of fibrosis predict biopsy findings in chronic hepatitis C. The authors searched MEDLINE and other electronic databases from January 1985 to March 2002. Additional articles were sought in references of pertinent articles and recent journals and by querying experts. Articles were eligible for review if they reported original human data from a study that used virological, histological, pathologic, or clinical outcome measures. Studies suggested that advanced fibrosis or cirrhosis (scarring) on initial liver biopsy is associated with a modestly decreased likelihood of a sustained virological response (SVR) to treatment. Also, studies relatively consistently showed that serum aminotransferases have modest value in predicting fibrosis on biopsy; that extracellular matrix tests hyaluronic acid and laminin may have value in predicting fibrosis; and that panels of tests may have the greatest value in predicting fibrosis or cirrhosis. Biochemical and serologic tests were best at predicting no or minimal fibrosis, or at predicting advanced fibrosis or cirrhosis, and were poor at predicting intermediate levels of fibrosis. Thus, evidence suggests that liver biopsy may have some usefulness in predicting efficacy of treatment in patients with chronic hepatitis C, and biochemical blood tests and serologic tests currently have only modest value in predicting fibrosis on liver biopsy. 2 tables. 81 references.

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Appropriateness of Liver Biopsy Source: Canadian Journal of Gastroenterology. 14(6): 543-548. June 2000. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Fax (905) 829-4799. E-mail: [email protected]. Summary: This review article discusses the appropriateness of liver biopsy in two frequent liver diseases, hepatitis C and alcoholic liver disease. The authors reviewed the medical literature, published between 1965 and 1999, by using MEDLINE. Only 0.1 percent of the publications were devoted specifically to the appropriateness of liver biopsy. Not all studies observed a significant agreement among doctors on the decision to use liver biopsy. Therefore, there is a possibility that hepatologists have significant, heterogeneous opinions concerning the appropriateness of liver biopsy. Appropriateness should be evaluated for different techniques such as percutaneous liver biopsy, guided or not by ultrasonography, and the types of needles, automatic or not. The article reviews the evaluation of liver biopsy appropriateness in the real world, the adverse events and mortality of liver biopsy, and the appropriateness of liver biopsy in alcoholic liver disease and chronic hepatitis C. The authors conclude that liver biopsy is appropriate for a few diagnoses, and for the staging of chronic liver diseases such as alcoholic liver disease and chronic hepatitis C. However, excess use of liver biopsy, because of its cost and risk, may be a barrier to treatment. Underused liver biopsy may lead to inappropriate treatment of hepatitis. 3 figures. 1 table. 44 references.

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Federally Funded Research on Liver Biopsy The U.S. Government supports a variety of research studies relating to liver biopsy. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to liver biopsy. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore liver biopsy. The following is typical of the type of information found when searching the CRISP database for liver biopsy: •

Project Title: ADULT LIVE DONOR LIVER TRANSPLANT-A COMPARATIVE ANALYSIS Principal Investigator & Institution: Abecassis, Michael; Associate Professor of Surgery; Surgery; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 17-SEP-2002; Project End 31-AUG-2009 Summary: (provided by applicant):The shortage of available cadaver organs has prompted the transplant community to consider living donor liver transplantation (LDLT) as an effective alternative to cadaveric liver transplantation (CLT). The potential limitations of LDLT consist primarily of 1) the potential risk to an otherwise healthy donor, and 2) the uncertainty regarding graft and patient outcomes for LDLT as compared to CLT. The core project of this proposal will compare outcomes for recipients of LDLT to those of CLT, while addressing the potential complications to living donors. In addition, we propose to analyze two separate issues. First, we will evaluate donor hepatic steatosis in both LDLT and CLT. We will compare novel non-invasive measurements of steatosis in living donors with the current gold standard, a liver biopsy. We will compare the results of transplanting steatotic livers from living and cadaveric donors, assessing graft and patient outcomes in both groups. We will also evaluate the role of hepatic steatosis on liver regeneration in both the living donor and recipient. We hypothesize that outcome of transplantation in steatotic livers of LDLT is superior to results obtained in steatotic CLT recipients. This first aim will help design a decision algorithm for the use of steatotic livers in both CLT and LDLT while validating non-invasive measurements of hepatic steatosis. Second, we propose to address the potential role for LDLT in the multimodal management of hepatocellular carcinoma (HCC). Given the lack of randomized trials and large case series, this issue has been recently addressed in studies utilizing decision-modeling analysis. This second aim will provide clinical data to validate these studies, and will compare CLT, with its inherent waiting times, to LDLT, a strategy that theoretically eliminates waiting times. We hypothesize that the outcome of transplantation of HCC in LDLT is superior to results obtained with CLT. In the aggregate, these studies will define the efficacy of LDLT in

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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the US, while a focus on both a donor issue (hepatic steatosis) and a recipient issue (the special problem of HCC) will help delineate the potential advantages of LDLT over CLT. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BARIATRIC SURGERY RESEARCH CONSORTIUM Principal Investigator & Institution: Flum, David R.; Professor; Surgery; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Bariatric procedures offer sustained and significant weight reduction with the potential to effect general patient health, comorbid conditions, quality of life and the healthcare system. A Bariatric Surgery Clinical Research Consortium (BSCRC) wilt provide important prospective information about the true impact of the procedure on patients and opportunities to better explore the physiologic mechanisms that result in post-surgical weight loss. The BSCRC will prospectively collect clinical, demographic, epidemiological, laboratory and histological information. In addition to this database the BSCRC will complete the following studies: 1. A cross-sectional examination of the epidemiology of non-alcoholic steatohepatitis (NASH) in patients undergoing bariatric surgery and a prospective evaluation of the effect of surgically induced weight loss on the severity NASH and cellular markers of cytotoxic activity. There is a need for epidemiologic information about the prevalence, risk factors for, and impact of fatty liver disease in patients undergoing bariatric surgery. We propose a study to evaluate liver histology in a large group of patients undergoing bariatric procedures. Patients with evidence of NASH by biopsy will undergo subsequent liver biopsy at one year to determine if NASH improves with rapid weight loss. Patients with NASH who improve after weight loss represent an important model for evaluating the cellular mechanisms that are involved in the development of NASH. This study will evaluate markers of oxidative stress and hepatic mitochondrial structure to determine their relationship to NASH during and after rapid, surgical weight loss. 2. A prospective evaluation of the relationship between ghrelin, PYY3-36, appetite and weight loss outcomes after gastric bypass. Ghrelin and PYY3-36 are gut-derived peptides that are involved in energy homeostasis principally through their effect on appetite. We propose a prospective study to determine the relationship of ghrelin and weight loss after gastric bypass and to determine if the degree of ghrelin suppression is correlated to hunger suppression and/or the amount of weight lost. This study will determine if inclusion of ghrelin producing cells in the gastric pouch is correlated to worsened weight loss outcomes. Lastly the study will begin to evaluate the relationship of PYY3-36 and ghrelin and determine if it is altered by or in response to the physiologic changes associated with gastric bypass. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CHRONIC HEPATITIS C: MOLECULAR & CELLULAR MARKERS Principal Investigator & Institution: Farrell, Geoffrey C.; University of Sydney Main Quadrangle, Bld A14 Sydney, 2006 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: Only a minority of HCV-infected individuals have progressive forms of chronic hepatitis that will result in cirrhosis in 20 to 30 years. This project is concerned with the biological basis of disease progression in chronic hepatitis C. We have noted that, to date, viral factors and the systemic immune response to HCV are poorly

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correlated with disease progression. The key pathobiological process that determines progression of liver disease in chronic hepatitis C is fibrogenesis, with hepatocyte cell death and proliferation playing lesser roles. In the present proposal, these processes are conceptualized as responses to hepatic inflammation and oxidative stress causing activation of hepatic stellate cells and liver cell injury. Thus our overall objective is to characterize how interactions between HCV, the hepatic inflammatory response and liver cells promote fibrogenesis and disease progression in chronic hepatitis C. In particular, we will test the hypothesis that, in the early stages of chronic HCV infection, an intrahepatic "molecular map" can be created to identify subsets of individuals who will develop progression of liver disease. We will then seek to identify patterns of hepatic gene expression that correlate with the pathogenesis of fibrosis, hepatocyte death and proliferation. A particular focus will be on the identification of genes not previously known to be associated with individual susceptibility to HCV. A unique feature of these studies is that they will be performed on serial liver biopsy samples obtained at 3 to 5 year intervals from 200 patients with mild to moderate chronic hepatitis C who will be followed prospectively and monitored by quantitative liver functional assessments. The Specific Aims are: 1) To establish the relationship between cytokine mediators of the hepatic inflammatory response, macrophage activation and the presence of oxidative stress in the liver, and to compare these with characteristics of the HCV infection in hepatocytes and other cell types; 2) To determine whether expression of these cytokines and/or oxidative stress correlate with the activity of hepatic fibrogenesis, using both cross-sectional and prospective longitudinal approaches. 3) To identify hepatic genes previously not known to be associated with a progressive course for hepatitis C. The findings may allow those individuals most at risk of progressive liver disease from HCV to be identified at a time when they are most likely to respond to antiviral therapy. It will also allow the design of adjunctive treatments more appropriately targeted towards the key pathogenic processes that determine disease progression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLASS I RESTRICTED T CELL RESPONSE DURING HCV INFECTION Principal Investigator & Institution: Greenberg, Harry B.; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002 Summary: We propose to study the class I restricted cellular immune response to hepatitis C virus (HCV) using new techniques, including peptide-MHC tetramers and intracellular cytokine staining. We are focusing on the class I cellular response because it is likely that the magnitude and/or the specificity of the response plays an important role in the control and possibly pathogenesis of HCV infection. The individual specific aims are: A1. To examine the role of HCV-specific CD8+ T lymphocytes in the control of HCV by quantitation and characterization if such peripheral blood. It is our hypothesis that: (i) the outcome (clearance or persistence) of HCV infection is correlated with characteristics and quantity of circulating CD8+ T cell populations specific for HCV; (ii) the HCV viral load is inversely related to HCV-specific CD8+ T cells; and (iii) the quality and quantify of HCV-specific T cells can be modulated by antiviral treatment. To test these hypotheses we will conduct we will conduct prospective studies on patients of interest, including patients with acute HCV infection, patients with chronic HCV infection, patients with chronic HCV infection receiving or not receiving antiviral therapy (IFN/ribavirin combination), and patients undergoing orthotopic liver

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transplantation. A2. To characterize the nature, functional activity and localization of HCV-specific CD8+ T lymphocytes in HCV-infected liver. We hypothesize that intrahepatic T cell response against HCV-specific CD8+ T lymphocytes in HCV-infected liver. We hypothesize that intrahepatic T cell responses against HCV are important determinants of outcomes and severity of liver infection. In order to test these hypotheses, we first plan to better characterize these cells. We will isolate and quantify intrahepatic lymphocytes from liver specificity and cytokine profile of such cells, and compare them to HCV-specific CD8+ T cells in the peripheral blood. We will also develop assays to identify and localize HCV specific CD8+ T cells directly in liver biopsy material. A3. To investigate mechanisms of HCV persistence. We intend to test the hypothesis that HCV may persists by one or more of the following mechanisms following viral mutation of epitope peptides: the target peptide of the virus (i) can no longer be recognized by circulating HCV- specific CD8+ T cells; or (ii) can be recognized as an altered peptide ligand but fails to induce adequate effector functions in the specific D8+ T cells, or (iii) acts as a T cell agonist. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--ANIMAL Principal Investigator & Institution: Wallace, Jeanne M.; Associate Professor; Wake Forest University 1834 Wake Forest Road Winston-Salem, Nc 27106 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2003 Summary: The primary objectives of the Animal Core are as follows: 1. Provide veterinary care for the monkeys and mice of the Program Project. 2. Provide veterinary and technical support for liver biopsy surgeries and for associated postoperative care. 3. Provide technical support for collection of blood samples, blood pressures, body weights, administering isotopes and performing urine sample collection, and preparing data sheets. 4. Coordinate and supervise the diet laboratory and animal care staffs to assure that diets are prepared and fed according to protocol. 5. Insure that liver perfusion studies and necropsies are performed according to protocol. 6. Evaluate atherosclerosis extent and severity in the aorta, coronary, carotid and iliac arteries. 7. Provide technical support for the transgenic mouse breeding colony. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--MICROARRAY & VIROLOGY Principal Investigator & Institution: Katze, Michael G.; Professor; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: In the Microarray & Virology Core, we have brought together a diverse group of NIH-funded investigators from basic science and clinical medicine. These investigators have a common interest in using state-of-the-art technologies to better understand the molecular mechanisms underlying the progression from HCV infection to end-stage liver disease. Our goal is to use DNA microarrays to provide a molecular blueprint of the changes in cellular gene expression that occur at multiple points along the continuum from virus infection to liver disease, including cirrhosis and hepatocellular carcinoma. Our Specific Aims are the following: Aim 1: Supply biological samples for microarray and proteomic analyses and provide molecular biology and virology support. Investigators associated with this core will provide the biological samples used for microarray and proteomic analyses. These samples will come from a variety of in vitro and in vivo systems, including HCV replicon cell lines, cultured

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primary human hepatocytes, liver biopsy material from patients with recurrent HCV after liver transplantation, and liver biopsy material from patients co-infected with HCV and human immunodeficiency virus (HIV). Aim 2: Use DNA microarrays to profile changes in cellular gene expression that occur during HCV infection and HCVassociated liver disease. This core will leverage the capabilities of a pre-existing microarray facility, the Center for Expression Arrays, to apply the technologies of global gene expression analysis to the study of HCV infection and liver disease. This technology infrastructure will be coupled with expertise in hepatitis C virology, virushost interactions (including extensive experience in the use of global gene expression profiling), and liver disease and transplantation. Data obtained from these analyses will be provided to the Bioinformatics & Biostatistics core for analysis and integration with data generated by the Proteomics & Modeling core. The information is likely to yield improved diagnostic methods, markers of disease progression, and novel approaches for therapeutic intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DRUG METABOLISM AND CHRONIC LIVER DISEASE Principal Investigator & Institution: Branch, Robert A.; Professor and Director; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 30-JUN-2006 Summary: (provided by applicant): This is a resubmission of a proposal whose goal is to use pharmacogenetic principles to better understand the influence of liver disease associated with hepatitis C on drug disposition and develop new tools to evaluate hepatic function. We propose to address the following specific hypotheses: In Specific Aim 1: Hepatitis C influences the clearance of drugs that undergo metabolism in comparison to matched controls. Furthermore, the extent of change in clearance is different for drugs that are metabolized by different drug metabolizing enzymes and is associated with the severity of the liver disease. Specific Aim 2: Selective decreases in drug metabolism in patients with hepatitis C without hepatic decompensation is associated with enzyme specific down-regulation of hepatic expression of mRNA for that enzyme and increased circulating levels of the cytokines, Interleukin-6 and Tumor Necrosis Factor- ?. Specific Aim 3: The measurement of activity of multiple drug metabolizing enzymes can be interpreted in the context of a sequential, progressive model of hepatic dysfunction to provide an integrated assessment of hepatic function and prognosis in patients with hepatitis C. We propose to study patients with hepatitis C (n= 112) associated with chronic persistent hepatitis, chronic active hepatitis and cirrhosis with or without hepatic decompensation and age, sex matched controls (n=48) on two occasions. Each study subject will participate in three pharmacokinetic (PK) studies that uses drugs selected as probes of substrates metabolized predominantly or exclusively by an individual drug metabolizing enzyme. Part 1: A cocktail to include: caffeine (CYP1A2), flurbiprofen (CYP2C9), mephenytoin (CYP2C19), debrisoquine (CYP2D6), chlorzoxazone (CYP2E1) and dapsone (acetylation). Part 2: Semisimultaneous oral:intravenous administration with midazolam to measure intestinal and hepatic contributions to CYP3A metabolism and Part 3: oral administration of acetaminophen (UGT1A6) simultaneously with intravenous morphine (UGT2B7). When feasible, liver tissue obtained at the time of diagnostic liver biopsy as part of routine patient care will have concentrations of mRNA for CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4, CYP3A5, UGT1A6 and UGT2B7 measured. Patients with hepatitis C-associated liver disease will be followed at 6 monthly intervals until liver

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transplantation, death or duration of funding. The study will be repeated either after a change in clinical status or at 2 years in patients with liver disease and after one or 12 months in control subjects. Collectively, these studies will provide a consolidated base of information within the same cohort of patients with hepatitis C and normal subjects to better understand the influence of hepatitis C-associated live disease on drug metabolizing enzymes. This information has potential to create new integrated indices to evaluate hepatic function and prognosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECT OF POLYUNSATURATED LECITHIN ON LIVER FIBROSIS Principal Investigator & Institution: Schenker, Steven; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2002 Summary: This is a multicenter, placebo-controlled, parallel study of polyunsaturated lecithin on the progression of fibrosis to cirrhosis in patients with alcoholic liver damage. Its objective is to evaluate the preventive effect of polyunsaturated lecithin and to assess the corresponding changes in hepatic collagen measured directly (by liver biopsy) and indirectly (by propeptide changes in the blood). The effect of lecithin on histologic parameters of steatosis, inflammation, and necrosis will also be assessed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EMORY MEDICINE LASER CAPTURE MICRODISSECTION FACILITY Principal Investigator & Institution: Hagedorn, Curt H.; Professor; Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2003 Summary: The information in the human genome database promises to provide a new means to investigate human diseases. However, a limiting factor in using this database in identifying new diagnostic/prognostic markers and defining the molecular mechanisms of disease is the challenge of isolating specific cell populations and their mRNA from clinical tissue biopsies Investigators have isolated specific cell types from small samples of tissue using micropipette dissection methods. However, they require a high degree of manual skill and are time-consuming. A Laser Capture Microdissection (LCM) system was developed at NIH to meet this challenge and more rapidly isolate specific cells from clinical biopsy samples. By combining LCM with non-thermophilic RNA amplification methods it is now possible to produce aRNA from 100-1,000 cells and probe high-density arrays for in vivo functional genomic studies of specific cells in clinical biopsies. The Emory Medicine LCM facility will be incorporated into the Vascular Medical Center at Emory University. It will be used to investigate gene expression of specific cell types in a variety of chronic inflammatory diseases such as atherosclerosis, hepatitis C, graft vs. host disease following stem cell transplantation, and studies regarding the in vivo source of actor VIII during chronic liver disease. Specific programs that will utilize the LCM facility include: 1) Comparing gene expression within Kupffer, endothelial stellate, and T cells in liver biopsy samples of control patients and those with chronic hepatitis C (acute vs. chronic; siblings with nonprogressive vs. severe progressive inflammation/fibrosis; responders vs. nonresponders to treatment); 2) Studying the modulation of gene expression in individual endothelial cells in humans and experimental animals exposed to different hemodynamic milieus and treatments; 3) Studying the in vivo gene expression of

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vascular adventitial myofibroblasts during post- angioplasty restenosis; 4) Studying the in vivo expression of vascular adventitial myofibroblasts during post-angioplasty restenosis; 4) Studying gene expression of Factor VIII in liver endothelial and parenchyma cells during chronic liver diseases; 5) studying the in vivo gene expression of endothelial cells of proliferating vs. regressing hemangiomas; and 6) studying the in vivo gene expression of human dermal endothelial cells during cutaneous inflammatory diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GALACTOSEMIA: IDENTIFICATION BY METABOLIC LIVER BIOPSY Principal Investigator & Institution: Segal, Stanton; Professor; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 191044399 Timing: Fiscal Year 2004; Project Start 01-MAR-2004; Project End 31-JAN-2006 Summary: (provided by applicant): Galactosemia, the inherited inability to metabolize galactose, a major nutrient in milk, due to deficient galactose-1-phosphate uridyltransferase (GALT), is an enigmatic disorder. The therapeutic use of galactoserestricted diets has failed to prevent long-term complications of cognitive impairment, speech disorders, neurologic ataxias and ovarian failure. The development of new therapeutic strategies is an imperative. Most patients, even those considered to have a severe mutation, have an ability to slowly oxidize galactose to CO2 which accounts in large part for disposition of their endogenous galactose production. Augmenting that ability may be a new therpeutic approach if the mechanism(s) involved can be delineated. The aim of this proposal is to determine, by a new technique of "metabolic biopsy" of liver uridinedisphospho glucose (UDPglu) pool, if galactosemic patients have residual GALT activity to explain their limited ability to metabolize the sugar and how much is accounted for by other known alternate pathways. The method involves the powerful tool of 13C NMR and 1H NMR to measure the 13C enrichment and total quantity of urinary acetaminophen (Tylenol) glucuronide over 24 hr following oral bolus administration of 2-13C galactose with concomittant administration of acetaminophen. Acetaminophen is largely excreted (65%) in subjects over age 9 yr as the glucuronide, which is derived from UDPglu, the key intermediate in the normal pathway of galactose metabolism. The extent to which this happens will indicate how much of the normal pathway remains. The study will be performed in normal subjects and galactosemics homozygous for the Q188R mutation which accounts for 50% of Caucasian patients, Q188R compound heterozygotes, S135L in African Americans who we know to have residual activity and Ashkenazi with homozygous gene deletions who cannot have any residual activity. An analysis will be made of residual GALT function in relation to various genetic types. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HCV COINFECTION

REPLICATION

AND

IMMUNE

RESPONSE

IN

HIV

Principal Investigator & Institution: Gretch, David R.; Associate Professor, Director Viral He; Laboratory Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 31-MAY-2006 Summary: Coinfection with hepatitis C virus and HIV is not uncommon. Approximately 10 percent to 30 percent of HIV-infected individuals are also infected with HCV. Many

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natural history studies have found that those with coinfection have more significant, and more rapidly progressive, liver disease than HCV-infected individuals who are HIV-negative. While the pathogenesis of HCV liver disease is not well understood, many believe that the more advanced liver disease seen in those with coinfection is due to HIV-related immune deficiency. The specific aims of this proposals are as follows: Aim 1: To determine serum HCV RNA levels and quasispecies complexity and diversity in HCV-infected patients with and without HCV coinfection. This study will test the hypothesis that those with coinfection have higher HCV viremia and lower quasispecies complexity and diversity than those who are HIV-negative. Aim 2: To determine intrahepatic HCV RNA by in situ assay in HCV-infected patients with and without HIV coinfection. This study will utilize an in situ assay for genomic and replicative HCV RNA to test the hypotheses that intrahepatic HCV replication is increased in those with HIV and correlates with liver disease severity. It will also test the hypothesis that both HCV replication and liver disease are increased in those with more advanced HIVrelated immune suppression. Aim 3: To determine the effect of HAART on HCV viremia, quasispecies complexity and diversity, intrahepatic HCV replication, and the immune response to HCV. HIV infected patients who are to be treated with HAART will undergo liver biopsy for measurement of intrahepatic HCV replication both before and 12 months after initiating HAART. Other pre- and post-HAART measurements will include HCV viremia, HCV quasispecies complexity and diversity, an increase in intrahepatic staining for CD4 and CD8 cells, and an increase in peripheral lymphoproliferative responses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HCV TREATMENT IN AFRICAN AMERICANS VS NON HISPANIC WHIT* Principal Investigator & Institution: Jeffers, Lennox J.; Professor; Medicine; University of Miami-Medical Box 248293 Coral Gables, Fl 33124 Timing: Fiscal Year 2002; Project Start 21-AUG-2001; Project End 30-JUN-2006 Summary: The proposed project is a 5-year multicenter open-label trial designed to evaluate the efficacy of 40 kDa Pegylated interferon alfa-2a (Peginterferon alfa-2a) in combination with Ribavirin in the treatment of genotype-1 chronic hepatitis C (HCV, genotype-1) in African American men and women as compared to non-Hispanic whites. The Primary Aim of this proposal is to establish rates of sustained virologic response to a 48-week course of Peginterferon alfa-2a in combination with ribavirin in African Americans as compared to non-Hispanic whites with chronic HCV genotype 1 as assessed at the end of 48-week post-treatment follow-up by HCV RNA (<25 IU/mL). As Secondary Aims, we will assess biochemical markers of response to treatment [e.g., normalization of alanine aminotransferase (ALT)], specific patterns of early (e.g., early vs. no response over a 28-day period) and longitudinal (i.e., weeks 12 24, 36, 48 of treatment and week 24 post-treatment) response patterns, as well as, hepatic histology activity index (HAI), Body Mass Index (BMI) and demographic (e.g., age, gender, education, income level) and psychosocial factors (e.g., depression, anxiety, social support, coping) associated with treatment response and adherence. The Specific Aims of this project are as follows: PRIMARY AIM: SPECIFIC AIM 1. To establish rates of sustained virologic response to a 48-week course of Peginterferon alfa-2a in combination with ribavirin in African Americans as compared to non- Hispanics whites with chronic HCV genotype 1 as assessed at the end of 48-week post-treatment follow-up by HCV RNA (<25 IU/mL). SECONDARY AIMS: SPECIFIC AIM 2. To establish rates of sustained biochemical response to a 48-week course of Peginterferon alfa-2a in

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combination with ribavirin in African Americans as compared to non- Hispanic whites with chronic HCV genotype 1 as assessed at the end of 48-week post-treatment followup by serum ALT. SPECIFIC AIM 3. To determine patterns of longitudinal response or non response (i.e., weeks 12, 24, 36, 48 and 24 weeks post-treatment) of Peginterferon alfa-2a in combination with Ribavirin on: a) viral load (HCV RNA) alone; b) serum ALT alone; and c) combined HCV RNA and serum ALT. SPECIFIC AIM 4. To determine patterns of early (i.e., within a 28-day period) virologic response or non- response following Peginterferon alfa- 2a in combination with Ribavirin. SPECIFIC AIM 5. To evaluate changes in histology as determined by HAI by comparison of liver biopsy findings pre-treatment (within 12months prior to study initiation) and at the end of the 48-week post-treatment observation period. SPECIFIC AIM 6. To correlate end of treatment and sustained virologic response with baseline HAI, BMI and compliance to treatment. SPECIFIC AIM 7. To identify sociodemographic (e.g., age, education income, gender, ethnicity) and psychosocial (e.g., anxiety, depression, coping) predictors of adherence to treatment and virologic response to HCV RNA. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEMOSTATIC LIVER BIOPSY DEVICE Principal Investigator & Institution: Krause, William R.; Professor; Bioengineering Consultants, Ltd 801 W Main St, Ste 201 Charlottesville, Va 22903 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-AUG-2005 Summary: The Specific Aim of this Phase II application will be to evaluate the biopsy unit and delivery device in an animal model, make any modifications and redesign resulting from the animal trials and, upon the anticipated successful application, proceed to human clinical trials. Under the Phase I study we have designed and manufactured a functional prototype, and evaluated the device in explanted liver sections and in a live, but terminal canine model (non-NIH funded project). It was observed in an in vivo canine model that the use of the device obtained a suitable biopsy specimen and automatically delivered a coagulant plug that stopped the bleeding from occurring within 5 seconds. It is the OBJECTIVE of the proposed Phase II project will be to evaluate the device in: (i.) a fibrotic swine animal model, (ii.) a cirrhotic swine model, (iii.) a laparoscopic guided human liver biopsy procedure, and (iv.) a controlled, percutaneous human liver biopsy procedure. It is anticipated that limited commercialization of the device will be available towards the end of the study period PROPOSED COMMERCIAL APPLICATIONS: The US market for liver biopsy needles is approximately $5 million based on a conservatively estimated 100,000 liver biopsies due to the hepatitis virus and alcoholism. Although offered at a higher price than current needles, we would offer a complete needle, syringe, and delivery system that would also reduce hospital costs of more expensive procedures and complications. The proposed device would realize substantial profits of $600K with minimum (20%) penetration and reduce health care costs by $5M. Additional markets for other highly vascular tissue biopsies will open upon development of the device. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HEPATITIS C CLINICAL TRIAL- CLINICAL CENTERS Principal Investigator & Institution: Lee, William H.; Professor; Internal Medicine; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2000; Project Start 01-MAY-1999; Project End 30-APR-2007

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Summary: This project is aimed at developing practical, safe and effective means of preventing the progression of liver disease in patients with chronic hepatitis C virus (HCV) infection. Approximately 800 patients with chronic hepatitis C who have failed to respond to therapy with alpha interferon (with or without ribavirin) and who have significant fibrosis on liver biopsy will be enrolled in a study of the efficacy and safety of a continuous long-term antiviral therapy (for as long as four years). The objective of the Trial is to evaluate whether continuous therapy with long-term antiviral therapy can slow the progression of liver disease, preventing cirrhosis or preventing worsening of cirrhosis, decompensation, development of hepatocellular carcinoma (HCC) and death from liver disease. The Trial will also evaluate the natural history of hepatitis C and the factors that predict or correlate with disease progression. The major focus will be to evaluate whether antiviral therapy, despite not leading to eradication of HCV, can suppress hepatocellular injury, necrosis and fibrosis. Patients with chronic hepatitis C who have previously been treated with alpha interferon without a sustained virological and biochemical response will be eligible to enter the Trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEPATITIS C CLINICAL TRIALS- CLINICAL CENTERS Principal Investigator & Institution: Hoefs, John; Medicine; University of California Irvine Irvine, Ca 926977600 Timing: Fiscal Year 2000; Project Start 01-MAY-1999; Project End 30-APR-2007 Summary: This project is aimed at developing practical, safe and effective means of preventing the progression of liver disease in patients with chronic hepatitis C virus (HCV) infection. Approximately 800 patients with chronic hepatitis C who have failed to respond to therapy with alpha interferon (with or without ribavirin) and who have significant fibrosis on liver biopsy will be enrolled in a study of the efficacy and safety of a continuous long-term antiviral therapy (for as long as four years). The objective of the Trial is to evaluate whether continuous therapy with long-term antiviral therapy can slow the progression of liver disease, preventing cirrhosis or preventing worsening of cirrhosis, decompensation, development of hepatocellular carcinoma (HCC) and death from liver disease. The Trial will also evaluate the natural history of hepatitis C and the factors that predict or correlate with disease progression. The major focus will be to evaluate whether antiviral therapy, despite not leading to eradication of HCV, can suppress hepatocellular injury, necrosis and fibrosis. Patients with chronic hepatitis C who have previously been treated with alpha interferon without a sustained virological and biochemical response will be eligible to enter the Trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HEPATITIS C: GRADING AND STAGING BY MR Principal Investigator & Institution: Mitchell, Donald G.; Radiology; Thomas Jefferson University Office of Research Administration Philadelphia, Pa 191075587 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 28-FEB-2005 Summary: (provided by applicant): Hepatitis C virus (HCV) accounts for about a third of liver transplants and a large proportion of the increasing incidence of hepatocellular carcinoma. MRI is noninvasive and can be cost effective if performed rapidly and without contrast agents. The purpose of this investigation is to determine whether a quick and noninvasive MRI examination can accurately grade the level of inflammatory activity and stage the amount of fibrosis in HCV patients, thereby potentially reducing the number of liver biopsies needed. Forty patients per year with chronic HCV

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infection who are undergoing diagnostic evaluation will be selected from our hepatology practice. All patients will have MR imaging performed within 1 month prior to or following core liver biopsy. MRI exams and biopsy specimens will be examined independently by, respectively, two radiologists and two pathologists, all blinded to other clinical and imaging data. MRI interpretations will include measurement of lymph node number, size and signal intensity. These parameters will be compared with the histologic grade of inflammatory activity. We will evaluate morphologic signs of early cirrhosis that have been established by prior investigations at our institution, including empty gallbladder fossa, enlarged periportal space, and increased caudate to right lobe ratio, and will determine if these signs are sufficiently accurate to identify patients who have developed hepatic fibrosis. We will also measure hepatic fibrosis through new MR spectroscopic techniques, and compare this with histologic results. We will use established MRI methods for measuring hepatic lipid, and determine if its presence affects the accuracy of MR spectroscopic measurement of fibrosis. We will record the duration of the MR examination to determine whether this data can be acquired within 30 minutes. Our hypotheses are as follows: 1. Patients with more active HCV will have more perihepatic lymph nodes greater than 5 mm. 2. Patients with more active HCV will have larger lymph nodes. 3. Patients with more active HCV will have more hyperintense perihepatic lymph nodes. 4. Number, size, and hyperintensity of perihepatic lymph nodes can differentiate mild HCV from higher grades of activity. 5. Signs of early cirrhosis (empty gallbladder fossa, enlarged periportal space, increased caudate to right lobe ratio) can diagnose patients with fibrosis. 6. MRI determination of the fraction of signal intensity from lipid will be higher in patients with histologic findings of fatty liver. 7. MR spectroscopic measurement of fibrosis can diagnose presence/absence of fibrosis. 8. MR diagnosis of fibrosis will be less accurate in patients with fatty livers. 9. The average duration of MR examinations will be 30 minutes or less. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HYPERINSULINEMIA AND THE PATHOGENESIS OF NASH Principal Investigator & Institution: Neuschwander-Tetri, Brent A.; Internal Medicine; St. Louis University St. Louis, Mo 63103 Timing: Fiscal Year 2002; Project Start 20-MAY-2002; Project End 30-APR-2007 Summary: Non-alcoholic fatty liver disease (NAFL or NAFLD) and its subset, nonalcoholic steatohepatitis (NASH) are increasingly recognized as common forms of liver disease. In the absence of concomitant cellular injury, fatty liver is a benign condition that may cause elevated liver enzymes, fatigue and abdominal pain. MASH is identified by the presence of fat in the liver plus hepatocellular injury, inflammation and varying degrees of liver fibrosis. It afflicts up to 3% of adults n the United States and one third of these people may be at risk for developing cirrhosis. NASH also affects children, although its prevalence in the pediatric population is less well defined. Currently 2% of liver transplants performed in the United States are performed because of known diagnosis of NASH. Insulin resistance, with its major associated diseases of obesity and Type 2 diabetes, is emerging as a major coexisting condition. This application proposes two clinical studies to be performed in the context of a cooperative clinical research network to achieve the long-term goals of establishing the role of hyperinsulinemia in the pathogenesis of NASH and identifying rational and effect strategies to prevent and cure NASH. These goals will be addressed by specific aims of this proposal that seek to better understand the prevalence of NASH in hyperinsulinemic patients and establish whether reducing insulin levels pharmacologically improves the necroinflammatory changes associated with NASH. Two clinical studies are proposed. The first study

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establishes the prevalence of NASH in patients with hyprinsulinemia and imaging evidence of fatty liver. A secondary goal of the prevalence study is to establish racial differences in the risk for developing NASH because NASH may be underrepresented or underdiagnosed in African Americans. Enrollment will include adequate African Americans to allow subgroup analysis. The second proposed study is to a 48 week treatment trail of patients with NASH using the PPAR-gamma ligand rosiglitazone and, if needed to control hyperinsulinemia, metformin. Liver biopsies of patients recruited from all Clinical Centers will be compared to liver biopsies of patients treated with the standard recommendation of weight reduction. The primary endpoint will be improvement in the liver biopsy necroinflammatory score. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMMUNE PATHOGENESIS OF HEPATITIS C VIRUS--HUMAN MODEL Principal Investigator & Institution: Wright, Teresa L.; Professor of Medicine; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002 Summary: This proposal is focused on the identification of predictors of disease progression in hepatitis C (HCV) infection. We will examine the influence of the immune response on the natural history in two cohorts; immune compromised liver transplant patients and immune competent patients with HCV. Our primary hypothesis is that fibrosis progression is accelerated by immune suppression. Our secondary hypothesis is that type of immune suppression and ethnicity contribute to fibrosis progression. We will use databases of patients who have undergone liver transplantation and immune competent patients who have undergone liver biopsy, databases which include clinical, demographic, biochemical and histological data as well as information regarding risk exposures and alcohol consumption. All liver biopsies have been graded and staged for the degree of inflammation and fibrosis respectively. Serum is available from the majority. Initial analysis of 284 liver transplant recipients showed that post-transplantation fibrosis progression was linear but variable, and was independently associated with year of transplantation, non-Caucasian ethnicity, number of steroid boluses and HCV RNA level at transplantation. Since the explanation of these associations was not apparent, we expanded the transplantation databases in order to identify precisely predictors of disease progression. We will also measure variables including ethnicity in fibrosis progression in immune competent patients. In most studies of natural history, the duration of HCV infection is estimated retrospectively from time of presumed first risk exposure. Through modeling timing of exposures, we will develop an approach to assign accurately time of initial infection. We will also investigate the association between genetic diversity in the envelope and NS3 genes and disease progression. Finally, we will collect lymphocytes from HCV- infected patients for future analysis of the association between genetic markers and disease progression. These cohorts will provide lymphocytes to Dr. Greenberg to measure HCVspecific CTL response and HCV variants to Dr. Kay to measure pathogenicity of HCV in an animal model. Elucidation of the mechanisms by which HCV causes disease is essential for the identification of those at risk for serious consequences. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMPACT OF HIV ON HEPATITIS C INFECTION IN HEMOPHILIA Principal Investigator & Institution: Ragni, Margaret V.; Professor; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260

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Timing: Fiscal Year 2002; Project Start 11-APR-2001; Project End 31-MAR-2005 Summary: (provided by applicant) The purpose of this study is to determine the impact of HIV infection on hepatitis C virus (HCV) liver disease outcome, and the prevalence, risk factors, and viral and immunologic characteristics of liver disease in HCV-infected hemophiliacs, both HIV(+) and HIV(-). Approximately 826 HCV-infected hemophiliacs from 10 U.S. hemophilia treatment centers will be available for study. This group is unique in that patients are well characterized, closely followed, the time of HCV infection is known, HCV infection duration is greater than 20 years, and the incidence of liver disease progression is increasing. The specific objectives of this study include: (1) a cross-sectional cohort study in which hemophiliacs with HCV infection, both HIV(+) and HIV(-), are enrolled and undergo transjugular liver biopsy to determine the prevalence of cirrhosis and fibrosis progression rate. (2) a cross-sectional study comparing HCV-infected patients, both HIV- and HIV+, to determine clinical, life-style, and laboratory, e.g. biochemical, serologic, molecular biologic, and immunologic characteristics associated with development of cirrhosis and stage of fibrosis progression. (3) a cytokine study, comparing cytokine mRNA levels, interleukin-6 (IL-6), interleukin-10 (IL-10), and transforming growth factor-beta (TGF-beta 1 and TGF-beta 2) in liver tissue, cytokine immunoassay levels in plasma, and cytokine expression genotypes with liver histopathologic score and with fibrosis progression rate in prospectively-biopsied hemophiliacs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERFERON-GAMMA TO TREAT CHRONIC HCV INFECTION Principal Investigator & Institution: Muir, Andrew J.; Medicine; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 21-SEP-2001; Project End 31-AUG-2004 Summary: (adapted from the application) Current treatment options for chronic hepatitis C infection remain limited and unsatisfactory. Treatment with interferon-alpha and ribavirin leads to a sustained response in the minority of patients, and many patients may not be eligible for treatment due to side effects associated with these medications. Other treatment options are clearly necessary for chronic hepatitis C infection. A major complication of chronic hepatitis C infection is fibrogenesis, ultimately leading to development of cirrhosis. Animal models have demonstrated that interferon-gamma reduces fibrogenesis through its effect on stellate cells. A recent report in patients with idiopathic pulmonary fibrosis found that interferon-gamma was well-tolerated and led to improved pulmonary function, ostensibly due to a reduction in fibrogenesis. Given these data, we postulate not only that interferon-gamma will be effective for treatment of hepatitis C mediated fibrogenesis, but also that it will be safe. We have therefore proposed a phase I study to assess the effectiveness of interferongamma in twenty patients with chronic hepatitis C infection. The patients will include those who have failed previous therapy with interferon-alpha or are not candidates for interferon-alpha therapy. Men or women 18 years of age or older are eligible. Other inclusion criteria are serum positive for hepatitis C virus by PCR; liver biopsy consistent with chronic hepatitis and with a fibrosis score of at least one on the Knodell scale; compensated liver disease; and informed, written consent obtained prior to entry. All patients will receive 200 micrograms of interferon-gamma three times a week for twelve months. Patients will undergo liver biopsy prior to treatment and at the end of treatment. Safety and tolerance will be evaluated at weeks 1, 2, 4, 8 and then every 4 weeks during treatment and at weeks 4 and 12 following the completion of therapy. Serum HCV-RNA will be evaluated prior to initiating therapy and at the end of therapy.

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The primary endpoint of this study will be the histological response of patients with chronic hepatitis C infection to treatment with interferon-gamma. Secondary endpoints include the biochemical response, inflammatory and regulatory cytokine levels, and quality of life during treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INVESTIGATIONS INTO PHENOTYPE & GENOTYPE OF ATYPICAL PRIMARY HYPEROXALURIA Principal Investigator & Institution: Milliner, Dawn S.; Mayo Clinic Coll of Medicine, Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: The causes of hyperoxaluria are manyfold. The spectrum of its clinical manifestations encompasses the more benign conditions such as idiopathic hyperoxaluria to the more malignant syndromes of primary hyperoxaluria. In primary hyperoxaluria, deficiencies of hepatic enzymes involved in oxalate metabolism, inherited in an autsomal recessive manner, lead to accumulation of oxalate. The phenotypic expression of the marked oxalate overproduction in these disorders is oxalate nephrolithiasis, progressive renal failure and systemic oxalosis. Primary hyperoxaluria type I is characterized by a defect of liver-specific alanine-glyoxylate transaminase (AGT). In primary hyperoxaluria type II there is an absence of either gyoxylate reductase (GR) and/or glycerate dehydrogenase (GDH). Since the availability of immunocytologic enzymatic evaluation of human liver biopsy specimens, a subgroup of patients with similar phenotypic features (marked hyperoxaluria with nephrolithiasis) but with normal AGT and GDH levels has been identified (atypical hyperoxaluria). The etiology of the marked hyperoxaluria in these patients is unknown. Metabolic overproduction due to an yet undefined hepatic enzyme pathway is a possible cause, and is suggested by data available to date. Enteric hyperabsorption is another possibility. We propose to measure enteric oxalate absorption in patients with atypical hyperoxaluria. The ten previously identified patients of the Mayo Clinic experience will serve as study subjects and will be compared to age-matched control subjects. An especially prepared oxalate meal consisting of 20 mg of 13c-labeled oxalate will be ingested and urinary 13c-oxalate excretion measured via gas chromatography/mass spectroscopy. Since the majority of oxalate that is absorbed from the gut can be recovered in the urine, i.e., it is neither catabolized nor absorbed, urinary oxalate levels are useful markers for exogenously-derived oxalate. If enteric hyperabsorption is found in these patients, future inquiry can be directed towards discovering pathways of oxalate absorption in the GI tract thus targeting potential lifechanging interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LIVER TRIGLYCERIDE METABOLISM IN NASH Principal Investigator & Institution: Parks, Elizabeth J.; Food Science and Nutrition; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 31-JUL-2004 Summary: (adapted from the application) Non-alcoholic steatohepatitis (NASH) is a disease of emerging clinical significance. The risk factors for NASH include female gender, non-insulin dependent diabetes, obesity and hyperlipidemia. In NASH, the fat that accumulates in the liver is primarily triglyceride (TG) and three sources potentially contribute to this lipid are fatty acids (FA) derived from the diet, those originating in the

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adipose tissue (FFA in the plasma), and FA newly synthesized in the liver via process called de novo lipogenesis. The origin of the fat that accumulates in the liver has not been extensively investigated previously due to the technical challenges of studying de novo lipogenesis and the limitations of using radioactive isotopes in humans. Recent advances in gas chromatography/mass spectrometry and stable (non-radioactive) isotope methodology now make it possible to study hepatic TG metabolism in vivo. The hypothesis to be tested is that de novo lipogenesis contributes substantially to hepatic TG found in NASH. Further, it is hypothesized that plasma-derived FFA will contribute quantitatively less to the fat stored in hepatocytes and more to the TG that is exported from the liver in lipoproteins. Patients with persistently elevated liver enzymes of uncertain etiology, who are being considered for liver biopsy, will undergo a 5-day, stable-isotope infusion of labeled FA and precursors of FA, preceding the scheduled biopsy. Liver biopsy tissue (100 mg) will be analyzed to determine its biochemical content (TG, cholesterol, phospholipid and FFA), the composition of FA within these fractions, and the enrichment of labeled FA in the tissue (the sources of these FA). Control subjects will be aged- and sex-matched individuals undergoing surgical treatment for obesity who will have an identical isotope infusion before surgery. These methods will be used to accomplish the specific aims: (1) to quantify the concentration of the various lipids in NASH liver samples and samples from obese control subjects; (2) to determine the sources of FA used for lipid synthesis, and the turnover of these lipids in NASH patients and controls; and (3) to determine whether there is a difference between NASH patients and controls with respect to the composition of FA within liver tissue. Liver samples will be graded histologically and the stage of NASH documented semi-quantitatively. Computer tomography will be used to quantify liver size and abdominal visceral fat; ultrasound will also be performed. The results of all of these measurements will be analyzed to determine their relationship with hepatic lipid content. NASH will become more clinically important in the future as the incidence of obesity and diabetes continue to rise in the United States. In combination with the clinical data obtained, an understanding of the contributions of FA sources to liver TG will aid in the development of future treatment strategies for this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISMS OF VIRAL RESISTANCE TO THERAPY IN CHRONIC HCV INFECTION Principal Investigator & Institution: Lindsay, Karen L.; Associate Professor; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2002 Summary: Recently published literature and our unpublished data suggests that HCV may develop several mechanisms to counter the effects of interferon (IFN) and ribavirin, the only therapy available for hepatitis C. The understanding of the mechanism of viral resistance to IFN and ribavirin is important in order to not only understand the mechanism by which recovery or non-recovery from chronic infection occurs during treatment, but also for future improvement in these therapies and the development of new antiviral therapy. Our group has unique collections of serum and liver biopsy samples from patients who received alpha interferon monotherapy, ribavirin monotherapy, or alpha interferon combined with ribavirin, thus allowing critical examination of the clinical significance of these potential mechanisms of viral resistance. The following specific aims will be pursued. Specific Aim 1: Examine the E2 and HS5a sequences in patients who are virological IFN-responders (including end-of-treatment responders and sustained responders) and non-responders (including patients with

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virologic breakthrough during therapy). The focus will be on the PKR, eIF2alphahomology domain (PePHD) of E2 and the interferon- sensitivity-determining region (ISDR) of ns5a. Specific Aim 2: Examine the ns5b sequences in patients who have undergone ribavirin-monotherapy, including ALT responders and non- responders (all of them, nevertheless, are virological non-responders). Specific Aim 3: Examine the E2, ns5a and ns5b sequences of patients who have undergone IFN and ribavirin combination therapy. Virological responders (including the end-of-treatment responders and sustained responders) and non-responders (including patients with virologic breakthrough during therapy). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MRI QUANTITATION OF TISSUE IRON IN HEMATOLOGIC DISORDERS Principal Investigator & Institution: Song, Hee Kwon; Radiology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 30-JUN-2007 Summary: (provided by applicant): Chronic iron overload leads to increased iron deposition in tissues. In chronically-transfused thalassemia patients, exogenous iron is stored in the spleen, liver, endocrine organs and heart. By contrast, in hereditary hemochromatosis iron overload occurs as a result of excessive absorption of iron from the diet. In both diseases, control of iron levels below the toxic threshold is essential. Further, since serum ferritin levels do not parallel tissue iron levels, periodic liver biopsies have to be performed. The invasive nature of this procedure calls for alternative, less traumatic approaches for multi-organ iron screening. Here we propose to implement, validate and apply to patients with thalassemia, a MRI-based quantitative tissue iron mapping technique focusing on the liver and heart, to evaluate the hypothesis that tissue iron levels can be measured accurately and reproducibly. The method is based on the GESFIDE imaging technique developed in the investigators' laboratory. This method allows efficient measurement of T2'and T2, the RF-reversible and RF-irreversible transverse relaxation times, both known to be reduced at elevated tissue iron levels. The following specific aims will be pursued: 1. We shall fully develop and implement improved GESFIDE MRI iron mapping technique at 1.5 and 3T and examine its performance in human volunteers. 2. We shall evaluate the method's accuracy on specimens of a murine model of thalassemia in comparison to chemical assay. 3. We shall, in a pilot study of 30 patients with thalassemia, measure iron levels in the heart and liver at three time points during a three-year observation period and compare the results with liver biopsy data and to results in age- and gender-matched controls. 4. We shall, in the patients of specific aim #3, evaluate cardiac function by MR to test the hypothesis that the severity of impaired function is associated with the degree of cardiac iron overload. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OCCULT HEPATITIS B Principal Investigator & Institution: Torbenson, Michael S.; Pathology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008 Summary: (provided by applicant): The goal of this proposal is to provide Michael Torbenson, MD with a period of mentorship in the proper scientific environment so that he can acquire the necessary skills to become an independent clinician-scientist. Dr.

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Torbenson has a strong background in diagnostic liver pathology and has a specific interest in viral hepatitis. This proposal focuses on occult hepatitis B, an emerging infectious entity of potentially large medical significance. Occult hepatitis B has been associated with advanced liver fibrosis, coinfection with hepatitis C, IFN alpha resistance in treatment of hepatitis C, and hepatocellular carcinoma. The overall aim of Dr. Torbenson's proposal is to assess the prevalence and clinical significance of occult hepatitis B in high risk patient population of injection drug users. This study utilizes the unique resources of a pre-existing longitudinal collection of sera and liver tissue from the mentor's ongoing research, allowing assessment of the prevalence of occult hepatitis B over time and estimation of the rate of fibrosis progression in these individuals. The first aim examines the overall prevalence of occult hepatitis B and investigates the impact of Human Immunodeficiency Virus status on the presence of occult hepatitis B. The second aim assess the clinical significance of occult hepatitis B by correlating the presence of occult hepatitis B with the amount of inflammation and fibrosis on liver biopsy. The rate of fibrosis progression will be investigated by comparing the amount of fibrosis on initial liver biopsy to that on follow-up biopsies. In addition, aim 2 will examine the role of occult hepatitis B in HIV progression. The third aim focuses on potential mechanisms of occult hepatitis B and seeks to identify relevant hepatitis B gene mutations. As a final element of this aim, carefully selected (based on known involvement in typical hepatitis B viral infection) signaling pathways will be investigated by analysis of mRNA and protein expression to investigate host-viral interactions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PILOT TRIAL OF SILYMARIN IN PATIENTS WITH HCV AND HIV Principal Investigator & Institution: Sacks, Henry S.; Director; Community and Preventive Med; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2004; Project Start 01-NOV-2003; Project End 31-OCT-2005 Summary: (provided by applicant): The objective of this project is to assess the feasibility of investigating the effect of silymarin, derived from the milk thistle plant, Silybum marianum (L.) Gaertn. in preventing or reversing the complications of chronic infection with hepatitis C virus (HCV) in patients with human immunodeficiency virus (HIV), to serve as the basis of a more definitive study. Allopathic therapeutic interventions for HCV are expensive and poorly tolerated, particularly with the genotype most commonly encountered in the US. There are limited rigorous assessments of the dietary supplement milk thistle, but there is suggestion of benefit and much interest on the part of co-infected patients and their providers. Specific aims: 1) To collect preliminary information on the safety and tolerability of milk thistle in HCV and HIV co-infected patients who are not on highly active antiretroviral therapy (HAART). 2)To collect preliminary information on the safety and tolerability of milk thistle in HCV and HIV co-infected patients who are on highly active antiretroviral therapy (HAART). 3) To collect preliminary information on the efficacy of milk thistle in HCV and HIV coinfected patients in preparation for a larger, more definitive trial. Co-infected patients will be randomly assigned to receive silymarin or a similar appearing placebo. Participants will be recruited from a large cohort of HCV-infected individuals currently enrolled in a large inner-city AIDS center. Participants will receive the study treatment daily for 52 weeks. Measures to be assessed will include: retention in the study, compliance with study assignment, self-described symptoms, liver enzyme levels, viral load and clearance, and quality of life (SF36 survey), and liver biopsy when available. It

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is hypothesized that silymarin can prevent progression of liver disease and possibly reverse hepatic lesions that are already present, as well as improve the quality of life. This exploratory project is anticipated to provide data to plan larger and more definitive studies of the effect of milk thistle on HCV infection. Evidence of beneficial effect of an inexpensive and benign herbal dietary supplement would have great impact on the large population suffering from chronic HCV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PILOT--ALCOHOL AND HEPATITIS C HOST RESPONSE AND DISEASE ACTIVITY Principal Investigator & Institution: Fried, Michael W.; Associate Professor of Medicine; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2003; Project Start 27-DEC-2002; Project End 30-NOV-2007 Summary: The clinical spectrum of chronic hepatitis C is variable and the factors responsible for these divergent outcomes remain unknown. Alcohol consumption has been identified as a co-factor in accelerating the progression of liver disease in patients with chronic hepatitis C. Studies of this issue are difficult because there is no animal model of hepatitis C-induced fibrosis. We propose to prospectively study a cohort of patients infected with hepatitis C who also consume alcohol to define the effects of alcohol consumption on hepatic fibrogenesis, oxidant stress, and expression of mediators of inflammation and fibrogenesis in liver tissue and peripheral blood mononuclear cells. The hypothesis to be tested is that alcohol consumption will increase markers of hepatic inflammation, fibrogenesis and oxidant stress, and ultimately reflect an increase in the progression of liver disease. Subjects with concurrent hepatitis C infection on ongoing alcohol use/abuse will undergo a detailed clinical evaluation, including liver biopsy and blood sampling. A control group of non-drinking subjects with chronic hepatitis C will be matched for gender, estimated duration of HCV infection, and mode of HCV acquisition. We will study the effects of alcohol use on hepatic fibrogenesis using standard histologic techniques and novel immunohistochemical markers of stellate cell activation (alpha-smooth muscle actin, collagen II propeptide) in liver biopsy specimens from alcohol consuming and nondrinking patients with chronic hepatitis C. We will also evaluate lipid peroxidation production products using immunohistochemical techniques with antibodies to 4nonalal and malondealdehyde. In addition, using specimens obtained from these two cohorts, we will identify mRNAs in liver tissue and peripheral blood mononuclear cells encoding host mediators of inflammation and fibrogenesis that are up-regulated in patients with hepatitis C who consume alcohol. This information will provide key information for developing additional hypotheses to be tested in a larger clinical trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PORPHYRIN BIOSYNTHESIS IN NORMAL AND DISEASE STATES Principal Investigator & Institution: Kushner, James P.; Professor of Medicine; Internal Medicine; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002; Project Start 01-SEP-1977; Project End 30-JUN-2007 Summary: (provided by applicant): Porphyria cutanea tarda (PCT), the most common form of porphyria in humans, is due to sub-normal activity of uroporphyrinogen decarboxylase (URO-D), a cytosolic enzyme in the heme biosynthetic pathway. Our preliminary data indicate that diminished activity of URO-D in the livers of rodents

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with experimentally induced porphyria and in humans with PCT is due to the generation of a low-molecular-weight inhibitor. Generation of the inhibitor can be initiated by both environmental and genetic factors, and involves an iron-catalyzed reaction. We hypothesize that the inhibitor is generated from oxidized hydroxymethyl bilane, an early intermediate in the heme biosynthetic pathway. We propose to chemically synthesize this inhibitor and to establish that an identical compound is generated in vivo in rats and mice with experimental porphyria. We have identified the presence of a URO-D inhibitor in liver biopsy samples from subjects with PCT. We plan to confirm this finding in additional subjects and to establish that the inhibitor occurs only in patients with PCT by attempting to detect inhibitor in liver biopsy samples from patients with hepatitis C, alcoholic liver disease, and hemochromatosis. Murine models of PCT will be developed in carefully characterized genetic backgrounds by intercrossing a strain we have generated by disrupting one allele of the URO-D gene (URO-D+/- mice). These animals have been intercrossed with homozygous hemochromatosis knockout animals (HFE-/-) and the resultant animals develop PCT without the need for any exogenous agents. We plan introduce null alleles of cytochrome P4501A2 (CYP1A2) and null alleles of peroxisome proliferator activated receptor (PPARa) onto the URO-D+/-:HFE-/- background to define the genetic components required for the development of experimental PCT. Our findings in PCT could serve as a paradigm for other dominantly transmitted porphyrias where clinical expression cannot be simply explained by half-normal activity of non-rate-limiting heme biosynthetic enzymes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RCT OF SAME IN ALCOHOLIC LIVER DISEASE Principal Investigator & Institution: Mendler, Michel H.; Medicine; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2004; Project Start 01-JUN-2004; Project End 31-MAY-2007 Summary: (provided by applicant): Background: Alcoholic liver disease is one of the most important causes of chronic liver disease in this country. There is currently no treatment for chronic alcoholic liver disease other than abstinence. Hepatic methionine metabolism is abnormal in these patients and one of the consequences is depletion of Sadenosylmethionine (SAMe) levels, which can affect numerous important cellular processes. SAMe has been increasingly utilized for the treatment of liver diseases although the protective mechanisms remain unclear. A recent randomized double-blind trial using SAMe in patients with alcoholic liver disease and found improvement in 2year survival in those with less advanced liver disease. However, important changes in methionine metabolism and histological changes were not included in the study. Aim: The goal of this study is to determine the effect of SAMe administration on key metabolic abnormalities of the methionine cycle and on the recovery from alcoholic liver disease. Methods: This is a randomized, double blind, placebo-controlled trial. Thirty patients with stable alcoholic hepatitis (Maddrey Score < 32) without cirrhosis who meet entry criteria will receive either 400 mg of SAMe (n=15) or placebo (n=15) three times a day for the duration of one year. History, physical assessment, various blood tests and a liver biopsy will be performed prior to treatment. Patients will have repeat blood tests on subsequent follow-up visits every month for the first two months, then every two months thereafter. They will also be encouraged to abstain from alcohol during these visits. A post-treatment liver biopsy will be obtained at the end of the trial. The primary outcome parameters include serum homocysteine, SAMe and TNFalpha levels, and the expression of key hepatic enzymes of the methionine cycle and of hepatic SAMe and

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glutathione levels. Histological progression of alcoholic liver disease, clinical and biochemical indices of liver disease, and quality of life assessment will also be examined. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESISTANCE TO ANTIVIRAL THERAPY IN CHRONIC HEPATITIS C Principal Investigator & Institution: Terrault, Norah A.; Medicine; University of California San Francisco 3333 California Street, Suite 315 San Francisco, Ca 941430962 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 30-JUN-2006 Summary: (provided by applicant): An estimated 600,000 African-Americans have chronic hepatitis C virus (HCV) infection, representing 22% of the total infected population in the U.S. Prior studies suggest African-Americans with chronic HCV infection have a lower rate of response to anti-viral therapy than non-Hispanic whites. The difference is, in part, related to the predominance of genotype 1 among AfricanAmericans. Response rates appear to higher with combination interferon plus ribavirin than with interferon monotherapy. However, the studies to date have included very low numbers of African-American subjects (<5%), limiting the interpretation of response rates. In the proposed study, the rate of sustained virological response (viral clearance) to pegylated interferon plus ribavirin will be compared in 200 African Americans and 200 non-Hispanic whites. The clinical, biochemical, or virological factors which predict sustained virological response to anti-viral therapy and reduced inflammatory activity on liver histology will be determined and early viral kinetics will be examined as a predictor of response or non-response. This collaborative study involving eight clinical centers will also provide the clinical data and biological specimens to coinvestigators focused on determining the virological, cellular, immunological and genetic factors that underlie the response to antiviral therapy in hepatitis C. Pegylated interferon plus interferon is chosen as the anti-viral intervention because combination therapy has been shown to be superior to interferon monotherapy and preliminary data indicate pegylated interferons are superior to standard interferons. Additionally, the convenience of once weekly dosing may improve compliance. Participants will undergo liver biopsy prior to study entry and at end of follow-up (96 wks). Virological analyses include HCV RNA quantitation (qualitative and quantitative) and HCV genotyping. Baseline assessments include demographic (using self-reporting of race/ethnicity) risk factor assessment, biochemistry and hematology, quality-of-life and fatigue assessments. Follow-up visits will include adverse events inquiry, assessment of compliance, collection of serum and peripheral blood mononuclear cells for virological analyses, and repeat liver biopys 48 weeks after completion of treatment. All study visits, including liver biopsies, will occur in the General Clinical Research Center. The primary treatment outcome is loss of HCV RNA at 96 weeks (48 weeks post-treatment). Secondary endpoints include loss of HCV RNA at 48 weeks; normalization of liver enzymes and improvement in histological inflammatory indices at 96 weeks; and tolerability (assessed by? adverse event inquiry and fatigue questionnaires). This study will accurately define the sustained response rates with optimal anti-viral therapy in African-Americans and provide important insights into the factors underlying differences in response compared to non-Hispanic whites. Moreover, the methodologies developed for patient outreach within the context of this collaborative study will serve as a model for enhancing participation of African Americans in clinical research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RETROVIRUS ISOLATION FROM PRIMARY BILIARY CIRRHOSIS Principal Investigator & Institution: Mason, Andrew; University of Alberta Edmonton T6g 2E1, Canada Edmonton, Ab Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Approximately 1 in 2,000 women above the age of 50 develop primary biliary cirrhosis (PBC). There is no cure for this progressive hepatobiliary disease, which is one of the major indications for liver transplantation in the US. About 95% of patients develop anti-mitochondrial antibodies (AMA) reactive to pyruvate dehydrogenase complex E2 component (PDC-E2), which is aberrantly expressed on cell surface of biliary epithelial cells of patients with PBC. This abnormal distribution of PDC-E2 is only observed in patients with PBC and considered a phenotypic manifestation of the disease. We have cloned an exogenous retrovirus from a PBC biliary epithelium cDNA library with homology to betaretroviruses. Most PBC patients have specific antibody reactivity to the virus by Western blot and evidence for infection in lymph nodes using RT-PCR and immunohistochemistry. Also, we have found that affinity purified AMA from PBC patient's serum react with the virus. To study the viral infection in vitro, we have developed a model for PBC by co-culturing normal biliary epithelium cells with perihilar lymph nodes from patients with chronic liver disease. The biliary epithelium cells incubated with PBC lymph node extracts express increased levels of PDC-E2 autoantigen after 5 days, which is a finding specific for the PBC co-cultures. The supernatants from the PBC co-cultures also induce PDC-E2 expression in fresh biliary epithelial cells, which can be abrogated by gamma irradiation. We have also demonstrated that the development of the PBC phenotype corresponds with betaretrovirus infection in the biliary epithelium cells and supernatants. In a pilot study of anti-retroviral therapy with Combivir, 40% of patients completely normalized their liver function tests and there was a significant reversal of ductopenia on liver biopsy. In order to test the hypothesis that a retrovirus is associated with PBC, we plan to isolate the retrovirus and use our in vitro model of PBC to demonstrate that the specific isolate induces the phenotypic manifestation of disease in normal biliary epithelial cells. We will then assess whether patients with PBC have serologic evidence for infection. We anticipate that our studies will help to further our knowledge of how viral infections can promote autoimmune disorders and provide alternative strategies to help manage PBC patients with anti-viral therapy or vaccination for susceptible individuals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ROLE OF LIVER CYTOKINES IN HEPATITIS C VIRAL INFECTION Principal Investigator & Institution: Liu, Chen; Assistant Professor; Pathology, Immunol & Lab Med; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and liver cancer, and is the most common indication for liver transplantation in the United States. The hallmarks of the HCV infection are viral persistence and liver cell injury. The underlying molecular mechanisms remain poorly understood. Cytokines appear to play a critical role in viral clearance and liver tissue damage. The Long-Term Goal of our research program is to understand how antiviral cytokines modulate viral RNA replication and the predictive role of these cytokines in response to interferon alpha treatment. In support of this goal, our Preliminary Studies have 1) demonstrated that IFN` and FGF1 have a direct effect on HCV viral subgenomic

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RNA (replicon) replication in hepatoma cells; 2) identified several IFN` responsive genes potentially responsible for its antiviral activity in the replicon cell lines; 3) established a cytokine-related cDNA microarray system and established the feasibility of carrying out microarray experiment using liver biopsy tissues. These studies have led us to formulate a Central Hypothesis of this proposal, that antiviral cytokines such as IFN` or others are critical in viral clearance by direct inhibition of viral replication within hepatocytes; and the presence of these cytokines before IFN` treatment can predict the responsiveness to the therapy. In the Specific Aims we will: 1) determine the efficacy of cytokines such as IFN` and FGF1 on inhibiting HCV viral RNA replication and to identify the key intracellular signaling molecules responsible for this effect; and 2) identify cytokines that favor viral clearance versus viral persistence through analyzing HCV-infected liver tissues before and after IFN-based treatment. To address these aims, we will utilize the existing HCV replicon cell line for in vitro mechanistic studies and carry out microarray experiments using liver biopsy tissues to determine the role of antiviral cytokines in HCV-infected patients. This proposal will delineate how IFN` and FGF1 exert antiviral activity within hepatocytes, and will identify cytokines that predict viral clearance in HCV viral infection. This study will enhance our understanding of the host and hepatitis C virus interactions underlying the pathogenesis of viral chronic infection. The candidate's long-term career goal is to be an independent physician scientist conducting translational research. The immediate career goal is to develop the scientific reasoning and skills necessary for a successful research career by carrying out the current research proposal. Our institution provides an outstanding supportive environment for career development. This funding mechanism will give the candidate the opportunity to establish an independent research career. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SECONDARY HEMOCHROMATOSIS IN BETA THALASSEMIA AND SCD Principal Investigator & Institution: Vichinsky, Elliott P.; Director; Children's Hospital & Res Ctr at Oakland Research Center at Oakland Oakland, Ca 946091809 Timing: Fiscal Year 2002; Project Start 01-AUG-2000; Project End 31-JUL-2005 Summary: (adapted from the application) The purpose of this study is to determine whether the pathologic effects of iron overload secondary to hypertransfusion are different in SCD and beta thalassemia. Iron-related organ injury and death are common in patients with beta thalassemia. Similar organ pathology and mortality have not been reported in SCD after hypertransfusion. Differences in organ and cellular iron localization, cellular processing of iron, inflammatory state, or the generation of reactive low molecular weight iron might explain the differences in disease response. Pilot data shows that the severity of iron overload is similar in hypertransfused patients with SCD and beta thalassemia, yet the rate of organ dysfunction (heart, endocrine) is much greater in beta thalassemia. The primary hypothesis of this study is that hypertransfused patients with SCD show less organ damage than patients with beta thalassemia. The specific aims of the study are: 1) to determine the organ and cellular distribution of iron in hypertransfused patients with beta thalassemia and SCD, 2) to determine whether severe organ damage occurs less frequently in hypertransfused patients with SCD than in patients with beta thalassemia and to evaluate whether markers for early organ dysfunction can be identified and used to guide chelation therapy, 3) to determine the molecular differences in ferritin between SCD and beta thalassemia which could account for a difference in iron deposition in response to chronic RBC transfusion. Organ and cellular iron distribution will be determined 1) post-mortem by histologic and chemical

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analyses of tissues obtained from hypertransfused patients with SCD or betathalassemia matched for age, transfusion volume, sex, and 2) pre-mortem, at an earlier stage of morbidity, by quantitative and histologic analyses of liver biopsy and bone marrow aspirates. Quantitative CT will be used to compare the organ distribution of iron in the two diseases. The frequency of severe organ damage (heart disease, diabetes, spinal fracture) will be determined prospectively over 3 years in a multicenter study (200 patients) to confirm the primary hypothesis. Evidence for early organ dysfunction will be sought using sensitive markers in patients (20 patients) followed prospectively for 4 years at CHO. In summary, if this study is successful and demonstrates a strong difference in the toxicity of severe iron overload in SCD as compared to beta thalassemia, it will change the approach to chelation therapy in hypertransfused patients with SCD, lead to reduced chelator-related toxicity, and improve quality of life in these patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STUDIES OF MECHANISMS AND TREATMENT OF LIVER DISEASE Principal Investigator & Institution: Sanyal, Arun J.; Associate Professor; Internal Medicine; Virginia Commonwealth University Richmond, Va 232980568 Timing: Fiscal Year 2002; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: This candidate is an Associate Professor of Gastroenterology and Hepatology at the Medical College of Virginia (MCV). He has played a key role in the growth of the Hepatology program at MCV and has won national recognition for his research on the role of transjugular intrahepatic portasystemic shunts (TIPS) in the treatment of portal hypertension. His career goals are: (1) to be an outstanding clinician, (2) to be a leading scientist in patient- oriented research in liver disease, and (3) to train junior clinicians as bio-medical scientists. This application has been written to mainly consolidate his status as a clinical scientist and teacher. During the period of the proposed studies, the candidate will perform research and serve as a mentor to junior colleagues. Two specific research projects will be performed: (1) a randomized prospective multi-center trial of total paracenteses (TP) vs TP + TIPS for refractory ascites of which he is the principal investigator. (2): studies on the pathogenesis of nonalcoholic steatohepatitis (NASH), a common yet poorly understood disease. It is hypothesized that susceptibility to NASH results from spontaneous mutations of mitochondrial DNA (mtDNA) which cause defective expression of electron-transport chain enzymes in a fraction of hepatocyte mitochondria. Functionally, this results in abnormal oxidation/phosphorylation. when such individuals develop insulin-resistance e.g. from obesity or diabetes, increased lipolysis provides more fatty acid for hepatic uptake and beta oxidation. The resultant oxidative stress in hepatocytes with abnormal mitochondria generates free radicals which cause lipid peroxidation and cell injury. This will be tested by (1) comparison of insulin sensitivity and lipolysis in patients with NASH to three control groups( nonalcoholic fatty liver, matched normal controls, and non-fatty liver disease) using an euglycemic clamp, (2) comparison of hepatocyte mitochondrial structure and function across these four groups by electron microscopy and histochemical assessment of cytochrome oxidase and succinate dehydrogenase, (3) comparison of lipid peroxides in liver biopsy homogenates across these four groups, and (4) comparison of the prevalence and types of mtDNA mutations across these four groups. The latter studies will be done by Dr. Vantuyle (Dept. Biochem, MCV). The institutional and departmental environment as well as the facilities and resources are excellent for career development in academic medicine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Liver Biopsy

Project Title: THE PROGRESSION OF HEPATITIS C AMONG IDUS Principal Investigator & Institution: Thomas, David L.; Professor of Medicine; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): In the United States, injection drug use is the principal route of hepatitis C virus (HCV) transmission and most persons who inject illicit drugs (IDUs) have HCV infection. The chief medical consequence of HCV infection is liver failure, which occurs after a progressive accumulation of fibrosis, a process that currently can only be detected reliably by biopsy. By carefully evaluating (including a liver biopsy) a random sample of 210 community-based, HCV-infected IDUs, we learned that some IDUs met published treatment criteria but almost none had been treated and that passive methods of counseling and referral did not improve treatment acquisition. These findings have led us to investigate methods to improve care delivery by (1) intensive case-management of the subset of IDUs that most need treatment and (2) detection of that subset by testing minimally-invasive markers of significant liver fibrosis. In this grant, we propose using the unique resources already established to expand our understanding of liver fibrosis progression among IDUs. The first aim is to evaluate demographic and behavioral markers of fibrosis progression. By the start of this investigation, a second liver biopsy will have been done on IDUs from the original group of 210. The rate of progression of liver fibrosis will be calculated according to gender, age, alcohol use history, and HIV infection status by subtracting the fibrosis score of the first from the second biopsy and dividing by the years between. The second aim is to develop blood markers of fibrosis progression, using a repository of sera collected every six months and at the biopsy visits. The third aim is to expand our understanding of fibrosis progression by carefully comparing viral sequence evolution and adaptive immune responses for a subset of IDUs with a high fibrosis progression rate and controls with low rates of progression. Collectively, this research will expand our understanding of liver fibrosis progression, substantially improving our ability to identify HCV-infected IDUs who are at greatest risk of disease. A high likelihood of success is anticipated since the work builds on precious existing resources and will be performed by a team of investigators who have already demonstrated the necessary skills. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals.

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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To generate your own bibliography of studies dealing with liver biopsy, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “liver biopsy” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for liver biopsy (hyperlinks lead to article summaries): •

A case of hemobilia after percutaneous liver biopsy treated by transcatheter arterial embolization with Histoacryl. Author(s): Murata K, Oohashi Y, Takase K, Nakano T, Tameda Y. Source: The American Journal of Gastroenterology. 1996 January; 91(1): 160. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8561122

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A histological semiquantitative scoring system for evaluation of hepatic fibrosis in needle liver biopsy specimens: comparison with morphometric studies. Author(s): Chevallier M, Guerret S, Chossegros P, Gerard F, Grimaud JA. Source: Hepatology (Baltimore, Md.). 1994 August; 20(2): 349-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8045495

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A survey of current liver biopsy practice patterns. Author(s): Muir AJ, Trotter JF. Source: Journal of Clinical Gastroenterology. 2002 July; 35(1): 86-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12080233

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Abdominal sonogram may prevent complications from liver biopsy. Author(s): Zackheim HS, Goldstein RB. Source: Journal of the American Academy of Dermatology. 1994 October; 31(4): 690-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8089307

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Abnormal liver function tests following bone marrow transplantation: aetiology and role of liver biopsy. Author(s): Ho GT, Parker A, MacKenzie JF, Morris AJ, Stanley AJ. Source: European Journal of Gastroenterology & Hepatology. 2004 February; 16(2): 15762. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15075988

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Acute cholecystitis secondary to hemobilia after percutaneous liver biopsy. Author(s): Coelho JC, Bonin EA, da Costa MA, da Cunha AG, Sartor MA. Source: Digestive Surgery. 2001; 18(3): 227-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11464018

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Acute pancreatitis with hemobilia following percutaneous liver biopsy. Author(s): Sood A, Midha V, Kumar A, Sood N. Source: Indian J Gastroenterol. 2002 March-April; 21(2): 81-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11990337

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Acute sickle cell hepatopathy represents a potential contraindication for percutaneous liver biopsy. Author(s): Zakaria N, Knisely A, Portmann B, Mieli-Vergani G, Wendon J, Arya R, Devlin J. Source: Blood. 2003 January 1; 101(1): 101-3. Epub 2002 August 15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12393551

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Adrenal gland sampling during transjugular liver biopsy leads to misdiagnosis of hepatocellular carcinoma. Author(s): Morales CP, Saboorian MH, Miller GL, Lee WM. Source: The American Journal of Gastroenterology. 1999 October; 94(10): 3071-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10520878

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Airway obstruction after trans-jugular liver biopsy: anaesthetic management. Author(s): Smurthwaite GJ, Letheren MJ. Source: British Journal of Anaesthesia. 1995 July; 75(1): 102-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7669447

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Allograft liver biopsy in patients with Epstein-Barr virus-associated posttransplant lymphoproliferative disease. Author(s): Randhawa P, Blakolmer K, Kashyap R, Raikow R, Nalesnik M, Demetris AJ, Jain A. Source: The American Journal of Surgical Pathology. 2001 March; 25(3): 324-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11224602

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An assessment of digital image analysis to measure fibrosis in liver biopsy specimens of patients with chronic hepatitis C. Author(s): O'Brien MJ, Keating NM, Elderiny S, Cerda S, Keaveny AP, Afdhal NH, Nunes DP. Source: American Journal of Clinical Pathology. 2000 November; 114(5): 712-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11068544

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Appropriateness of liver biopsy. Author(s): Poynard T, Ratziu V, Bedossa P. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2000 June; 14(6): 543-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10888734

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Arterioportal fistula and hemobilia with associated acute cholecystitis: a complication of percutaneous liver biopsy. Author(s): Cacho G, Abreu L, Calleja JL, Prados E, Albillos A, Chantar C, Perez Picouto JL, Escartin P. Source: Hepatogastroenterology. 1996 July-August; 43(10): 1020-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8884332

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Arterioportal fistula causing acute pancreatitis and hemobilia after liver biopsy. Author(s): Machicao VI, Lukens FJ, Lange SM, Scolapio JS. Source: Journal of Clinical Gastroenterology. 2002 April; 34(4): 481-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11907368

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Arterioportal fistula following liver biopsy demonstrated by lipiodol computed tomography. Author(s): Lee WK, Stuckey S. Source: Clinical Radiology. 2000 June; 55(6): 489-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10873701

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Arterioportal fistula following liver biopsy. Three cases occurring in liver transplant recipients. Author(s): Jabbour N, Reyes J, Zajko A, Nour B, Tzakis AG, Starzl TE, Van Thiel DH. Source: Digestive Diseases and Sciences. 1995 May; 40(5): 1041-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7729261

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Assessment of prognosis in alcoholic liver disease: can serum hyaluronate replace liver biopsy? Author(s): Phillips MG, Preedy VR, Hughes RD. Source: European Journal of Gastroenterology & Hepatology. 2003 September; 15(9): 941-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12923364

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Audit of percutaneous liver biopsy. Author(s): Fisher N. Source: Gut. 1995 August; 37(2): 296-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7557588

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Audit of percutaneous liver biopsy. Author(s): Jolobe OM. Source: Gut. 1995 August; 37(2): 296; Author Reply 297. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7557587

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Bacteremia after liver biopsy. Author(s): McCloskey RV, Gold M, Weser E. Source: Archives of Internal Medicine. 1973 August; 132(2): 213-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4578268

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Bil pleuritis: another complication of percutaneous liver biopsy. Author(s): Dosik MH. Source: Am J Dig Dis. 1975 January; 20(1): 91-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1115055

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Bile ascites following percentaneous trucut needle liver biopsy. Author(s): Sahni A, Thapa BR, Mehta S. Source: Indian J Gastroenterol. 1990 January; 9(1): 98-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2307511

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Bile duct paucity - making a case for liver biopsy in the investigation of neonatal cholestasis. Author(s): Sibal A, Mishra U. Source: Indian Pediatrics. 2001 December; 38(12): 1430-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11752749

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Bile leakage as a complication of liver biopsy in liver transplants. Author(s): Paymani M, Zajko AB, Campbell WL. Source: Abdominal Imaging. 1993; 18(3): 258-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8508087

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Bile peritonitis after liver biopsy: nonsurgical management of a patient with an acute abdomen: a case report with review of the literature. Author(s): Ruben RA, Chopra S. Source: The American Journal of Gastroenterology. 1987 March; 82(3): 265-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3548330

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Bile peritonitis and hemobilia after percutaneous liver biopsy: endoscopic retrograde cholangiopancreatography demonstration of bile leak. Author(s): Taylor JD, Carr-Locke DL, Fossard DP. Source: The American Journal of Gastroenterology. 1987 March; 82(3): 262-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3826034

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Bilious pleural effusion following liver biopsy. Author(s): Pisani RJ, Zeller FA. Source: Chest. 1990 December; 98(6): 1535-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2245707

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Biochemical markers of hepatic fibrogenesis: single measurements are not reliable enough to replace liver biopsy. Author(s): George J. Source: Journal of Gastroenterology and Hepatology. 2000 August; 15(8): 819-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11022820

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Bioplast fibrin buttons for liver biopsy and partial hepatic resection. Author(s): Wood CB, Capperauld I, Blumgart LH. Source: Annals of the Royal College of Surgeons of England. 1976 September; 58(5): 4014. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=970888

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Biopsy evaluation of chronic active hepatitis. Peritoneoscopy with directed liver biopsy versus blind percutaneous liver biopsy. Author(s): Wytock DH, Coleman TW, Sharp JR, Brady CE 3rd, Baybick JA, Bagnall JW. Source: Journal of Clinical Gastroenterology. 1988 June; 10(3): 320-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2980998

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Bleeding after liver biopsy does not correlate with indices of peripheral coagulation. Author(s): Ewe K. Source: Digestive Diseases and Sciences. 1981 May; 26(5): 388-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7249879

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Bleeding after liver biopsy in a patient with systemic mastocytosis and malabsorption. Author(s): Adler SN, Klein RA, Lyon DT. Source: Journal of Clinical Gastroenterology. 1985 August; 7(4): 350-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4045181

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Bleeding after liver biopsy. Author(s): Kondlapoodi P. Source: The Western Journal of Medicine. 1982 July; 137(1): 77-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7135943

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Bleeding after liver biopsy. Author(s): Mahal AS, Knauer CM, Gregory PB. Source: The Western Journal of Medicine. 1981 January; 134(1): 11-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7210659

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Bleeding complications after percutaneous liver biopsy. An analysis of risk factors. Author(s): Terjung B, Lemnitzer I, Dumoulin FL, Effenberger W, Brackmann HH, Sauerbruch T, Spengler U. Source: Digestion. 2003; 67(3): 138-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12853725

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Blind and target liver biopsy in the diagnosis of malignant liver diseases--a comparison. Author(s): Atoba MA. Source: Cent Afr J Med. 1984 November; 30(11): 225-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6241502

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Blind and ultrasound-guided percutaneous liver biopsy in children. Author(s): Nobili V, Comparcola D, Sartorelli MR, Natali G, Monti L, Falappa P, Marcellini M. Source: Pediatric Radiology. 2003 November; 33(11): 772-5. Epub 2003 September 05. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12961044

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Blind liver biopsy in children--diagnostic significance and complications in authors' own material. Author(s): Lebensztejn DM, Kaczmarski M, Sobaniec-Lotowska M, Barwijuk-Machala M. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2000 November-December; 6(6): 1155-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11208472

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Blood transfusion requirements after liver biopsy. Author(s): O'Brien BD. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2000 November; 14(10): 901-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11111113

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Can one predict when ultrasound will be useful with percutaneous liver biopsy? Author(s): Ahmad M, Riley TR 3rd. Source: The American Journal of Gastroenterology. 2001 February; 96(2): 547-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11232704

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Can pre-emptive analgesia reduce pain experienced after liver biopsy? Author(s): Ferencz S, Batey R. Source: Internal Medicine Journal. 2002 March; 32(3): 122-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11885843

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Cardiovascular collapse after laparoscopic liver biopsy. Author(s): Shaughnessy TE, Raskin D. Source: British Journal of Anaesthesia. 1995 December; 75(6): 782-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8672332

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Case report. Diagnosis of disseminated Mycobacterium avium complex infection by liver biopsy. Author(s): Shah SR, Rastegar DA, Nicol TL. Source: Aids Read. 2000 November; 10(11): 669-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11186192

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Cecal volvulus after laparoscopic liver biopsy. Author(s): Ulloa SA, Ramirez LO, Ortiz VN. Source: Bol Asoc Med P R. 1997 October-December; 89(10-12): 195-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9577055

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Cholestatic hepatitis after ingestion of chaparral leaf: confirmation by endoscopic retrograde cholangiopancreatography and liver biopsy. Author(s): Alderman S, Kailas S, Goldfarb S, Singaram C, Malone DG. Source: Journal of Clinical Gastroenterology. 1994 October; 19(3): 242-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7806838

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Chronic viral hepatitis: liver biopsy, yes or no? Author(s): Castellano Tortajada G. Source: Rev Esp Enferm Dig. 2002 October; 94(10): 613-24. Review. English, Spanish. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12647411

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Clinical utility of liver biopsy in children with acquired immunodeficiency syndrome. Author(s): Lacaille F, Fournet JC, Blanche S. Source: The Pediatric Infectious Disease Journal. 1999 February; 18(2): 143-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10048686

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Comment to the editorial: Liver biopsy in HIV-infected patients with chronic hepatitis C: pros and cons, by Vincent Soriano and Javier Garcia-Samaniego. Author(s): Puoti M, Bruno R, Castelli F, Filice G, Carosi G. Source: Hiv Clinical Trials. 2002 September-October; 3(5): 419-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12407492

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Complications of percutaneous liver biopsy in infants and children. Author(s): Lachaux A, Le Gall C, Chambon M, Regnier F, Loras-Duclaux I, Bouvier R, Pinzaru M, Stamm D, Hermier M. Source: European Journal of Pediatrics. 1995 August; 154(8): 621-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7588960

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Complications of percutaneous liver biopsy. Author(s): Sparchez Z. Source: Rom J Gastroenterol. 2002 September; 11(3): 267-8; Author Reply 268-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12368949

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Complications of percutaneous liver biopsy. Author(s): Wawrzynowicz-Syczewska M, Kruszewski T, Boron-Kaczmarska A. Source: Rom J Gastroenterol. 2002 June; 11(2): 105-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12145665

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Congenital tuberculosis proven by percutaneous liver biopsy: report of a case. Author(s): Chou YH. Source: Journal of Perinatal Medicine. 2002; 30(5): 423-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12442608

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Contribution of transjugular liver biopsy in fulminant hepatic failure. Author(s): Macedo G, Maia JC, Carneiro F, Lopes S, Mota AM, Teixeira A, Ribeiro T. Source: Transplantation Proceedings. 2000 December; 32(8): 2643. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11134738

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Controlling pain in liver biopsy, or "we will probably need to repeat the biopsy in a year or two to assess the response". Author(s): Caldwell SH. Source: The American Journal of Gastroenterology. 2001 May; 96(5): 1327-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11374664

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Controversies in liver biopsy: who, where, when, how, why? Author(s): Friedman LS. Source: Current Gastroenterology Reports. 2004 February; 6(1): 30-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14720451

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Correlation of percutaneous liver biopsy fragmentation with the degree of fibrosis. Author(s): Malik AH, Kumar KS, Malet PF, Jain R, Prasad P, Ostapowicz G. Source: Alimentary Pharmacology & Therapeutics. 2004 March 1; 19(5): 545-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14987323

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Cost-effectiveness of ultrasonography in percutaneous liver biopsy. Author(s): Smith CI. Source: Hepatology (Baltimore, Md.). 1999 February; 29(2): 610. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10026028

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Cost-effectiveness of ultrasound-guided liver biopsy. Author(s): Pasha T, Gabriel S, Therneau T, Dickson ER, Lindor KD. Source: Hepatology (Baltimore, Md.). 1998 May; 27(5): 1220-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9581674

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Current liver biopsy practices for suspected parenchymal liver diseases in the United States: the evolving role of radiologists. Author(s): Angtuaco TL, Lal SK, Banaad-Omiotek GD, Zaidi SS, Howden CW. Source: The American Journal of Gastroenterology. 2002 June; 97(6): 1468-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12094867

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Decreasing frequency, with time, of hepatitis B surface antigen positive liver biopsy in hepatitis, cirrhosis, and hepatocellular carcinoma. Author(s): Senba M, Nakamura T, Toda T, Matsumura H. Source: Lancet. 1988 March 12; 1(8585): 588-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2894519

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Delayed fatal hemorrhage from pseudoaneurysm of the hepatic artery after percutaneous liver biopsy. Author(s): Ahmed A, Samuels SL, Keeffe EB, Cheung RC. Source: The American Journal of Gastroenterology. 2001 January; 96(1): 233-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11197259

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Delayed hemorrhage after percutaneous liver biopsy. Role of therapeutic angiography. Author(s): Kowdley KV, Aggarwal AM, Sachs PB. Source: Journal of Clinical Gastroenterology. 1994 July; 19(1): 50-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7930434

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Delayed massive hemobilia following percutaneous liver biopsy: treatment by embolotherapy. Author(s): Lichtenstein DR, Kim D, Chopra S. Source: The American Journal of Gastroenterology. 1992 December; 87(12): 1833-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1449153

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Delayed subcapsular hematoma after percutaneous liver biopsy as a manifestation of warfarin toxicity. Author(s): Scott DA, Netchvolodoff CV, Bacon BR. Source: The American Journal of Gastroenterology. 1991 April; 86(4): 503-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1849346

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Delayed symptomatic hemobilia after ultrasound-guided liver biopsy: a case report. Author(s): Rossi P, Sileri P, Gentileschi P, Sica GS, Ercoli L, Coscarella G, De Majo A, Gaspari AL. Source: Hepatogastroenterology. 2002 November-December; 49(48): 1659-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12397758

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Demonstration of Entamoeba histolytica from liver biopsy specimen. Author(s): Malhotra KC, Singh A, Ahuja IS. Source: J Assoc Physicians India. 1966 October; 14(10): 603-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4292278

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Detection of hepatitis C viral RNA sequences in fresh and paraffin-embedded liver biopsy specimens of non-A, non-B hepatitis patients. Author(s): Bresters D, Cuypers HT, Reesink HW, Chamuleau RA, Schipper ME, BoeserNunnink BD, Lelie PN, Jansen PL. Source: Journal of Hepatology. 1992 July; 15(3): 391-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1280289

•

Detection of hepatitis C virus RNA in formalin-fixed, paraffin-embedded thin-needle liver biopsy specimens. Author(s): Vogt S, Schneider-Stock R, Klauck S, Roessner A, Rocken C. Source: American Journal of Clinical Pathology. 2003 October; 120(4): 536-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14560564

•

Diagnosis of chronic liver disease: reproducibility and validation of liver biopsy. Author(s): Persico M, Palmentieri B, Vecchione R, Torella R, de SI. Source: The American Journal of Gastroenterology. 2002 February; 97(2): 491-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11866299

•

Diagnosis of fructose-1,6-bisphosphatase deficiency using cultured lymphocyte fraction: a secure and noninvasive alternative to liver biopsy. Author(s): Kikawa Y, Shin YS, Inuzuka M, Zammarchi E, Mayumi M. Source: Journal of Inherited Metabolic Disease. 2002 February; 25(1): 41-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11999979

Studies

41

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Diagnosis of hepatic allograft rejection: role of liver biopsy. Author(s): Aran PP, Bissel MG, Whitington PF, Bostwick DG, Adamac T, Baker AL. Source: Clinical Transplantation. 1993 October; 7(5): 475-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10146410

•

Diagnostic usefulness of percutaneous liver biopsy in HIV-infected patients with fever of unknown origin. Author(s): Garcia-Ordonez MA, Colmenero JD, Jimenez-Onate F, Martos F, Martinez J, Juarez C. Source: The Journal of Infection. 1999 March; 38(2): 94-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10342648

•

Diagnostic value of liver biopsy in alcoholic liver disease. Author(s): Talley NJ, Roth A, Woods J, Hench V. Source: Journal of Clinical Gastroenterology. 1988 December; 10(6): 647-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3068303

•

Differential diagnosis and prognosis of cirrhosis: role of liver biopsy. Author(s): Desmet VJ, Sciot R, Van Eyken P. Source: Acta Gastroenterol Belg. 1990 March-April; 53(2): 198-208. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2267899

•

Differential diagnosis of hereditary hemochromatosis from other liver disorders by genetic analysis: gene mutation analysis of patients previously diagnosed with hemochromatosis by liver biopsy. Author(s): Bartolo C, McAndrew PE, Sosolik RC, Cawley KA, Balcerzak SP, Brandt JT, Prior TW. Source: Archives of Pathology & Laboratory Medicine. 1998 July; 122(7): 633-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9674544

•

Disseminated coccidioidomycosis detected by percutaneous liver biopsy in a liver transplant recipient. Author(s): Dodd LG, Nelson SD. Source: American Journal of Clinical Pathology. 1990 January; 93(1): 141-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2294693

•

DNA ploidy pattern in human chronic liver diseases and hepatic nodular lesions. Flow cytometric analysis on echo-guided needle liver biopsy. Author(s): Anti M, Marra G, Rapaccini GL, Rumi C, Bussa S, Fadda G, Vecchio FM, Valenti A, Percesepe A, Pompili M, et al. Source: Cancer. 1994 January 15; 73(2): 281-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8293389

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Liver Biopsy

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Does liver biopsy provide sufficient diagnostic information to differentiate autosomal recessive from autosomal dominant polycystic kidney disease? Author(s): Cole BR. Source: Pediatric Nephrology (Berlin, Germany). 1994 August; 8(4): 411. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7947027

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Does noninvasive staging of fibrosis challenge liver biopsy as a gold standard in chronic hepatitis C? Author(s): Berg T, Sarrazin C, Hinrichsen H, Buggisch P, Gerlach T, Zachoval R, Zeuzem S. Source: Hepatology (Baltimore, Md.). 2004 May; 39(5): 1456-7; Author Reply 1457-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15122779

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Early detection of cytomegalovirus in the allograft liver biopsy: a comparison of methods. Author(s): Rabah R, Jaffe R. Source: Pediatr Pathol. 1987; 7(5-6): 549-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2453048

•

Early discharge after core liver biopsy: is it safe and cost-effective? Author(s): Bicknell SG, Richenberg J, Cooperberg PL, Tiwari P, Halperin L. Source: Canadian Association of Radiologists Journal = Journal L'association Canadienne Des Radiologistes. 2002 October; 53(4): 205-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12391926

•

Effect of protease pretreatment on immunomorphologic demonstration of hepatitis-Bsurface antigen in conventional paraffin-embedded liver biopsy material: quantitative evaluation. Author(s): Radaszkiewicz T, Dragosics B, Abdelfattahgad M, Denk H. Source: Journal of Immunological Methods. 1979; 29(1): 27-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=385783

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Electron microscopic analysis of sequential liver biopsy samples from patients with rheumatoid arthritis. Correlation with light microscopic findings. Author(s): Kremer JM, Kaye GI. Source: Arthritis and Rheumatism. 1989 October; 32(10): 1202-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2803323

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Embolic control of massive haematobilia after liver biopsy. Author(s): Doyle T, Tress B, Begley G. Source: Australasian Radiology. 1985 February; 29(1): 35-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4004666

Studies

43

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Endoscopic diagnosis and therapy of a case of bilhemia after percutaneous liver biopsy. Author(s): Sears RJ, Ishitani MB, Bickston SJ. Source: Gastrointestinal Endoscopy. 1997 September; 46(3): 276-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9378220

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Enzymatic sulphation of bile salts in man. Bile salt sulphotransferase activity in percutaneous liver biopsy specimens from patients with liver disease. Author(s): Loof L, Wengle B. Source: Scandinavian Journal of Gastroenterology. 1982 January; 17(1): 69-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6291135

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Enzyme histochemical investigation of ITO's cells in semithin sections of human liver biopsy specimens. Author(s): Korner T, Rath FW. Source: Acta Histochemica. 1989; 85(1): 73-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2523630

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Epithelioid hemangioendothelioma of the liver diagnosed by liver biopsy under laparoscopy. Author(s): Furuta K, Sodeyama T, Usuda S, Yoshizawa K, Kiyosawa K, Furuta S, Imai Y, Itoh N, Fukuzawa M, Hotchi M. Source: The American Journal of Gastroenterology. 1992 June; 87(6): 797-800. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1534200

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Epoxide hydrase in human liver biopsy specimens: assay and properties. Author(s): Oesch F, Thoenen H, Fahrlaender H. Source: Biochemical Pharmacology. 1974 April 15; 23(8): 1307-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4207548

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Estrogen receptors, progesterone receptors and heat-shock 27-kD protein in liver biopsy specimens from patients with hepatitis B virus infection. Author(s): Ciocca DR, Jorge AD, Jorge O, Milutin C, Hosokawa R, Diaz Lestren M, Muzzio E, Schulkin S, Schirbu R. Source: Hepatology (Baltimore, Md.). 1991 May; 13(5): 838-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1851492

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Evaluating liver disease in chronic hepatitis C--the role of the liver biopsy. Author(s): Baalmann-Mangano L, Brunt EM. Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2003 August 8; 5(3): 21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14600657

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Liver Biopsy

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Evaluation of a new fine needle technique in routine percutaneous liver biopsy. Author(s): Ali G, Lubcke R, Schlup M, Barbezat GO. Source: N Z Med J. 1990 April 25; 103(888): 184-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2330167

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Evaluation of HBV and HCV antigens expression in correlation with HBV DNA and HCV RNA occurrence in liver biopsy specimens of patients with chronic hepatitis type B and chronic hepatitis type C, respectively. Author(s): Walewska-Zielecka B, Swiderska H, Jonczyk M, Nowoslawski A. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2001 May; 7 Suppl 1: 147-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12211710

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Evaluation of hepatitis B and hepatitis C virus-infected renal allograft recipients with liver biopsy and noninvasive parameters. Author(s): Fehr T, Riehle HM, Nigg L, Gruter E, Ammann P, Renner EL, Ambuhl PM. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 July; 42(1): 193-201. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12830472

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Evidence of neurofibromatosis and chronic myelogenous leukemia in a liver biopsy specimen. Author(s): Ludwig J, Wester S, Elston AC. Source: Journal of Clinical Gastroenterology. 1993 April; 16(3): 265-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8505508

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Experience with liver biopsy in chronic hepatitis in children. Author(s): Kadas I, Peley I. Source: Zentralbl Allg Pathol. 1981; 125(3): 208-16. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7347964

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Experience with transjugular liver biopsy. Author(s): Bull HJ, Gilmore IT, Bradley RD, Marigold JH, Thompson RP. Source: Gut. 1983 November; 24(11): 1057-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6629116

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Experiences with two simple aspiration liver biopsy techniques. Author(s): Lundvall O, Iwarsson S. Source: Acta Med Scand. 1970 March 3; 187(3): 225-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5444979

Studies

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Factors associated with liver biopsy performance in HCV-HIV coinfected injecting drug users with HCV viremia: results from a five-year longitudinal assessment. Author(s): Rey D, Carrieri MP, Spire B, Loubiere S, Dellamonica P, Gallais H, Cassuto GP, Gastaut JA, Obadia Y; MANIF 2000 Study Group. Source: Journal of Urban Health : Bulletin of the New York Academy of Medicine. 2004 March; 81(1): 48-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15047783

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Failure of electron paramagnetic resonance spectroscopy studies to detect elevated free radical signals in liver biopsy specimens from patients with alcoholic liver disease. Author(s): Butcher GP, Raqabah A, Jackson MJ, Hoffman J, Rhodes JM, Symons MC. Source: Free Radical Research. 1995 February; 22(2): 99-107. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7704188

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Failure of percutaneous liver biopsy: anatomical variation. Author(s): Dixon AK, Nunez DJ, Bradley JR, Seymour CA. Source: Lancet. 1987 August 22; 2(8556): 437-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2887736

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Fatal haemorrhage following liver biopsy in patients with HIV infection. Author(s): Churchill DR, Mann D, Coker RJ, Miller RF, Glazer G, Goldin RD, Lucas SB, Weber JN, De Cock KM. Source: Genitourinary Medicine. 1996 February; 72(1): 62-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8655172

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Fatal hemorrhage from an arterio-portal-peritoneal fistula after percutaneous liver biopsy. Author(s): Korula J, Fried J, Weissman M, Greaney G, Liew CT, Finck E. Source: Gastroenterology. 1989 January; 96(1): 244-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2909424

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Fatal intrahepatic hemorrhage after percutaneous liver biopsy using a Menghini needle: a rare but real complication. Author(s): Whittle TS Jr. Source: Southern Medical Journal. 1977 November; 70(11): 1355-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=918702

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Fatal pulmonary embolism complicating percutaneous liver biopsy--case reports. Author(s): Atoba MA. Source: Cent Afr J Med. 1982 May; 28(5): 115-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7127453

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Fetal hepatic infarction caused by percutaneous liver biopsy. Author(s): Wolfe JH, Jackson BT. Source: Journal of the Royal College of Surgeons of Edinburgh. 1982 January; 27(1): 57-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7077583

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Fetal liver biopsy for prenatal diagnosis of carbamoyl phosphate synthetase deficiency. Author(s): Murotsuki J, Uehara S, Okamura K, Yajima A, Oura T, Miyabayashi S. Source: American Journal of Perinatology. 1994 March; 11(2): 160-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8198660

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Fetal liver biopsy for prenatal diagnosis of ornithine carbamyl transferase deficiency. Author(s): Rodeck CH, Patrick AD, Pembrey ME, Tzannatos C, Whitfield AE. Source: Lancet. 1982 August 7; 2(8293): 297-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6124717

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Fibrin sealant as a plug for the post liver biopsy needle track. Author(s): Chisholm RA, Jones SN, Lees WR. Source: Clinical Radiology. 1989 November; 40(6): 627-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2598591

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Fibrin-glue sealed liver biopsy in patients with a liver transplantation or in liver transplantation waiting list: preliminary results. Author(s): Albeniz Arbizu E, Lopez San Roman A, Garcia Gonzalez M, Foruny Olcina JR, Garcia-Hoz Rosales F, Barcena Marugan R, Plaza Palacios G, Gil Grande LA. Source: Transplantation Proceedings. 2003 August; 35(5): 1911-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12962845

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Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. Author(s): Skelly MM, James PD, Ryder SD. Source: Journal of Hepatology. 2001 August; 35(2): 195-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11580141

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Fine needle liver biopsy of hepatocellular carcinoma: is sampling simple? Author(s): D'Aquino M, Michieletto L, Caprioglio L, Wolf P. Source: Gastroenterology. 1989 July; 97(1): 247-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2542119

Studies

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First do no harm: power, oppression, and violence of liver biopsy. Author(s): Andriulli A, Annese V, Facciorusso D, Giacobbe A. Source: Gastroenterology. 2003 July; 125(1): 272-3; Author Reply 273-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12870494

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Formation of a fatal arterioportal fistula following needle liver biopsy in a child with a living-related liver transplant: report of a case. Author(s): Otobe Y, Hashimoto T, Shimizu Y, Nakamura T, Yamamori N, Hayashi S, Kurono K, Manabe T. Source: Surgery Today. 1995; 25(10): 916-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8574060

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Fractal geometry: a useful tool for quantifying irregular lesions in human liver biopsy specimens. Author(s): Grizzi F, Ceva-Grimaldi G, Dioguardi N. Source: Ital J Anat Embryol. 2001; 106(2 Suppl 1): 337-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11729975

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Fractured liver biopsy needles. Author(s): Lazar H. Source: Gastroenterology. 1978 April; 74(4): 801. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=631516

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Frozen section of liver biopsy for the evaluation of liver allografts. Author(s): Kakizoe S, Yanaga K, Starzl TE, Demetris AJ. Source: Transplantation Proceedings. 1990 April; 22(2): 416-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2326938

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Functional human hepatocytes: isolation from small liver biopsy samples and primary cultivation with liver-specific functions. Author(s): Kim HM, Han SB, Hyun BH, Ahn CJ, Cha YN, Jeong KS, Oh GT. Source: J Toxicol Sci. 1995 November; 20(5): 565-78. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8720163

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Gallbladder perforation during liver biopsy diagnosed using hepatobiliary scintigraphy: a case report. Author(s): Dennison KG, Khoury D, Heironimus JD. Source: Clinical Nuclear Medicine. 1990 February; 15(2): 95-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2311329

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Gallbladder pseudopolyp formation following percutaneous liver biopsy. Author(s): Barzilai M, Ish-Shalom N, Lerner A. Source: Pediatric Surgery International. 1997 July; 12(5-6): 422-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9244116

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Giant intrahepatic hematoma after liver biopsy in a liver transplant recipient. Author(s): Yu MC, Jeng LB, Lee WC, Hung CM, Hung CF, Chiu CT, Chen MF. Source: Transplantation Proceedings. 2000 November; 32(7): 2217-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11120139

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Gilbert's syndrome: analytical subcellular fractionation of liver biopsy specimens. Enzyme activities, organelle pathology and evidence for subpopulations of the syndrome. Author(s): Dawson J, Seymour CA, Peters TJ. Source: Clinical Science (London, England : 1979). 1979 December; 57(6): 491-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=391473

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Gold and liver biopsy. Author(s): Prichanond S, Skosey JL. Source: Annals of Internal Medicine. 1978 April; 88(4): 579. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=416737

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Granulomatous hepatitis. The usefulness of liver biopsy in the diagnosis of tuberculosis and sarcoidosis. Author(s): Alexander JF, Galambos JT. Source: The American Journal of Gastroenterology. 1973 January; 59(1): 23-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4686469

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Guided liver biopsy septicemia. Author(s): Navarro A, Diaz-Curiel M, Castrillo JM. Source: Gastroenterology. 1978 March; 74(3): 639-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=147194

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Guided versus blind liver biopsy for chronic hepatitis C: clinical benefits and costs. Author(s): Farrell RJ, Smiddy PF, Pilkington RM, Tobin AA, Mooney EE, Temperley IJ, McDonald GS, Bowmer HA, Wilson GF, Kelleher D. Source: Journal of Hepatology. 1999 April; 30(4): 580-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10207798

Studies

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Guidelines for routine liver biopsy during methotrexate treatment. Author(s): Cash JM, Wilke WS. Source: Cleve Clin J Med. 1994 July-August; 61(4): 317-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7923752

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Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology. Author(s): Grant A, Neuberger J. Source: Gut. 1999 October; 45 Suppl 4: Iv1-Iv11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10485854

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Haematochezia in Crohn's disease caused by late-onset haemobilia following percutaneous liver biopsy. Author(s): Hodgson RS, Taylor-Robinson SD, Jackson JE. Source: European Journal of Gastroenterology & Hepatology. 2004 February; 16(2): 22932. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15076000

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Haemobilia causing acute pancreatitis after percutaneous liver biopsy: diagnosis by magnetic resonance cholangiopancreatography. Author(s): Asselah T, Condat B, Sibert A, Rivet P, Lebray P, Bernuau J, Benhamou JP, Erlinger S, Marcellin P, Valla D. Source: European Journal of Gastroenterology & Hepatology. 2001 July; 13(7): 877-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11474321

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Heat shock proteins are present in mallory bodies (cytokeratin aggresomes) in human liver biopsy specimens. Author(s): Riley NE, Li J, McPhaul LW, Bardag-Gorce F, Lue YH, French SW. Source: Experimental and Molecular Pathology. 2003 April; 74(2): 168-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12710948

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Hemobilia after minilaparoscopic liver biopsy: a rare complication. Author(s): Moehler M, Sanwald B, Kanzler S, Wanitschke R, Galle PR, Helmreich-Becker I. Source: Endoscopy. 2000 September; 32(9): S60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10990010

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Hemobilia causing acute biliary pancreatitis after percutaneous liver biopsy. Author(s): Kim HJ, Shin JH, Lee YY, Lee JK, Yim BC, Park UT, Myung SJ, Lee SK, Kim MH, Min YI. Source: Endoscopy. 1999 March; 31(3): S18-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10344446

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Hemobilia causing acute pancreatitis after percutaneous liver biopsy. Author(s): de Ribot X, Casellas F, Papo M, Vilaseca J, Moreiras M, Malagelada JR. Source: Journal of Clinical Gastroenterology. 1995 September; 21(2): 171-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8583088

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Hemobilia, a rare cause of acute pancreatitis after percutaneous liver biopsy: diagnosis and treatment by endoscopic retrograde cholangiopancreatography. Author(s): Jornod P, Wiesel PH, Pescatore P, Gonvers JJ. Source: The American Journal of Gastroenterology. 1999 October; 94(10): 3051-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10520869

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Hemochromatosis (HFE) gene sequence analysis of formalin-fixed, paraffinembedded liver biopsy specimens. Author(s): Przygodzki RM, Goodman ZD, Rabin L, Centeno JA, Liu Y, Hubbs AE, O'Leary TJ. Source: Molecular Diagnosis : a Journal Devoted to the Understanding of Human Disease Through the Clinical Application of Molecular Biology. 2001 December; 6(4): 227-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11774187

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Hemothorax after percutaneous liver biopsy: an unusual complication. Author(s): Chahal PS, Ready J. Source: The American Journal of Gastroenterology. 2002 April; 97(4): 1068-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12003398

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Hepatitis B E antigen detection in formalin-fixed liver biopsy specimens. A tool to investigate wild-type and E-minus variant HBV infection. Author(s): Villari D, Pollicino T, Spinella S, Russo F, Campo S, Rodino G, Squadrito G, Longo G, Raimondo G. Source: American Journal of Clinical Pathology. 1995 February; 103(2): 136-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7856554

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Hepatitis B virus DNA is frequently found in liver biopsy samples from hepatitis C virus-infected chronic hepatitis patients. Author(s): Koike K, Kobayashi M, Gondo M, Hayashi I, Osuga T, Takada S. Source: Journal of Medical Virology. 1998 April; 54(4): 249-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9557290

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Hepatitis C in chronic liver disease: an epidemiological study based on 566 consecutive patients undergoing liver biopsy during a 10-year period. Author(s): Verbaan H, Widell A, Lindgren S, Lindmark B, Nordenfelt E, Eriksson S. Source: Journal of Internal Medicine. 1992 July; 232(1): 33-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1322443

Studies

51

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Hepatocellular nodules in cirrhosis: focus on diagnostic criteria on liver biopsy. A Western experience. Author(s): Roncalli M. Source: Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2004 February; 10(2 Suppl 1): S9-15. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14762832

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High-resolution sonographic guidance for transjugular liver biopsy. Author(s): Soyer P, Lacheheb D, Levesque M. Source: Abdominal Imaging. 1993 Fall; 18(4): 360-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8220037

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Histologic changes in liver biopsy specimens produced by recombinant interferon alpha-2b therapy for chronic non-A,non-B viral hepatitis. A randomized controlled trial. Author(s): David E, Pucci A, Palladin D, Saracco G, Garello E, Pintus C, Rocca G, Chiandussi L, Solinas A, Mollo F, et al. Source: American Journal of Clinical Pathology. 1992 October; 98(4): 397-401. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1415021

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Histologic scoring of liver biopsy in focal nodular hyperplasia with atypical presentation. Author(s): Fabre A, Audet P, Vilgrain V, Nguyen BN, Valla D, Belghiti J, Degott C. Source: Hepatology (Baltimore, Md.). 2002 February; 35(2): 414-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11826417

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Histological features in liver biopsy specimens of patients with acute reactivation of chronic type B hepatitis. Author(s): Villari D, Raimondo G, Brancatelli S, Longo G, Rodino G, Smedile V. Source: Histopathology. 1991 January; 18(1): 73-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2013461

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How often does ultrasound marking change the liver biopsy site? Author(s): Riley TR 3rd. Source: The American Journal of Gastroenterology. 1999 November; 94(11): 3320-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10566737

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How to restrict liver biopsy to high-risk patients in early-stage Hodgkin's disease. German Hodgkin's Lymphoma Study Group. Author(s): Lieberz D, Sextro M, Paulus U, Franklin J, Tesch H, Diehl V. Source: Annals of Hematology. 2000 February; 79(2): 73-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10741918

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Hyperbilirubinemia during quinupristin-dalfopristin therapy in liver transplant recipients: correlation with available liver biopsy results. Author(s): Linden PK, Bompart F, Gray S, Talbot GH. Source: Pharmacotherapy. 2001 June; 21(6): 661-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11401179

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Immunohistochemical, molecular, and pathomorphological study of liver biopsy specimens during chronic hepatitis C. Author(s): Nepomnyashchikh GI, Aidagulova SV, Nepomnyashchikh DL, Tolokonskaya NP, Karavaeva YY, Sakharova EG, Mezentseva GA, Batemirova EV. Source: Bulletin of Experimental Biology and Medicine. 2002 September; 134(3): 307-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12512009

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Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. Author(s): Colloredo G, Guido M, Sonzogni A, Leandro G. Source: Journal of Hepatology. 2003 August; 39(2): 239-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12873821

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Improved method for transjugular liver biopsy. Author(s): Middlebrook M, Cohen AM, Wallace MJ, Clark J, Galati J. Source: Journal of Vascular and Interventional Radiology : Jvir. 1999 June; 10(6): 807-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10392952

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In Orvieto: new insights into liver biopsy and disease therapy. 8th Biennial International Congress on Liver Development, Gene Regulation and Disease. Orvieto, Italy, 2-5 June 1999. Author(s): Taub R. Source: Molecular Medicine Today. 1999 October; 5(10): 425-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10610199

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In situ enzymatic oligonucleotide amplification of hepatitis C virus-RNA in liver biopsy specimens (reverse transcriptase in situ polymerase chain reaction) after orthotopic liver transplantation for hepatitis C-related liver disease. Author(s): Fragulidis GP, Cirocco RE, Weppler D, Berho M, Gillian G, Markou M, Viciana A, Esquenazi V, Nery JR, Miller J, Reddy KR, Tzakis AG. Source: Transplantation. 1998 December 15; 66(11): 1472-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9869088

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In situ polymerase chain reaction detection of transfusion-transmitted virus in liver biopsy. Author(s): Comar M, Ansaldi F, Morandi L, Dal Molin G, Foschini PM, Croce SL, Bonin S, Stanta G, Tiribelli C, Campello C. Source: Journal of Viral Hepatitis. 2002 March; 9(2): 123-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11876794

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Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Author(s): Gilmore IT, Burroughs A, Murray-Lyon IM, Williams R, Jenkins D, Hopkins A. Source: Gut. 1995 March; 36(3): 437-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7698705

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Inflammatory myopathy and hepatitis C in a pediatric patient: role of liver biopsy in evaluating the severity of liver disease. Author(s): Mohan P, Chandra RS, Escolar DM, Luban NL. Source: Hepatology (Baltimore, Md.). 2001 October; 34(4 Pt 1): 851-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11584390

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Inflammatory pseudotumor of the liver diagnosed by needle liver biopsy under ultrasonographic tomography guidance. Author(s): Nakama T, Hayashi K, Komada N, Ochiai T, Hori T, Shioiri S, Tsubouchi H. Source: Journal of Gastroenterology. 2000; 35(8): 641-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10955605

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Interest of transjugular liver biopsy in adult patients with haemophilia or other congenital bleeding disorders infected with hepatitis C virus. Author(s): Stieltjes N, Ounnoughene N, Sava E, Paugy P, Roussel-Robert V, Rosenberg AR, Terris B, Salmon-Ceron D, Sogni P. Source: British Journal of Haematology. 2004 June; 125(6): 769-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15180867

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Intrahepatic arterioportal fistula most likely due to liver biopsy: an unusual cause of esophageal variceal hemorrhage. Author(s): Sugano S, Kawafune T, Ohe K, Watanabe M, Tanigawa K, Ishikawa T. Source: Journal of Clinical Gastroenterology. 1999 October; 29(3): 289-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10509960

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Intrahepatic hepatitis C viral RNA status of serum polymerase chain reactionnegative individuals with histological changes on liver biopsy. Author(s): Barrett S, Kieran N, Ryan E, O'keane JC, Crowe J. Source: Hepatology (Baltimore, Md.). 2001 June; 33(6): 1496-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11391539

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Intraoperative liver biopsy with the loop electrosurgical excision procedure in patients with gynecologic malignancies. Author(s): Finan MA, Larisey JS, Kline RC, Fiorica JV, Pinelli D, Roberts WS, Hoffman MS. Source: Gynecologic Oncology. 1996 July; 62(1): 78-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8690297

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Is a prolonged bleeding time associated with an increased risk of hemorrhage after liver biopsy? Author(s): Boberg KM, Brosstad F, Egeland T, Egge T, Schrumpf E. Source: Thrombosis and Haemostasis. 1999 March; 81(3): 378-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10102464

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Is bleeding time measurement useful for choosing the liver biopsy route? The results of a pragmatic, prospective multicentric study in 219 patients. Author(s): Bonnard P, Vitte RL, Barbare JC, Denis J, Stepani P, Di Martino V, Coutarel P, Eugene C, Van Batten C, Cadranel JF. Source: Journal of Clinical Gastroenterology. 1999 December; 29(4): 347-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10599642

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Is day case liver biopsy underutilised? Author(s): Douds AC, Joseph AE, Finlayson C, Maxwell JD. Source: Gut. 1995 October; 37(4): 574-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7489948

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Is liver biopsy necessary for hepatitis C virus carriers with persistently normal aminotransferase levels? Author(s): Pasquale G, Sagnelli E, Coppola N, Scarano F, Scolastico C, Bellomo PF, Lettieri A, Piccinino F. Source: European Journal of Gastroenterology & Hepatology. 2003 July; 15(7): 831-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12811317

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Is pain experienced during liver biopsy an important factor? Author(s): Soykan I, Toruner M, Sarioglu M, Idilman R. Source: Journal of Clinical Gastroenterology. 2002 July; 35(1): 102-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12080240

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Is replication of hepatitis C virus a marker of activity of infectious process? (Findings of polymerase chain reaction and morphological analysis of liver biopsy specimens). Author(s): Nepomnyashchikh GI, Tolokonskaya NP, Aidagulova SV, Nepomnyashchikh DL, Karavaeva YY, Sakharova EG, Mezentseva GA, Batemirova EV. Source: Bulletin of Experimental Biology and Medicine. 2003 March; 135(3): 296-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12802406

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Is there a role for liver biopsy in primary sclerosing cholangitis? Author(s): Burak KW, Angulo P, Lindor KD. Source: The American Journal of Gastroenterology. 2003 May; 98(5): 1155-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12809842

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Junior doctors' experience of percutaneous liver biopsy: a questionnaire survey. Author(s): Haniffa MA, Kumaran S, Tamin SS, Alexander GJ. Source: Clinical Medicine (London, England). 2002 July-August; 2(4): 379-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12195871

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Ketamine hydrochloride as sole anesthetic for open liver biopsy. Author(s): Abu Khalaf A, Takrouri M, Toukan A, Abu Khalaf M, Amr S. Source: Middle East J Anesthesiol. 1988 October; 9(6): 537-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3211082

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Laparoscopic liver biopsy in patients with coagulopathy, portal hypertension, and ascites. Author(s): Inabnet WB, Deziel DJ. Source: The American Surgeon. 1995 July; 61(7): 603-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7793741

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Laparoscopic liver biopsy to evaluate hepatic dysfunction in patients with hematologic malignancies: a useful tool to effect changes in management. Author(s): Iqbal M, Creger RJ, Fox RM, Cooper BW, Jacobs G, Stellato TA, Lazarus HM. Source: Bone Marrow Transplantation. 1996 April; 17(4): 655-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8722371

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Light and electron microscopic analysis of sequential liver biopsy samples from rheumatoid arthritis patients receiving long-term methotrexate therapy. Followup over long treatment intervals and correlation with clinical and laboratory variables. Author(s): Kremer JM, Kaye GI, Kaye NW, Ishak KG, Axiotis CA. Source: Arthritis and Rheumatism. 1995 September; 38(9): 1194-203. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7575712

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Liver biopsy complications and routine ultrasound. Author(s): Stotland BR, Lichtenstein GR. Source: The American Journal of Gastroenterology. 1996 July; 91(7): 1295-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8677980

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Liver biopsy discloses a new apolipoprotein A-I hereditary amyloidosis in several unrelated Italian families. Author(s): Obici L, Palladini G, Giorgetti S, Bellotti V, Gregorini G, Arbustini E, Verga L, Marciano S, Donadei S, Perfetti V, Calabresi L, Bergonzi C, Scolari F, Merlini G. Source: Gastroenterology. 2004 May; 126(5): 1416-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15131802

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Liver biopsy findings in 501 patients infected with human immunodeficiency virus (HIV). Author(s): Poles MA, Dieterich DT, Schwarz ED, Weinshel EH, Lew EA, Lew R, Scholes JV. Source: Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology : Official Publication of the International Retrovirology Association. 1996 February 1; 11(2): 170-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8556399

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Liver biopsy findings in patients with alcoholic liver disease complicated by chronic hepatitis C virus infection. Author(s): Kyriacou E, Simmonds P, Miller EK, Bouchier IA, Hayes PC, Harrison DJ. Source: European Journal of Gastroenterology & Hepatology. 1995 April; 7(4): 331-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7600139

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Liver biopsy findings in patients with juvenile rheumatoid arthritis receiving longterm, weekly methotrexate therapy. Author(s): Kugathasan S, Newman AJ, Dahms BB, Boyle JT. Source: The Journal of Pediatrics. 1996 January; 128(1): 149-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8551408

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Liver biopsy in co-infected patients. Author(s): Santos J, Palacios R. Source: Aids (London, England). 2004 January 23; 18(2): 354. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15075565

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Liver biopsy in evaluation of complications following liver transplantation. Author(s): Yu YY, Ji J, Zhou GW, Shen BY, Chen H, Yan JQ, Peng CH, Li HW. Source: World Journal of Gastroenterology : Wjg. 2004 June 1; 10(11): 1678-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15162551

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Liver biopsy in liver transplantation: no additional risk of infections in patients with choledochojejunostomy. Author(s): Ben-Ari Z, Neville L, Rolles K, Davidson B, Burroughs AK. Source: Journal of Hepatology. 1996 March; 24(3): 324-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8778200

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Liver biopsy in patients without psoriasis receiving methotrexate: what guidelines are medical dermatologists following? Author(s): Larson MJ, Costner MI. Source: Journal of the American Academy of Dermatology. 2004 June; 50(6): E11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15153917

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Liver biopsy in the diagnosis of malignancy. Author(s): Jenkins D, Gilmore IT, Doel C, Gallivan S. Source: Qjm : Monthly Journal of the Association of Physicians. 1995 November; 88(11): 819-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8542267

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Liver biopsy in the mid-1990s: questions and answers. Author(s): van Leeuwen DJ, Wilson L, Crowe DR. Source: Seminars in Liver Disease. 1995 November; 15(4): 340-59. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8578319

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Liver biopsy sampling in chronic viral hepatitis. Author(s): Guido M, Rugge M. Source: Seminars in Liver Disease. 2004 February; 24(1): 89-97. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15085489

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Liver biopsy. Author(s): Desmet V, Fevery J. Source: Baillieres Clin Gastroenterol. 1995 December; 9(4): 811-28. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8903807

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Liver biopsy. Day case procedure is safe. Author(s): Douds AC, Maxwell JD. Source: Bmj (Clinical Research Ed.). 1995 March 18; 310(6981): 739. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7711558

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Liver biopsy. Most are performed by radiologists. Author(s): Davies RJ, Ward CS. Source: Bmj (Clinical Research Ed.). 1995 March 18; 310(6981): 739. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7711559

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Liver biopsy: review of methodology and complications. Author(s): Tobkes AI, Nord HJ. Source: Digestive Diseases (Basel, Switzerland). 1995 September-October; 13(5): 267-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8542662

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Liver biopsy--past, present and future. Author(s): Chuah SY. Source: Singapore Med J. 1996 February; 37(1): 86-90. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8783921

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Major hemorrhage after percutaneous liver biopsy in patients with AIDS. Author(s): Gordon SC, Veneri RJ, McFadden RF, Reddy KR, Schiff ER. Source: Gastroenterology. 1991 June; 100(6): 1787. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2019391

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Management of hemobilia after liver biopsy in liver transplant recipients. Author(s): Manzarbeitia C, Jonsson J, Rustgi V, Oyloe VK, Olson L, Hefter L, Kankam C. Source: Transplantation. 1993 December; 56(6): 1545-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8279035

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Massive haemobilia after percutaneous liver biopsy in a patient with POEMS syndrome successfully treated by arterial embolization. Author(s): Grieco A, Bianco A, Pieri S, Costamagna G, Flammia G, Greco AV. Source: European Journal of Gastroenterology & Hepatology. 1996 June; 8(6): 595-8. Review. Erratum In: Eur J Gastroenterol Hepatol 1997 January; 9(1): 97. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8823576

Studies

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Massive intrahepatic hemorrhage following routine liver biopsy in a patient with rheumatoid arthritis treated with methotrexate. Author(s): Cash JM, Swain M, Di Bisceglie AM, Wilder RL, Crofford LJ. Source: The Journal of Rheumatology. 1992 September; 19(9): 1466-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1433018

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Medical aspects of liver disease. The role of liver biopsy. Author(s): Scheuer PJ. Source: Trans Med Soc Lond. 1975-77; 92-93: 95-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1053129

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Menghini needle fracture after attempted liver biopsy. Author(s): Purow E, Grosberg SJ, Wapnick S. Source: Gastroenterology. 1977 December; 73(6): 1404-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=913981

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Method for obtaining both frozen and paraffin sections from the same liver biopsy. Author(s): Raia S, Scheuer PJ. Source: Journal of Clinical Pathology. 1968 May; 21(3): 413-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5699084

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Methotrexate and liver toxicity: role of surveillance liver biopsy. Conflict between guidelines for rheumatologists and dermatologists. Author(s): Hassan W. Source: Annals of the Rheumatic Diseases. 1996 May; 55(5): 273-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8660097

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Methotrexate hepatotoxicity and the role of routine liver biopsy: a collective opinion. Author(s): Sinclair RD, Rotstein H, Clemmens L, Prentice D, Rode J, Breen K. Source: The Australasian Journal of Dermatology. 1995 November; 36(4): 228-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8593119

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Micromethod for the assay of glutamate: glyoxylate aminotransferase and modifications of a micromethod for the assay of alanine: glyoxylate aminotransferase. Implications for the prenatal diagnosis of type I hyperoxaluria by fetal liver biopsy. Author(s): Toone JR, Applegarth DA. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 1991 November 9; 203(1): 105-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1769117

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Microscopic incipient hepatocellular carcinoma found incidentally in a routine liver biopsy specimen. Author(s): Hirooka N, Nitta Y, Tsunoda T, Kitazawa E, Sato J, Machii A, Murakami Y, Takahashi M, Kondo F. Source: Hepatology (Baltimore, Md.). 1990 August; 12(2): 291-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2167868

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Midazolam sedation for percutaneous liver biopsy. Author(s): Alexander JA, Smith BJ. Source: Digestive Diseases and Sciences. 1993 December; 38(12): 2209-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8261822

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Morbidity after percutaneous liver biopsy. Author(s): Lichtman S, Guzman C, Moore D, Weber JL, Roberts EA. Source: Archives of Disease in Childhood. 1987 September; 62(9): 901-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3674945

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Morphological classification of liver cirrhosis based upon measurement of per cent of interstitial tissue in liver biopsy specimens. Author(s): Nakamura T, Nakamura S, Aikawa T, Tazawa T, Suzuki O, Suzuki T. Source: The Tohoku Journal of Experimental Medicine. 1965 November 25; 87(2): 110-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5864165

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Motion - all patients with NASH need to have a liver biopsy: arguments against the motion. Author(s): Laurin J. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2002 October; 16(10): 722-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12420035

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Motion - all patients with NASH need to have a liver biopsy: arguments for the motion. Author(s): Talwalkar JA. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2002 October; 16(10): 718-21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12420034

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Necessity of liver biopsy for accurate diagnosis of Reye's syndrome. Author(s): Kimura A, Yoshida I, Yamashita F. Source: Journal of Pediatric Gastroenterology and Nutrition. 1987 January-February; 6(1): 153-4. Erratum In: J Pediatr Gastroenterol Nutr 1987 May-June; 6(3): 489. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3794930

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Need for liver biopsy in alcoholic liver disease. Author(s): Bird G, Williams R. Source: Bmj (Clinical Research Ed.). 1991 March 16; 302(6777): 662. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1672827

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Needle liver biopsy in general medical conditions: an analysis of 500 biopsies. Author(s): Barniville HT. Source: J Ir Med Assoc. 1967 April; 60(358): 122-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6045691

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Needle liver biopsy in thalassaemia: analyses of diagnostic accuracy and safety in 1184 consecutive biopsies. Author(s): Angelucci E, Baronciani D, Lucarelli G, Baldassarri M, Galimberti M, Giardini C, Martinelli F, Polchi P, Polizzi V, Ripalti M, et al. Source: British Journal of Haematology. 1995 April; 89(4): 757-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7772512

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Needle track seeding of primary and secondary liver carcinoma after percutaneous liver biopsy. Author(s): John TG, Garden OJ. Source: Hpb Surg. 1993; 6(3): 199-203; Discussion 203-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8387809

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Needle tract implantation of hepatocellular carcinoma after percutaneous liver biopsy. Author(s): Sakurai M, Okamura J, Seki K, Kuroda C. Source: The American Journal of Surgical Pathology. 1983 March; 7(2): 191-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6305217

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Needle tract implantation of hepatocellular carcinoma after ultrasonically guided needle liver biopsy: a case report. Author(s): Hamazaki K, Matsubara N, Mori M, Gochi A, Mimura H, Orita K, Lygidakis NJ. Source: Hepatogastroenterology. 1995 September-October; 42(5): 601-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8751221

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Neonatal cholestasis syndrome: identifying the disease from liver biopsy. Author(s): Nayak NC, Vasdev N. Source: Indian Pediatrics. 2002 May; 39(5): 421-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12037270

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Nephrectomy following liver biopsy. Author(s): Blain C. Source: Am J Dig Dis. 1969 October; 14(10): 745-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5823885

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Nodular regenerative hyperplasia of the liver: diagnosis by liver biopsy. Author(s): Qizilbash AH, Castelli M. Source: Can Med Assoc J. 1980 May 24; 122(10): 1151-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7388707

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Non-A, non-B hepatitis: characterization of liver biopsy pathology. Author(s): Lefkowitch JH, Apfelbaum TF. Source: Journal of Clinical Gastroenterology. 1989 April; 11(2): 225-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2500477

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Nuclide scanning, ultrasonography and liver biopsy in the diagnosis of hepatic tumours: a comparative evaluation of the available techniques. Author(s): Conn HO. Source: Clin Gastroenterol. 1976 September; 5(3): 665-80. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=139218

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Omental arteriovenous fistula following liver biopsy. Author(s): Satava RM Jr, van Heerden JA, Sheedy PF 2nd, Summerskill WH. Source: Gastroenterology. 1975 August; 69(2): 492-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1150051

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Open abdomen liver biopsy by a modified one-second technic. Author(s): Menghini G, Antonini R, Bruschelli P. Source: American Journal of Surgery. 1977 March; 133(3): 383-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=848670

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Operation-associated neutrophils in a percutaneous liver biopsy: effect of prior transjugular procedure. Author(s): McDonald GS, Courtney MG. Source: Histopathology. 1986 February; 10(2): 217-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3957254

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Operative liver biopsy abnormalities in patients with functional disorders of the biliary tract. Author(s): Ham JM, Bolin TD, Stevenson D, Jefferies S, Liddelow A. Source: The Australian and New Zealand Journal of Surgery. 1978 October; 48(5): 499503. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=285696

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Optimization, rationalization and cost reduction of liver biopsy: the GEOT protocol. Gruppo Epatologico Osservazione Temporanea. Author(s): Croce LS, Masutti F, Pozzato G, Moretti M, Marchi P, Mazzoran L, Zucca R, Stroili M, Ricci C, Stacul F, et al. Source: Ital J Gastroenterol. 1994 December; 26(9): 446-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7599346

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Outcome of patients hospitalized for complications after outpatient liver biopsy. Author(s): Janes CH, Lindor KD. Source: Annals of Internal Medicine. 1993 January 15; 118(2): 96-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8416324

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Outpatient liver biopsy in children: a medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. Author(s): Fox VL, Cohen MB, Whitington PF, Colletti RB. Source: Journal of Pediatric Gastroenterology and Nutrition. 1996 October; 23(3): 213-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8890068

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Outpatient liver biopsy in children: has the time come? Author(s): Rothbaum RJ. Source: Journal of Pediatric Gastroenterology and Nutrition. 1993 November; 17(4): 3545. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8145086

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Outpatient liver biopsy using ultrasound guidance and the Biopty gun is safe and cost effective. Author(s): Smith BC, Desmond PV. Source: Aust N Z J Med. 1995 June; 25(3): 209-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7487687

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Outpatient liver biopsy. Author(s): Liaw YF. Source: Gastroenterology. 1978 August; 75(2): 351. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=669229

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Outpatient liver biopsy: how safe is it? Author(s): Garcia-Tsao G, Boyer JL. Source: Annals of Internal Medicine. 1993 January 15; 118(2): 150-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8416312

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Outpatient liver biopsy: one man's experience. Author(s): Wright RA. Source: Southern Medical Journal. 1991 July; 84(7): 889-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2068633

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Outpatient percutaneous liver biopsy in children. Author(s): Gonzalez-Vallina R, Alonso EM, Rand E, Black DD, Whitington PF. Source: Journal of Pediatric Gastroenterology and Nutrition. 1993 November; 17(4): 3705. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8145090

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Oxacillin hepatitis. Two patients with liver biopsy, and review of the literature. Author(s): Bruckstein AH, Attia AA. Source: The American Journal of Medicine. 1978 March; 64(3): 519-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=637061

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Pancreatitis secondary to percutaneous liver biopsy-associated hemobilia. Author(s): Van Os EC, Petersen BT. Source: The American Journal of Gastroenterology. 1996 March; 91(3): 577-80. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8633513

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Patient's preference regarding the option of performing unselective liver biopsy following methotrexate treatment in rheumatoid arthritis. Author(s): Ferraz MB, Ciconelli RM, Vilar MJ. Source: Clin Exp Rheumatol. 1994 November-December; 12(6): 621-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7895396

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Percutaneous liver biopsy complications in patients with chronic renal failure. Author(s): Ozdogan M, Ozgur O, Boyacioglu S, Coskun M, Kart H, Ozdal S, Telatar H. Source: Nephron. 1996; 74(2): 442-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8893179

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Percutaneous transhepatic liver biopsy with tract embolization. Author(s): Smith TP, McDermott VG, Ayoub DM, Suhocki PV, Stackhouse DJ. Source: Radiology. 1996 March; 198(3): 769-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8628869

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Percutaneous transpulmonary CT-guided liver biopsy: a safe and technically easy approach for lesions located near the diaphragm. Author(s): Gervais DA, Gazelle GS, Lu DS, Han PF, Mueller PR. Source: Ajr. American Journal of Roentgenology. 1996 August; 167(2): 482-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8686631

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Plugged-percutaneous liver biopsy in patients with impaired coagulation and ascites. Author(s): Kamphuisen PW, Wiersma TG, Mulder CJ, de Vries RA. Source: Pathophysiology of Haemostasis and Thrombosis. 2002 July-August; 32(4): 1903. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12759521

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Preliminary evaluation of an automated device for percutaneous liver biopsy. Author(s): Root S, DeAngelis S, Sherman KE. Source: Journal of Clinical Gastroenterology. 1996 June; 22(4): 325-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8771435

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Prevalence and characteristics of pain induced by percutaneous liver biopsy. Author(s): Eisenberg E, Konopniki M, Veitsman E, Kramskay R, Gaitini D, Baruch Y. Source: Anesthesia and Analgesia. 2003 May; 96(5): 1392-6, Table of Contents. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12707140

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Progression of hepatic fibrosis in patients with hepatitis C: a prospective repeat liver biopsy study. Author(s): Ryder SD, Irving WL, Jones DA, Neal KR, Underwood JC; Trent Hepatitis C Study Group. Source: Gut. 2004 March; 53(3): 451-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14960533

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Prospective study of the incidence of ultrasound-detected hepatic hematomas due to percutaneous Menghini needle liver biopsy and laparoscopy-guided Silverman needle biopsy. Author(s): Glaser J, Mann O, Siegmuller M, Pausch J. Source: Ital J Gastroenterol. 1994 September; 26(7): 338-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7812026

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Quantitation of intrinsic drug-metabolizing capacity in human liver biopsy specimens: support for the intact-hepatocyte theory. Author(s): Meyer B, Luo HS, Bargetzi M, Renner EL, Stalder GA. Source: Hepatology (Baltimore, Md.). 1991 March; 13(3): 475-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1671846

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Quantitative evaluation of telomerase activity in small liver tumors: analysis of ultrasonography-guided liver biopsy specimens. Author(s): Kojima H, Yokosuka O, Kato N, Shiina S, Imazeki F, Saisho H, Shiratori Y, Omata M. Source: Journal of Hepatology. 1999 September; 31(3): 514-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10488712

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Quantitative reverse transcriptase-PCR amplification of cytokine mRNA in liver biopsy specimens using a non-competitive method. Author(s): Bishop GA, Rokahr KL, Lowes M, McGuinness PH, Napoli J, DeCruz DJ, Wong WY, McCaughan GW. Source: Immunology and Cell Biology. 1997 April; 75(2): 142-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9107566

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Randomized controlled trial of aspiration needle versus automated biopsy device for transjugular liver biopsy. Author(s): Banares R, Alonso S, Catalina MV, Casado M, Rincon D, Salcedo M, Alvarez E, Guerrero C, Echenagusia A, Camunez F, Simo G. Source: Journal of Vascular and Interventional Radiology : Jvir. 2001 May; 12(5): 583-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11340136

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Re: Daniel et al.: liver biopsy without clear indication or informed consent. Author(s): Kirsch M. Source: The American Journal of Gastroenterology. 2000 June; 95(6): 1588-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10894606

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Reactivation of herpes zoster after liver biopsy. Author(s): Levy JM, Smyth SH. Source: Journal of Vascular and Interventional Radiology : Jvir. 2002 February; 13(2 Pt 1): 209-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11830629

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Receiver operating characteristic analysis of glycogenated nuclei in liver biopsy specimens: quantitative evaluation of their relationship with diabetes and obesity. Author(s): Abraham S, Furth EE. Source: Human Pathology. 1994 October; 25(10): 1063-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7927311

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Recommendations for handling of pediatric liver biopsy specimens. Author(s): Finn LS, Knisely AS. Source: Semin Diagn Pathol. 1998 November; 15(4): 300-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9845430

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Reproducibility of liver biopsy grading and staging. Author(s): Hunt N, Fleming K. Source: Liver. 1999 June; 19(3): 169-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10395033

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Role of genetic testing and liver biopsy in the diagnosis of hemochromatosis. Author(s): Adams PC. Source: Current Gastroenterology Reports. 1999 February-March; 1(1): 27-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10980923

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Role of liver biopsy in management of chronic hepatitis C: a systematic review. Author(s): Gebo KA, Herlong HF, Torbenson MS, Jenckes MW, Chander G, Ghanem KG, El-Kamary SS, Sulkowski M, Bass EB. Source: Hepatology (Baltimore, Md.). 2002 November; 36(5 Suppl 1): S161-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12407590

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Role of liver biopsy in the diagnosis of hepatic iron overload in the era of genetic testing. Author(s): Nash S, Marconi S, Sikorska K, Naeem R, Nash G. Source: American Journal of Clinical Pathology. 2002 July; 118(1): 73-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12109859

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Role of liver biopsy in the management of liver dysfunction after hematopoietic stem-cell transplantation in a hepatitis B virus-prevalent patient population. Author(s): Ma SY, Au WY, Ng IO, Lie AK, Leung AY, Liang RH, Lau GK, Kwong YL. Source: Transplantation. 2003 July 15; 76(1): 169-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865805

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Safety and efficacy of blind percutaneous liver biopsy at the University College Hospital, Ibadan. Author(s): Otegbayo JA, Durodoye OM, Maxwell OA. Source: Niger J Med. 2002 October-December; 11(4): 187-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12955998

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Safety and efficacy of recombinant factor VIIa in patients with liver disease undergoing laparoscopic liver biopsy. Author(s): Jeffers L, Chalasani N, Balart L, Pyrsopoulos N, Erhardtsen E. Source: Gastroenterology. 2002 July; 123(1): 118-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12105840

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Safety of liver biopsy in acute sickle hepatic crisis. Author(s): Kakarala S, Lindberg M. Source: Conn Med. 2004 May; 68(5): 277-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15171263

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Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Author(s): Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, Feng ZZ, Reddy KR, Schiff ER. Source: The American Journal of Gastroenterology. 2002 October; 97(10): 2614-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12385448

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Sampling variability of percutaneous liver biopsy in primary sclerosing cholangitis. Author(s): Olsson R, Hagerstrand I, Broome U, Danielsson A, Jarnerot G, Loof L, Prytz H, Ryden BO, Wallerstedt S. Source: Journal of Clinical Pathology. 1995 October; 48(10): 933-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8537493

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Sampling variability on percutaneous liver biopsy in patients with chronic hepatitis C virus infection. Author(s): Siddique I, El-Naga HA, Madda JP, Memon A, Hasan F. Source: Scandinavian Journal of Gastroenterology. 2003 April; 38(4): 427-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12739716

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Severe sepsis caused by Clostridium sordellii following liver biopsy in a liver transplant recipient. Author(s): Mory F, Lozniewski A, Guirlet MN, Guidat D, Bresler L, Weber M, Boissel P. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1995 December; 21(6): 1522-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8749659

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Small gauge gelfoam plug liver biopsy in high risk patients: safety and diagnostic value. Author(s): Fandrich CA, Davies RP, Hall PM. Source: Australasian Radiology. 1996 August; 40(3): 230-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8826724

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Spontaneously reversible extensive portal vein thrombosis after gallbladder puncture during transjugular liver biopsy. Author(s): Spahr L, Willems B, Gianfelice D, Pomier-Layrargues G, Fenyves D. Source: Journal of Hepatology. 1996 February; 24(2): 246-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8907581

Studies

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Stellate-cell lipidosis in liver biopsy specimens. Recognition and significance. Author(s): Levine PH, Delgado Y, Theise ND, West AB. Source: American Journal of Clinical Pathology. 2003 February; 119(2): 254-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12579996

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The cost-effectiveness of liver biopsy in rheumatoid arthritis patients treated with methotrexate. Author(s): Bergquist SR, Felson DT, Prashker MJ, Freedberg KA. Source: Arthritis and Rheumatism. 1995 March; 38(3): 326-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7880186

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The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Author(s): Shalhub S, Parsee A, Gallagher SF, Haines KL, Willkomm C, Brantley SG, Pinkas H, Saff-Koche L, Murr MM. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2004 January; 14(1): 54-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14980034

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The liver biopsy diagnosis of Wilson's disease. Methods in pathology. Author(s): Ludwig J, Moyer TP, Rakela J. Source: American Journal of Clinical Pathology. 1994 October; 102(4): 443-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7942601

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The nature of complications following liver biopsy in transplant patients with Rouxen-Y choledochojejunostomy. Author(s): Galati JS, Monsour HP, Donovan JP, Zetterman RK, Schafer DF, Langnas AN, Shaw BW Jr, Sorrell MF. Source: Hepatology (Baltimore, Md.). 1994 September; 20(3): 651-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8076923

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The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy. Author(s): Lindor KD, Bru C, Jorgensen RA, Rakela J, Bordas JM, Gross JB, Rodes J, McGill DB, Reading CC, James EM, Charboneau JW, Ludwig J, Batts KP, Zinsmeister AR. Source: Hepatology (Baltimore, Md.). 1996 May; 23(5): 1079-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8621137

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The value of a baseline liver biopsy prior to methotrexate treatment. Author(s): Dolan OM, Burrows D, Irvine A, Walsh M. Source: The British Journal of Dermatology. 1994 December; 131(6): 891-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7857846

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The value of early transjugular liver biopsy after liver transplantation. Author(s): Azoulay D, Raccuia JS, Roche B, Reynes M, Bismuth H. Source: Transplantation. 1996 February 15; 61(3): 406-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8610351

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Transjugular liver biopsy in patients with end-stage renal disease. Author(s): Ahmad A, Hasan F, Abdeen S, Sheikh M, Kodaj J, Nampoory MR, Johny KV, Asker H, Siddique I, Thalib L, Al-Nakib B. Source: Journal of Vascular and Interventional Radiology : Jvir. 2004 March; 15(3): 25760. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15028810

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Transjugular liver biopsy: a prospective study in 43 patients with the Quick-Core biopsy needle. Author(s): Little AF, Zajko AB, Orons PD. Source: Journal of Vascular and Interventional Radiology : Jvir. 1996 January-February; 7(1): 127-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8773987

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Transvenous liver biopsy with the radial jaw forceps in patients with non-correctable coagulopathy. Author(s): Lundstedt C, Linjawi T. Source: Rofo. Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Neuen Bildgebenden Verfahren. 1995 March; 162(3): 246-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7718782

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Ultrasound-assisted percutaneous liver biopsy performed by a physician assistant. Author(s): Gunneson TJ, Menon KV, Wiesner RH, Daniels JA, Hay JE, Charlton MR, Brandhagen DJ, Rosen CB, Porayko MK. Source: The American Journal of Gastroenterology. 2002 June; 97(6): 1472-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12094868

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Ultrasound-guided percutaneous liver biopsy: indications, risks, and technique. Author(s): Copel L, Sosna J, Kruskal JB, Kane RA. Source: Surg Technol Int. 2003; 11: 154-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12931297

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Ultrastructural analysis of liver biopsy specimens in diabetes mellitus associated with chronic opisthorchiasis. Author(s): Nepomnyashchikh GI, Pavlenko OA, Aidagulova SV, Nepomnyashchikh DL. Source: Bulletin of Experimental Biology and Medicine. 2001 December; 132(6): 1190-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12152884

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Use of a stiff guidewire in transjugular liver biopsy in patients with a pronounced angle of the suprahepatic veins. Author(s): de Hoyos A, Loredo ML, Martinez MA, Gil MR. Source: Ann Hepatol. 2004 April-June; 3(2): 72-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15257250

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Usefulness of a liver biopsy in the evaluation of patients with elevated ALT values and serological markers of hepatitis viral infection: an AIGO study. Author(s): Andriulli A, Festa V, Leandro G, Rizzetto M. Source: Digestive Diseases and Sciences. 2001 July; 46(7): 1409-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11478491

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Usefulness of laparoscopy with liver biopsy in the assessment of liver involvement at diagnosis of Hodgkin's and non-Hodgkin's lymphomas. Author(s): Sans M, Andreu V, Bordas JM, Llach J, Lopez-Guillermo A, Cervantes F, Bruguera M, Mondelo F, Montserrat E, Teres J, Rodes J. Source: Gastrointestinal Endoscopy. 1998 May; 47(5): 391-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9609433

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Usefulness of the American College of Rheumatology recommendations for liver biopsy in methotrexate-treated rheumatoid arthritis patients. Author(s): Erickson AR, Reddy V, Vogelgesang SA, West SG. Source: Arthritis and Rheumatism. 1995 August; 38(8): 1115-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7639808

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Uselessness of liver biopsy in patients with hepatitis C virus chronic infection and persistently normal aminotransferase levels. Author(s): Pasquale G, Sagnelli E, Coppola N, Scarano F, Scolastico C, Sagnelli C, Bellomo PF, Lettieri A, Filippini P, Piccinino F. Source: Infez Med. 2003 March; 11(1): 11-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12719665

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US-guided liver biopsy: predicting the effect of interventional treatment of hepatocellular carcinoma. Author(s): Yamashita Y, Matsukawa T, Arakawa A, Hatanaka Y, Urata J, Takahashi M. Source: Radiology. 1995 September; 196(3): 799-804. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7644646

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Utility of liver biopsy culture in pediatric liver transplant recipients. Author(s): Cohen MS, Wise BV, Stamato LH, Colombani PM, Schwarz KB. Source: Pediatric Transplantation. 1999 November; 3(4): 322-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10562978

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Value and safety of percutaneous liver biopsy in obstructive jaundice. Author(s): Spellberg MA, Bermudez F. Source: The American Journal of Gastroenterology. 1977 May; 67(5): 444-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=900107

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Value of copper-associated protein in diagnostic assessment of liver biopsy. Author(s): Guarascio P, Yentis F, Cevikbas U, Portmann B, Williams R. Source: Journal of Clinical Pathology. 1983 January; 36(1): 18-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6185545

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Value of liver biopsy combined with cholecystectomy. Author(s): Zuegel NP, Hehl JA, Auerbach-Heber K, Eberl T. Source: Hepatogastroenterology. 1999 November-December; 46(30): 3095-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10626168

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Value of liver biopsy for the rapid diagnosis of infection in human immunodeficiency virus-infected patients who have unexplained fever and elevated serum levels of alkaline phosphatase or gamma-glutamyl transferase. Author(s): Cavicchi M, Pialoux G, Carnot F, Offredo C, Romana C, Deslandes P, Dupont B, Berthelot P, Pol S. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1995 March; 20(3): 606-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7756483

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Value of liver biopsy in sarcoidosis. Author(s): Hercules HD, Bethlem NM. Source: Archives of Pathology & Laboratory Medicine. 1984 October; 108(10): 831-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6548124

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Value of liver biopsy in the evaluation and management of chronic liver disease in renal transplant recipients. Author(s): Rao KV, Anderson WR, Kasiske BL, Dahl DC. Source: The American Journal of Medicine. 1993 March; 94(3): 241-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8452147

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Value of liver biopsy prior to interferon therapy for chronic viral hepatitis. Author(s): Heintges T, Mohr L, Hensel F, Petry W, Borchard F, Haussinger D, Niederau C. Source: Digestive Diseases and Sciences. 1998 July; 43(7): 1562-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9690395

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Variation between centers in technique and guidelines for liver biopsy. Author(s): Sue M, Caldwell SH, Dickson RC, Macalindong C, Rourk RM, Charles C, Doobay R, Cambridge SL, Barritt AS, McCallum RW. Source: Liver. 1996 August; 16(4): 267-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8877999

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Videolaparoscopic management of percutaneous liver biopsy complications. Author(s): Gama-Odrigues J, Bresciani C, Seid VE. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2001 April; 11(2): 134-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11330381

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Wash off liver cytology: a complementary diagnostic tool to liver biopsy. Author(s): Vogel W, Fagan EA, Bomford A, Portmann B, Williams R. Source: Journal of Clinical Pathology. 1986 April; 39(4): 449-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3009558

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Watchful waiting with periodic liver biopsy versus immediate empirical therapy for histologically mild chronic hepatitis C. A cost-effectiveness analysis. Author(s): Wong JB, Koff RS. Source: Annals of Internal Medicine. 2000 November 7; 133(9): 665-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11074899

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What is the criterion for differentiating chronic hepatitis from compensated cirrhosis? A prospective study comparing ultrasonography and percutaneous liver biopsy. Author(s): Gaiani S, Gramantieri L, Venturoli N, Piscaglia F, Siringo S, D'Errico A, Zironi G, Grigioni W, Bolondi L. Source: Journal of Hepatology. 1997 December; 27(6): 979-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9453422

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When is liver biopsy needed in the diagnosis of primary biliary cirrhosis? Author(s): Zein CO, Angulo P, Lindor KD. Source: Clin Gastroenterol Hepatol. 2003 March; 1(2): 89-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15017500

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When not to do a liver biopsy. Author(s): Atterbury CE. Source: Journal of Clinical Gastroenterology. 1982 October; 4(5): 465-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7175150

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CHAPTER 2. NUTRITION AND LIVER BIOPSY Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and liver biopsy.

Finding Nutrition Studies on Liver Biopsy The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “liver biopsy” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “liver biopsy” (or a synonym): •

A technique for obtaining repeated liver biopsies from rats. Author(s): Department of Histopathology, Flinders Medical Centre, Australia. Source: Cmielewski, P L Plummer, J L Ahern, M J Ilsley, A H Hall, P M Pathology. 1997 August; 29(3): 286-8 0031-3025

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In situ hybridization using a biotinylated DNA probe on formalin-fixed liver biopsies with hepatitis B virus infections: in situ hybridization superior to immunochemistry. Author(s): Department of Pathology, Bronx-Lebanon Hospital Center, New York. Source: Choi, Y J Mod-Pathol. 1990 May; 3(3): 343-7 0893-3952

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Partial hepatectomy and laparoscopic-guided liver biopsy in rhesus macaques (Macaca mulatta): novel approach for study of liver regeneration. Source: Gaglio, P.J. Baskin, G. Bohm, R. Jr. Blanchard, J. Cheng, S. Dunne, B. Davidson, J. Liu, H. Dash, S. Comp-med. Memphis, TN : American Association for Laboratory Animal Science, 2000-. August 2000. volume 50 (4) page363-368.

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Pretreatment liver biopsy in 20 children with histiocytosis X: a clinicopathologic correlation. Author(s): Department of Pediatrics, University of Michigan, Ann Arbor. Source: Heyn, R M Hamoudi, A Newton, W A Med-Pediatr-Oncol. 1990; 18(2): 110-8 0098-1532

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Use of fibrin sealant as a hemostatic agent after liver biopsy in swine. Author(s): Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA. [email protected] Source: Paulson, E K Stephenson, G R Neal, M C Rossin, V Lawson, J H J-Vasc-IntervRadiol. 2000 Jul-August; 11(7): 905-11 1051-0443

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Usefulness of indocyanine green injection during ultrasound-guided liver biopsy for the diagnosis of small hepatocellular carcinoma. Author(s): First Department of Internal Medicine, Okayama University Medical School, Japan. Source: Kimura, Y Higashi, T Kuwahara, N Nouso, K Ohguchi, S Hino, N Tanimizu, M Nakatsukasa, H Tobe, K Tsuji, T Acta-Med-Okayama. 1996 October; 50(5): 255-9 0386300X

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. PATENTS ON LIVER BIOPSY Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.5 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “liver biopsy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on liver biopsy, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Liver Biopsy By performing a patent search focusing on liver biopsy, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 5Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on liver biopsy: •

Disposable liver biopsy tray Inventor(s): Jamshidi; Khosrow (610 Winston Court, St. Paul, MN 55118) Assignee(s): none reported Patent Number: 3,987,895 Date filed: October 6, 1975 Abstract: Biopsy tray means for sequentially conducting sterile procedures and comprising, in combination, upper and lower nested tray members retaining means for performing biopsy techniques in a sterile field. The upper tray of the nested pair is provided with a plurality of article supporting recesses formed within the top surface, with means for defining a sterile zone upon the body of a patient being releasably retained within said recesses. The lower tray of the nested pair is provided with collective apparatus for performing biopsy procedures, with the upper tray generally enveloping the lower tray so as to generally confine and conceal the upper surface of the lower tray from the ambient during the time that the sterile field is being defined on the body of the patient. Excerpt(s): The present invention relates generally to an improved tray for use in retaining instruments and other items necessary for conducting biopsy procedures within a sterile field, and more specifically to a biopsy tray assembly which employs a pair of superimposed nested tray members, the upper tray being arranged to retain apparatus for preparing the sterile field, the lower tray being concealed from the ambient until such time as the sterile field has been established and the upper tray is removed so as to expose the lower tray to the surgeon. In the course of conducting biopsy procedures, it is normally required that a sterile field be established before initiating the biopsy procedure. In order to permit the establishment of such a field, it had been necessary in the past to utilize separate materials for the various phases of the overall procedure, including one for the establishment of the sterile field, and a second for retention of the instruments, solutions and the like which are required for the actual taking of the specimen. For example, individual or sequentially delivered trays may be utilized, with the first tray being employed for the establishment of the sterile field, and with this tray being removed prior to the introduction of the second tray to the zone, so as to avoid contamination of the instruments, solution-containing vials, and the like required in the actual biopsy procedure. In accordance with the present invention, however, it is possible to utilize a single in-place tray stack which comprises upper and lower nested trays, the upper tray containing materials for the establishment of a sterile field, and with the lower tray containing the actual instruments, solutions, and the like required in the biopsy procedure. The arrangement of the system of the present invention is particularly adapted for biopsy procedures involving soft tissue, such as those required for obtaining specimens of such organs as the liver, kidneys, spleen, and the like. It will be appreciated, of course, that the present invention is applicable to the obtaining of specimens from virtually any biopsy procedure, particularly where a sterile field is initially defined and provided. Web site: http://www.delphion.com/details?pn=US03987895__

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Genes for biologically active proteins Inventor(s): Ragg; Hermann (Kelkheim, DE) Assignee(s): Hoechst Aktiengesellschaft (Frankfurt am Main, DE) Patent Number: 4,849,349 Date filed: February 6, 1986 Abstract: The cDNA of a new proteinase inhibitor was isolated from a cDNA library of human liver biopsy material using a synthetic Oligonucleotide probe. The cDNA can be expressed by introduction of the cDNA to a microbial host on a DNA vector. Analogs of known proteinase inhibitors can be producing by alteration of the cDNA by substituting codons in the active center of the new proteinase inhibitor. Excerpt(s): The invention relates to a new member of the gene family which has hitherto comprised the genes for the proteinase inhibitors antithrombin III,.alpha.sub.1 proteinase inhibitor (.alpha.sub.1 -antitrypsin), antichymotrypsin, contrapsin and.alpha.sub.2 -antiplasmin, and by angiotensinogen. Amino acid sequence I allows those skilled in the art to prepare antibodies in a known manner, by selection of oligopeptides from this amino acid sequence I, to load an antibody column with them, and to use this column to isolate the complete protein from biological material. On the other hand, it is possible to use the gene or the cDNA sequence I to express the protein in suitable host organisms. Web site: http://www.delphion.com/details?pn=US04849349__

Patent Applications on Liver Biopsy As of December 2000, U.S. patent applications are open to public viewing.6 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to liver biopsy: •

Assessment of liver fibrosis scoring with serum marker algorithms Inventor(s): Arthur, Michael J.; (West Wellow, GB), Becka, Michael; (Ense, DE), Burchardt, Elmar-Reinhold; (Schwerte, DE), Burt, Alastair D.; (Fairmoor Morphet, GB), Gehrmann, Mathias; (Leverkusen, DE), Hennig, Guido; (Koln, DE), Knorr, Andreas; (Erkrath, DE), Kroll, Werner; (Solingen, DE), Pinzani, Massimo; (Scandicci, IT), Schuppan, Detlef; (Bubenreuth, DE), Unger, Sylvia; (Heidelberg, DE), Volker, Michael; (Koln, DE) Correspondence: Bayer Corporation; Law & Patents; 511 Benedict Avenue; Tarrytown; NY; 10591; US Patent Application Number: 20040053242 Date filed: October 7, 2003 Abstract: The present invention concerns a method for diagnosing liver fibrosis wherein two or more diagnostic markers are measured and the measurements are correlated by a mathematic algorithm characterized in that the diagnostic markers are selected from the group N-terminal procollagen III propeptide (PIIINP), Collagen IV/, Collagen VI,

6

This has been a common practice outside the United States prior to December 2000.

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Tenascin, Laminin, Hyaluronan, MMP-2, TIMP-1 and MMP-9/TIMP complex. The algorithm can be used to predict the histological score of a liver biopsy. Excerpt(s): Progressive fibrotic diseases of the liver are a major cause of morbidity and mortality throughout the world. Recent scientific advances demonstrate that the pathogenic process of fibrosis in liver is critically dependent on proliferation and activation of hepatic stellate cells (also called lipocytes, fat-storing or Ito cells) which synthesize and secrete excess extracellular matrix proteins (1). Moreover it is evident that this process is common to liver disease of all aetiologies. Of particular importance are chronic viral hepatitis B and C and alcoholic liver disease as well as autoimmune and genetic liver diseases, all of which lead to clinical problems via the common final pathway of progressive liver fibrosis, with the eventual development of cirrhosis. An important concept is the distinction between hepatic fibrosis and cirrhosis. Hepatic fibrosis is a reversible accumulation of extracellular matrix in response to chronic injury in which nodules have not yet developed, whereas cirrhosis implies an irreversible process, in which thick bands of matrix fully encircle the parenchyma, forming nodules. Consequently, any therapy must be directed towards patients with reversible disease (fibrosis), which will require early identification and monitoring of those at risk (2). Severity and progression of liver fibrosis are difficult to assess, with liver biopsy currently remaining the most reliable clinical method. The qualitative evaluation of hepatic fibrosis by biopsies is limited by interobserver variability. Biopsies are clearly inadequate for the early clinical phase of drug development, where there is an imperative to-employ less invasive methods that identify effective compounds within a commercially acceptable time frame, usually measured in weeks to a maximum of three months of experimental therapeutic exposure. Further disadvantages are the low diagnostic specificity and the risk of bleeding. Therefore there is a need for surrogate markers of liver fibrosis. Serum tests allow a non-invasive assessment of fibrogenesis and fibrolysis in the liver and can be done repeatedly and at short time intervals (3). Serum tests measuring the dynamic processes of extracellular matrix synthesis (fibrogenesis) and extracellular matrix degradation (fibrolysis) reflect the amount of extracellular matrix present, the degree of fibrosis or the ongoing process of architectural change of the liver (4). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with liver biopsy, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “liver biopsy” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on liver biopsy. You can also use this procedure to view pending patent applications concerning liver biopsy. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 4. BOOKS ON LIVER BIOPSY Overview This chapter provides bibliographic book references relating to liver biopsy. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on liver biopsy include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “liver biopsy” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on liver biopsy: •

Laparoscopy in Children Source: Heidelberg, Germany: Springer-Verlag. 2003. 147 p. Contact: Available from Springer-Verlag. Tiergartenstr. 17, D-69121 Heidelberg, Germany. (49)6221-487-0. Website: www.springer.de. E-mail: [email protected]. PRICE: $69.95 plus shipping and handling. ISBN: 3540429751. Summary: Most surgeons are familiar with the techniques of laparoscopic surgery, however, in children there are variations in size and technical approach. This book describes the differences and characteristic aspects of laparoscopy in small children. The book is an atlas of numerous drawings, accompanied by textual descriptions. Technical guidelines are given on how to perform laparoscopy safely, even in small children. Topics include patient selection, anesthesia, insufflation, trocar insertion, instruments, ligating, needle insertion, suturing, adhesiolysis, appendectomy, cholecystectomy (gallbladder removal), cryptorchidism, fundoplication, inguinal hernia, intussusception,

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liver biopsy, Meckel's diverticulum, ovary, pyloromyotomy, sigmoid resection, splenectomy, varicocele, thoracoscopy, and postoperative care. The aim of the book is to provide surgeons with the knowledge to extend their expertise in adult laparoscopy to children. A subject index concludes the textbook. •

Management of Hepatitis C: NIH Consensus Development Conference Program and Abstracts Source: Bethesda, MD: National Institutes of Health. 1997. 139 p. Contact: Available from NIH Consensus Program Information Center. P.O. Box 2577, Kensington, MD 20891. (888) 644-2667. Fax (301) 816-2494. PRICE: Single copy free. Summary: This document presents abstracts of the NIH Consensus Development Conference on the Management of Hepatitis C, held in March 1997 in Bethesda, Maryland. It notes the conference's agenda, panel, speakers, and planning committee members. The document was designed for the use of panelists and participants in the conference and as a pertinent reference document for anyone interested in the conference deliberations. The abstracts are presented in four sections: the natural history of hepatitis C, diagnostic considerations, the epidemiology and spread of hepatitis C, and therapeutic issues. Specific topics covered include the clinical spectrum of disease, blood donors with hepatitis C, hepatitis C and hepatocellular carcinoma (liver cancer), hepatitis C and alcohol, diagnostic tests for hepatitis C, the role of liver biopsy, the epidemiology of hepatitis C, the sexual and perinatal spread of hepatitis C virus infection, the use of interferon alfa-2b, ribavirin treatment, drug side effects, predictive factors for a beneficial response to drug therapy in hepatitis C, the treatment of patients with liver cirrhosis, retreatment with interferon, and cost effectiveness considerations. Each abstract includes brief references.

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Hepatitis C: Diagnostic Techniques and Monitoring Strategies Source: Thousand Oaks, CA: Amgen, Inc. 1997. 32 p. Contact: Available from Amgen Professional Services. 1840 DeHavilland Drive, Thousand Oaks, CA 91320-1789. (800) 77-AMGEN. PRICE: Single copy free to health professionals. Summary: This document summarizes the present diagnostic techniques and monitoring strategies used as part of the management of hepatitis C virus (HCV). HCV infection results in a chronic disease state in 50 to 70 percent of cases and is now the most common cause of chronic liver disease in the United States. It is highly infectious; known routes of transmission include blood and blood products, injection drug use, and sexual contacts. The virus has been cloned and is now well characterized with respect to both structural and nonstructural proteins. Molecular cloning technology has resulted in the development of specific and sensitive screening, diagnostic, and monitoring assays for HCV. In addition, tests to determine the quantity of viral RNA in blood and to define areas of the viral genome have been developed. Both viral load and genome have been suggested to be predictive of patient response to therapy. The authors review HCV diagnostic and monitoring tests, including liver enzymes, serological assays, virological assays, genotyping and serotyping, and liver biopsy. The discovery of antibodies to HCV or elevated ALT in a patient with or without symptoms of liver disease frequently culminates in the diagnosis of hepatitis C. The sequence of tests used to confirm the diagnosis may depend on the patient's known risk factors and the type of test (ALT, anti-HCV, or both) that initially established the likelihood of infection. The authors conclude that once the diagnosis of HCV infection is confirmed, determination of the

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presence or absence of cirrhosis, HCV RNA concentration, and genotype or serotype are important predictive factors in determining which patients are most likely to respond to therapy. 8 figures. 8 tables. 66 references. (AA-M). •

Gastrointestinal Diseases and Disorders Sourcebook Source: Detroit, MI: Omnigraphics, Inc. 1996. 413 p. Contact: Available from Omnigraphics, Inc. Penobscot Building, Detroit, MI 48226. (800) 234-1340 or (313) 961-1340. Fax (800) 875-1340 or (313) 961-1383. PRICE: $75.00. ISBN: 0780800788. Summary: This health reference book provides nontechnical information about gastrointestinal diseases and disorders. This sourcebook describes the signs and symptoms of many digestive system problems, discusses ongoing research and treatment, provides statistical data, and recommends dietary and lifestyle changes. The book has 46 chapters arranged in five sections: general information, including how the digestive system works, how to maintain healthy digestion, and statistical data; esophageal problems, including hiatal hernia, heartburn, and chronic pulmonary aspiration in children; stomach problems, notably ulcers and their treatment; intestinal and anorectal disorders; and liver, pancreatic, and gallbladder diseases and disorders, including liver function tests, liver transplants, and liver biopsy. The sourcebook includes numerous charts and graphs; a subject index concludes the volume.

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Liver Disorders Sourcebook Source: Detroit, MI: Omnigraphics. 2000. 591 p. Contact: Available from Omnigraphics, Inc. 615 Griswold, Detroit, MI 48226. (800) 2341340. Fax (800) 875-1340. PRICE: $78.00 plus shipping and handling. ISBN: 0780802403. Summary: This Sourcebook provides basic health care information about liver functions, guidelines for liver health, and tests that assess liver distress. The book also presents the symptoms, treatments, and preventive measures available for liver cancer; hepatitis A, B, C, D and E; genetically based liver diseases; and other liver diseases. The liver transplantation process is explained. Specific topics include strategies for protecting the liver, risk factors, common laboratory tests in liver disease, liver biopsy, cancer tumor markers, cirrhosis (scarring of the liver), infectious agents and parasites, pregnancy and the liver, jaundice in the healthy newborn, the liver's response to drugs, alcohol and the liver, acetaminophen, herbs and alternative medicine, galactosemia, Gaucher disease, hereditary hemochromatosis, Niemann-Pick disease, Wilson's disease, biliary atresia, cystic disease of the liver, fatty liver, gallstones, primary biliary cirrhosis, primary sclerosing cholangitis, organ donation, and the bioartificial liver. A glossary, a directory of organizations and support groups with up to date contact information (including websites and email addresses), a listing of transplant centers, and a subject index conclude the volume.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT

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NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “liver biopsy” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “liver biopsy” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “liver biopsy” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Grases Colour Atlas of Liver Biopsy - A Clinical Pathological Guide by PJ GRASES; ISBN: 0471564095; http://www.amazon.com/exec/obidos/ASIN/0471564095/icongroupinterna

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Interpretation of Liver Biopsies (Biopsy Interpretation Series) by Richard J. Stenger; ISBN: 0890045542; http://www.amazon.com/exec/obidos/ASIN/0890045542/icongroupinterna

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Practical Liver Biopsy Interpretation: Diagnostic Algorithms by Jurgen, M.D. Ludwig; ISBN: 0891893474; http://www.amazon.com/exec/obidos/ASIN/0891893474/icongroupinterna

Chapters on Liver Biopsy In order to find chapters that specifically relate to liver biopsy, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and liver biopsy using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “liver biopsy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on liver biopsy: •

When You Have Hepatitis B: Understanding the Diagnosis: Blood Tests and Biopsies Source: in Everson, G.T.; Weinberg, H. Living with Hepatitis B: A Survivor's Guide. Long Island, NY: Hatherleigh Press. 2002. p.18-37. Contact: Available from Hatherleigh Press. 5-22 46th Avenue Suite 200, Long Island City, NY 11101. (800) 528-2550. E-mail: [email protected]. Website: http://store.yahoo.com/hatherleighpress/index.html. PRICE: $15.95 plus shipping and handling. ISBN: 1578260841. Summary: Chronic hepatitis B can lead to cirrhosis (liver scarring), liver cancer, and the need for liver transplantation. This chapter on diagnostic tests is from a book that helps readers diagnosed with hepatitis B virus (HBV) infection educate themselves about the disease and its treatment. The authors answer questions about the testing process for hepatitis B, from diagnosis through monitoring during the years of ongoing care. The chapter covers hepatitis B virus tests, including proteins, antigens, and antibodies; liver imaging tests, including ultrasound, computed tomography, and magnetic resonance imaging (MRI); liver biopsy, including the procedure used and how to interpret the results obtained; liver blood tests, including liver enzymes, bilirubin, albumin, clotting factors, alpha-fetoprotein, and complete blood count (CBC); and patterns of hepatitis B tests in patients, including for acute and chronic disease, and for chronic carriers. Throughout the chapter the authors include quotes from real people who are living with hepatitis. 6 figures. 3 tables.

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Cirrhosis Source: in PDxMD. PDxMD Gastroenterology. St. Louis, MO: Elsevier Science. 2003. p. 101-129. Contact: Available from Elsevier Science. Customer Service Department, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 545-2522. Fax (800) 535-9935. Email: [email protected]. Website: www.elsevierhealth.com. PRICE: $39.95. ISBN: 932141049. Summary: Cirrhosis is a chronic disease of the liver, characterized by fibrosis (scarring). Liver biopsy is the standard for diagnosis. Specific treatment depends on the cause and whether or not complications are present. Prognosis is very variable and depends on the cause, stage of disease, and patient's adherence to alcohol abstinence, medical compliance, and nutritional advice. This chapter on cirrhosis is from a book on gastroenterology that offers concise, action-oriented recommendations for primary care medicine. The chapter covers summary information and background on the condition, and comprehensive information on diagnosis, treatment, outcomes, and prevention. Specific topics covered include the ICD9 code, urgent action, synonyms, cardinal features, causes (etiology), epidemiology, differential diagnosis, signs and symptoms, associated disorders, investigation of the patient, appropriate referrals and consultations, diagnostic considerations, clinical tips, treatment options, patient management issues, drug therapies, prognosis, complications, and how to prevent recurrence. The information is provided in outline and bulleted format for ease of accessibility. The final section of the chapter offers resources, including related associations, key references, and the answers to frequently asked questions (FAQs). 10 references.

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Investigation of Liver and Biliary Disease Source: in Beckingham, I.J., ed. ABC of Liver, Pancreas and Gallbladder. London, UK: BMJ Publishing Group. 2001. p.1-4. Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. E-mail: [email protected]. Website: www.bmjbooks.com. PRICE: Contact publisher for price. ISBN: 0727915312. Summary: Diseases of the liver, pancreas, and biliary system affect a substantial proportion of the world's population and involve doctors and health care workers across many disciplines. This introductory chapter on the investigation and diagnosis of liver and biliary disease is from an atlas of the liver, pancreas and gallbladder that covers the symptoms, diagnosis, etiology, natural course, and treatment of these diseases. This chapter covers jaundice (the most common presentation of patients with liver and biliary disease), liver function tests, plasma proteins and coagulation factors, imaging in liver and biliary disease, and the use of liver biopsy. The chapter concludes with summary points of the concepts discussed. 7 figures. 1 table.

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Gastrointestinal Manifestations Source: in Libman, H. and Witzburg, R.A., eds. HIV Infection: A Primary Care Manual. 3rd ed. Boston, MA: Little, Brown and Company. 1995. p. 165-180. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $39.95. ISBN: 0316511609.

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Summary: Gastrointestinal (GI) involvement in patients with AIDS is almost universal, and clinically significant disease occurs in 50 to 90 percent of patients. This chapter, from a primary care manual on HIV infection, focuses on the GI manifestations of the disease. Topics include diarrhea, bacterial infections, viral infections, parasitic infections, HIV enteropathy, 'gay bowel syndrome,' the general management of diarrhea, odynophagia (pain on swallowing), abdominal pain, hepatobiliary disease, viral hepatitis, opportunistic infections, peliosis hepatitis, drug-induced liver injury, fatty liver, role of liver biopsy, biliary tract disease, acute cholecystitis, papillary stenosis, sclerosing cholangitis, and vanishing bile duct syndrome. 3 figures. 2 tables. 41 references. •

When You Have Hepatitis C, Understanding the Diagnosis: Blood Tests and Biopsies Source: in Everson, G.T. and Weinberg, H. Living with Hepatitis C: A Survivor's Guide. New York, NY: Hatherleigh Press. 1999. p. 15-30. Contact: Available from Hatherleigh Company, Ltd. 1114 First Avenue, Suite 500, New York, NY 10021. (800) 367-2550 or (212) 832-1039. Website: hatherleigh.com. PRICE: $14.95 plus shipping and handling. ISBN: 1578260345. Summary: Hepatitis C is a viral infection that causes inflammation, injury, and ultimately scarring of the liver (cirrhosis). This chapter discussing the diagnosis of hepatitis C is from a book that offers information and guidance for people living with hepatitis C. The authors explain in nontechnical language some basic facts about the testing process for hepatitis C from diagnosis through the years of ongoing care. Diagnostic tests described include: ELISA I, ELISA II, and III; RIBA; HCV RNA assays; PCR quantitative assay; branched chain DNA assay; genotyping and quasispecies; radiologic imaging; ultrasound; CT scan; and liver biopsy. The authors also discuss testing limits, interpreting biopsy results, and monitoring tests, including liver enzymes, bilirubin, albumin, clotting factors, and complete blood count (CBC). The authors note that one predictor of response to therapy may be the number of quasispecies of hepatitis C circulating in the patient's blood. The virus mutates freely, so patients often have multiple copies of the hepatitis C virus that vary genetically; these are called quasispecies. In addition, the subtypes of hepatitis C respond differently to therapy, so it can be useful to have the subtype diagnosed. The authors recognize that many readers fear even the word 'biopsy,' but they stress that only a biopsy can give the doctor a true idea of the condition of the liver. They detail exactly what the patient can expect during and after the biopsy. The chapter includes lengthy quotes from patients with hepatitis, which offer the patients' perspectives, insights, and experiences to the reader. 2 figures. 1 table.

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Hepatitis C: Diagnosis and Treatment Source: in McDonald, J.W.D.; Burroughs, A.K.; Feagan, B.G., eds. Evidence Based Gastroenterology and Hepatology. London, UK: BMJ Publishing Group. 1999. p. 294304. Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. E-mail: [email protected]. Website: www.bmjbooks.com. PRICE: Contact publisher for price. Summary: Hepatitis C is often characterized by a progression to chronic disease. This chapter on the diagnosis and treatment of hepatitis C is from a book that emphasizes the approaches of evidence based medicine in gastroenterology (the study of the gastrointestinal tract and gastrointestinal diseases) and hepatology (the study of the

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liver and liver diseases). The author of this chapter notes that since chronic hepatitis C is generally silent, its diagnosis often happens in conjunction with investigation for another disease. Systematic screening should be recommended in subjects who have a history of blood transfusion or intravenous drug addiction. The ELISA is the appropriate test for screening. In ELISA positive subjects, the presence of chronic infection is established by the detection of serum HCV RNA by polymerase chain reaction (PCR). A liver biopsy is recommended in patients who are HCV RNA positive with increased ALT levels in order to assess the severity of the liver disease and determine whether there is an indication for therapy. Combination therapy with interferon and ribavirin is now standard therapy, and results in a sustained response in approximately 40 percent of patients. Genotyping of the virus and the measure of baseline viral load are useful to assess the probability of sustained response and to determine the appropriate duration of combination therapy. 5 tables. 66 references. •

Inherited Metabolic Disorders of the Liver Source: in Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1240-1259. Contact: Available from Elsevier. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 545-2522. Fax (800) 568-5136. Website: www.us.elsevierhealth.com. PRICE: $229.00 plus shipping and handling. ISBN: 0721689736. Summary: Inborn errors of metabolism encompass a vast variety of maladies with varied presentations and pathophysiology. This chapter on inherited metabolic disorders of the liver is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include alpha-1 antitrypsin deficiency, glucogen storage disease, congenital disorders of glycosylation, porphyrias, tyrosinemia, urea cycle defects, bile acid synthesis and transport defects, cystic fibrosis, and mitochondrial liver disease. The authors stress that because patients with metabolic liver disease often present with acute or recurrent symptoms, it is vital for the physician to obtain the diagnostic studies as soon as possible. The laboratory values for many of these illnesses may normalize between acute episodes. Liver biopsy is also a valuable diagnostic tool in these patients. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 5 figures. 6 tables. 133 references.

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Nonalcoholic Fatty Liver Disease Source: in Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1393-1403. Contact: Available from Elsevier. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 545-2522. Fax (800) 568-5136. Website: www.us.elsevierhealth.com. PRICE: $229.00 plus shipping and handling. ISBN: 0721689736. Summary: Nonalcoholic steatohepatitis (NASH) is a form of chronic hepatitis (inflammation of the liver) with histologic features of alcohol-induced liver disease that occurs in persons who do not consume a significant amount of alcohol. Another term, nonalcoholic fatty liver disease (NAFLD) is in current use; NASH is considered to be a part of the spectrum of NAFLD. This chapter on NAFLD is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders.

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Topics include etiology, pathogenesis, clinical features, histologic features, the role of liver biopsy in diagnosis, prognosis, treatment options, and focal fatty liver. The authors note that the prevalence of NAFLD and lack of information about its natural history have generated controversy about the wisdom of recommending invasive diagnostic tests or attempting to develop specific therapies for patients with this disease. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 6 figures. 4 tables. 69 references. •

Primary Biliary Cirrhosis Source: in Friedman, L.S. and Keeffe, E.B., eds. Handbook of Liver Disease. Philadelphia, PA: Churchill-Livingstone. 1998. p. 197-214. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. Email: [email protected]. PRICE: $73.00 plus shipping and handling. ISBN: 0443055203. Summary: Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease that usually affects middle aged women. This chapter on PBC is from a comprehensive handbook in outline format that offers easy access to information on the full range of liver disorders and covers symptoms, signs, differential diagnoses, and treatments. The cause of PBC is unknown, although genetic and immunologic factors appear to play a role. PBC is divided into four histologic stages. Many patients are asymptomatic at the time of diagnosis. The signs and symptoms of cholestasis develop as the disease progresses. PBC should be considered in patients with unexplained cholestasis or elevation of serum alkaline phosphatases. A percutaneous liver biopsy should be performed to confirm the diagnosis and to determine the prognosis. There is no proven medical treatment for the underlying disease, although drugs such as ursodeoxycholic acid, colchicine, and methotrexate are promising and are associated with histiologic improvement in some patients. Liver transplantation has improved the survival of the patients with liver failure arising from PBC. 11 figures. 1 table. 15 references. (AA-M).

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Gastroenterology Source: in Golish, J.A., ed. Diagnostic Procedure Handbook with Key Word Index. Hudson, OH: Lexi-Comp Inc. 1994. p. 75-128. Contact: Available from Lexi-Comp Inc. 1100 Terex Road, Hudson, OH 44236-3771. (800) 837-5394. (216) 650-6506. Fax (216) 656-4307. PRICE: $34.95 paperback; $37.95 hardback (as of 1995). ISBN: 068303619X (paperback); 0916589161 (hardback). Summary: This chapter from a diagnostic procedure handbook covers gastroenterology. The handbook succinctly lists synonyms, a description of the procedure, contraindications, patient care and scheduling, method and equipment, data acquired, and interpretation for a variety of gastrointestinal (GI) tract diagnostic tests, including anorectal manometry; anoscopy; Bernstein test; biliary drainage; breath hydrogen analysis; colonoscopy; endoscopic retrograde cholangiopancreatography; esophageal dilation; esophageal motility study; flexible fiberoptive sigmoidoscopy; gastric saline load test; Hollander test; I.V. secretin gastrin levels; liver biopsy; paracentesis; peritoneoscopy; pH study, 12-24 hour; small bowel biopsy; sphincter of Oddi manometry; standard acid reflux test; and upper GI endoscopy. Each subsection includes a list of references for more information. The book includes key word, code number, and subject indices. 101 references.

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Assessment of Liver Function and Diagnostic Studies Source: in Friedman, L.S. and Keeffe, E.B., eds. Handbook of Liver Disease. Philadelphia, PA: Churchill-Livingstone. 1998. p. 1-14. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. Email: [email protected]. PRICE: $73.00 plus shipping and handling. ISBN: 0443055203. Summary: This chapter on assessment of liver function and diagnostic studies is from a comprehensive handbook in outline format that offers easy access to information on the full range of liver disorders and covers symptoms, signs, differential diagnoses, and treatments. The authors stress that there is no ideal study or battery of studies to evaluate the many functions of the liver. The colloquial term liver function tests includes true tests of hepatic function (e.g., serum albumin), excretory function (e.g., bilirubin), and hepatic inflammatory activity (e.g., serum aminotransferases). Abnormal liver function tests are often the first indication of liver disease. The widespread inclusion of liver function tests in routine blood work panels uncovers many patients with asymptomatic hepatic dysfunction. Liver biopsy remains the gold standard for detecting and determining the cause of liver disease. A variety of imaging studies are useful in detecting focal hepatic defects, portal hypertension, and abnormalities of the biliary tract. 3 tables. 11 references. (AA-M).

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Budd-Chiari Syndrome and Other Vascular Disorders Source: in Friedman, L.S. and Keeffe, E.B., eds. Handbook of Liver Disease. Philadelphia, PA: Churchill-Livingstone. 1998. p. 267-275. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. Email: [email protected]. PRICE: $73.00 plus shipping and handling. ISBN: 0443055203. Summary: This chapter on Budd Chiari syndrome and other vascular disorders is from a comprehensive handbook in outline format that offers easy access to information on the full range of liver disorders and covers symptoms, signs, differential diagnoses, and treatments. Hepatic vein occlusion, or Budd Chiari syndrome, is an uncommon disorder characterized by hepatomegaly, ascites, and abdominal pain. The disorder most often occurs in patients with underlying thrombotic diathesis, including myeloproliferative disorders such as polycythemia vera and paroxysmal nocturnal hemoglobinuria, tumors, chronic inflammatory diseases, clotting disorders, and infections. Diagnosis is confirmed by visualization of thrombus or absent flow in hepatic veins on Doppler ultrasound or magnetic resonance imaging (MRI). Hepatic venography and liver biopsy provide definitive confirmation. Budd Chiari syndrome is often fatal. Medical therapy with diuretics and conventional anticoagulation provides only short term symptomatic relief. Most patients require portosystemic decompression or liver transplantation for long term relief of symptoms and correction of the underlying pathophysiology. Transjugular intrahepatic portal shunts and hepatic venous stents are promising options to replace or delay the need for surgery. Veno-occlusive disease of the liver is a disease of the small hepatic venules that mimics Budd Chiari syndrome and develops primarily in patients after allogeneic or autologous bone marrow transplantation. It is probably the result of toxic injury to the endothelial cells from cytoreductive therapy. Treatment is largely supportive.

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Chronic Hepatitis: General Features, Autoimmune Chronic Disease Source: in Sherlock, S.; Dooley, J. Diseases of the Liver and Biliary System. Malden, MA: Blackwell Science, Inc. 2002. p.321-333. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail: [email protected]. Website: www.blackwell-science.com. PRICE: $178.95. ISBN: 0632055820. Summary: This chapter on chronic hepatitis, defined as a chronic inflammatory reaction in the liver, is from a textbook that presents a comprehensive and up-to-date account of diseases of the liver and biliary system. The chapter covers clinical presentation (symptoms), hepatic (liver) histology, the role of liver biopsy, and classification, then describes three types of autoimmune chronic hepatitis: Type 1 (formerly called lupoid), Type 2, and primary biliary cirrhosis and immune cholangitis. The chapter then focuses on chronic autoimmune hepatitis (type 1), discussing etiology, hepatic pathology, clinical features, differential diagnosis, treatment, course and prognosis, and syncytial giant-cell hepatitis. 16 figures. 13 tables. 40 references.

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Digestive Tract Conditions Source: in Daly, S., et al., eds. Living Longer and Better With Health Problems. Springhouse, PA: Springhouse Corporation. 1996. p. 300-357. Contact: Available from Springhouse Corporation. 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477-0908. (800) 346-7844 or (215) 646-8700. Fax (215) 646-4508. PRICE: $21.95 (as of 1995). ISBN: 0874348269. Summary: This chapter on digestive tract conditions is from a text on living longer and better with health problems. Seven sections cover irritable bowel syndrome (IBS); inflammatory bowel disease (IBD); cirrhosis; chronic pancreatitis; hiatal hernia; constipation; and fecal incontinence. For each condition, the authors cover the causes; complications; symptoms; diagnostic tests used to confirm the condition; common questions and answers; treatment options; other recommendations for self-care; and sources of information and support. Sidebars throughout the chapter cover topics like managing IBS with diet; the different types of ostomies; ileoanal reservoirs and continent ileostomies; managing an ostomy pouch; liver structure and function; preparing for a liver biopsy; dietary recommendations for liver disease; the anatomy of hiatal hernias; how lifestyle can contribute to constipation; how to insert a rectal suppository; how to perform bowel stimulation; and how to give an enema. The chapter is illustrated with simple line drawings.

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Hepatitis B Virus and Hepatitis Delta Virus Source: in Sherlock, S.; Dooley, J. Diseases of the Liver and Biliary System. Malden, MA: Blackwell Science, Inc. 2002. p.285-303. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail: [email protected]. Website: www.blackwell-science.com. PRICE: $178.95. ISBN: 0632055820. Summary: This chapter on hepatitis B virus (HBV) and hepatitis Delta virus (HDV) is from a textbook that presents a comprehensive and up-to-date account of diseases of the liver and biliary system. The chapter includes three sections: acute HBV, chronic HBV,

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and HDV. Specific topics include epidemiology, the clinical course and features of each disease, prevention strategies for acute HBV, clinical relapse and reactivation of the hepatitis B virus, laboratory tests to monitor chronic HBV, needle liver biopsy, course and prognosis, treatment strategies, and screening for hepatocellular carcinoma (liver cancer). Each section offers a list of references for additional reading. 20 figures. 11 tables. 103 references. •

Your Digestive System Source: in Larson, D.E., ed. Mayo Clinic Family Health Book. 2nd ed. New York, NY: William Morrow and Company, Inc. 1996. p. 737-824. Contact: Available from Mayo Clinic. 200 First Street, S.W., Rochester, MN 55905. (800) 291-1128 or (507) 284-2511. Fax (507) 284-0161. Website: www.mayo.edu. PRICE: $39.95 plus shipping and handling. ISBN: 0688144780. Summary: This chapter on the digestive system is from a family health guide published by the Mayo Clinic. The lengthy chapter features nine sections: the digestive system at work, esophageal problems, stomach problems, disorders of the small and large intestines, anorectal disorders, liver disease, gallbladder and bile duct disorders, pancreatic diseases, and hernias. Within each section, multiple entries each begin with a review of signs and symptoms of the problem. This is followed by a description of the disease and a discussion on how the physician might make a diagnosis. The authors often include reviews of the real or potential seriousness of the problem. Each section then discusses treatment options, including medications or surgery, and, when appropriate, self help strategies. Topics covered include heartburn, hiatal hernia, hiccups, swallowing problems, gastrostomy, esophageal stricture, foreign bodies, esophageal tumors, esophageal varices, esophageal rupture, indigestion, peptic ulcer, Zollinger Ellison syndrome, gastritis, drug induced stomach problems, gastrointestinal tract bleeding, stomach tumors, stomach dilation, Menetrier disease, eosinophilic gastroenteritis, infections of the gastrointestinal tract, antibiotic associated diarrhea, malabsorption problems, acute appendicitis, Meckel diverticulum, intussusception, protein losing enteropathy, primarily (idiopathic) intestinal pseudo-obstruction, carcinoid syndrome, Crohn's disease, ulcerative colitis, colostomy and ileostomy, tumors of the small intestine, ileo anal anastomosis, diverticulosis and diverticulitis, irritable bowel syndrome, chronic constipation, dietary fiber, laxative abuse, intestinal gas, fecal impaction, colon polyps, colonoscopy, colon cancer, megacolon, peritonitis, familial Mediterranean fever, intestinal obstruction, vascular problems of the bowel, hemorrhoids, anal itch, anal fissures and fistulas, rectal bleeding, anorectal abscess, anal pain, proctitis, fecal incontinence, acute viral hepatitis, alcoholic (and other drug related) hepatitis, chronic hepatitis, cirrhosis, liver biopsy, liver tumors, liver abscess, liver transplantation, gallstones, bile duct obstruction, choledochal cysts, acute and chronic pancreatitis, malignant pancreatic tumors, congenital pancreatic abnormalities, inguinal hernia, and other abdominal hernias. The chapter features line drawings, black and white photographs, and sidebars for additional information.

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Management of Chronic Active Hepatitis Source: in Danzi, J.T.; Scopelliti, J.A., eds. Office Management of Digestive Diseases. Malvern, PA: Lea and Febiger. 1992. p. 143-151. Contact: Available from Lea and Febiger. P.O. Box 1496, Baltimore, MD 21298-9724. (800) 638-0672. PRICE: $45. ISBN: 0812114361.

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Summary: This chapter, from a medical textbook about the office management of common gastrointestinal diseases, discusses the management of chronic active hepatitis. Topics include the clinical manifestations of the disease; the suggestive clinical profiles for chronic hepatitis B, hepatitis C, autoimmune chronic active hepatitis, drug-related chronic active hepatitis, and Wilson's disease; the use of liver biopsy to confirm a diagnosis; and the management of each of the types of chronic disease noted above. 4 figures. 1 table. 8 references. •

Biopsies: Checking for Cancer: Digestive System Source: in Shaw, M., et al., eds. Everything You Need to Know About Medical Tests. Springhouse, PA: Springhouse Corporation. 1996. p. 222-225. Contact: Available from Springhouse Publishing. Attention: Trade and Textbook Department, 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477-0908. (800) 3313170 or (215) 646-4670 or (215) 646-4671. Fax (215) 646-8716. PRICE: $24.95 (as of 1995). ISBN: 0874348234. Summary: This section on the digestive system, from a chapter on biopsy, is from a consumer reference guide to over 400 diagnostic tests. For each test, the book covers the reasons the test is performed; what patients should know before the test; what to expect during and after the test; risk factors associated with the test; the normal results; and what abnormal results mean. Tests in this section include small intestine biopsy and liver biopsy.

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Viral Hepatitis Source: in Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 219-232. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgraw-hill.com. PRICE: $45.00;plus shipping and handling. ISBN: 0070220557. Summary: Viral hepatitis (inflammation of the liver) is the most common cause of chronic liver disease, cirrhosis (scarring), and hepatocellular carcinoma (HCC, liver cancer) in the United States. This chapter on viral hepatitis is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include incidence and background; an overview of the hepatotropic viruses (hepatitis A, B, C, D and E) and the clinical syndromes, including acute viral hepatitis, fulminant hepatic failure, chronic viral hepatitis, end stage liver disease, and HCC; key history, notably risk factors for the subvarieties of hepatitis; the physical examination and ancillary tests, including routine blood tests, serologic evaluation, imaging, and liver biopsy; treatment options, including prevention of the hepatitis A, B, and C viruses, prophylaxis of exposed individuals, vaccination, antiviral therapy, and liver transplantation; patient education; common errors in diagnosis and treatment; and controversies, including HIV coinfection. The chapter includes an outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. 5 figures. 2 tables. 21 references.

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Day Seven: Managing Your Fatigue Source: in Green, W.F. First Year: Hepatitis B. New York, NY: Marlowe and Company. 2002. p. 72-84. Contact: Available from Marlowe and Company. 161 William Street, 16th Floor, New York, NY 10038. PRICE: $15.95 plus shipping and handling. ISBN: 1569245339. Summary: Viral hepatitis B (liver infection) is one of the most preventable medical conditions due to the availability of a hepatitis B vaccine, yet an estimated 100,000 people in the United States are infected each year, and 6,000 die from complications. When the author of this book was diagnosed in 1993, he decided to be proactive in his quest to understand and manage his illness. In this chapter, the author focuses on fatigue management. The chapter is in two parts: first, a focus on the psychosocial aspects that the reader might experience, followed by a section of instructional material. In nontechnical language, the author discusses the symptoms of fatigue, the mental and physical aspects of fatigue, causes of fatigue, the role of adequate sleep, and nutrition and nutrients. The second section of the chapter reviews the liver biopsy, including the biopsy procedure itself, pre and post procedure care, and understanding the results. The author stresses that having a biopsy is not as painful as it sounds, and it is absolutely essential for determining the exact condition of the liver.

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Wilson's Disease and Related Disorders Source: in Friedman, L.S. and Keeffe, E.B., eds. Handbook of Liver Disease. Philadelphia, PA: Churchill-Livingstone. 1998. p. 239-254. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. Email: [email protected]. PRICE: $73.00 plus shipping and handling. ISBN: 0443055203. Summary: Wilson's disease (WD) is a rare progressive disease characterized by a defect in the metabolism of copper; it results in the accumulation of copper in liver, brain, kidney, cornea, and other tissues. This chapter on WD and related disorders is from a comprehensive handbook in outline format that offers easy access to information on the full range of liver disorders and covers symptoms, signs, differential diagnoses, and treatments. The WD gene is located on chromosome 13 and encodes a copper transporting P type ATPase protein. Deficiency of the WD gene product is likely to be responsible for the lack of copper incorporation into ceruloplasmin and the defective biliary excretion of copper in WD. Most symptomatic patients with WD present with hepatic or neuropsychiatric features; the principal hepatic (liver) manifestations include fulminant hepatic failure, chronic hepatitis, and cirrhosis. In patients with low serum ceruloplasmin, a diagnosis of WD in the absence of Kayser-Fleischer rings requires determination of hepatic copper concentration. Serum detection of radiocopper incorporation into ceruloplasmin may be a useful alternative test when liver biopsy is contraindicated. The use of DNA marker studies is limited largely to genetic screening of young family members or difficult diagnostic situations. The drug of choice for treating patients with WD is D penicillamine, but alternatives under selected circumstances include trientine, zinc, or tetrathiomolybdate. Liver transplantation is indicated for patients with fulminant hepatitis or decompensated cirrhosis unresponsive to therapy. 3 figures. 1 table. 11 references. (AA-M).

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Wilson's Disease Source: in Sherlock, S.; Dooley, J. Diseases of the Liver and Biliary System. Malden, MA: Blackwell Science, Inc. 2002. p.413-422. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail: [email protected]. Website: www.blackwell-science.com. PRICE: $178.95. ISBN: 0632055820. Summary: Wilson's disease is a rare autosomal recessive disorder of copper metabolism that is characterized by liver disease and neurological symptoms. This chapter on Wilson's disease is from a textbook that presents a comprehensive and up-to-date account of diseases of the liver and biliary system. The chapter covers molecular genetics, pathogenesis, pathology, the clinical picture (symptoms), hepatic (liver) forms, neuropsychiatric forms, renal (kidney) changes, other changes, laboratory tests, liver biopsy, scanning, diagnostic difficulties, treatment, and prognosis. 9 figures. 1 table. 51 references.

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CHAPTER 5. MULTIMEDIA ON LIVER BIOPSY Overview In this chapter, we show you how to keep current on multimedia sources of information on liver biopsy. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on liver biopsy is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “liver biopsy” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “liver biopsy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on liver biopsy: •

Basics of Alpha 1-Antitrypsin Liver Disease Source: Washington, DC: Alpha-1 Association. 200x. (videorecording). Contact: Available from Alpha-1 Association. 1225 Eye Street NW, Suite 1225, Washington, DC 20005-5918. (800) 521-3025 or (202) 887-1900. Fax: (202) 887-1964. Website: www.alpha1.org. E-mail: [email protected]. PRICE: Contact organization for copies. Summary: This videocassette depicts a slide lecture program given by Dr. Jeffrey Teckman at an Alpha-1 Association conference. Dr. Teckman describes the physiology and chemistry of the alpha-antitrypsin system, then the pathophysiology of alpha1antitrypsin deficiency. Dr. Teckman uses highly technical language, but then defines his terms and uses graphics to explain how the pathophysiology works (not all slides to which he refers are included in this videotape). Dr. Teckman also discusses the complications that are seen with this common, but underdiagnosed, genetic liver disease, including chronic hepatitis (liver inflammation), cirrhosis (scarring of the liver),

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liver cancer, and emphysema. Other topics include the Swedish research study that provided a great deal of basic information about this disease, the genetics, screening, diagnosis, the role of liver biopsy in diagnosis, and treatment options. The program concludes with a section of questions from the lecture audience, along with Dr. Teckman's answers.

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CHAPTER 6. PERIODICALS AND NEWS ON LIVER BIOPSY Overview In this chapter, we suggest a number of news sources and present various periodicals that cover liver biopsy.

News Services and Press Releases One of the simplest ways of tracking press releases on liver biopsy is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “liver biopsy” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to liver biopsy. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “liver biopsy” (or synonyms). The following was recently listed in this archive for liver biopsy: •

Europe drops liver biopsy for Schering-Plough's PegIntron Source: Reuters Industry Breifing Date: October 21, 2003

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “liver biopsy” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “liver biopsy” (or synonyms). If you know the name of a company that is relevant to liver biopsy, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “liver biopsy” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly

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to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “liver biopsy” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on liver biopsy: •

Hepatitis B in Asia Source: Asian Pacific Gastroenterology News. Issue 4: 12-13. June 2000. Contact: Available from Blackwell Science Asia. 54 University Street, Carlton, Victoria 3053, Australia. 61 3 9347 0300. Fax 61 3 9347 5001. E-mail: [email protected]. Summary: Five to 20 percent of the population of Asia and Africa are chronically infected with hepatitis B virus (HBV). This article reviews the main issues related to hepatitis B in Asia, including the evaluation and treatment of infected but asymptomatic subjects, the so-called HBV carriers; the continued horizontal spread of HBV infection, emergence of HBV mutants, and implementation of vaccination programs. The author contends that the term 'carrier' should therefore be deleted from the terminology of hepatitis B and should be replaced by 'chronic hepatitis B virus infection.' Evaluation of a subject with chronic HBV infection should include a reliable ALT (repeated three times), an HbeAg test, and if needed, an HBV DNA ultrasound and liver biopsy. The prevalence of HBV and hepatitis C (HCV) in chronic liver disease has been reported to be approximately 15 percent in the Asian region. In several countries in Asia, vaccination against HBV has been successfully included in the EPI program. This has led to a substantial reduction in the chronic HBV infection in the pediatric population. 1 table. 6 references.

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Aquaholics Corner Anyone for Liver? Source: Endless Water. 7(3): 8, 10. Summer 2002. Contact: Available from Diabetes Insipidus Foundation, Inc. 4533 Ridge Drive, Baltimore, MD 21229.E-mail: [email protected]. Website: http://diabetesinsipidus.maxinter.net. Summary: In this newsletter article, an author with diabetes insipidus ( a disease characterized by excessive urination and thirst) shares her experience undergoing a liver biopsy. The author describes the preoperative routine, the local anesthetic, what happens during the procedure itself, the pain involved, questions to ask the technicians and radiologist, and postprocedure care to expect. The article concludes with the website of the author (www.elderwyn.com/medicallinks).

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Liver Tests: Simple Blood Tests Can Reveal a Lot Source: Mayo Clinic Health Letter. 18(5): 1-3. May 2000. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This article, from a health newsletter, reviews the liver function tests that are used to monitor liver health and disease. The author begins by reviewing the healthy functions of the liver, including regulating the composition of the blood, manufacturing vital nutrients (such as cholesterol, vitamin A, certain proteins, bile), and neutralizing

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toxic substances. Sometimes there is an obvious sign of a problem, such as jaundice, which is a buildup of bilirubin in the blood, resulting in a yellow appearance of the skin and eyes. The various liver tests basically screen for three types of abnormalities: liver cell damage, reduced protein levels in the blood, and failure to eliminate certain substances from the blood. Information from the blood tests, combined with a thorough physical exam and sometimes diagnostic imaging, may be enough to reach a specific diagnosis; sometimes a liver biopsy is added to the list of diagnostic tests. Some of the more common liver disorders that are detected with these tests are viral hepatitis, alcohol or drug related liver disease, liver cancer, nonalcoholic steatohepatitis (a form of fatty liver), and hemochromatosis (high amounts of iron stored in the body). One sidebar reviews the drugs that can lead to liver toxicity. The author concludes that mild liver test abnormalities are normal; however, significantly abnormal test results should never be ignored. 1 figure.

Academic Periodicals covering Liver Biopsy Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to liver biopsy. In addition to these sources, you can search for articles covering liver biopsy that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute7: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

7

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:9 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

8

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 9 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway10 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “liver biopsy” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 110479 112 1011 246 428 112276

HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.14 Simply search by “liver biopsy” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

10

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

11

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists15 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.16 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.17 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

15 Adapted 16

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 17 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on liver biopsy can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to liver biopsy. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to liver biopsy. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “liver biopsy”:

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Cirrhosis http://www.nlm.nih.gov/medlineplus/cirrhosis.html Hepatitis http://www.nlm.nih.gov/medlineplus/hepatitis.html Hepatitis C http://www.nlm.nih.gov/medlineplus/hepatitisc.html Liver Cancer http://www.nlm.nih.gov/medlineplus/livercancer.html Liver Diseases http://www.nlm.nih.gov/medlineplus/liverdiseases.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on liver biopsy. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Liver Biopsy: Diagnosing Liver Conditions Source: Yardley, PA: The StayWell Company: KRAMES Health and Safety Education. 2002. 2 p. Contact: StayWell Company: KRAMES Health and Safety Education. 780 Township Line Road, Yardley, PA 19067. (800) 333-3032. Fax: (866) 722-4377. E-mail: [email protected]. Website: www.staywell.com. PRICE: Single copy free; $20.95 for 50. Item number: 911260. Summary: This brochure describes the use of liver biopsy to help assess the health of the liver. In a liver biopsy, a needle is inserted through the skin (percutaneous) and into the liver. A small sample of liver tissue is then removed and sent to a lab to be examined. The brochure discusses the indications for having a liver biopsy, the preprocedure preparation, possible risks and complications, what to expect during the procedure, what to expect after the procedure (including how to know when to call the doctor), and getting the results. One sidebar includes an illustration of the liver and a brief description of its physiology. 4 figures.

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Liver Biopsy Source: Bethesda, MD: National Digestive Diseases Information Clearinghouse (NDDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. 2000. 2 p. Contact: Available from National Digestive Diseases Information Clearinghouse (NDDIC). 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389 or (301) 6543810. Fax (301) 634-0716. E-mail: [email protected]. Website: www.niddk.nih.gov. PRICE: Full-text available online at no charge; single copy free; bulk copies available. Summary: With a liver biopsy, the physician is able to examine a small piece of tissue from the liver for signs of damage or disease. This fact sheet reviews the technique of liver biopsy. Designed for patients who will be undergoing a liver biopsy, the fact sheet reviews preparation, the procedure itself, and what to expect during the recovery time. The physician decides to do a liver biopsy after tests suggest that the liver is not working properly. Liver biopsy is considered minor surgery and is done at the hospital; the entire procedure takes about 20 minutes. The fact sheet describes standard liver biopsy, laparoscopic biopsy, and transvenous (through the vein) biopsy. After biopsy, the physician will put a bandage over the incision and have the patient lie on their right side, for at least 2 hours. The patient may remain in the hospital for up to 24 hours after the surgery to recover from the sedative and to allow the medical staff to check for complications before sending the patient home. The fact sheet notes that like any surgery, liver biopsy does have some risks, such as puncture of the lung or gallbladder, infection, bleeding, and pain, but these complications are rare. One diagram illustrates the anatomical location of the liver in relation to other organs in the abdomen. 1 figure. The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to liver biopsy. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

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Med Help International: http://www.medhelp.org/HealthTopics/A.html

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•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to liver biopsy. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with liver biopsy. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about liver biopsy. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “liver biopsy” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “liver biopsy”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format

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option “Organization Resource Sheet.” Type “liver biopsy” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “liver biopsy” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.18

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

18

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)19: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

19

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on liver biopsy: •

Basic Guidelines for Liver Biopsy Liver biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003895.htm

•

Diagnostics and Tests for Liver Biopsy Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm

•

Background Topics for Liver Biopsy Adolescent test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002054.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Clot Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm

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Infant test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002055.htm Pain medication Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Preschooler test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002057.htm Schoolage test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002058.htm Toddler test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002056.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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LIVER BIOPSY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 1-phosphate: A drug that halts cell suicide in human white blood cells. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal fat: Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Actin: Essential component of the cell skeleton. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aetiology: Study of the causes of disease. [EU] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent

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chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allogeneic: Taken from different individuals of the same species. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alpha-fetoprotein: AFP. A protein normally produced by a developing fetus. AFP levels are usually undetectable in the blood of healthy nonpregnant adults. An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy,

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magnet therapy, spiritual healing, and meditation. [NIH] Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility. [NIH]

Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino-terminal: The end of a protein or polypeptide chain that contains a free amino group (-NH2). [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]

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Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anoscopy: A test to look for fissures, fistulae, and hemorrhoids. The doctor uses a special instrument, called an anoscope, to look into the anus. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH]

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Antiplasmin: A member of the serpin superfamily found in human plasma that inhibits the lysis of fibrin clots which are induced by plasminogen activator. It is a glycoprotein, molecular weight approximately 70,000 that migrates in the alpha 2 region in immunoelectrophoresis. It is the principal plasmin inactivator in blood, rapidly forming a very stable complex with plasmin. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Appendectomy: An operation to remove the appendix. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arterial embolization: The blocking of an artery by a clot of foreign material. This can be done as treatment to block the flow of blood to a tumor. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arteriovenous Fistula: An abnormal communication between an artery and a vein. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autoimmune Hepatitis: A liver disease caused when the body's immune system destroys liver cells for no known reason. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autologous bone marrow transplantation: A procedure in which bone marrow is removed from a person, stored, and then given back to the person after intensive treatment. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its

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subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Beta-Thalassemia: A disorder characterized by reduced synthesis of the beta chains of hemoglobin. There is retardation of hemoglobin A synthesis in the heterozygous form (thalassemia minor), which is asymptomatic, while in the homozygous form (thalassemia major, Cooley's anemia, Mediterranean anemia, erythroblastic anemia), which can result in severe complications and even death, hemoglobin A synthesis is absent. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Atresia: Atresia of the biliary tract, most commonly of the extrahepatic bile ducts. [NIH]

Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopsy specimen: Tissue removed from the body and examined under a microscope to determine whether disease is present. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bleeding Time: Duration of blood flow after skin puncture. This test is used as a measure of capillary and platelet function. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example,

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in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]

Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone Marrow Transplantation: The transference of bone marrow from one human or animal to another. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cadaver: A dead body, usually a human body. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal

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functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Oxalate: The calcium salt of oxalic acid, occurring in the urine as crystals and in certain calculi. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Carcinoid: A type of tumor usually found in the gastrointestinal system (most often in the appendix), and sometimes in the lungs or other sites. Carcinoid tumors are usually benign. [NIH]

Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catalyse: To speed up a chemical reaction. [EU] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Celiac Artery: The arterial trunk that arises from the abdominal aorta and after a short course divides into the left gastric, common hepatic and splenic arteries. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH]

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Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Transplantation: Transference of cells within an individual, between individuals of the same species, or between individuals of different species. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU] Chelation Therapy: Therapy of heavy metal poisoning using agents which sequester the metal from organs or tissues and bind it firmly within the ring structure of a new compound which can be eliminated from the body. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholangitis: Inflammation of a bile duct. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Choledochal Cyst: A congenital cystic dilatation of the common bile duct; this condition may be asymptomatic, or cause vomiting, fever, jaundice, or pain in the right upper quadrant. [NIH] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH]

Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic granulocytic leukemia: A slowly progressing disease in which too many white blood cells are made in the bone marrow. Also called chronic myelogenous leukemia or chronic myeloid leukemia. [NIH] Chronic myelogenous leukemia: CML. A slowly progressing disease in which too many white blood cells are made in the bone marrow. Also called chronic myeloid leukemia or chronic granulocytic leukemia. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient.

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[NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clonic: Pertaining to or of the nature of clonus. [EU] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coccidioidomycosis: An infectious disease caused by a fungus, Coccidioides immitis, that is prevalent in the western United States and is acquired by inhalation of dust containing the spores. [NIH] Codons: Any triplet of nucleotides (coding unit) in DNA or RNA (if RNA is the carrier of primary genetic information as in some viruses) that codes for particular amino acid or signals the beginning or end of the message. [NIH] Colchicine: A major alkaloid from Colchicum autumnale L. and found also in other Colchicum species. Its primary therapeutic use is in the treatment of gout, but it has been used also in the therapy of familial Mediterranean fever (periodic disease). [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colon Polyps: Small, fleshy, mushroom-shaped growths in the colon. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Common Bile Duct: The largest biliary duct. It is formed by the junction of the cystic duct and the hepatic duct. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names.

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Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]

Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or

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treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Criterion: A standard by which something may be judged. [EU] Cryptorchidism: A condition in which one or both testicles fail to move from the abdomen, where they develop before birth, into the scrotum. Cryptorchidism may increase the risk for development of testicular cancer. Also called undescended testicles. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] De novo: In cancer, the first occurrence of cancer in the body. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH]

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Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially death. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diathesis: A constitution or condition of the body which makes the tissues react in special ways to certain extrinsic stimuli and thus tends to make the person more than usually

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susceptible to certain diseases. [EU] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissection: Cutting up of an organism for study. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Diuresis: Increased excretion of urine. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulosis: A condition marked by small sacs or pouches (diverticula) in the walls of an organ such as the stomach or colon. These sacs can become inflamed and cause a condition called diverticulitis, which may be a risk factor for certain types of cancer. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH]

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Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrolytes: Substances that break up into ions (electrically charged particles) when they are dissolved in body fluids or water. Some examples are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells, and the movement of wastes out of cells. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopic retrograde cholangiopancreatography: ERCP. A procedure to x-ray the pancreatic duct, hepatic duct, common bile duct, duodenal papilla, and gallbladder. In this procedure, a thin, lighted tube (endoscope) is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted

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through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and an x-ray is taken. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Eosinophilic: A condition found primarily in grinding workers caused by a reaction of the pulmonary tissue, in particular the eosinophilic cells, to dust that has entered the lung. [NIH] Eosinophilic Gastroenteritis: Infection and swelling of the lining of the stomach, small intestine, or large intestine. The infection is caused by white blood cells (eosinophils). [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]

Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Stricture: A narrowing of the esophagus often caused by acid flowing back

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from the stomach. This condition may require surgery. [NIH] Esophageal Varices: Stretched veins in the esophagus that occur when the liver is not working properly. If the veins burst, the bleeding can cause death. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Family Health: The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also, the impact of family organization or disorganization on the health status of its members. [NIH]

Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty Liver: The buildup of fat in liver cells. The most common cause is alcoholism. Other causes include obesity, diabetes, and pregnancy. Also called steatosis. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU]

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Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Femoral Vein: The vein accompanying the femoral artery in the same sheath; it is a continuation of the popliteal vein and becomes the external iliac vein. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fetoprotein: Transabdominal aspiration of fluid from the amniotic sac with a view to detecting increases of alpha-fetoprotein in maternal blood during pregnancy, as this is an important indicator of open neural tube defects in the fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fever of Unknown Origin: Fever in which the etiology cannot be ascertained. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibronectins: Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fine-needle aspiration: The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Flurbiprofen: An anti-inflammatory analgesic and antipyretic of the phenylalkynoic acid series. It has been shown to reduce bone resorption in periodontal disease by inhibiting carbonic anhydrase. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Fulminant Hepatic Failure: Liver failure that occurs suddenly in a previously healthy person. The most common causes of FHF are acute hepatitis, acetaminophen overdose, and liver damage from prescription drugs. [NIH]

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Functional Disorders: Disorders such as irritable bowel syndrome. These conditions result from poor nerve and muscle function. Symptoms such as gas, pain, constipation, and diarrhea come back again and again, but there are no signs of disease or damage. Emotional stress can trigger symptoms. Also called motility disorders. [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Galactosemia: Buildup of galactose in the blood. Caused by lack of one of the enzymes needed to break down galactose into glucose. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma irradiation: A type of radiation therapy that uses gamma radiation. Gamma radiation is a type of high-energy radiation that is different from x-rays. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Bypass: Surgical procedure in which the stomach is transected high on the body. The resulting proximal remnant is joined to a loop of the jejunum in an end-to-side anastomosis. This procedure is used frequently in the treatment of morbid obesity. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Deletion: A genetic rearrangement through loss of segments of DNA or RNA, bringing sequences which are normally separated into close proximity. This deletion may be detected using cytogenetic techniques and can also be inferred from the phenotype,

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indicating a deletion at one specific locus. [NIH] Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Expression Profiling: The determination of the pattern of genes expressed i.e., transcribed, under specific circumstances or in a specific cell. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic Markers: A phenotypically recognizable genetic trait which can be used to identify a genetic locus, a linkage group, or a recombination event. [NIH] Genetic Screening: Searching a population or individuals for persons possessing certain genotypes or karyotypes that: (1) are already associated with disease or predispose to disease; (2) may lead to disease in their descendants; or (3) produce other variations not known to be associated with disease. Genetic screening may be directed toward identifying phenotypic expression of genetic traits. It includes prenatal genetic screening. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Giant Cells: Multinucleated masses produced by the fusion of many cells; often associated with viral infections. In AIDS, they are induced when the envelope glycoprotein of the HIV virus binds to the CD4 antigen of uninfected neighboring T4 cells. The resulting syncytium leads to cell death and thus may account for the cytopathic effect of the virus. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or N-

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acetylgalactosamine. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH]

Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haematuria: Blood in the urine. [EU] Haemophilia: A haemorrhagic diathesis occurring in two main forms: 1. Haemophilia A (classic haemophilia, factor VIII deficiency), an X-linked disorder due to deficiency of coagulation factor VIII; 2. Haemophilia B (factor IX deficiency, Christmas disease), also Xlinked, due to deficiency of coagulation factor IX. Both forms are determined by a mutant gene near the telomere of the long arm of the X chromosome (Xq), but a different loci, and are characterized by subcutaneous and intramuscular haemorrhages; bleeding from the mouth, gums, lips, and tongue; haematuria; and haemarthroses. [EU] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health

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care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematologic malignancies: Cancers of the blood or bone marrow, including leukemia and lymphoma. Also called hematologic cancers. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemochromatosis: A disease that occurs when the body absorbs too much iron. The body stores the excess iron in the liver, pancreas, and other organs. May cause cirrhosis of the liver. Also called iron overload disease. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemophilia: Refers to a group of hereditary disorders in which affected individuals fail to make enough of certain proteins needed to form blood clots. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hepatic: Refers to the liver. [NIH] Hepatic Artery: A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum. [NIH] Hepatic Duct, Common: Predominantly extrahepatic bile duct which is formed by the junction of the right and left hepatic ducts, which are predominantly intrahepatic, and, in

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turn, joins the cystic duct to form the common bile duct. [NIH] Hepatic Veins: Veins which drain the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatitis A: Hepatitis caused by hepatovirus. It can be transmitted through fecal contamination of food or water. [NIH] Hepatitis, Chronic: A collective term for a clinical and pathological syndrome which has several causes and is characterized by varying degrees of hepatocellular necrosis and inflammation. Specific forms of chronic hepatitis include autoimmune hepatitis, chronic hepatitis B, chronic hepatitis C, chronic hepatitis D, indeterminate chronic viral hepatitis, cryptogenic chronic hepatitis, and drug-related chronic hepatitis. [NIH] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocellular carcinoma: A type of adenocarcinoma, the most common type of liver tumor. [NIH] Hepatocyte: A liver cell. [NIH] Hepatology: The field of medicine concerned with the functions and disorders of the liver. [NIH]

Hepatoma: A liver tumor. [NIH] Hepatomegaly: Enlargement of the liver. [NIH] Hepatotoxicity: How much damage a medicine or other substance does to the liver. [NIH] Hepatovirus: A genus of Picornaviridae causing infectious hepatitis naturally in humans and experimentally in other primates. It is transmitted through fecal contamination of food or water. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Heterozygotes: Having unlike alleles at one or more corresponding loci on homologous chromosomes. [NIH] Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Histiocytosis: General term for the abnormal appearance of histiocytes in the blood. Based on the pathological features of the cells involved rather than on clinical findings, the histiocytic diseases are subdivided into three groups: Langerhans cell histiocytosis, non-

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Langerhans cell histiocytosis, and malignant histiocytic disorders. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperoxaluria: Excretion of an excessive amount of oxalate in the urine. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions

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upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Idiopathic: Describes a disease of unknown cause. [NIH] Ileoanal Reservoir: An operation to remove the colon, upper rectum, and part of the lower rectum. An internal pouch is created from the remaining intestine to hold stool. The operation may be done in two stages. The pouch may also be called a J-pouch or W-pouch. [NIH]

Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH] Iliac Vein: A vein on either side of the body which is formed by the union of the external and internal iliac veins and passes upward to join with its fellow of the opposite side to form the inferior vena cava. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunochemistry: Field of chemistry that pertains to immunological phenomena and the study of chemical reactions related to antigen stimulation of tissues. It includes physicochemical interactions between antigens and antibodies. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunoelectrophoresis: A technique that combines protein electrophoresis and double immunodiffusion. In this procedure proteins are first separated by gel electrophoresis (usually agarose), then made visible by immunodiffusion of specific antibodies. A distinct elliptical precipitin arc results for each protein detectable by the antisera. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunologic Factors: Biologically active substances whose activities affect or play a role in the functioning of the immune system. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppression: Deliberate prevention or diminution of the host's immune response. It may be nonspecific as in the administration of immunosuppressive agents (drugs or

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radiation) or by lymphocyte depletion or may be specific as in desensitization or the simultaneous administration of antigen and immunosuppressive drugs. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incubated: Grown in the laboratory under controlled conditions. (For instance, white blood cells can be grown in special conditions so that they attack specific cancer cells when returned to the body.) [NIH] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Indocyanine Green: A tricarbocyanine dye that is used diagnostically in liver function tests and to determine blood volume and cardiac output. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH]

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Inguinal: Pertaining to the inguen, or groin. [EU] Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon Alfa-2a: A recombinant alfa interferon consisting of 165 amino acids with lysine at position 23 and histidine at position 34. It is used extensively as an antiviral and antineoplastic agent. [NIH] Interferon Alfa-2b: A recombinant alfa interferon consisting of 165 amino acid residues with arginine in position 23 and histidine in position 34. It is used extensively as an antiviral and antineoplastic agent. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-10: Factor that is a coregulator of mast cell growth. It is produced by T-cells and B-cells and shows extensive homology with the Epstein-Barr virus BCRFI gene. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU]

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Intestinal: Having to do with the intestines. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intrahepatic: Within the liver. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Karyotypes: The characteristic chromosome complement of an individual, race, or species as defined by their number, size, shape, etc. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and

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lipid A. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Lesion: An area of abnormal tissue change. [NIH] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipid Peroxides: Peroxides produced in the presence of a free radical by the oxidation of unsaturated fatty acids in the cell in the presence of molecular oxygen. The formation of lipid peroxides results in the destruction of the original lipid leading to the loss of integrity of the membranes. They therefore cause a variety of toxic effects in vivo and their formation is considered a pathological process in biological systems. Their formation can be inhibited

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by antioxidants, such as vitamin E, structural separation or low oxygen tension. [NIH] Lipolysis: The hydrolysis of lipids. [NIH] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [NIH]

Liver Cirrhosis: Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Living Donors: Non-cadaveric providers of organs for transplant to related or non-related recipients. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lucida: An instrument, invented by Wollaton, consisting essentially of a prism or a mirror through which an object can be viewed so as to appear on a plane surface seen in direct view and on which the outline of the object may be traced. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphokines: Soluble protein factors generated by activated lymphocytes that affect other

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cells, primarily those involved in cellular immunity. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lymphoproliferative: Disorders characterized by proliferation of lymphoid tissue, general or unspecified. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Macrophage Activation: The process of altering the morphology and functional activity of macrophages so that they become avidly phagocytic. It is initiated by lymphokines, such as the macrophage activation factor (MAF) and the macrophage migration-inhibitory factor (MMIF), immune complexes, C3b, and various peptides, polysaccharides, and immunologic adjuvants. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Mastocytosis: A group of diseases resulting from proliferation of mast cells. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megacolon: Pathological enlargement of the colon. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mephenytoin: An anticonvulsant effective in tonic-clonic epilepsy. It may cause blood dyscrasias. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary

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arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and cardiac patients. [NIH]

Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milk Thistle: The plant Silybum marianum in the family Asteraceae containing the bioflavonoid complex silymarin. For centuries this has been used traditionally to treat liver disease. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH]

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Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelogenous: Produced by, or originating in, the bone marrow. [NIH] Myeloproliferative Disorders: Disorders in which one or more stimuli cause proliferation of hemopoietically active tissue or of tissue which has embryonic hemopoietic potential. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopathy: Any disease of a muscle. [EU] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Needle biopsy: The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nephrolithiasis: Kidney stones. [NIH] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and

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stainable by neutral dyes. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Odynophagia: A painful condition of the esophagus. [NIH] Office Management: Planning, organizing, and administering activities in an office. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oligopeptides: Peptides composed of between two and twelve amino acids. [NIH] Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opisthorchiasis: Infection with flukes of the genus Opisthorchis. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Ornithine: An amino acid produced in the urea cycle by the splitting off of urea from arginine. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment

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in a clinic or dispensary connected with the hospital. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oxalate: A chemical that combines with calcium in urine to form the most common type of kidney stone (calcium oxalate stone). [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Ducts: Ducts that collect pancreatic juice from the pancreas and supply it to the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Papilla: A small nipple-shaped elevation. [NIH] Papillary: Pertaining to or resembling papilla, or nipple. [EU] Papillary Stenosis: A condition in which the openings of the bile ducts and pancreatic ducts narrow. [NIH] Paracentesis: A procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument. [NIH] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical antiinflammatory. It is also commonly used as an embedding material in histology. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parenchyma: The essential elements of an organ; used in anatomical nomenclature as a general term to designate the functional elements of an organ, as distinguished from its framework, or stroma. [EU] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the

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parietal bone, as the parietal lobe. [EU] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the

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greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physicochemical: Pertaining to physics and chemistry. [EU] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH]

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Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Platelet Count: A count of the number of platelets per unit volume in a sample of venous blood. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pleura: The thin serous membrane enveloping the lungs and lining the thoracic cavity. [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Pleural Effusion: Presence of fluid in the pleural cavity resulting from excessive transudation or exudation from the pleural surfaces. It is a sign of disease and not a diagnosis in itself. [NIH] Ploidy: The number of sets of chromosomes in a cell or an organism. For example, haploid means one set and diploid means two sets. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polycythemia Vera: A myeloproliferative disorder of unknown etiology, characterized by abnormal proliferation of all hematopoietic bone marrow elements and an absolute increase in red cell mass and total blood volume, associated frequently with splenomegaly, leukocytosis, and thrombocythemia. Hematopoiesis is also reactive in extramedullary sites (liver and spleen). In time myelofibrosis occurs. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear

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polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polyethylene Glycols: Alpha-Hydro-omega-hydroxypoly(oxy-1,2-ethanediyls). Additional polymers of ethylene oxide and water and their ethers. They vary in consistency from liquid to solid, depending on the molecular weight, indicated by a number following the name. Used as surfactants in industry, including foods, cosmetics and pharmaceutics; in biomedicine, as dispersing agents, solvents, ointment and suppository bases, vehicles, tablet excipients. Some specific groups are lauromagrogols, nonoxynols, octoxynols and poloxamers. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Popliteal: Compression of the nerve at the neck of the fibula. [NIH] Popliteal Vein: The vein formed by the union of the anterior and posterior tibial veins; it courses through the popliteal space and becomes the femoral vein. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Porphyrins: A group of compounds containing the porphin structure, four pyrrole rings connected by methine bridges in a cyclic configuration to which a variety of side chains are attached. The nature of the side chain is indicated by a prefix, as uroporphyrin, hematoporphyrin, etc. The porphyrins, in combination with iron, form the heme component in biologically significant compounds such as hemoglobin and myoglobin. [NIH] Portal Hypertension: High blood pressure in the portal vein. This vein carries blood into the liver. Portal hypertension is caused by a blood clot. This is a common complication of cirrhosis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and

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costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predictive factor: A situation or condition that may increase a person's risk of developing a certain disease or disorder. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Diagnosis: Determination of the nature of a pathological condition or disease in the postimplantation embryo, fetus, or pregnant female before birth. [NIH] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Biliary Cirrhosis: A chronic liver disease. Slowly destroys the bile ducts in the liver. This prevents release of bile. Long-term irritation of the liver may cause scarring and cirrhosis in later stages of the disease. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Primary Sclerosing Cholangitis: Irritation, scarring, and narrowing of the bile ducts inside and outside the liver. Bile builds up in the liver and may damage its cells. Many people with this condition also have ulcerative colitis. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procollagen: A biosynthetic precursor of collagen containing additional amino acid sequences at the amino-terminal ends of the three polypeptide chains. Protocollagen, a precursor of procollagen consists of procollagen peptide chains in which proline and lysine have not yet been hydroxylated. [NIH] Proctitis: Inflammation of the rectum. [EU] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Progressive disease: Cancer that is increasing in scope or severity. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential

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component of collagen and is important for proper functioning of joints and tendons. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH]

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Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulmonary Fibrosis: Chronic inflammation and progressive fibrosis of the pulmonary alveolar walls, with steadily progressive dyspnea, resulting finally in death from oxygen lack or right heart failure. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Pyridoxal: 3-Hydroxy-5-(hydroxymethyl)-2-methyl-4- pyridinecarboxaldehyde. [NIH] Pyruvate Dehydrogenase Complex: An organized assembly of three kinds of enzymes; catalyzes the oxidative decarboxylation of pyruvate. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH]

Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Rationalization: A defense mechanism operating unconsciously, in which the individual attempts to justify or make consciously tolerable, by plausible means, feelings, behavior, and motives that would otherwise be intolerable. [NIH] Reactivation: The restoration of activity to something that has been inactivated. [EU]

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Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Progesterone: Specific proteins found in or on cells of progesterone target tissues that specifically combine with progesterone. The cytosol progesterone-receptor complex then associates with the nucleic acids to initiate protein synthesis. There are two kinds of progesterone receptors, A and B. Both are induced by estrogen and have short half-lives. [NIH]

Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Replicon: In order to be replicated, DNA molecules must contain an origin of duplication and in bacteria and viruses there is usually only one per genome. Such molecules are called replicons. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into

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the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Retreatment: The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retrovirus: A member of a group of RNA viruses, the RNA of which is copied during viral replication into DNA by reverse transcriptase. The viral DNA is then able to be integrated into the host chromosomal DNA. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribavirin: 1-beta-D-Ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Rosiglitazone: A drug taken to help reduce the amount of sugar in the blood. Rosiglitazone helps make insulin more effective and improves regulation of blood sugar. It belongs to the family of drugs called thiazolidinediones. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH]

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Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Secretin: A hormone made in the duodenum. Causes the stomach to make pepsin, the liver to make bile, and the pancreas to make a digestive juice. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Sequence Analysis: A multistage process that includes the determination of a sequence (protein, carbohydrate, etc.), its fragmentation and analysis, and the interpretation of the resulting sequence information. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Sequester: A portion of dead bone which has become detached from the healthy bone tissue, as occurs in necrosis. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serologic Tests: Diagnostic procedures involving immunoglobulin reactions. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silymarin: A mixture of flavonoids extracted from seeds of the milk thistle, Silybum marianum. It consists primarily of three isomers: silicristin, silidianin, and silybin, its major component. Silymarin displays antioxidant and membrane stabilizing activity. It protects various tissues and organs against chemical injury, and shows potential as an antihepatoxic agent. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH]

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Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin graft: Skin that is moved from one part of the body to another. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sonogram: A computer picture of areas inside the body created by bouncing sound waves off organs and other tissues. Also called ultrasonogram or ultrasound. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Speech Disorders: Acquired or developmental conditions marked by an impaired ability to comprehend or generate spoken forms of language. [NIH] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in

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the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splenectomy: An operation to remove the spleen. [NIH] Splenomegaly: Enlargement of the spleen. [NIH] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Standard therapy: A currently accepted and widely used treatment for a certain type of cancer, based on the results of past research. [NIH] Steatosis: Fatty degeneration. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stellate: Star shaped. [NIH] Stem cell transplantation: A method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH]

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Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subcapsular: Situated below a capsule. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Systemic: Affecting the entire body. [NIH] Telomerase: Essential ribonucleoprotein reverse transcriptase that adds telomeric DNA to the ends of eukaryotic chromosomes. Telomerase appears to be repressed in normal human somatic tissues but reactivated in cancer, and thus may be necessary for malignant transformation. EC 2.7.7.-. [NIH] Telomere: A terminal section of a chromosome which has a specialized structure and which is involved in chromosomal replication and stability. Its length is believed to be a few hundred base pairs. [NIH] Testicle: The male gonad where, in adult life, spermatozoa develop; the testis. [NIH] Testicular: Pertaining to a testis. [EU] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thoracoscopy: Endoscopic examination, therapy or surgery of the pleural cavity. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or

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intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Traction: The act of pulling. [NIH] Transaminase: Aminotransferase (= a subclass of enzymes of the transferase class that catalyse the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally 2-keto acid). Most of these enzymes are pyridoxal-phosphate-proteins. [EU]

Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group

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or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transfusion-Transmitted Virus: An unclassified, non-enveloped DNA virus associated with transfusions and hepatitis. However, no etiological role has been found for TTV in hepatitis, and evidence suggests it is not a Hepatovirus. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the

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muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uroporphyrinogen Decarboxylase: One of the enzymes active in heme biosynthesis. It catalyzes the decarboxylation of uroporphyrinogen III to coproporphyrinogen III by the conversion of four acetic acid groups to four methyl groups. EC 4.1.1.37. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Valine: A branched-chain essential amino acid that has stimulant activity. It promotes muscle growth and tissue repair. It is a precursor in the penicillin biosynthetic pathway. [NIH]

Varicocele: A complex of dilated veins which surround the testicle, usually on the left side. [NIH]

Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU]

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Viral Hepatitis: Hepatitis caused by a virus. Five different viruses (A, B, C, D, and E) most commonly cause this form of hepatitis. Other rare viruses may also cause hepatitis. [NIH] Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] Viremia: The presence of viruses in the blood. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral fat: One of the three compartments of abdominal fat. Retroperitoneal and subcutaneous are the other two compartments. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

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INDEX 1 1-phosphate, 13, 125 A Abdominal, 17, 21, 31, 34, 51, 88, 91, 93, 125, 132, 137, 152, 159, 160, 161, 174, 176 Abdominal fat, 125, 176 Abdominal Pain, 17, 88, 91, 125, 152, 161, 174 Abscess, 93, 125, 169 Acceptor, 125, 153, 159, 173, 174 Acetaminophen, 11, 13, 85, 125, 142 Acquired Immunodeficiency Syndrome, 37, 125 Actin, 24, 125 Adaptability, 125, 132 Adenocarcinoma, 125, 147 Adenosine, 125, 131, 161 Adipose Tissue, 21, 125 Adrenal Glands, 125, 127 Adverse Effect, 125, 169 Aerobic, 125, 156 Aetiology, 31, 125 Affinity, 27, 125, 126 Agonist, 10, 126 Alanine, 14, 20, 59, 126 Albumin, 86, 88, 126, 162 Alertness, 126, 131 Algorithms, 81, 86, 126, 130 Alimentary, 38, 126, 138 Alkaline, 72, 90, 126, 127, 131 Alkaline Phosphatase, 72, 90, 126 Alkaloid, 126, 134, 156 Alleles, 25, 126, 147 Allogeneic, 91, 126 Allograft, 32, 41, 42, 44, 126 Alpha-1, 89, 97, 126 Alpha-fetoprotein, 86, 126, 142 Alternative medicine, 85, 100, 126 Ambulatory Care, 5, 127 Amino Acid Sequence, 81, 127, 128, 164 Amino-terminal, 127, 164 Ammonia, 127, 175 Amnestic, 127, 156 Amplification, 12, 53, 66, 127 Ampulla, 127, 133, 139 Amyloidosis, 56, 127 Anaesthesia, 32, 37, 127 Anaesthetic, 32, 127

Anal, 93, 127, 141 Anal Fissure, 93, 127 Analgesic, 125, 127, 142, 156, 158 Anastomosis, 93, 127, 143 Anatomical, 45, 113, 127, 133, 150, 159 Anemia, 4, 127, 130, 172 Anesthesia, 65, 83, 127, 156 Angiography, 39, 128 Angiotensinogen, 81, 128, 167 Animal model, 15, 18, 19, 24, 128 Anions, 126, 128, 152, 169 Annealing, 128, 163 Anorectal, 85, 90, 93, 128 Anoscopy, 90, 128 Antagonism, 128, 131 Antibacterial, 128, 170 Antibiotic, 93, 128, 160, 170 Antibodies, 24, 27, 81, 84, 86, 128, 145, 148, 149, 154, 162 Antibody, 27, 81, 126, 128, 134, 140, 145, 148, 149, 150, 152, 166, 169, 170 Anticonvulsant, 128, 155 Antigen, 39, 42, 50, 126, 128, 135, 144, 148, 149, 150, 169 Anti-inflammatory, 125, 128, 142, 159 Antimetabolite, 128, 155, 168 Antineoplastic, 128, 151, 155 Antioxidant, 128, 159, 169 Antiplasmin, 81, 129 Antipyretic, 125, 129, 142 Antiviral, 5, 9, 16, 21, 26, 27, 94, 129, 151, 168 Anus, 127, 128, 129, 131, 134, 140, 152, 167 Anxiety, 14, 129 Anxiolytic, 129, 156 Aorta, 10, 129, 132 Appendectomy, 83, 129 Appendicitis, 93, 129 Arginine, 129, 151, 158 Arterial, 31, 58, 129, 132, 149, 165 Arterial embolization, 31, 58, 129 Arteries, 10, 129, 130, 131, 132, 136, 156 Arteriovenous, 62, 129, 156 Arteriovenous Fistula, 62, 129 Artery, 129, 136, 139, 142, 160, 166 Ascites, 4, 29, 34, 55, 65, 91, 129 Aspiration, 44, 66, 85, 129, 142 Assay, 14, 22, 43, 59, 88, 129, 149

178

Liver Biopsy

Asymptomatic, 90, 91, 101, 129, 130, 133, 159 Atypical, 20, 51, 129 Autodigestion, 129, 159 Autoimmune Hepatitis, 92, 129, 147 Autologous, 91, 129 Autologous bone marrow transplantation, 91, 129 B Bacteria, 128, 129, 130, 139, 140, 141, 143, 156, 167, 169, 170, 173, 175 Bacterial Infections, 88, 129 Basement Membrane, 129, 141, 153 Benign, 17, 20, 24, 130, 132, 145, 157 Beta-Thalassemia, 29, 130 Bile, 34, 43, 88, 89, 93, 101, 130, 133, 139, 143, 146, 147, 150, 152, 154, 159, 164, 169, 171 Bile Acids, 130, 171 Bile Acids and Salts, 130 Bile duct, 34, 88, 93, 130, 133, 139, 146, 150, 159, 164 Bile Pigments, 130, 152 Biliary, 4, 27, 49, 63, 85, 87, 88, 89, 90, 91, 92, 95, 96, 130, 133, 134, 147, 159 Biliary Atresia, 85, 130 Biliary Tract, 63, 88, 91, 130, 159 Bilirubin, 5, 86, 88, 91, 102, 126, 130, 148 Biochemical, 6, 14, 16, 18, 19, 20, 21, 26, 35, 43, 126, 128, 130, 145 Biosynthesis, 130, 175 Biotechnology, 30, 100, 107, 130 Bladder, 130, 135, 151, 165, 175 Bleeding Time, 54, 130 Bloating, 130, 150, 152 Blood pressure, 10, 130, 149, 156, 163 Blood transfusion, 36, 89, 131 Blood vessel, 128, 130, 131, 133, 140, 145, 146, 154, 160, 170, 171, 173, 175 Blood Volume, 131, 150, 162 Blot, 27, 131 Body Fluids, 131, 138, 139, 158, 174 Bolus, 13, 131 Bolus infusion, 131 Bone Marrow, 29, 31, 55, 129, 131, 133, 146, 154, 156, 157, 162, 171 Bone Marrow Transplantation, 31, 55, 131 Bowel, 88, 90, 92, 93, 127, 131, 138, 140, 150, 152, 153, 161, 171, 174 Bowel Movement, 131, 138, 171 Bradykinin, 131, 162 Breeding, 10, 131

Bypass, 8, 131 C Cadaver, 7, 131 Caffeine, 11, 131 Calcium, 131, 132, 134, 139, 159 Calcium Oxalate, 132, 159 Cannula, 132, 159 Capillary, 130, 131, 132, 175 Carbohydrate, 132, 145, 163, 169 Carcinogenic, 132, 151, 171 Carcinoid, 93, 132 Carcinoma, 61, 132 Cardiac, 22, 131, 132, 137, 150, 156, 157, 171 Cardiac Output, 132, 150 Cardiorespiratory, 132, 156 Carrier Proteins, 132, 162 Case report, 34, 37, 40, 45, 47, 61, 132 Case series, 7, 132 Catalyse, 132, 173 Catheter, 132, 139 Cecum, 132, 153 Celiac Artery, 132, 146 Cell Death, 9, 132, 144, 157 Cell Respiration, 133, 156, 168 Cell Transplantation, 67, 133 Central Nervous System, 126, 131, 133, 145, 156 Chelation, 28, 133 Chelation Therapy, 28, 133 Chin, 133, 155 Cholangitis, 4, 88, 92, 133 Cholecystectomy, 72, 83, 133 Cholecystitis, 31, 33, 88, 133 Choledochal Cyst, 93, 133 Cholestasis, 34, 61, 90, 133 Cholesterol, 21, 101, 130, 133, 171 Chromatin, 133, 140, 157 Chromosomal, 127, 133, 168, 172 Chromosome, 95, 133, 145, 152, 153, 172 Chronic Disease, 84, 86, 87, 88, 92, 94, 133 Chronic granulocytic leukemia, 133 Chronic myelogenous leukemia, 44, 133 Chronic renal, 64, 133, 162, 174 Clamp, 29, 133 Clinical Medicine, 10, 55, 133, 164 Clinical trial, 7, 15, 24, 107, 134, 136, 138, 157, 160, 165, 166 Clonic, 134, 155 Cloning, 84, 130, 134 Coccidioidomycosis, 41, 134 Codons, 81, 134

179

Colchicine, 90, 134 Colitis, 134, 152 Collagen, 12, 24, 81, 127, 129, 134, 141, 142, 143, 164, 165 Collapse, 37, 134 Colloidal, 126, 134, 169 Colon, 93, 134, 138, 149, 150, 152, 153, 155, 169, 174 Colon Polyps, 93, 134 Colonoscopy, 90, 93, 134 Colostomy, 93, 134 Common Bile Duct, 133, 134, 147 Complement, 134, 144, 152, 162 Compliance, 15, 23, 26, 87, 135 Computational Biology, 107, 135 Computed tomography, 33, 86, 135 Computerized axial tomography, 135 Computerized tomography, 4, 135 Concomitant, 17, 135 Confusion, 135, 175 Conjugated, 130, 135, 136 Connective Tissue, 131, 134, 135, 142, 143, 154, 168 Constipation, 92, 93, 135, 143, 152, 161 Contamination, 80, 135, 147 Continuum, 10, 135 Contraindications, ii, 4, 90, 135 Contrast medium, 128, 136 Control group, 24, 29, 136, 164 Cornea, 95, 136, 172 Coronary, 10, 136, 155 Coronary Thrombosis, 136, 156 Cortisol, 126, 136 Criterion, 73, 136 Cryptorchidism, 83, 136 Cutaneous, 13, 136 Cyclic, 131, 136, 163 Cytochrome, 25, 29, 136 Cytokine, 9, 19, 20, 28, 66, 136 Cytomegalovirus, 42, 136 Cytoplasm, 136, 140, 156, 157 Cytotoxic, 8, 136 D De novo, 21, 136 Deamination, 136, 175 Decarboxylation, 137, 166, 175 Decompensation, 11, 16, 137 Decompression, 91, 137 Decompression Sickness, 137 Degenerative, 137, 147 Deletion, 137, 143 Delivery of Health Care, 137, 146

Dementia, 125, 137 Denaturation, 137, 163 Density, 12, 137, 158, 162, 170 Dermal, 13, 137 Deuterium, 137, 148 Diabetes Insipidus, 101, 137 Diabetes Mellitus, 71, 137, 144, 146 Diagnostic Imaging, 102, 137 Diagnostic procedure, 79, 90, 100, 137, 169 Diaphragm, 65, 137, 147, 162 Diarrhea, 88, 93, 137, 143, 152 Diathesis, 91, 137, 145 Dietary Fiber, 93, 138 Digestion, 36, 85, 126, 130, 131, 138, 139, 150, 152, 154, 160, 171 Digestive system, 85, 93, 94, 138, 143 Digestive tract, 92, 138, 170 Dihydrotestosterone, 138, 167 Dilation, 90, 93, 131, 138 Diploid, 138, 161, 162 Direct, iii, 4, 27, 133, 138, 148, 154, 167 Disposition, 11, 13, 138 Dissection, 12, 138 Dissociation, 126, 138 Diuresis, 131, 138 Diverticula, 138 Diverticulitis, 93, 138 Diverticulosis, 93, 138 Diverticulum, 84, 93, 138 Double-blind, 25, 138 Drug Tolerance, 138, 173 Duct, 93, 127, 132, 134, 138, 139, 141, 147, 158, 168 Duodenum, 130, 138, 139, 146, 152, 159, 160, 169, 171 Dyes, 139, 158 Dyspepsia, 139, 150 Dyspnea, 137, 139, 166 E Edema, 137, 139, 153, 175 Effector, 10, 134, 139 Efficacy, 6, 7, 14, 16, 23, 28, 67, 139, 174 Elastin, 134, 139, 141 Electrolytes, 130, 139, 153 Electrons, 128, 139, 152, 159, 166 Emaciation, 125, 139 Emboli, 64, 139 Embolization, 64, 139 Embolus, 139, 150 Embryo, 139, 164 Emphysema, 98, 139 Empirical, 73, 139

180

Liver Biopsy

Endogenous, 13, 139 Endoscope, 139 Endoscopic, 34, 37, 43, 50, 90, 134, 139, 140, 156, 169, 172 Endoscopic retrograde cholangiopancreatography, 34, 37, 50, 90, 139 Endoscopy, 5, 43, 49, 71, 73, 90, 140 Endothelial cell, 12, 91, 140 Endotoxic, 140, 153 End-stage renal, 70, 133, 140, 162 Enema, 92, 140 Environmental Health, 106, 108, 140 Enzymatic, 20, 43, 53, 127, 132, 135, 140, 163 Enzyme, 11, 20, 23, 24, 43, 48, 126, 139, 140, 155, 160, 162, 163, 165, 167, 173, 174, 176 Enzyme Inhibitors, 140, 162 Eosinophilic, 93, 140 Eosinophilic Gastroenteritis, 93, 140 Eosinophils, 140, 153 Epidemic, 3, 140 Epidemiological, 3, 8, 50, 140 Epigastric, 140, 159 Epithelial, 27, 125, 140, 153 Epithelial Cells, 27, 140, 153 Epithelium, 27, 129, 140, 152 Epitope, 10, 140 Erythrocytes, 127, 131, 140 Esophageal, 54, 85, 90, 93, 140, 141 Esophageal Stricture, 93, 140 Esophageal Varices, 93, 141 Esophagus, 138, 140, 141, 143, 146, 158, 160, 167, 171 Estrogen, 43, 141, 167 Eukaryotic Cells, 141, 150 Evacuation, 135, 141, 153, 166 Exocrine, 141, 159 Exogenous, 22, 25, 27, 139, 141 Extensor, 141, 165 Extracellular, 6, 82, 135, 141, 142 Extracellular Matrix, 6, 82, 135, 141, 142 Extracellular Matrix Proteins, 82, 141 Extracellular Space, 141 Extravasation, 141, 146 F Family Health, 93, 141 Family Planning, 107, 141 Fat, 17, 20, 82, 125, 130, 131, 139, 141, 153, 168, 170, 174 Fatigue, 17, 26, 95, 141, 146

Fatty Liver, 8, 17, 29, 85, 88, 89, 102, 141 Fecal Incontinence, 92, 93, 141 Feces, 135, 141, 171 Femoral, 4, 141, 142, 163 Femoral Artery, 142 Femoral Vein, 4, 142, 163 Femur, 141, 142 Ferritin, 22, 28, 142 Fetoprotein, 142 Fetus, 126, 142, 164 Fever of Unknown Origin, 41, 142 Fibrinogen, 142, 162 Fibroblasts, 142, 151 Fibronectins, 141, 142 Fibrosis, 5, 6, 9, 12, 16, 17, 18, 19, 23, 24, 30, 31, 32, 38, 42, 65, 81, 82, 87, 89, 142, 166, 168 Fine-needle aspiration, 142, 157 Fistula, 33, 45, 47, 54, 142 Flatus, 141, 142, 143 Flurbiprofen, 11, 142 Forearm, 131, 142 Fossa, 17, 142 Fractionation, 48, 142 Free Radicals, 29, 128, 138, 142 Fulminant Hepatic Failure, 38, 94, 95, 142 Functional Disorders, 63, 143 Fungus, 134, 143 G Galactosemia, 13, 85, 143 Gallbladder, 17, 47, 48, 68, 83, 85, 87, 93, 113, 125, 130, 133, 138, 139, 143, 146 Gamma irradiation, 27, 143 Gas, 20, 21, 93, 127, 137, 142, 143, 148, 150, 151, 152, 158, 175 Gastric, 8, 90, 129, 132, 143, 146, 160 Gastric Bypass, 8, 143 Gastric Juices, 143, 160 Gastrin, 90, 143, 148 Gastritis, 93, 143 Gastroenterologist, 4, 143 Gastrointestinal, 4, 43, 71, 85, 87, 88, 89, 90, 93, 94, 131, 132, 143, 171, 174 Gastrointestinal tract, 88, 89, 93, 143, 171, 174 Gastrostomy, 93, 143 Gelatin, 143, 144, 172 Gene, 9, 10, 12, 13, 23, 25, 41, 50, 52, 81, 95, 126, 130, 143, 144, 145, 151 Gene Deletion, 13, 143 Gene Expression, 9, 10, 12, 144 Gene Expression Profiling, 11, 144

181

Genetic Engineering, 130, 134, 144 Genetic Markers, 18, 144 Genetic Screening, 95, 144 Genetic testing, 67, 144, 163 Genetics, 96, 98, 144 Genotype, 14, 23, 26, 85, 144, 161 Germ Cells, 144, 159 Gestation, 144, 160 Giant Cells, 144, 168 Gland, 32, 144, 154, 159, 160, 165, 171, 173 Glomerular, 144, 167 Glucose, 13, 137, 143, 144, 146, 151, 168 Glucose Intolerance, 137, 144 Glutamate, 59, 144 Glycine, 127, 130, 144, 157 Glycoprotein, 129, 142, 144, 153 Glycosaminoglycans, 141, 144 Glycosylation, 89, 145 Gonadal, 145, 171 Gout, 134, 145 Governing Board, 145, 164 Grade, 4, 5, 16, 145 Grading, 67, 145 Graft, 7, 12, 145 Grafting, 145, 150 Groin, 145, 151 H Haematoma, 145 Haematuria, 145 Haemophilia, 53, 145 Haemorrhage, 45, 145 Haploid, 145, 161, 162 Haptens, 126, 145 Headache, 131, 145 Health Care Costs, 15, 145, 146 Health Expenditures, 146 Health Status, 141, 146 Heart failure, 146, 166 Heartburn, 85, 93, 146, 147, 150 Hematologic malignancies, 55, 146 Hematology, 26, 52, 146 Hematoma, 40, 48, 146 Heme, 24, 130, 136, 146, 163, 175 Hemochromatosis, 22, 25, 41, 50, 67, 85, 102, 146 Hemoglobin, 127, 130, 140, 146, 163, 172 Hemoglobinuria, 91, 146 Hemolytic, 146, 172 Hemophilia, 19, 146 Hemorrhage, 39, 45, 54, 58, 59, 145, 146, 166 Hemorrhoids, 93, 128, 146

Hepatic Artery, 39, 146 Hepatic Duct, Common, 139, 146 Hepatic Veins, 91, 147 Hepatitis A, 11, 19, 37, 147 Hepatitis, Chronic, 11, 93, 147 Hepatobiliary, 27, 47, 88, 147 Hepatocellular, 7, 10, 16, 17, 23, 32, 39, 46, 51, 60, 61, 71, 76, 84, 93, 94, 147 Hepatocellular carcinoma, 7, 10, 16, 23, 32, 39, 46, 60, 61, 71, 76, 84, 93, 94, 147 Hepatocyte, 9, 29, 65, 133, 147 Hepatoma, 28, 147 Hepatomegaly, 91, 147 Hepatotoxicity, 59, 147 Hepatovirus, 147, 174 Hereditary, 22, 41, 56, 85, 145, 146, 147, 172 Heredity, 143, 144, 147 Herpes, 66, 147 Herpes Zoster, 66, 147 Heterogeneity, 126, 147 Heterozygotes, 13, 147 Hiatal Hernia, 85, 92, 93, 147 Histidine, 147, 151 Histiocytosis, 76, 147 Histology, 5, 8, 14, 26, 92, 148, 159 Homeostasis, 8, 148 Homogeneous, 135, 148 Homologous, 126, 147, 148 Hormone, 136, 143, 148, 151, 164, 168, 169, 172 Hospital Charges, 148 Hospital Costs, 15, 148 Hybridomas, 148, 151 Hydrogen, 90, 125, 132, 137, 141, 148, 153, 156, 159, 165 Hydrogen Peroxide, 148, 153 Hydrolysis, 148, 154, 163, 165 Hydroxylysine, 134, 148 Hydroxyproline, 127, 134, 148 Hyperbilirubinemia, 52, 148, 152 Hyperlipidemia, 20, 148 Hyperoxaluria, 20, 59, 148 Hyperplasia, 51, 62, 148 Hypersensitivity, 148, 168 Hypertension, 145, 149, 163, 175 Hypertrophy, 148, 149 Hypnotic, 149, 156 I Idiopathic, 19, 20, 93, 149, 168 Ileoanal Reservoir, 92, 149 Ileostomy, 93, 149

182

Liver Biopsy

Ileum, 132, 149, 152 Iliac Vein, 142, 149 Immune response, 8, 9, 14, 18, 30, 128, 145, 149, 175, 176 Immune system, 129, 149, 154, 155, 176 Immunoassay, 19, 149 Immunochemistry, 76, 149 Immunodeficiency, 11, 23, 56, 72, 125, 149 Immunoelectrophoresis, 129, 149 Immunogenic, 149, 153 Immunoglobulin, 128, 149, 169 Immunohistochemistry, 27, 149 Immunologic, 19, 90, 149, 155 Immunologic Factors, 90, 149 Immunology, 66, 126, 149 Immunosuppressant, 149, 155 Immunosuppression, 149, 158 Impaction, 93, 150 Impairment, 13, 133, 150, 152 Implantation, 61, 150 In situ, 14, 53, 76, 150 In Situ Hybridization, 76, 150 In vitro, 10, 27, 28, 150, 163, 169 In vivo, 10, 12, 15, 21, 25, 150, 153 Incision, 113, 150, 152 Incubated, 27, 150 Indigestion, 93, 150 Indocyanine Green, 76, 150 Infarction, 46, 136, 150, 155 Inflammatory bowel disease, 92, 150 Informed Consent, 4, 66, 150 Infusion, 21, 150, 174 Ingestion, 37, 150, 162 Inguinal, 83, 93, 151 Inguinal Hernia, 83, 93, 151 Inhalation, 134, 151, 162 Initiation, 15, 151 Insufflation, 83, 151 Insulin, 17, 20, 29, 151, 168 Insulin-dependent diabetes mellitus, 151 Interferon, 14, 16, 19, 21, 26, 27, 51, 73, 84, 89, 151 Interferon Alfa-2a, 14, 151 Interferon Alfa-2b, 84, 151 Interferon-alpha, 19, 151 Interleukin-1, 19, 151 Interleukin-10, 19, 151 Interleukin-2, 151 Interleukin-6, 11, 19, 151 Intermittent, 151, 154 Interstitial, 60, 141, 151, 152, 167 Intestinal, 11, 85, 93, 152, 155

Intestinal Obstruction, 93, 152 Intestine, 130, 131, 149, 152, 153, 176 Intracellular, 9, 28, 131, 150, 152 Intrahepatic, 9, 10, 14, 29, 45, 48, 54, 59, 91, 146, 152 Intramuscular, 145, 152 Intravenous, 11, 89, 150, 152 Intrinsic, 65, 126, 129, 152 Intussusception, 83, 93, 152 Invasive, 7, 22, 30, 82, 90, 152, 155 Involuntary, 141, 152, 157 Ions, 138, 139, 148, 152 Iris, 136, 152, 166 Irradiation, 152 Irritable Bowel Syndrome, 92, 93, 143, 152 J Jaundice, 72, 85, 87, 102, 133, 148, 152 Jejunum, 143, 152 K Karyotypes, 144, 152 Kb, 106, 152 Keto, 152, 173 Kidney Disease, 42, 44, 106, 113, 153 Kidney Failure, 140, 153 Kidney stone, 153, 157, 159 Kinetics, 26, 153 L Laminin, 6, 82, 129, 141, 153 Laparoscopy, 43, 65, 71, 73, 83, 153 Large Intestine, 93, 132, 138, 140, 152, 153, 167, 170, 176 Laxative, 93, 153 Lesion, 153, 154 Leucocyte, 126, 153 Leukemia, 4, 133, 146, 153 Leukocytes, 131, 140, 151, 153, 156, 157 Leukocytosis, 153, 162 Ligaments, 136, 153 Linkage, 144, 153 Lipid, 17, 20, 24, 29, 151, 153, 154, 156, 159, 174 Lipid A, 20, 153 Lipid Peroxidation, 24, 29, 153, 159 Lipid Peroxides, 29, 153 Lipolysis, 29, 154 Lipopolysaccharides, 153, 154 Liver cancer, 27, 84, 85, 86, 93, 94, 98, 102, 126, 154 Liver Cirrhosis, 60, 84, 154 Liver Transplantation, 7, 10, 11, 12, 18, 27, 46, 51, 53, 57, 70, 85, 86, 91, 93, 94, 154 Living Donors, 7, 154

183

Lobe, 17, 154, 160 Localization, 10, 28, 149, 154 Localized, 125, 127, 145, 146, 150, 153, 154, 161 Long-Term Care, 28, 154 Loop, 54, 143, 149, 154 Lucida, 153, 154 Lymph, 17, 27, 140, 154, 168 Lymph node, 17, 27, 154, 168 Lymphatic, 150, 154, 171 Lymphatic system, 154, 171 Lymphocyte, 40, 125, 128, 150, 154 Lymphocyte Count, 125, 154 Lymphoid, 128, 153, 154, 155 Lymphokines, 154, 155 Lymphoma, 52, 146, 155 Lymphoproliferative, 14, 32, 155 Lysine, 148, 151, 155, 164 Lytic, 155, 169 M Macrophage, 9, 151, 155 Macrophage Activation, 9, 155 Magnetic Resonance Imaging, 86, 91, 155 Malabsorption, 35, 93, 155 Malignancy, 57, 155 Malignant, 20, 36, 93, 125, 128, 148, 154, 155, 157, 172 Malnutrition, 126, 155 Manometry, 90, 155 Mastocytosis, 35, 155 Medical Staff, 113, 155 MEDLINE, 6, 107, 155 Megacolon, 93, 155 Membrane, 135, 141, 153, 155, 158, 160, 161, 162, 169, 174 Mental, iv, 7, 62, 95, 106, 108, 133, 135, 137, 138, 141, 155, 165, 175 Mephenytoin, 11, 155 Metabolic disorder, 89, 137, 145, 155 Methionine, 25, 155, 172 Methotrexate, 49, 56, 57, 59, 64, 69, 70, 71, 90, 155 MI, 57, 85, 124, 155 Microbe, 156, 173 Microbiology, 129, 156 Microcirculation, 154, 156 Microorganism, 156, 176 Midazolam, 11, 60, 156 Migration, 155, 156 Milk Thistle, 23, 156, 169 Mitochondria, 29, 156 Mitochondrial Swelling, 156, 157

Modeling, 7, 11, 18, 156 Modification, 127, 144, 156, 166 Molecule, 128, 135, 138, 139, 140, 148, 156, 159, 167, 173, 175 Monitor, 36, 44, 93, 101, 156, 158 Monocytes, 151, 153, 156 Mononuclear, 24, 26, 156 Monotherapy, 21, 26, 156 Morphine, 11, 156, 157, 158 Morphological, 55, 60, 139, 143, 157 Morphology, 146, 155, 157 Motility, 90, 143, 157 Mucus, 157, 174 Multicenter study, 29, 157 Mydriatic, 138, 157 Myelogenous, 157 Myeloproliferative Disorders, 91, 157 Myocardium, 155, 157 Myopathy, 53, 157 N Narcotic, 156, 157 Nausea, 150, 157, 174, 175 Necrosis, 11, 12, 16, 147, 150, 155, 157, 168, 169 Needle biopsy, 65, 69, 142, 157 Neonatal, 34, 61, 157 Neoplasms, 125, 128, 157 Nephrolithiasis, 20, 157 Nephropathy, 153, 157 Nerve, 127, 133, 143, 157, 160, 163, 171 Nervous System, 133, 157 Neurologic, 13, 157 Neurotransmitter, 125, 127, 131, 144, 157 Neutrophils, 62, 153, 157 Nitrogen, 126, 137, 141, 158, 174 Nuclear, 47, 139, 141, 157, 158 Nuclei, 66, 139, 144, 155, 158, 165 Nucleic acid, 150, 158, 167, 168 Nucleus, 133, 136, 137, 140, 141, 156, 157, 158, 165, 171 Nutritional Support, 143, 158 O Occult, 23, 158 Odynophagia, 88, 158 Office Management, 93, 94, 158 Ointments, 158, 159 Oligopeptides, 81, 158 Omentum, 146, 158 Opacity, 137, 158 Opiate, 156, 158 Opisthorchiasis, 71, 158 Opium, 156, 158

184

Liver Biopsy

Opportunistic Infections, 88, 125, 158 Ornithine, 46, 158 Osmotic, 126, 156, 158, 169 Ostomy, 92, 158 Outpatient, 5, 63, 64, 69, 158 Ovary, 84, 159 Overdose, 142, 159 Oxalate, 20, 148, 159 Oxidation, 29, 125, 128, 136, 153, 159 Oxidative Stress, 8, 9, 29, 159 P Pancreas, 87, 89, 125, 138, 143, 146, 151, 159, 169, 174 Pancreatic, 85, 93, 139, 159 Pancreatic Ducts, 140, 159 Pancreatitis, 31, 33, 49, 50, 64, 92, 93, 159 Papilla, 139, 159 Papillary, 88, 159 Papillary Stenosis, 88, 159 Paracentesis, 90, 159 Paraffin, 40, 42, 50, 59, 159 Parasite, 159 Parasitic, 88, 159 Parenchyma, 13, 82, 159 Parietal, 159, 161, 162 Parotid, 160, 168 Paroxysmal, 91, 160 Pathogenesis, 9, 14, 17, 28, 29, 90, 96, 160 Pathologic, 6, 28, 130, 136, 148, 160, 165, 167 Pathophysiology, 65, 89, 91, 97, 160 Patient Education, 94, 112, 118, 120, 124, 160 Patient Selection, 83, 160 Pelvis, 125, 153, 160 Penicillamine, 95, 160 Penicillin, 128, 160, 175 Pepsin, 160, 169 Peptic, 93, 160 Peptic Ulcer, 93, 160 Peptide, 9, 127, 160, 163, 164, 165 Percutaneous, 3, 4, 6, 15, 31, 32, 33, 34, 35, 36, 38, 39, 40, 41, 43, 44, 45, 46, 48, 49, 50, 53, 55, 58, 60, 61, 62, 64, 65, 67, 68, 69, 70, 72, 73, 90, 112, 160 Perforation, 47, 160, 176 Perfusion, 10, 160 Perinatal, 38, 84, 160 Periodontal disease, 142, 160 Peripheral blood, 9, 24, 26, 151, 160 Peritoneal, 45, 89, 129, 160 Peritoneal Cavity, 129, 160

Peritoneum, 158, 160, 161 Peritonitis, 34, 93, 161, 176 Petechiae, 145, 161 Petroleum, 159, 161 Pharmacokinetic, 11, 161 Pharmacologic, 127, 161, 173 Phenotype, 27, 143, 161 Phospholipids, 141, 161 Phosphorus, 131, 161 Phosphorylation, 29, 161 Physical Examination, 94, 161 Physicochemical, 149, 161 Physiologic, 8, 126, 130, 137, 161, 167 Physiology, 97, 112, 143, 146, 161 Pigment, 130, 161 Pilot study, 22, 27, 161 Plants, 126, 131, 144, 157, 161, 168, 171, 173 Plasma, 19, 21, 87, 126, 128, 129, 131, 142, 143, 144, 146, 153, 161, 162, 167, 169, 176 Plasma cells, 128, 162 Plasma protein, 87, 126, 162, 169 Plasmin, 129, 162 Plasminogen, 129, 162 Platelet Count, 5, 162 Platelets, 162, 173 Platinum, 154, 162 Pleura, 162 Pleural, 34, 162, 172 Pleural cavity, 162, 172 Pleural Effusion, 34, 162 Ploidy, 41, 162 Pneumonia, 136, 162 Poisoning, 133, 157, 162, 169 Polycystic, 42, 162 Polycythemia Vera, 91, 162 Polyethylene, 162, 163, 172 Polyethylene Glycols, 163, 172 Polymerase, 53, 54, 55, 89, 163 Polymerase Chain Reaction, 53, 54, 55, 89, 163 Polypeptide, 127, 134, 142, 162, 163, 164, 165, 172 Polysaccharide, 128, 163, 165 Popliteal, 142, 163 Popliteal Vein, 142, 163 Porphyria, 24, 163 Porphyrins, 163 Portal Hypertension, 29, 55, 91, 163 Posterior, 127, 152, 159, 163 Postoperative, 10, 84, 163 Potentiates, 151, 163

185

Practicability, 163, 174 Practice Guidelines, 4, 108, 164 Precursor, 128, 139, 140, 162, 164, 174, 175 Predictive factor, 84, 85, 164 Prenatal, 46, 59, 139, 144, 164 Prenatal Diagnosis, 46, 59, 164 Preoperative, 101, 164 Prevalence, 5, 8, 17, 19, 23, 29, 65, 90, 101, 164 Primary Biliary Cirrhosis, 27, 73, 85, 90, 92, 164 Primary endpoint, 18, 20, 164 Primary Sclerosing Cholangitis, 55, 68, 85, 164 Probe, 12, 76, 81, 164 Procollagen, 81, 164 Proctitis, 93, 164 Progesterone, 164, 167, 171 Progression, 5, 8, 10, 12, 16, 18, 19, 23, 24, 26, 30, 65, 82, 88, 128, 164, 176 Progressive, 8, 11, 12, 14, 20, 27, 30, 82, 95, 133, 137, 138, 157, 164, 166, 167 Progressive disease, 95, 164 Proline, 134, 148, 164 Prophylaxis, 94, 165, 175 Prospective Studies, 9, 165 Prospective study, 8, 65, 70, 73, 165 Prostate, 165, 174 Protease, 42, 165 Protein C, 126, 127, 142, 165, 175 Protein Conformation, 127, 165 Protein S, 130, 165, 167 Proteoglycans, 129, 141, 165 Proteolytic, 126, 135, 142, 162, 165 Protocol, 10, 63, 165 Protons, 148, 165, 166 Psoriasis, 57, 165 Psychic, 155, 165, 169 Public Policy, 107, 165 Pulmonary, 19, 45, 85, 130, 140, 153, 165, 166 Pulmonary Artery, 130, 166 Pulmonary Embolism, 45, 166 Pulmonary Fibrosis, 19, 166 Pulse, 156, 166 Pupil, 136, 138, 157, 166 Purgative, 153, 166 Purpura, 145, 166 Pyridoxal, 166, 173 Pyruvate Dehydrogenase Complex, 27, 166

Q Quality of Life, 8, 20, 23, 26, 29, 166 R Race, 26, 152, 156, 166 Radiation, 142, 143, 150, 152, 166, 176 Radiation therapy, 142, 143, 152, 166 Radioactive, 21, 148, 150, 152, 158, 166 Radiological, 4, 160, 166 Radiologist, 4, 101, 166 Radiology, 16, 22, 33, 36, 42, 46, 52, 64, 66, 68, 70, 71, 76, 166 Randomized, 7, 25, 29, 51, 66, 139, 166 Rationalization, 63, 166 Reactivation, 51, 66, 93, 166 Receptor, 25, 128, 167 Receptors, Progesterone, 43, 167 Recombinant, 51, 67, 151, 167, 175 Recombination, 144, 167 Rectal, 92, 93, 167, 172 Rectum, 128, 129, 131, 134, 138, 142, 143, 149, 150, 153, 164, 165, 167, 169 Recurrence, 87, 167 Reductase, 20, 155, 167 Refer, 1, 134, 147, 154, 167, 173 Reflux, 90, 167 Refraction, 167, 170 Refractory, 29, 167 Regeneration, 7, 76, 167 Regimen, 139, 167, 168 Regurgitation, 146, 167 Relapse, 93, 167 Remission, 167 Renal failure, 20, 146, 167 Renin, 128, 167 Replicon, 10, 28, 167 Resection, 35, 84, 167 Resorption, 142, 167 Respiration, 156, 167 Response rate, 3, 26, 168 Retreatment, 84, 168 Retrograde, 168 Retrovirus, 27, 168 Rheumatism, 42, 56, 69, 71, 168 Rheumatoid, 42, 56, 59, 64, 69, 71, 168 Rheumatoid arthritis, 42, 56, 59, 64, 69, 71, 168 Ribavirin, 9, 14, 16, 19, 21, 26, 84, 89, 168 Risk factor, 8, 19, 20, 26, 36, 84, 85, 94, 138, 165, 168 Risk patient, 23, 52, 68, 168 Rod, 133, 168 Rosiglitazone, 18, 168

186

Liver Biopsy

S Saline, 90, 168 Salivary, 136, 138, 168 Salivary glands, 136, 138, 168 Saponins, 168, 171 Sarcoidosis, 48, 72, 168 Screening, 22, 84, 89, 93, 98, 134, 144, 169 Scrotum, 136, 169 Secretin, 90, 169 Sedative, 113, 156, 169 Seizures, 160, 169 Sepsis, 68, 169 Septal, 5, 169 Septicemia, 48, 169 Sequence Analysis, 50, 169 Sequencing, 163, 169 Sequester, 133, 169 Serologic, 6, 19, 27, 94, 149, 169 Serologic Tests, 6, 169 Serology, 46, 169 Serum, 6, 14, 15, 18, 19, 21, 22, 25, 26, 27, 33, 54, 72, 81, 82, 89, 90, 91, 95, 126, 134, 161, 169 Serum Albumin, 91, 169 Shock, 43, 49, 169, 174 Side effect, 19, 84, 125, 169, 173 Sigmoid, 84, 169 Sigmoid Colon, 169 Sigmoidoscopy, 90, 169 Signs and Symptoms, 85, 87, 90, 93, 167, 169, 174 Silymarin, 23, 156, 169 Skeletal, 133, 169 Skeleton, 125, 142, 169, 170 Skin graft, 170 Small intestine, 93, 94, 132, 138, 139, 140, 148, 149, 151, 152, 170 Smooth muscle, 24, 131, 156, 170 Social Environment, 166, 170 Social Support, 14, 170 Soft tissue, 80, 131, 170 Somatic, 170, 172 Sonogram, 31, 170 Sound wave, 166, 170 Spastic, 152, 170 Specialist, 114, 138, 170 Species, 126, 133, 134, 152, 156, 159, 166, 170, 174, 176 Specificity, 9, 82, 126, 170 Spectroscopic, 17, 170 Spectrum, 20, 24, 84, 89, 170 Speech Disorders, 13, 170

Sperm, 133, 170 Sphincter, 90, 170 Spinal cord, 133, 157, 170 Spleen, 22, 80, 127, 136, 154, 162, 168, 171 Splenectomy, 84, 171 Splenomegaly, 162, 171 Spores, 134, 171 Staging, 6, 42, 67, 171 Standard therapy, 89, 171 Steatosis, 7, 12, 141, 171 Steel, 133, 171 Stellate, 9, 12, 19, 24, 69, 82, 171 Stem cell transplantation, 12, 171 Stem Cells, 171 Stent, 158, 171 Sterile, 80, 171 Steroid, 18, 130, 136, 168, 171 Stimulant, 131, 171, 175 Stimulus, 171, 173 Stoma, 158, 171 Stool, 134, 149, 150, 152, 153, 171 Strand, 163, 171 Stress, 4, 9, 24, 88, 89, 91, 136, 143, 152, 157, 159, 168, 171 Stroma, 152, 159, 172 Subacute, 150, 172 Subcapsular, 40, 172 Subclinical, 150, 169, 172 Subcutaneous, 139, 145, 172, 176 Sulfur, 141, 155, 172 Support group, 85, 172 Suppository, 92, 163, 172 Suppression, 8, 14, 18, 172 Symptomatic, 40, 91, 95, 159, 172 Systemic, 8, 20, 35, 127, 129, 130, 150, 152, 166, 168, 169, 172 T Telomerase, 66, 172 Telomere, 145, 172 Testicle, 172, 175 Testicular, 136, 172 Testosterone, 167, 172 Thalassemia, 22, 28, 130, 172 Thermal, 138, 163, 172 Thigh, 141, 142, 145, 172 Thoracic, 137, 162, 172 Thoracoscopy, 84, 172 Thorax, 125, 172 Threshold, 22, 149, 172 Thrombosis, 54, 65, 68, 165, 173 Thrombus, 91, 136, 150, 173 Thyroxine, 126, 173

187

Tolerance, 19, 125, 144, 173 Tomography, 21, 53, 173 Tone, 159, 173 Tonic, 155, 173 Topical, 148, 159, 173 Torsion, 150, 173 Toxic, iv, 22, 91, 102, 153, 173 Toxicity, 29, 40, 59, 102, 173 Toxicology, 108, 173 Toxin, 140, 173 Traction, 133, 173 Transaminase, 20, 173 Transcriptase, 53, 66, 168, 172, 173 Transfection, 130, 173 Transferases, 145, 173 Transfusion, 28, 53, 174 Transfusion-Transmitted Virus, 53, 174 Translation, 127, 174 Translational, 28, 174 Transplantation, 7, 11, 18, 38, 41, 46, 47, 48, 51, 53, 58, 67, 70, 72, 90, 95, 133, 174 Trauma, 145, 157, 159, 174 Treatment Outcome, 6, 26, 174 Triglyceride, 20, 174 Tryptophan, 134, 174 Tuberculosis, 38, 48, 174 Tumor marker, 85, 174 U Ulceration, 160, 174 Ulcerative colitis, 93, 150, 164, 174 Ultrasonography, 6, 39, 62, 66, 69, 73, 174 Uraemia, 159, 174 Urea, 89, 158, 174, 175 Uremia, 4, 153, 167, 175 Urethra, 165, 175 Urinary, 13, 20, 175 Urine, 10, 20, 130, 132, 137, 138, 145, 146, 148, 153, 159, 175

Uroporphyrinogen Decarboxylase, 24, 175 V Vaccination, 27, 94, 101, 175 Vaccines, 175, 176 Vaginal, 172, 175 Valine, 160, 175 Varicocele, 84, 175 Vascular, 12, 15, 52, 66, 70, 91, 93, 150, 154, 156, 173, 175 Vasculitis, 159, 175 VE, 73, 91, 175 Vector, 81, 175 Vein, 68, 91, 113, 129, 142, 149, 152, 158, 160, 163, 175 Venous, 91, 129, 137, 146, 162, 165, 175 Venous blood, 162, 175 Venules, 91, 131, 132, 156, 175 Vesicular, 147, 175 Veterinary Medicine, 107, 175 Viral Hepatitis, 23, 37, 51, 52, 53, 57, 73, 82, 88, 93, 94, 102, 147, 176 Viral Load, 9, 15, 23, 84, 89, 176 Viremia, 14, 45, 176 Virulence, 173, 176 Visceral, 21, 161, 176 Visceral fat, 21, 176 Vitro, 27, 176 Vivo, 12, 176 Volvulus, 37, 176 W White blood cell, 125, 128, 133, 140, 150, 153, 154, 155, 157, 162, 176 X Xenograft, 128, 176 X-ray, 135, 136, 139, 143, 152, 158, 166, 176 Y Yeasts, 143, 161, 176

188

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