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

ELEVATED LIVER ENZYMES A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCE...

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ELEVATED LIVER ENZYMES 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., 1960Elevated Liver Enzymes: 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: 0-497-00397-X 1. Elevated Liver Enzymes-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 elevated liver enzymes. 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 ELEVATED LIVER ENZYMES ...................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Elevated Liver Enzymes................................................................ 4 The National Library of Medicine: PubMed .................................................................................. 8 CHAPTER 2. ALTERNATIVE MEDICINE AND ELEVATED LIVER ENZYMES ...................................... 29 Overview...................................................................................................................................... 29 National Center for Complementary and Alternative Medicine.................................................. 29 Additional Web Resources ........................................................................................................... 35 General References ....................................................................................................................... 36 CHAPTER 3. BOOKS ON ELEVATED LIVER ENZYMES ...................................................................... 37 Overview...................................................................................................................................... 37 Chapters on Elevated Liver Enzymes........................................................................................... 37 CHAPTER 4. MULTIMEDIA ON ELEVATED LIVER ENZYMES ........................................................... 41 Overview...................................................................................................................................... 41 Video Recordings ......................................................................................................................... 41 CHAPTER 5. PERIODICALS AND NEWS ON ELEVATED LIVER ENZYMES ........................................ 43 Overview...................................................................................................................................... 43 News Services and Press Releases................................................................................................ 43 Academic Periodicals covering Elevated Liver Enzymes ............................................................. 45 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 49 Overview...................................................................................................................................... 49 NIH Guidelines............................................................................................................................ 49 NIH Databases............................................................................................................................. 51 Other Commercial Databases....................................................................................................... 53 APPENDIX B. PATIENT RESOURCES ................................................................................................. 55 Overview...................................................................................................................................... 55 Patient Guideline Sources............................................................................................................ 55 Finding Associations.................................................................................................................... 58 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 61 Overview...................................................................................................................................... 61 Preparation................................................................................................................................... 61 Finding a Local Medical Library.................................................................................................. 61 Medical Libraries in the U.S. and Canada ................................................................................... 61 ONLINE GLOSSARIES.................................................................................................................. 67 Online Dictionary Directories ..................................................................................................... 67 ELEVATED LIVER ENZYMES DICTIONARY ......................................................................... 69 INDEX .............................................................................................................................................. 101

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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 elevated liver enzymes 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 elevated liver enzymes, 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 elevated liver enzymes, 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 elevated liver enzymes. 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 elevated liver enzymes, 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 elevated liver enzymes. 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 ELEVATED LIVER ENZYMES Overview In this chapter, we will show you how to locate peer-reviewed references and studies on elevated liver enzymes.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and elevated liver enzymes, 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 “elevated liver enzymes” (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: •

Mildly Elevated Liver Enzymes: Significance and Diagnostic Strategies. (editorial) Source: Liver Update: Function and Disease. 5(1): 1-2. Spring 1991. Contact: Available from American Liver Foundation. 1425 Pompton Avenue, Cedar Grove, NJ 07009. (800) 223-0179 or (201) 256-2550. Summary: This article discusses the significance of and diagnostic strategies for mildly elevated liver enzymes. Although there is no standard definition of what constitutes mild elevation of liver enzymes, the author proposes a working definition in multiples of the upper limits of normal for each individual enzyme test: aspartate and alanine aminotransferases; alkaline phosphatase; and gamma-glutamyltransferase.

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HELLP Syndrome: Hemolysis, Elevated Liver Enzymes, and Low Platelets Source: JAMA. Journal of the American Medical Association. 280(6): 559-562. August 12, 1998. Summary: This article presents a detailed case study and discussion of HELLP syndrome, which consists of hemolysis, elevated liver enzymes, and low platelets. The HELLP syndrome is one of the hypertensive disorders of pregnancy, which also include preeclampsia and eclampsia. The multi-organ dysfunction in HELLP can lead to acute tubular necrosis and renal failure. Preeclampsia is associated with glomerular endotheliosis, whose pathologic hallmark is a thickening of the basement membranes; a similar renal lesion may account for the proteinuria in HELLP. With proper supportive care, most patients fully recover kidney function. The author emphasizes that all physicians should know that a cardinal symptom of the HELLP syndrome is right upper quadrant pain. Clinicians examining pregnant women in a primary care or subspecialty setting should have a low threshold for ordering a complete blood count, urinalysis, and liver function tests, even if the patients complaints are nonspecific. Finally, pregnant women need regular, accurate blood pressure measurement. A blood pressure of 140 over 90 mm Hg, normal in most nonpregnant patients, may indicate serious disease in pregnant women. 28 references.

Federally Funded Research on Elevated Liver Enzymes The U.S. Government supports a variety of research studies relating to elevated liver enzymes. 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 elevated liver enzymes. 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 elevated liver enzymes. The following is typical of the type of information found when searching the CRISP database for elevated liver enzymes: •

Project Title: FEASIBILITY STUDY OF THREE NCES FOR RHEUMATOID ARTHRITIS Principal Investigator & Institution: Shaw, Jiajiu; Unitech Pharmaceuticals, Inc. 4220A Varsity Dr Ann Arbor, Mi 48108 Timing: Fiscal Year 2004; Project Start 01-AUG-2004; Project End 31-JAN-2005 Summary: (provided by applicant): Rheumatoid arthritis is a potentially crippling autoimmune disease that affects more than two million Americans. Generally arthritis

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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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drugs may be divided into two categories: NSAID (Non-steroidal Anti-Inflammatory Drug) and DMARD (Disease Modifying Anti-Rheumatic Drug). Leflunomide is a DMARD sold as Aravas by Aventis Pharmaceuticals. Unfortunately, it is associated with many side effects, such as elevated liver enzymes; liver damage was blamed for some fatal cases. In order to discover and develop a better drug for Rheumatoid Arthritis, we have made a series of compounds based on Leflunomide and our proprietary compound (compound A) and performed in vivo inhibition studies for inflammation induced by carrageenan. Based on the anti-inflammation results, we have selected three most promising compounds (UTL-5b, UTL-5d, and UTL-5g) as potential drug candidates for treating Rheumatoid Arthritis. We also performed a preliminary LD50 study and obtained very promising results for these three compounds. We are proposing to perform this Phase I study to further understand and validate the antiinflammatory and immunosuppressant effect in vitro for these three compounds. At the end of this Phase I study, we will be able to select the most appropriate drug candidates among the three compounds and prepare for the Phase II application. The specific aims of this Phase I study are: (a) Synthesis of about 500 mg each of three selected drug candidates. (b) Develop and validate a stability-indicating HPLC method for each compound. (c) Study the anti-inflammatory effects of the compounds on primary cultures of macrophages in vitro. (d) Study the in vitro immunosuppressant effect of the three drug candidates. The proposed Phase I and Phase II are only the beginning of a long journey to developing a new drug for rheumatoid arthritis. However, if the Phase I and Phase II are successful, the project will be essentially ready for an IND filing to the Food and Drug Administration (FDA), and large pharmaceutical companies are more likely to co-develop this project. Ultimately, the successful drug candidate will provide a significantly improved therapy for patients suffering from Rheumatoid Arthritis. 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 establishes the prevalence of NASH in patients with hyprinsulinemia and imaging

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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: 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 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.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INFECTION

LONGITUDINAL

COHORT

OF

NEWLY

Principal Investigator & Institution: Kaldor, John M.; Epidemiology/Clncl Res Epidemiology/Clinical Research Sydney,

ACQUIRED Natl

HCV

Centre/Hiv

Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Currently, there is no effective hepatitis C virus (HCV) vaccine. Despite introduction of harm minimization strategies in Australia since the late 1980s, incidence of HCV infection among injecting drug users is extremely high. An estimated 16,000 new HCV infections occur each year in Australia, with approximately 90% related to injecting drug use. This estimate of new HCV infections has increased from 11,000 in 1997, due largely to an increasing prevalence of injecting. Although the vast majority of people with new HCV infection are asymptomatic at the time of infection, an increasing number of cases of newly acquired HCV infection are detected through enhanced HCV surveillance in Australia. For HCV surveillance purposes newly acquired HCV infection is defined as a person with a positive HCV antibody with evidence of a negative HCV antibody in the previous 24 months, or a person with acute clinical hepatitis (e.g. jaundice) with a positive HCV antibody where other causes of acute hepatitis have been excluded. In 2000 approximately 450 cases of newly acquired HCV infection were detected through enhanced surveillance in Australia. Further cases of newly acquired HCV infection are detected through primary care clinics that regularly screen injecting drug users for HCV, and referrals to tertiary care clinics of people with acute hepatitis. We propose to establish a longitudinal cohort of current injecting drug users (injected within previous 12 months) with newly acquired HCV infection. Within this cohort we propose to offer antiviral therapy for HCV infection with a 24-week course of pegylated interferon monotherapy to those people who have evidence of HCV viraemia (HCV-RNA positive) and biochemical hepatic inflammation (elevated liver enzymes). The major objectives of the study are to examine the feasibility of interferon therapy for newly acquired HCV infection among injecting drug users. In addition, the untreated group within the longitudinal cohort will be studied to examine the natural history of early HCV infection. Both groups will continue followup for a period of three years, to examine sustainability of HCV clearance (both through natural and therapeutic means) and monitor incidence of HCV reinfection among people with evidence of HCV clearance. Drug use behavior including injecting drug use will also be closely monitored, to assess the impact of enrollment into the study and specific drug dependency and risk reduction strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MATERNAL LIVER DISEASE AND FATTY ACID OXIDATION DEFECTS Principal Investigator & Institution: Ibdah, Jamal A.; Internal Medicine; Wake Forest University Health Sciences Winston-Salem, Nc 27157 Timing: Fiscal Year 2002; Project Start 21-SEP-2001; Project End 31-AUG-2006 Summary: Mitochondrial trifunctional protein (TFP) catalyzes the last 3 steps in the beta-oxidation spiral of long chain fatty acids and consists of 4 alpha and 4 beta subunits. Long chain 3- hydroxyacyl Co-A dehydrogenase (LCHAD) resides in the alpha- subunit. Mutations in the alpha-subunit such as the prevalent G1528C mutation cause "isolated" LCHAD deficiency. Other mutations cause complete TFP deficiency (all

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the 3 enzymes are deficient). Recently, we have documented a fetal-maternal interaction that causes maternal liver disease in heterozygote women who carry fetuses with isolated LCHAD deficiency. This raises several questions. First, what is the mechanism of this fetal-maternal interaction? Second, what is the effect of environmental factors such as high fat diet and fasting on the development of maternal liver disease in the susceptible heterozygotes? Our hypothesis is that heterozygote women develop acute fatty liver of pregnancy (AFLP) or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome due to accumulation of hepato-toxic fatty acid metabolites generated by either the affected fetus or the susceptible heterozygote under conditions of oxidative stress. To test this hypothesis we propose the following studies. 1) To use conventional and inducible Cre/lox P strategies to generate and characterize two knockout mice models for complete TFP deficiency (null mutation) and isolated LCHAD deficiency (G1528C mutation). Clinical, biochemical, histological, and molecular analyses will be performed. Tissue-specific and developmental stage-specific gene expression will also be characterized in these mice. Differences in the accumulated fatty acid metabolites will be correlated to the genotypes and phenotypes to elucidate the role of fatty acid metabolites in the genotype-phenotype correlations in these disorders. 2) To employ preimplantation genotyping and embryo transfer to independently study the effects of fetal and maternal genotypes on development of maternal liver disease in knockout mice. Pregnant dams will be monitored for evidence of liver disease. Fatty acid metabolites will be measured in fetal and maternal sera, fetal and maternal livers, and placentas, and will be correlated to the fetal/maternal genotypes and maternal phenotypes to identify the fatty acid metabolites that are potentially toxic to the maternal liver. 3) To conduct dietary studies in knockout mice to elucidate the effects of high fat diet and fasting on pregnant heterozygotes while carrying unaffected fetuses. Four different high fat diets will be studied to elucidate the effects of fat content, fatty acid configuration, and protein/carbohydrate contents. 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. To generate your own bibliography of studies dealing with elevated liver enzymes, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “elevated liver enzymes” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for elevated liver enzymes (hyperlinks lead to article summaries):

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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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A 51-year-old woman with elevated liver enzymes seven months after transplantation for primary biliary cirrhosis. Author(s): Nsien EE, Silverman JF, Goodman ZD. Source: Seminars in Liver Disease. 1992 February; 12(1): 93-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1570555

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A case of postpartum cerebellar infarction with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Author(s): Soh Y, Yasuhi I, Nakayama D, Ishimaru T. Source: Gynecologic and Obstetric Investigation. 2002; 53(4): 240-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12186992

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A case report of spontaneous splenic capsular rupture associated with atypical presentation of haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. Author(s): Manda P, Dorman E, Olagbaiye F, Akinfenwa O. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2004 April; 24(3): 317-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15203642

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A pregnant woman with de novo polyuria-polydipsia and elevated liver enzymes. Author(s): Barbey F, Bonny O, Rothuizen L, Gomez F, Burnier M. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 October; 18(10): 2193-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13679504

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A prospective, randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Author(s): Isler CM, Barrilleaux PS, Magann EF, Bass JD, Martin JN Jr. Source: American Journal of Obstetrics and Gynecology. 2001 June; 184(7): 1332-7; Discussion 1337-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11408849

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Activated protein C resistance and factor V Leiden in patients with hemolysis, elevated liver enzymes, low platelets syndrome. Author(s): Krauss T, Augustin HG, Osmers R, Meden H, Unterhalt M, Kuhn W. Source: Obstetrics and Gynecology. 1998 September; 92(3): 457-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9721789

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Acute fatty liver of pregnancy, hemolysis, elevated liver enzymes, and low platelets syndrome, and long chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency. Author(s): Treem WR, Shoup ME, Hale DE, Bennett MJ, Rinaldo P, Millington DS, Stanley CA, Riely CA, Hyams JS. Source: The American Journal of Gastroenterology. 1996 November; 91(11): 2293-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8931405

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Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets. Author(s): Sibai BM, Ramadan MK. Source: American Journal of Obstetrics and Gynecology. 1993 June; 168(6 Pt 1): 1682-7; Discussion 1687-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8317509

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Adult celiac disease presenting with intussusception and elevated liver enzymes. Author(s): Sclarovsky-Benjaminov F, Wilson S, Habal F. Source: Isr Med Assoc J. 2003 March; 5(3): 203-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12725145

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Aldehyde dehydrogenase 2 and beta3-adrenergic receptor gene polymorphisms: their association with elevated liver enzymes and metabolic syndrome. Author(s): Murata C, Watanabe T, Furuya H, Sugioka Y, Mikurube H, Yokoyama A, Atsumi Y, Matsuoka K, Okazaki I. Source: Metabolism: Clinical and Experimental. 2003 September; 52(9): 1096-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14506613

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An atypical case of hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. Author(s): Grisaru D, Lessing JB, Azem F, Niv J, Kupferminc M, Peyser MR. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1994 January; 44(1): 67-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7907061

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Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) Author(s): Magann EF, Bass D, Chauhan SP, Sullivan DL, Martin RW, Martin JN Jr. Source: American Journal of Obstetrics and Gynecology. 1994 October; 171(4): 1148-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7943088

Studies

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Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury? Author(s): Zaninotto G, Costantini M. Source: Annals of Surgery. 1995 April; 221(4): 433. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7726681

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Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury? Author(s): Halevy A, Gold-Deutch R, Negri M, Lin G, Shlamkovich N, Evans S, Cotariu D, Scapa E, Bahar M, Sackier JM. Source: Annals of Surgery. 1994 April; 219(4): 362-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8161261

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Ascites: a portent of cardiopulmonary complications in the preeclamptic patient with the syndrome of hemolysis, elevated liver enzymes, and low platelets. Author(s): Woods JB, Blake PG, Perry KG Jr, Magann EF, Martin RW, Martin JN Jr. Source: Obstetrics and Gynecology. 1992 July; 80(1): 87-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1603505

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Autoimmune hepatitis: diagnosis after preeclampsia-induced elevated liver enzymes failed to normalize postpartum. Author(s): Carson MP, Smulian JC, Fedorciw B. Source: Obstetrics and Gynecology. 2003 May; 101(5 Pt 2): 1118-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12738122

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Better maternal outcomes are achieved with dexamethasone therapy for postpartum HELLP (hemolysis, elevated liver enzymes, and thrombocytopenia) syndrome. Author(s): Martin JN Jr, Perry KG Jr, Blake PG, May WA, Moore A, Robinette L. Source: American Journal of Obstetrics and Gynecology. 1997 November; 177(5): 1011-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9396884

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Bilirubin found in syndrome of hemolysis, elevated liver enzymes, and low platelet count. Author(s): Minakami H, Sato I, Tamada T. Source: American Journal of Obstetrics and Gynecology. 1988 April; 158(4): 1014-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3364489

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Change in platelet count predicts eventual maternal outcome with syndrome of hemolysis, elevated liver enzymes and low platelet count. Author(s): Rinehart BK, Terrone DA, May WL, Magann EF, Isler CM, Martin JN Jr. Source: The Journal of Maternal-Fetal Medicine. 2001 February; 10(1): 28-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11332416

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Elevated Liver Enzymes

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Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Author(s): Audibert F, Friedman SA, Frangieh AY, Sibai BM. Source: American Journal of Obstetrics and Gynecology. 1996 August; 175(2): 460-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8765269

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Coagulation studies in the syndrome of haemolysis, elevated liver enzymes and low platelets. Author(s): de Boer K, Buller HR, ten Cate JW, Treffers PE. Source: British Journal of Obstetrics and Gynaecology. 1991 January; 98(1): 42-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1998631

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Complement, neutrophil, and macrophage activation in women with severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Author(s): Haeger M, Unander M, Norder-Hansson B, Tylman M, Bengtsson A. Source: Obstetrics and Gynecology. 1992 January; 79(1): 19-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1727579

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Complete versus partial HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Author(s): Van Bogaert LJ. Source: American Journal of Obstetrics and Gynecology. 1997 May; 176(5): 1120-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9166185

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Current understanding of severe preeclampsia, pregnancy-associated hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, hemolysis, elevated liver enzymes, and low platelet syndrome, and postpartum acute renal failure: different clinical syndromes or just different names? Author(s): Sibai BM, Kustermann L, Velasco J. Source: Current Opinion in Nephrology and Hypertension. 1994 July; 3(4): 436-45. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8076148

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Dexamethasone-facilitated postponement of delivery of an extremely preterm pregnancy complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets. Author(s): O'Boyle JD, Magann EF, Waxman E, Martin JN Jr. Source: Military Medicine. 1999 April; 164(4): 316-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10226464

Studies

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Diagnosis by radiocolloid imaging of postpartum hepatic necrosis in the syndrome of hemolysis, elevated liver enzymes, and low platelets. Author(s): Davidson RM, Barron BJ, White PA, Fraire AE. Source: Clinical Nuclear Medicine. 1992 April; 17(4): 322-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1572125

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Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Author(s): Sibai BM. Source: Obstetrics and Gynecology. 2004 May; 103(5 Pt 1): 981-91. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15121574

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Disseminated intravascular coagulation and the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia. Author(s): Van Dam PA, Renier M, Baekelandt M, Buytaert P, Uyttenbroeck F. Source: Obstetrics and Gynecology. 1989 January; 73(1): 97-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2909047

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Doppler velocimetry of hepatic blood flow in postpartum patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) Author(s): Kurzel RB, Au AH, Rooholamini SA. Source: American Journal of Obstetrics and Gynecology. 1996 December; 175(6): 1677-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8987963

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Elevated liver enzymes after nontraumatic intracranial hemorrhages. Author(s): Meythaler JM, Hazlewood J, DeVivo MJ, Rosner M. Source: Archives of Physical Medicine and Rehabilitation. 1998 July; 79(7): 766-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9685089

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Elevated liver enzymes and thrombocytopenia in the third trimester of pregnancy: an unusual case report and a review of the literature. Author(s): Hannah ME, Gonen R, Mocarski EJ, Cameron R, Blendis L, Glynn M. Source: American Journal of Obstetrics and Gynecology. 1989 August; 161(2): 322-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2669487

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Elevated liver enzymes as an operative complication of gastric bypass surgery. Author(s): Saranita J, Soto RG, Paoli D. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2003 April; 13(2): 314-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12740146

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Elevated liver enzymes following initiation of antiretroviral therapy. Author(s): Velasco M, Guijarro C. Source: Jama : the Journal of the American Medical Association. 2000 May 17; 283(19): 2526-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10815112

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Elevated liver enzymes in asymptomatic patients. Author(s): Froom P, Froom J. Source: The New England Journal of Medicine. 2000 August 31; 343(9): 663. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10979809

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Elevated liver enzymes in asymptomatic patients. Author(s): Wallis K, Price S, Gorard DA. Source: The New England Journal of Medicine. 2000 August 31; 343(9): 662-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10979808

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Elevated liver enzymes in asymptomatic patients. Author(s): Sibille M, Durieu I, Durand DV. Source: The New England Journal of Medicine. 2000 August 31; 343(9): 662; Author Reply 663. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10979807

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Elevated liver enzymes in asymptomatic patients. Author(s): Blanc PD, Redlich CA. Source: The New England Journal of Medicine. 2000 August 31; 343(9): 662; Author Reply 663. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10979806

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Elevated liver enzymes in serum during suloctidil treatment. Author(s): Schouten JA, Westerman RF. Source: European Journal of Clinical Pharmacology. 1982; 22(6): 559-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6290229

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Elevated liver enzymes preceding vessel involvement in Takayasu's arteritis. Author(s): Lankisch MR, Scolapio JS, Thistle JL, Witzig TE, McBane RD. Source: Journal of Hepatology. 1999 February; 30(2): 349-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10068122

Studies

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Enhanced anaphylatoxin and terminal C5b-9 complement complex formation in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Author(s): Haeger M, Unander M, Bengtsson A. Source: Obstetrics and Gynecology. 1990 October; 76(4): 698-702. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2216207

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Enhancement of hepatic artery resistance to blood flow in preeclampsia in presence or absence of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) Author(s): Oosterhof H, Voorhoeve PG, Aarnoudse JG. Source: American Journal of Obstetrics and Gynecology. 1994 August; 171(2): 526-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8059835

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Evaluating asymptomatic patients with mildly elevated liver enzymes. Author(s): Younossi ZM. Source: Cleve Clin J Med. 1998 March; 65(3): 150-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9540248

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Factors relevant to mode of preterm delivery with syndrome of HELLP (hemolysis, elevated liver enzymes, and low platelets). Author(s): Magann EF, Roberts WE, Perry KG Jr, Chauhan SP, Blake PG, Martin JN Jr. Source: American Journal of Obstetrics and Gynecology. 1994 June; 170(6): 1828-32; Discussion 1832-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8203445

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Familial thrombotic thrombocytopenic purpura imitating HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) in two sisters during pregnancy. Author(s): Uslu M, Guzelmeric K, Asut I. Source: American Journal of Obstetrics and Gynecology. 1994 February; 170(2): 699-700. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8116734

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Haemolysis, elevated liver enzymes and low platelets syndrome: ultrasound and magnetic resonance imaging findings in the liver. Author(s): Maher MM, Kalra MK, Lucey BC, Jhaveri K, Sahani DV, Hahn PF, O'Neill MJ, Mueller PR. Source: Australasian Radiology. 2004 March; 48(1): 64-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15027924

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Haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome associated with increased maternal serum levels of soluble HLA-DR antigens. Author(s): Steinborn A, Sohn C, Rebmann V, Grosse-Wilde H. Source: Aust N Z J Med. 2000 August; 30(4): 511-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10985521

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HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus severe preeclampsia: onset at < or =28.0 weeks' gestation. Author(s): Haddad B, Barton JR, Livingston JC, Chahine R, Sibai BM. Source: American Journal of Obstetrics and Gynecology. 2000 December; 183(6): 1475-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11120513

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HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: the benefit of corticosteroids. Author(s): Tompkins MJ, Thiagarajah S. Source: American Journal of Obstetrics and Gynecology. 1999 August; 181(2): 304-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10454673

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HELLP (hemolysis, elevated liver enzymes, and low platelets) needs help. Author(s): Hohlagschwandtner M, Bancher-Todesca D, Strohmer H. Source: American Journal of Obstetrics and Gynecology. 2000 May; 182(5): 1271. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10819870

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HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) pathophysiology and anesthetic considerations. Author(s): Portis R, Jacobs MA, Skerman JH, Skerman EB. Source: Aana Journal. 1997 February; 65(1): 37-47. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9223938

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HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) presenting as generalized malaise. Author(s): Tomsen TR. Source: American Journal of Obstetrics and Gynecology. 1995 June; 172(6): 1876-8; Discussion 1878-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7778647

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HELLP syndrome: hemolysis, elevated liver enzymes, and low platelets. Author(s): Stone JH. Source: Jama : the Journal of the American Medical Association. 1998 August 12; 280(6): 559-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9707148

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HELLP syndrome--a syndrome of hemolysis, elevated liver enzymes and low platelet count--complicating preeclampsia-eclampsia. Author(s): Reubinoff BE, Schenker JG. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1991 October; 36(2): 95-102. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1683323

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Hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome associated with systemic lupus erythematosus. Author(s): Matsuda M, Mitsuhashi S, Watarai M, Yamamoto K, Hashimoto T, Ikeda S. Source: Intern Med. 2003 October; 42(10): 1052-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14606727

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Hemolysis, elevated liver enzymes and low platelet count. The HELLP syndrome. Author(s): Bertakis KD, Hufford DB. Source: The Western Journal of Medicine. 1986 January; 144(1): 81-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3953075

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Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome as a complication of preeclampsia in pregnant women increases the amount of cell-free fetal and maternal DNA in maternal plasma and serum. Author(s): Swinkels DW, de Kok JB, Hendriks JC, Wiegerinck E, Zusterzeel PL, Steegers EA. Source: Clinical Chemistry. 2002; 48(4): 650-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11901066

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Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome with acute cortical blindness. Author(s): Tung CF, Peng YC, Chen GH, Chow WK, Yang DY, Hu WH. Source: Zhonghua Yi Xue Za Zhi (Taipei). 2001 August; 64(8): 482-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11720149

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Hemolysis, elevated liver enzymes, and low platelet count syndrome: nursing care of the critically ill obstetric patient. Author(s): Whittaker AA, Hull B, Clochesy JM. Source: Heart & Lung : the Journal of Critical Care. 1986 July; 15(4): 402-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3636299

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Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome: a review of diagnosis and management. Author(s): Saphier CJ, Repke JT. Source: Semin Perinatol. 1998 April; 22(2): 118-33. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9638906

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Hemolysis, elevated liver enzymes, and low platelets in pregnancy (HELLP syndrome). A case report and literature review. Author(s): Schorr-Lesnick B, Dworkin B, Rosenthal WS. Source: Digestive Diseases and Sciences. 1991 November; 36(11): 1649-52. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1935505

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Hemolysis, elevated liver enzymes, and low platelets syndrome associated with primary anti-phospholipid antibody syndrome. Author(s): Nagayama K, Izumi N, Miyasaka Y, Saito K, Ono K, Noguchi O, Hoshino Y, Uchihara M, Miyake S, Enomoto N, Tanaka Y, Marumo F, Sato C. Source: Intern Med. 1997 September; 36(9): 661-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9313115

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Hemolysis, elevated liver enzymes, and low platelets syndrome. Author(s): Goodlin RC. Source: Obstetrics and Gynecology. 1984 September; 64(3): 449-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6462583

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Hepatic histopathologic characteristics in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) Author(s): Minakami H, Tamada T. Source: American Journal of Obstetrics and Gynecology. 1993 November; 169(5): 1357-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8238206

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Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) Author(s): Barton JR, Riely CA, Adamec TA, Shanklin DR, Khoury AD, Sibai BM. Source: American Journal of Obstetrics and Gynecology. 1992 December; 167(6): 1538-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1471661

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Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Author(s): Barton JR, Sibai BM. Source: American Journal of Obstetrics and Gynecology. 1996 June; 174(6): 1820-5; Discussion 1825-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8678146

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Highly abnormal maternal inhibin and beta-human chorionic gonadotropin levels along with severe HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome at 17 weeks' gestation with triploidy. Author(s): Craig K, Pinette MG, Blackstone J, Chard R, Cartin A. Source: American Journal of Obstetrics and Gynecology. 2000 March; 182(3): 737-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10739543

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Identification of alcoholic liver disease or hidden alcohol abuse in patients with elevated liver enzymes. Author(s): Prytz H, Melin T. Source: Journal of Internal Medicine. 1993 January; 233(1): 21-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8429282

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Immunohistological study in cases of HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) and acute fatty liver of pregnancy. Author(s): Halim A, Kanayama N, El Maradny E, Maehara K, Takahashi A, Nosaka K, Fukuo S, Amamiya A, Kobayashi T, Terao T. Source: Gynecologic and Obstetric Investigation. 1996; 41(2): 106-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8838970

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Impact of high-dose corticosteroid therapy for patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Author(s): O'Brien JM, Milligan DA, Barton JR. Source: American Journal of Obstetrics and Gynecology. 2000 October; 183(4): 921-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11035338

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Increased release of tumor necrosis factor-alpha and interleukin-6 in women with the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Author(s): Haeger M, Unander M, Andersson B, Tarkowski A, Arnestad JP, Bengtsson A. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1996 September; 75(8): 695-701. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8906000

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Increased serum levels of hyaluronic acid in pregnancies complicated by preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome. Author(s): Osmers RG, Schutz E, Diedrich F, Wehry B, Krauss T, Oellerich M, Kuhn W. Source: American Journal of Obstetrics and Gynecology. 1998 February; 178(2): 341-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9500497

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Intrahepatic cholangiocarcinoma masquerading as the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) in pregnancy: case report. Author(s): Balderston KD, Tewari K, Azizi F, Yu JK. Source: American Journal of Obstetrics and Gynecology. 1998 September; 179(3 Pt 1): 823-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9758000

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Is liver biopsy useful in the evaluation of patients with chronically elevated liver enzymes? Author(s): Van Ness MM, Diehl AM. Source: Annals of Internal Medicine. 1989 September 15; 111(6): 473-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2774372

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Lipid hydroperoxides and free radical scavenging enzyme activities in preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: no evidence for circulating primary products of lipid peroxidation. Author(s): Diedrich F, Renner A, Rath W, Kuhn W, Wieland E. Source: American Journal of Obstetrics and Gynecology. 2001 July; 185(1): 166-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11483923

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Low whole blood glutathione levels in pregnancies complicated by preeclampsia or the hemolysis, elevated liver enzymes, low platelets syndrome. Author(s): Knapen MF, Mulder TP, Van Rooij IA, Peters WH, Steegers EA. Source: Obstetrics and Gynecology. 1998 December; 92(6): 1012-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9840568

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Management of pre-eclampsia and haemolysis, elevated liver enzymes, and low platelets syndrome. Author(s): Anumba DO, Robson SC. Source: Current Opinion in Obstetrics & Gynecology. 1999 April; 11(2): 149-56. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10219916

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Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: impact on the rate of regional anesthesia. Author(s): O'Brien JM, Shumate SA, Satchwell SL, Milligan DA, Barton JR. Source: American Journal of Obstetrics and Gynecology. 2002 March; 186(3): 475-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11904610

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Maternal haemolysis, elevated liver enzymes and low platelets syndrome: perinatal and neurodevelopmental neonatal outcomes for infants weighing less than 1250 g. Author(s): Singhal N, Amin HJ, Pollard JK, Tough SC, Johnston DW, Clark DJ, Sauve R. Source: Journal of Paediatrics and Child Health. 2004 March; 40(3): 121-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15009576

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Maternal haemolysis, elevated liver enzymes and low platelets syndrome: specific problems in the newborn. Author(s): Eeltink CM, van Lingen RA, Aarnoudse JG, Derks JB, Okken A. Source: European Journal of Pediatrics. 1993 February; 152(2): 160-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8444227

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Maternal hemolysis, elevated liver enzymes, low platelet count, and neonatal outcome. Author(s): Harms K, Rath W, Herting E, Kuhn W. Source: American Journal of Perinatology. 1995 January; 12(1): 1-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7710566

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Maternal hyponatremia and the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Author(s): Goodlin R, Mostello D. Source: American Journal of Obstetrics and Gynecology. 1987 April; 156(4): 910-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3578399

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Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) Author(s): Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Source: American Journal of Obstetrics and Gynecology. 1993 October; 169(4): 1000-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8238109

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Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Author(s): Isler CM, Rinehart BK, Terrone DA, Martin RW, Magann EF, Martin JN Jr. Source: American Journal of Obstetrics and Gynecology. 1999 October; 181(4): 924-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10521755

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Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. Author(s): Sibai BM, Taslimi MM, el-Nazer A, Amon E, Mabie BC, Ryan GM. Source: American Journal of Obstetrics and Gynecology. 1986 September; 155(3): 501-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3529964

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Neonatal morbidity and mortality associated with maternal haemolysis elevated liver enzymes and low platelets syndrome. Author(s): Dotsch J, Hohmann M, Kuhl PG. Source: European Journal of Pediatrics. 1997 May; 156(5): 389-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9177983

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Neonatal morbidity and mortality associated with maternal haemolysis, elevated liver enzymes and low platelets syndrome--the impact of neutropenia. Author(s): Schwab M, Kuhls E. Source: European Journal of Pediatrics. 1998 May; 157(5): 439-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9625346

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Neonatal outcome in severe preeclampsia at 24 to 36 weeks' gestation: does the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome matter? Author(s): Abramovici D, Friedman SA, Mercer BM, Audibert F, Kao L, Sibai BM. Source: American Journal of Obstetrics and Gynecology. 1999 January; 180(1 Pt 1): 221-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9914607

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Neurofibromatosis type 1 with pregnancy-associated renovascular hypertension and the syndrome of hemolysis, elevated liver enzymes, and low platelets. Author(s): Hagymasy L, Toth M, Szucs N, Rigo J Jr. Source: American Journal of Obstetrics and Gynecology. 1998 July; 179(1): 272-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9704804

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Nonalcoholic fatty liver disease in patients investigated for elevated liver enzymes. Author(s): Kichian K, McLean R, Gramlich LM, Bailey RJ, Bain VG. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2003 January; 17(1): 38-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12560853

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Obstetrical anaesthesia for patients with the syndrome of haemolysis, elevated liver enzymes and low platelets. Author(s): Crosby ET. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1991 March; 38(2): 227-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2021995

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Patients with elevated liver enzymes are not at higher risk for statin hepatotoxicity. Author(s): Chalasani N, Aljadhey H, Kesterson J, Murray MD, Hall SD. Source: Gastroenterology. 2004 May; 126(5): 1287-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15131789

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Persistant pre-eclampsia post partum with elevated liver enzymes and hemolytic uremic syndrome. Author(s): Mahalati K, Dawson RB, Collins JO, Bell WR, McCrae KR, Martin JN Jr. Source: Journal of Clinical Apheresis. 1999; 14(2): 69-78. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10440942

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Placenta-derived CD95 ligand causes liver damage in hemolysis, elevated liver enzymes, and low platelet count syndrome. Author(s): Strand S, Strand D, Seufert R, Mann A, Lotz J, Blessing M, Lahn M, Wunsch A, Broering DC, Hahn U, Grischke EM, Rogiers X, Otto G, Gores GJ, Galle PR. Source: Gastroenterology. 2004 March; 126(3): 849-58. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14988839

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Postoperative incision complications after cesarean section in patients with antepartum syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP): does delayed primary closure make a difference? Author(s): Briggs R, Chari RS, Mercer B, Sibai B. Source: American Journal of Obstetrics and Gynecology. 1996 October; 175(4 Pt 1): 893-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8885743

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Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Author(s): Magann EF, Perry KG Jr, Meydrech EF, Harris RL, Chauhan SP, Martin JN Jr. Source: American Journal of Obstetrics and Gynecology. 1994 October; 171(4): 1154-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7943089

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Postpartum hepatic hemorrhage in the syndrome of hemolysis, elevated liver enzymes, and low platelets: diagnosis by radiocolloid scanning. Author(s): Lee HK, Skarzynski J, De Regt RH, McLymont F. Source: Clinical Nuclear Medicine. 1988 September; 13(9): 635-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3180609

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Postpartum plasma exchange for atypical preeclampsia-eclampsia as HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Author(s): Martin JN Jr, Files JC, Blake PG, Perry KG Jr, Morrison JC, Norman PH. Source: American Journal of Obstetrics and Gynecology. 1995 April; 172(4 Pt 1): 1107-25; Discussion 1125-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7726248

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Postpartum renal failure: a complex case with probable coexistence of hemolysis, elevated liver enzymes, low platelet count, and hemolytic uremic syndrome. Author(s): Kahra K, Draganov B, Sund S, Hovig T. Source: Obstetrics and Gynecology. 1998 October; 92(4 Pt 2): 698-700. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9764670

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Preeclampsia associated with hemolysis, elevated liver enzymes, and low platelets-an obstetric emergency? Author(s): MacKenna J, Dover NL, Brame RG. Source: Obstetrics and Gynecology. 1983 December; 62(6): 751-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6634002

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Preeclampsia/eclampsia with hemolysis, elevated liver enzymes, and thrombocytopenia. Author(s): Weinstein L. Source: Obstetrics and Gynecology. 1985 November; 66(5): 657-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4058824

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Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Author(s): Sibai BM, Ramadan MK, Chari RS, Friedman SA. Source: American Journal of Obstetrics and Gynecology. 1995 January; 172(1 Pt 1): 125-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7847520

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Pregnancy complicated by preeclampsia-eclampsia with the syndrome of hemolysis, elevated liver enzymes, and low platelet count: how rapid is postpartum recovery? Author(s): Martin JN Jr, Blake PG, Lowry SL, Perry KG Jr, Files JC, Morrison JC. Source: Obstetrics and Gynecology. 1990 November; 76(5 Pt 1): 737-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2216215

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Pregnancy induced hypertension complicated by thrombocytopenia, haemolysis and elevated liver enzymes (HELLP) syndrome. Renal biopsies and outcome. Author(s): Beller FK, Dame WR, Ebert C. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1985 May; 25(2): 83-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3863600

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Prevalence of hepatitis C virus in Japanese children with non-A, non-B hepatitis and those with elevated liver enzymes after repeated blood transfusions. Author(s): Tomomasa T, Ogawa T, Shitara T, Sotomatu M, Yugami S, Itoh K, Kuroume T. Source: Journal of Pediatric Gastroenterology and Nutrition. 1992 February; 14(2): 244-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1593383

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Prolongation of premature gestation in women with hemolysis, elevated liver enzymes and low platelets. A report of five cases. Author(s): Heyborne KD, Burke MS, Porreco RP. Source: J Reprod Med. 1990 January; 35(1): 53-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2299613

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Relation between gestational thrombocytopenia and the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). Author(s): Minakami H, Kohmura Y, Izumi A, Watanabe T, Matsubara S, Sato I. Source: Gynecologic and Obstetric Investigation. 1998; 46(1): 41-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9692341

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Report of elevated liver enzymes as an operative complication of gastric bypass surgery. Author(s): Shapiro DH. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2003 October; 13(5): 810; Author Reply 810. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14627485

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Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Author(s): Haddad B, Barton JR, Livingston JC, Chahine R, Sibai BM. Source: American Journal of Obstetrics and Gynecology. 2000 August; 183(2): 444-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10942484

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Serum soluble Fas in the syndrome of hemolysis, elevated liver enzymes, and low platelets. Author(s): Harirah H, Donia SE, Hsu CD. Source: Obstetrics and Gynecology. 2001 August; 98(2): 295-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11506848

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Severe folate deficiency masquerading as the syndrome of hemolysis, elevated liver enzymes, and low platelets. Author(s): Walker SP, Wein P, Ihle BU. Source: Obstetrics and Gynecology. 1997 October; 90(4 Pt 2): 655-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11770582

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Severe syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP) in the 18th week of pregnancy associated with the antiphospholipid-antibody syndrome. Author(s): Haram K, Trovik J, Sandset PM, Hordnes K. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 July; 82(7): 679-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12790854

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Sonographic findings of liver and gallbladder in early hemolysis, elevated liver enzymes, and low platelet count syndrome. Author(s): Peitz U, Labenz J, Borsch G. Source: Journal of Clinical Ultrasound : Jcu. 1993 October; 21(8): 557-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8270679

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Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Author(s): Weinstein L. Source: American Journal of Obstetrics and Gynecology. 1982 January 15; 142(2): 159-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7055180

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Syndrome of hemolysis, elevated liver enzymes, and low platelet count: report of 4 cases. Author(s): Hsieh TT, Lo LM, Chu KK, Soong YK. Source: Taiwan Yi Xue Hui Za Zhi. 1989 August; 88(8): 824-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2592946

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The HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome in severe hypertensive crises of pregnancy--does it exist? Author(s): Pillay M, Moodley J. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1985 February 16; 67(7): 246-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3983769

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The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Author(s): Sibai BM. Source: American Journal of Obstetrics and Gynecology. 1990 February; 162(2): 311-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2309811

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The intrapartum platelet count in patients with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome: is it predictive of later hemorrhagic complications? Author(s): Roberts WE, Perry KG Jr, Woods JB, Files JC, Blake PG, Martin JN Jr. Source: American Journal of Obstetrics and Gynecology. 1994 September; 171(3): 799804. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8092232

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The maternal benefits of corticosteroids with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. Author(s): Crane JM, Tabarsi B, Hutchens D. Source: J Obstet Gynaecol Can. 2003 August; 25(8): 650-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12908017

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The recurrence risk of the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) in subsequent gestations. Author(s): Sullivan CA, Magann EF, Perry KG Jr, Roberts WE, Blake PG, Martin JN Jr. Source: American Journal of Obstetrics and Gynecology. 1994 October; 171(4): 940-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7943105

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The utility of umbilical artery Doppler investigation in women with the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Author(s): Bush KD, O'brien JM, Barton JR. Source: American Journal of Obstetrics and Gynecology. 2001 May; 184(6): 1087-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11349165

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Thrombotic thrombocytopenic purpura and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome: differential diagnostic problems. Author(s): Kaiser C, Distler W. Source: American Journal of Obstetrics and Gynecology. 1996 August; 175(2): 506-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8765282

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Ticlopidine-induced elevated liver enzymes. Author(s): Klepser TB, Jogerst GJ. Source: Pharmacotherapy. 1997 July-August; 17(4): 819-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9250564

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Vascular endothelial growth factor ligands and receptors that regulate human cytotrophoblast survival are dysregulated in severe preeclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome. Author(s): Zhou Y, McMaster M, Woo K, Janatpour M, Perry J, Karpanen T, Alitalo K, Damsky C, Fisher SJ. Source: American Journal of Pathology. 2002 April; 160(4): 1405-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11943725

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Vascular reactivity in patients with preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Author(s): Fischer T, Schneider MP, Schobel HP, Heusser K, Langenfeld M, Schmieder RE. Source: American Journal of Obstetrics and Gynecology. 2000 December; 183(6): 1489-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11120516

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CHAPTER 2. ALTERNATIVE MEDICINE AND ELEVATED LIVER ENZYMES Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to elevated liver enzymes. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to elevated liver enzymes and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “elevated liver enzymes” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to elevated liver enzymes: •

3-Hydroxy-3-methyl-glutaryl coenzyme A reductase activity in chicks fed coumestrol, a phytoestrogen. Author(s): Beguin DP, Kincaid RL. Source: Poultry Science. 1984 April; 63(4): 686-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6539472

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A ceramic glazer presenting with extremely high lead levels. Author(s): Ooi DS, Perkins SL. Source: Hum Toxicol. 1988 March; 7(2): 171-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3132419

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A novel antioxidant flavonoid (IdB 1031) affecting molecular mechanisms of cellular activation. Author(s): Ursini F, Maiorino M, Morazzoni P, Roveri A, Pifferi G. Source: Free Radical Biology & Medicine. 1994 May; 16(5): 547-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8026797

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A placebo-controlled trial of the immune modulator, lentinan, in HIV-positive patients: a phase I/II trial. Author(s): Gordon M, Bihari B, Goosby E, Gorter R, Greco M, Guralnik M, Mimura T, Rudinicki V, Wong R, Kaneko Y. Source: J Med. 1998; 29(5-6): 305-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10503166

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A supplement to alkaline phosphatase fractionations: utilization of gamma-glutamyl transpeptidase and hydroxyproline assays. Author(s): Slaunwhite D, Tuggey RL, Reynoso G. Source: Ann Clin Lab Sci. 1978 March-April; 8(2): 117-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=25040

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Accelerative effect of olive oil on liver glycogen synthesis in rats subjected to waterimmersion restraint stress. Author(s): Takeuchi H, Suzuki N, Tada M, He P. Source: Bioscience, Biotechnology, and Biochemistry. 2001 July; 65(7): 1489-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11515530

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Acetaminophen activation by human liver cytochromes P450IIE1 and P450IA2. Author(s): Raucy JL, Lasker JM, Lieber CS, Black M. Source: Archives of Biochemistry and Biophysics. 1989 June; 271(2): 270-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2729995

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Acetylation of S-substituted cysteines by a rat liver and kidney microsomal Nacetyltransferase. Author(s): Green RM, Elce JS. Source: The Biochemical Journal. 1975 May; 147(2): 283-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=241322

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Action of cypermethrin on tissue transamination during nitrogen metabolism in Cyprinus carpio. Author(s): Philip GH, Rajasree BH. Source: Ecotoxicology and Environmental Safety. 1996 July; 34(2): 174-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8812184

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Action of vitamin P like compounds on lysosomal fragility in hypercholesterolemia: implication of ascorbic acid and its metabolites. Author(s): Rathi AB, Nath N, Chari SN. Source: Acta Vitaminol Enzymol. 1984; 6(2): 97-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6496258

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Activity of Cassia auriculata leaf extract in rats with alcoholic liver injury. Author(s): Kumar Rajagopal S, Manickam P, Periyasamy V, Namasivayam N. Source: The Journal of Nutritional Biochemistry. 2003 August; 14(8): 452-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12948875

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Acute renal failure in pregnancy in South Africa. Author(s): Randeree IG, Czarnocki A, Moodley J, Seedat YK, Naiker IP. Source: Renal Failure. 1995 March; 17(2): 147-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7644765

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Acute, chronic and terminal toxicity to 4'-demethylepipodophyllotoxin thenylidene glucoside (VM26) in mice. Author(s): Hacker M, Roberts DW. Source: Cancer Research. 1975 July; 35(7): 1756-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1131830

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Acyl group distributions in tissue lipids of rats fed evening primrose oil (gamma linolenic plus linoleic acid) or soybean oil (alpha-linolenic plus linoleic acid). Author(s): Hoy CE, Holmer G, Kaur N, Byrjalsen I, Kirstein D. Source: Lipids. 1983 November; 18(11): 760-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6318009

•

Administration of human inter-alpha-inhibitors maintains hemodynamic stability and improves survival during sepsis. Author(s): Yang S, Lim YP, Zhou M, Salvemini P, Schwinn H, Josic D, Koo DJ, Chaudry IH, Wang P. Source: Critical Care Medicine. 2002 March; 30(3): 617-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11990925

•

Alkaline phosphatase activity in human and rat liver tumors. Author(s): Kovalszky I, Kralovanszky J, Jeney A, Lapis K, Karacsonyi S, Szecheny A. Source: Oncology. 1991; 48(2): 144-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1847742

•

Alpha-tocopherol attenuates lipopolysaccharide-induced sickness behavior in mice. Author(s): Berg BM, Godbout JP, Kelley KW, Johnson RW.

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Source: Brain, Behavior, and Immunity. 2004 March; 18(2): 149-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14759592 •

Alteration of glucose-6-phosphatase activity and regenerative, and total DNA concentrations in regenerating and normal rat liver of aqueous extracts of two Nigerian plants. Author(s): Oruambo IF. Source: Journal of Environmental Pathology, Toxicology and Oncology : Official Organ of the International Society for Environmental Toxicology and Cancer. 1989 MarchApril; 9(2): 191-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2543807

•

Amelioration of alloxan induced diabetes mellitus and oxidative stress in rats by oil of Eruca sativa seeds. Author(s): El-Missiry MA, El Gindy AM. Source: Annals of Nutrition & Metabolism. 2000; 44(3): 97-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11053894

•

Amplification of signal transduction capacity and down-regulation by drugs. Author(s): Weber G, Shen F, Yang H, Prajda N, Li W. Source: Advances in Enzyme Regulation. 1999; 39: 51-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10470366

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An alternative promoter contributes to tissue- and inducer-specific expression of the rat UDP-glucuronosyltransferase 1A6 gene. Author(s): Auyeung DJ, Kessler FK, Ritter JK. Source: Toxicology and Applied Pharmacology. 2001 July 1; 174(1): 60-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11437649

•

An ethanol-extract of Ampelopsis brevipedunculata (Vitaceae) berries decreases ferrous iron-stimulated hepatocyte injury in culture. Author(s): Yabe N, Tanaka K, Matsui H. Source: Journal of Ethnopharmacology. 1998 January; 59(3): 147-59. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9507898

•

Anti-diabetic activity of green tea polyphenols and their role in reducing oxidative stress in experimental diabetes. Author(s): M C S, K S, Kuttan R. Source: Journal of Ethnopharmacology. 2002 November; 83(1-2): 109-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12413715

•

Antifibrotic effect of silymarin in rat secondary biliary fibrosis is mediated by downregulation of procollagen alpha1(I) and TIMP-1.

Alternative Medicine 33

Author(s): Jia JD, Bauer M, Cho JJ, Ruehl M, Milani S, Boigk G, Riecken EO, Schuppan D. Source: Journal of Hepatology. 2001 September; 35(3): 392-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11592601 •

Anti-obesity effects of lipase inhibitor CT-II, an extract from edible herbs, Nomame Herba, on rats fed a high-fat diet. Author(s): Yamamoto M, Shimura S, Itoh Y, Ohsaka T, Egawa M, Inoue S. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 2000 June; 24(6): 758-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10878683

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Anti-oxidant activities of fucosterol from the marine algae Pelvetia siliquosa. Author(s): Lee S, Lee YS, Jung SH, Kang SS, Shin KH. Source: Arch Pharm Res. 2003 September; 26(9): 719-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14560919

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Anti-oxidant activities of the extracts from the herbs of Artemisia apiacea. Author(s): Kim KS, Lee S, Lee YS, Jung SH, Park Y, Shin KH, Kim BK. Source: Journal of Ethnopharmacology. 2003 March; 85(1): 69-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12576204

•

Antioxidant activity of Smoke Shield in-vitro and in-vivo. Author(s): Sreekanth KS, Sabu MC, Varghese L, Manesh C, Kuttan G, Kuttan R. Source: The Journal of Pharmacy and Pharmacology. 2003 June; 55(6): 847-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12841947

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Antioxidant activity of Tinospora cordifolia and its usefulness in the amelioration of cyclophosphamide induced toxicity. Author(s): Mathew S, Kuttan G. Source: J Exp Clin Cancer Res. 1997 December; 16(4): 407-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9505214

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Apolipoprotein B mRNA editing and the reduction in synthesis and secretion of the atherogenic risk factor, apolipoprotein B100 can be effectively targeted through TATmediated protein transduction. Author(s): Yang Y, Ballatori N, Smith HC. Source: Molecular Pharmacology. 2002 February; 61(2): 269-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11809850

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Apoptosis in murine hepatoma hepa 1c1c7 wild-type, C12, and C4 cells mediated by bilirubin. Author(s): Seubert JM, Darmon AJ, El-Kadi AO, D'Souza SJ, Bend JR.

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Source: Molecular Pharmacology. 2002 August; 62(2): 257-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12130676 •

Aqueous kava extracts do not affect liver function tests in rats. Author(s): Singh YN, Devkota AK. Source: Planta Medica. 2003 June; 69(6): 496-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865965

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Aryl hydrocarbon hydroxylase activity in F-344 rats subchronically exposed to benzo(a)pyrene and fluoranthene through diet. Author(s): Ramesh A, Inyang F, Hood DB, Knuckles ME. Source: Journal of Biochemical and Molecular Toxicology. 2000; 14(3): 155-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10711631

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Assessment of the influence of dietary vitamin E on sows and offspring in three parities: reproductive performance, tissue tocopherol, and effects on progeny. Author(s): Mahan DC. Source: Journal of Animal Science. 1991 July; 69(7): 2904-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1885399

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Assimilation of LDL by experimental tumours in mice. Author(s): Lombardi P, Norata G, Maggi FM, Canti G, Franco P, Nicolin A, Catapano AL. Source: Biochimica Et Biophysica Acta. 1989 June 28; 1003(3): 301-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2500972

•

BCNU-induced quantitative and qualitative changes in hepatic cytochrome P-450 can be correlated with cholestasis. Author(s): Stolzenbach JC, Larson RE. Source: Cancer Chemotherapy and Pharmacology. 1990; 25(4): 227-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2295110

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Beneficial effect of methionine and threonine supplements on tyrosine toxicity in rats. Author(s): Yamamoto Y, Katayama H, Muramatsu K. Source: J Nutr Sci Vitaminol (Tokyo). 1976; 22(6): 467-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15052

•

beta-Naphthoflavone disrupts cortisol responsiveness in rainbow trout. Author(s): Aluru N, Vijayan MM.

production

and

liver

glucocorticoid

Alternative Medicine 35

Source: Aquatic Toxicology (Amsterdam, Netherlands). 2004 April 28; 67(3): 273-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15063076 •

Elevated liver enzymes in asymptomatic patients. Author(s): Linkner EJ. Source: The New England Journal of Medicine. 2000 August 31; 343(9): 663. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10979810

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

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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

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

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

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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

•

HealthGate: http://www.tnp.com/

•

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

•

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

•

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

The following is a specific Web list relating to elevated liver enzymes; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview High Cholesterol Source: Prima Communications, Inc.www.personalhealthzone.com

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•

Elevated Liver Enzymes

Herbs and Supplements Andrographis Alternative names: Andrographis paniculata Source: Healthnotes, Inc.; www.healthnotes.com Green Tea Source: Prima Communications, Inc.www.personalhealthzone.com Red Yeast Rice Source: Prima Communications, Inc.www.personalhealthzone.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

37

CHAPTER 3. BOOKS ON ELEVATED LIVER ENZYMES Overview This chapter provides bibliographic book references relating to elevated liver enzymes. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on elevated liver enzymes include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Chapters on Elevated Liver Enzymes In order to find chapters that specifically relate to elevated liver enzymes, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and elevated liver enzymes 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 “elevated liver enzymes” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on elevated liver enzymes: •

Pregnant Patient with Liver Disease Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume Two. Philadelphia, PA: Current Medicine. 1999. p. 961-969. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Liver diseases encountered in pregnant patients include those present before conception, those that occur coincident with pregnancy, and those that are unique to pregnancy. This chapter on the pregnant patient with liver disease is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. The author describes the features of liver diseases unique to pregnancy and briefly discusses the pregnant patient with viral

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Elevated Liver Enzymes

hepatitis. Evaluation of pregnant patients with abnormal liver test results is similar to that of nonpregnant patients suspected of having liver disease; however, attention to the stage of pregnancy and the obstetric history is important. Diseases discussed include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, pregnancy induced hypertension (high blood pressure, previously called preeclampsia), HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), acute fatty liver of pregnancy, hepatic rupture, and viral hepatitis. In each section, the author reviews the epidemiology and risk factors, the pathogenesis, the clinical features, maternal and fetal outcome, and patient care management. 2 figures. 7 tables. 17 references. •

Pregnancy-Related Hepatic and Gastrointestinal Disorders 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. 1448-1461. 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: Pregnancy is a state of altered, but normal, physiologic processes. Gastroenterologists and internists often are not well versed in the physiologic characteristics of pregnancy and may be uneasy when confronted with a pregnant patient who has a gastrointestinal or liver (hepatic) disorder. This chapter on pregnancyrelated hepatic and gastrointestinal disorders 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 cholestasis of pregnancy; liver disease of preeclampsia; hemolysis, elevated liver enzymes, and low platelets syndrome; hepatic rupture, hematoma, and infarct; acute fatty liver of pregnancy; liver disorders complicating pregnancy, including viral hepatitis, portal hypertension caused by chronic liver disease, Wilson disease, autoimmune liver disease, hepatic neoplasia (liver cancer), Budd-Chiari syndrome, and liver transplant recipients; and gastrointestinal disorders complicating pregnancy, including nausea and vomiting of pregnancy, hyperemesis gravidarum, gastroesophageal reflux disease, constipation and diarrhea, hemorrhoidal disease, gallstone disease, pancreatitis, and inflammatory bowel disease (IBD). The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 3 figures. 1 table. 172 references.

•

Hemolytic Uremic Syndrome in Association with Pregnancy Source: in Kaplan, B.S., Trompeter, R.S., and Moake, J.L., eds. Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura. New York, NY: Marcel Dekker, Inc. 1992. p. 241-254. Contact: Available from Marcel Dekker, Inc. P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (212) 696-9000. Fax (914) 796-1772. E-mail: [email protected]. PRICE: $215.00. ISBN: 0824786637. Summary: This chapter, from a medical text on hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP), discusses HUS in association with pregnancy. The authors provide a classification system of three main clinical entities and stress that patient management depends in part on a classification that is as precise as possible. Topics include postpartum HUS, its clinical presentation, histological findings, evolution, and etiology; TTP, its clinical presentation, evolution, and differential

Books

39

diagnosis; severe pre-eclampsia; the HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count); acute fatty liver of pregnancy (AFLP); bilateral renal cortical necrosis; the pathophysiology of TTP/HUS, regardless of the triggering factor; and treatment options, including supportive therapy and specific therapy. A number of tables summarize the case reports in the literature. 5 tables. 41 references.

41

CHAPTER 4. MULTIMEDIA ON ELEVATED LIVER ENZYMES Overview In this chapter, we show you how to keep current on multimedia sources of information on elevated liver enzymes. 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 elevated liver enzymes is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “elevated liver enzymes” 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 “elevated liver enzymes” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on elevated liver enzymes: •

Diagnosing Alpha 1 Antitrypsin Deficiency Source: Minneapolis, MN: Alpha 1 Association. 199x. (videocassette). Contact: Available from Alpha 1 Association. 8120 Penn Avenue, South, Suite 549, Minneapolis, MN 55431-1326. (800) 521-3025 or (612) 703-9979. Fax (612) 703-9977. Email: [email protected]. Website: www.alpha1.org. PRICE: $3.00 plus shipping and handling. Summary: This videotape program, narrated by Sandra Brandley, the Executive Director of the Alpha 1 National Association, reminds physicians of the symptoms and differential diagnosis of alpha 1 antitrypsin deficiency (A1AD or Alpha 1). The program features Dr. James Stoller, who describes the typical underdiagnosis of A1AD which is typical: the mean time until diagnosis is 7 years (from onset of symptoms) and the mean number of doctors consulted before diagnosis is 3.5. Alpha 1 is a relatively common genetic disorder that affects infants, children, and adults. It is the most common

42

Elevated Liver Enzymes

metabolic disorder that causes liver disease in infants and children; the disorder also causes cirrhosis and cancer of the liver in adults. Symptoms of A1AD deficiency in children include prolonged obstructive jaundice, low birth weight, mildly elevated liver enzymes, cholestasis, enlarged liver, abnormal bleeding, feeding difficulties, poor growth (or failure to thrive), and ascites (abnormal accumulation of fluids). In adults, the spectrum of liver disease associated with A1AD deficiency varies from mild to severe. Symptoms include chronic active hepatitis, cryptogenic cirrhosis (liver scarring of unknown cause), portal hypertension (high blood pressure in the portal vein of the liver), and hepatocellular carcinoma (liver cancer). A rare but telling symptom is panniculitis, a chronic inflammation of subcutaneous fat featuring ulcerated skin lesions on the torso. Dr. Stoller reminds viewers of the indications for A1AD screening: premature onset of moderate to severe chronic obstructive pulmonary disease (COPD) before age 50; predominant basilar emphysema; chronic bronchitis with airflow obstruction in a nonsmoker; bronchiectasis (irreversible dilation and destruction of the bronchial walls) without clear risk factors; development of unremitting asthma; family history of A1AD; cirrhosis without apparent risk factors; and family history of panniculitis. The program includes a chart of laboratory values and the risk of development of A1AD, and a series of interviews with patients about the interplay of early diagnosis and good quality of life. The program concludes with the contact information for the Alpha 1 National Association (800-521-3025).

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CHAPTER 5. PERIODICALS AND NEWS ON ELEVATED LIVER ENZYMES Overview In this chapter, we suggest a number of news sources and present various periodicals that cover elevated liver enzymes.

News Services and Press Releases One of the simplest ways of tracking press releases on elevated liver enzymes 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 “elevated liver enzymes” (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 elevated liver enzymes. 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 “elevated liver enzymes” (or synonyms). The following was recently listed in this archive for elevated liver enzymes: •

Vitamin E normalizes elevated liver enzymes in children with steatohepatitis Source: Reuters Medical News Date: July 07, 2000

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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 “elevated liver enzymes” (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 “elevated liver enzymes” (or synonyms). If you know the name of a company that is relevant to elevated liver enzymes, 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 “elevated liver enzymes” (or synonyms).

Periodicals and News

45

Academic Periodicals covering Elevated Liver Enzymes Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to elevated liver enzymes. In addition to these sources, you can search for articles covering elevated liver enzymes 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

49

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 Institute4: •

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

4

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

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Elevated Liver Enzymes

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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51

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.5 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:6 •

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

•

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

•

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

•

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/

•

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

•

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

•

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/

•

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

•

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

•

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

•

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

5

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). 6 See http://www.nlm.nih.gov/databases/databases.html.

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Elevated Liver Enzymes

•

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

•

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 Gateway7 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.8 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “elevated liver enzymes” (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 9386 6 793 37 776 10998

HSTAT9 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.10 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.11 Simply search by “elevated liver enzymes” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

7

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

8

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). 9 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 10 11

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 Biologists12 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.13 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.14 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/.

12 Adapted 13

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. 14 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.

55

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 elevated liver enzymes 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 elevated liver enzymes. 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 elevated liver enzymes. 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 “elevated liver enzymes”:

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Alpha-1 Antitrypsin Deficiency http://www.nlm.nih.gov/medlineplus/alpha1antitrypsindeficiency.html Cirrhosis http://www.nlm.nih.gov/medlineplus/cirrhosis.html Hemochromatosis http://www.nlm.nih.gov/medlineplus/hemochromatosis.html Hepatitis C http://www.nlm.nih.gov/medlineplus/hepatitisc.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 elevated liver enzymes. 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: •

Alpha 1-Antitrypsin Deficiency Liver Disease Source: Minneapolis, MN: Alpha 1 Association. 2000. [4 p.]. Contact: Available from Alpha 1 Association. 8120 Penn Avenue, South, Suite 549, Minneapolis, MN 55431-1326. (800) 521-3025 or (612) 703-9979. Fax (612) 703-9977. Email: [email protected]. Website: www.alpha1.org. PRICE: $0.10 plus shipping and handling; bulk copies available. Summary: This brochure describes Alpha 1 antitrypsin deficiency (A1AD or Alpha 1), a genetic disorder that affects infants, children, and adults. It is the most common metabolic disorder that causes liver disease in infants and children; the disorder also causes cirrhosis and cancer of the liver in adults. The brochure reviews the functions of the liver, the causes of the deficiency, symptoms in children and adults, and treatment options. Alpha 1 antitrypsin (AAT) is a protein primarily manufactured in the liver and then released into the blood. The normal function of AAT is to protect body tissues from being damaged by neutrophil elastase, a protein found in white blood cells. The backup of abnormal AAT in the liver can cause liver damage. Symptoms of A1AD in children includes jaundice, low birth weight, mildly elevated liver enzymes, cholestasis, enlarged liver, abnormal bleeding, feeding difficulties, poor growth (or failure to thrive), and ascites (abnormal accumulation of fluids). In adults, the spectrum of liver disease

Patient Resources

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associated with A1AD deficiency varies from mild to severe. Symptoms include chronic active hepatitis, cryptogenic cirrhosis (liver scarring of unknown cause), portal hypertension (high blood pressure in the portal vein of the liver), and hepatocellular carcinoma (liver cancer). Clinical care for all affected individuals largely involves supportive management for liver dysfunction and prevention of complications. For those who develop severe liver injury, liver transplantation is usually recommended. Proper nutrition is essential for everyone with A1AD. The brochure concludes with contact information for the Alpha 1 Association. 1 figure. 3 references. •

Management of Chronic Hepatitis B in Children and Guidelines in Adults with Chronic Hepatitis B Source: St. Paul, MN: Hepatitis B Coalition. 1997. 2 p. Contact: Available from Hepatitis B Coalition. 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 647-9009. Fax (612) 647-9131. PRICE: $1.00. Summary: This fact sheet provides guidelines for the management of chronic hepatitis B in children and in adults. Topics in the first section include tests to be done once a child is found to be HBsAg positive, follow up in children, considerations for therapy in children, and vaccination indications for household members and close, frequent contacts of children with chronic hepatitis B. The author stresses that interferon has been shown to hasten the rates of remission in adults and children. All children with elevated serum liver enzymes (ALT, AST) more than 2 to 3 times the normal range, evidence of active viral replication, and evidence of active disease on liver biopsy should be considered candidates for interferon therapy. The section on adults with chronic hepatitis B emphasizes that all patients who are HBeAg positive with elevated liver enzymes for more than 6 months should be referred for liver biopsy. Treatment options include interferon, experimental trials with lamivudine (3TC) and famciclovir, and liver transplantation. Patients with evidence of cirrhosis and signs of decompensation of their liver disease should be evaluated for liver transplantation. (AA-M). 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 elevated liver enzymes. 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

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•

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

•

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

•

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

•

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

•

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

•

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 elevated liver enzymes. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with elevated liver enzymes. 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 elevated liver enzymes. 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 “elevated liver enzymes” (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

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your search to “Organizations” and “elevated liver enzymes”. 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 option “Organization Resource Sheet.” Type “elevated liver enzymes” (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 “elevated liver enzymes” (or a synonym) into the search box, and click “Submit Query.”

61

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.15

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

15

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)16: •

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

•

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

•

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

•

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

•

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

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

16

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

Finding Medical Libraries

63

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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/

•

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

Finding Medical Libraries

65

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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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).

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/

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

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ELEVATED LIVER ENZYMES DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 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] 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] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acute tubular: A severe form of acute renal failure that develops in people with severe illnesses like infections or with low blood pressure. Patients may need dialysis. Kidney function often improves if the underlying disease is successfully treated. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] 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] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] 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]

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Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Alopecia: Absence of hair from areas where it is normally present. [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, magnet therapy, spiritual healing, and meditation. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [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] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [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] Antiallergic: Counteracting allergy or allergic conditions. [EU] 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] 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

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antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [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] Antiviral: Destroying viruses or suppressing their replication. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteritis: Inflammation of an artery. [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] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspartate: A synthetic amino acid. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atherogenic: Causing the formation of plaque in the lining of the arteries. [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 disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [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] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH]

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Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] 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 subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzo(a)pyrene: A potent mutagen and carcinogen. It is a public health concern because of its possible effects on industrial workers, as an environmental pollutant, an as a component of tobacco smoke. [NIH] Bilateral: Affecting both the right and left side of body. [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 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] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] 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] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH]

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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, 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] 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] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchiectasis: Persistent abnormal dilatation of the bronchi. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [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 functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] 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] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] 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] Cardiopulmonary: Having to do with the heart and lungs. [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] Causal: Pertaining to a cause; directed against a cause. [EU] 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] Celiac Disease: A disease characterized by intestinal malabsorption and precipitated by gluten-containing foods. The intestinal mucosa shows loss of villous structure. [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 Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH]

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Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [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] 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 Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [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] 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] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU]

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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] 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] 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. 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] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [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

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biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] 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] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] 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] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortical Blindness: The inability to understand or interpret what is seen due to a disturbance in the cerebral associational areas, the retina, the sensory pathways, and the striate area being intact. [NIH] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Coumarin: A fluorescent dye. [NIH] Coumestrol: A coumarin derivative occurring naturally in forage crops which has estrogenic activity. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU]

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Curative: Tending to overcome disease and promote recovery. [EU] Cyclophosphamide: Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the liver to form the active aldophosphamide. It is used in the treatment of lymphomas, leukemias, etc. Its side effect, alopecia, has been made use of in defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. [NIH] 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] Cytotoxic: Cell-killing. [NIH] De novo: In cancer, the first occurrence of cancer in the body. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [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 procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [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] Dihydrotestosterone: Anabolic agent. [NIH]

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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] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [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] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] 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] 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] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [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

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released only when the cells are disrupted). [EU] Endotoxin: Toxin from cell walls of bacteria. [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] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [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] 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] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogens: A class of sex hormones associated with the development and maintenance of secondary female sex characteristics and control of the cyclical changes in the reproductive cycle. They are also required for pregnancy maintenance and have an anabolic effect on protein metabolism and water retention. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Evacuation: An emptying, as of the bowels. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [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]

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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 acids: A major component of fats that are used by the body for energy and tissue development. [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] 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] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Flatus: Gas passed through the rectum. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Follicles: Shafts through which hair grows. [NIH] Forearm: The part between the elbow and the wrist. [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] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma-Glutamyltransferase: An enzyme that catalyzes reversibly the transfer of a glutamyl group from a glutamyl-peptide and an amino acid to a peptide and a glutamylamino acid. EC 2.3.2.2. [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] 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]

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Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [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 Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [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]

Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] 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] Glucose-6-Phosphatase: An enzyme that catalyzes the conversion of D-glucose 6-phosphate and water to D-glucose and orthophosphate. EC 3.1.3.9. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to

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supplement the action of estrogens. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Granulosa Cells: Cells of the membrana granulosa lining the vesicular ovarian follicle which become luteal cells after ovulation. [NIH] Haemolysis: Disruption of the integrity of the red cell membrane causing release of haemoglobin. Haemolysis may be caused by bacterial haemolysins, by antibodies that cause complement-dependent lysis, by placing red cells in a hyptonic solution, or by defects in the red cell membrane. [EU] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [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] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [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] Hemorrhage: Bleeding or escape of blood from a vessel. [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] 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] 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] Hepatoma: A liver tumor. [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] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterozygote: An individual having different alleles at one or more loci in homologous chromosome segments. [NIH]

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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] Hormonal: Pertaining to or of the nature of a hormone. [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] 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] 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] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperemesis: Excessive vomiting. [EU] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions 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] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune Complex Diseases: Group of diseases mediated by the deposition of large soluble complexes of antigen and antibody with resultant damage to tissue. Besides serum sickness and the arthus reaction, evidence supports a pathogenic role for immune complexes in many other systemic immunologic diseases including glomerulonephritis, systemic lupus erythematosus and polyarteritis nodosa. [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] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunogenic: Producing immunity; evoking an immune response. [EU] Immunologic: The ability of the antibody-forming system to recall a previous experience

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with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] 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] Incompetence: Physical or mental inadequacy or insufficiency. [EU] 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]

Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Inhibin: Glyceroprotein hormone produced in the seminiferous tubules by the Sertoli cells in the male and by the granulosa cells in the female follicles. The hormone inhibits FSH and LH synthesis and secretion by the pituitary cells thereby affecting sexual maturation and fertility. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [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]

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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-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] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intracranial Hemorrhages: Bleeding within the intracranial cavity, including hemorrhages in the brain and within the cranial epidural, subdural, and subarachnoid spaces. [NIH] Intrahepatic: Within the liver. [NIH] Intravascular: Within a vessel or vessels. [EU] 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]

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] Kava: Dried rhizome and roots of Piper methysticum, a shrub native to Oceania and known for its anti-anxiety and sedative properties. Heavy usage results in some adverse effects. It contains alkaloids, lactones, kawain, methysticin, mucilage, starch, and yangonin. Kava is also the name of the pungent beverage prepared from the plant's roots. [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] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] 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] Lamivudine: A reverse transcriptase inhibitor and zalcitabine analog in which a sulfur atom replaces the 3' carbon of the pentose ring. It is used to treat HIV disease. [NIH]

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Lesion: An area of abnormal tissue change. [NIH] Ligands: A RNA simulation method developed by the MIT. [NIH] Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. It is produced by glands on the tongue and by the pancreas and initiates the digestion of dietary fats. (From Dorland, 27th ed) EC 3.1.1.3. [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] Lipopolysaccharide: 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 Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [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] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [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] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphokines: Soluble protein factors generated by activated lymphocytes that affect other cells, primarily those involved in cellular immunity. [NIH] 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

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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] Malaise: A vague feeling of bodily discomfort. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanin: The substance that gives the skin its color. [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] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [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] 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] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU] 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] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [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] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

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

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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] 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] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mutagen: Any agent, such as X-rays, gamma rays, mustard gas, TCDD, that can cause abnormal mutation in living cells; having the power to cause mutations. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [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] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [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] Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Neutrophil: A type of white blood cell. [NIH] Nidation: Implantation of the conceptus in the endometrium. [EU] 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] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH]

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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] Nursing Care: Care given to patients by nursing service personnel. [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] Ovum: A female germ cell extruded from the ovary at ovulation. [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] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] 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 Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in 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] Panniculitis: General term for inflammation of adipose tissue, usually of the skin, characterized by reddened subcutaneous nodules. [NIH] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Particle: A tiny mass of material. [EU] 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 Care Management: Generating, planning, organizing, and administering medical

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and nursing care and services for patients. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [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] 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 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] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] 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] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [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] Phosphorylated: Attached to a phosphate group. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] 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] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected

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to the hypothalamus by a short stalk. [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] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [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] Plasma Exchange: Removal of plasma and replacement with various fluids, e.g., fresh frozen plasma, plasma protein fractions (PPF), albumin preparations, dextran solutions, saline. Used in treatment of autoimmune diseases, immune complex diseases, diseases of excess plasma factors, and other conditions. [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] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [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] 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] Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes insipidus. [EU] Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [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] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Post partum: After childbirth, or after delivery. [EU] 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] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for

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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] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Pre-Eclampsia: Development of hypertension with proteinuria, edema, or both, due to pregnancy or the influence of a recent pregnancy. It occurs after the 20th week of gestation, but it may develop before this time in the presence of trophoblastic disease. [NIH] Pre-eclamptic: A syndrome characterized by hypertension, albuminuria, and generalized oedema, occurring only in pregnancy. [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [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] Progeny: The offspring produced in any generation. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prophylaxis: An attempt to prevent disease. [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] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that

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promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] 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] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [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] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [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] 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] Radioactive: Giving off radiation. [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] 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] 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] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [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] 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] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial

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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] Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into 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] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [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] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [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] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Seminiferous tubule: Tube used to transport sperm made in the testes. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [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] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter)

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is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [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] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soybean Oil: Oil from soybean or soybean plant. [NIH] 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] 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] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Splenic Vein: Vein formed by the union (at the hilus of the spleen) of several small veins from the stomach, pancreas, spleen and mesentery. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Stabilization: The creation of a stable state. [EU] Steatosis: Fatty degeneration. [EU] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] 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]

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Stillbirth: The birth of a dead fetus or baby. [NIH] 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] 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] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Striate: Recurrent branch of the anterior cerebral artery which supplies the anterior limb of the internal capsule. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [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] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [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] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [NIH] 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] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH]

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Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [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 intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] 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] Tonicity: The normal state of muscular tension. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxaemia: 1. The condition resulting from the spread of bacterial products (toxins) by the bloodstream. 2. A condition resulting from metabolic disturbances, e.g. toxaemia of pregnancy. [EU] 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] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] 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] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [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] 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]

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Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [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] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [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 muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

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] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [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] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [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] 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] Villous: Of a surface, covered with villi. [NIH]

Dictionary 99

Viraemia: The presence of virus in blood or blood plasma. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] 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] 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] 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]

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] Zalcitabine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is a potent inhibitor of HIV replication at low concentrations, acting as a chainterminator of viral DNA by binding to reverse transcriptase. Its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy. [NIH] Zygote: The fertilized ovum. [NIH]

101

INDEX A Abdominal, 5, 6, 69, 73, 74, 89, 90, 99 Abdominal fat, 69, 99 Abdominal Pain, 5, 69 Acceptor, 69, 86, 89 Acute renal, 10, 12, 31, 69, 82 Acute tubular, 4, 69 Adenocarcinoma, 69, 82 Adipose Tissue, 6, 69, 89 Adrenal Cortex, 69, 76 Adrenergic, 10, 69, 79 Adverse Effect, 69, 85, 94 Alanine, 3, 69 Albumin, 69, 91 Algorithms, 69, 72 Alkaline, 3, 30, 31, 69, 73 Alkaline Phosphatase, 3, 30, 69 Alleles, 70, 82 Alopecia, 70, 77 Alternative medicine, 44, 70 Ampulla, 70, 74 Anaesthesia, 22, 70 Analog, 70, 85 Anaphylatoxins, 70, 75 Anastomosis, 70, 80 Androgens, 69, 70, 76 Anesthesia, 20, 70 Antiallergic, 70, 76 Antibacterial, 70, 95 Antibiotic, 70, 95 Antibodies, 70, 82, 83 Antibody, 7, 18, 26, 70, 71, 75, 83, 84 Antigen, 70, 71, 75, 83, 84 Antigen-Antibody Complex, 71, 75 Anti-inflammatory, 5, 71, 76, 77, 81 Anti-Inflammatory Agents, 71, 76 Antineoplastic, 71, 76, 77 Antioxidant, 30, 33, 71, 89, 95 Antiviral, 7, 71, 85 Anxiety, 71, 85 Aqueous, 32, 34, 71, 72, 83 Arterial, 71, 73, 83, 92, 96 Arteries, 71, 73 Arteritis, 14, 71 Artery, 27, 71, 78, 93, 96 Ascites, 11, 42, 56, 71 Ascorbic Acid, 31, 71, 83 Aspartate, 3, 71

Asymptomatic, 7, 14, 15, 35, 71, 89 Atherogenic, 33, 71 Atypical, 9, 10, 23, 71 Autodigestion, 71, 89 Autoimmune disease, 4, 71, 91 B Bacteria, 70, 71, 72, 78, 79, 80, 82, 87, 94, 95, 97, 98 Bactericidal, 71, 79 Bacterium, 71, 82 Bacteriuria, 71, 98 Base, 72, 85, 98 Basement Membrane, 4, 72, 85 Benign, 5, 72 Benzo(a)pyrene, 34, 72 Bilateral, 39, 72 Bile, 11, 72, 80, 81, 85, 86, 92, 95 Bile Acids, 72, 81, 95 Bile Acids and Salts, 72 Bile duct, 11, 72, 92 Bile Pigments, 72, 85 Biliary, 32, 38, 72, 74, 89 Biliary Tract, 72, 89 Bilirubin, 11, 33, 69, 72, 83 Biochemical, 6, 7, 8, 30, 34, 70, 72 Biological response modifier, 72, 84 Biopsy, 6, 20, 57, 72 Biotechnology, 8, 30, 44, 51, 72 Blastocyst, 72, 76, 78 Blood Platelets, 72, 97 Blood pressure, 4, 38, 42, 57, 69, 73, 83, 88, 91 Blood transfusion, 24, 73 Blood vessel, 73, 81, 82, 90, 94, 98 Bowel, 73, 77, 84, 90 Bronchi, 73, 79 Bronchial, 42, 73 Bronchiectasis, 42, 73 Bronchitis, 42, 73, 74 C Calcium, 73, 75, 95 Carbohydrate, 8, 73, 76 Carcinogen, 72, 73 Carcinogenic, 73, 84, 92, 95 Carcinoma, 73 Cardiac, 73, 77, 79, 95 Cardiopulmonary, 11, 73 Case report, 9, 13, 18, 20, 39, 73

102

Elevated Liver Enzymes

Causal, 73, 82 Celiac Artery, 73, 82 Celiac Disease, 10, 73 Cell, 17, 70, 71, 72, 73, 74, 75, 77, 78, 79, 82, 83, 84, 85, 88, 89, 90, 91, 93, 94, 95, 97, 98, 99 Cell Differentiation, 73, 95 Cell Division, 71, 73, 74, 91 Cell membrane, 74, 77, 82, 90 Cell proliferation, 74, 95 Central Nervous System, 69, 74 Centrifugation, 74, 87 Cerebellar, 9, 74 Cerebellum, 74 Cerebral, 74, 76, 79, 96 Cesarean Section, 23, 74 Chemotactic Factors, 74, 75 Cholecystectomy, 11, 74 Cholestasis, 34, 38, 42, 56, 74 Cholesterol, 6, 35, 72, 74, 83, 95 Chromosome, 74, 82 Chronic, 31, 38, 42, 57, 74, 77, 79, 84, 89, 91, 92, 96, 98 Chronic Obstructive Pulmonary Disease, 42, 74 Cirrhosis, 5, 42, 56, 57, 74, 82, 91, 92 Clinical trial, 4, 51, 74, 76, 93 Cloning, 72, 74 Coagulation, 12, 13, 72, 73, 74, 91 Coenzyme, 10, 29, 71, 74 Colitis, 75, 84 Collagen, 72, 75, 80, 92 Colon, 75, 84 Complement, 12, 15, 70, 75, 82, 91 Complementary and alternative medicine, 29, 36, 75 Complementary medicine, 29, 75 Complete remission, 75, 94 Computational Biology, 51, 75 Conception, 37, 76, 80, 92, 95 Concomitant, 5, 76 Conjugated, 72, 76, 77 Connective Tissue, 71, 75, 76, 80, 96 Constipation, 38, 76 Contamination, 76, 82 Contraindications, ii, 76 Control group, 76, 92 Convulsions, 76, 78, 92 Cortex, 76 Cortical, 17, 39, 76 Cortical Blindness, 17, 76 Corticosteroid, 19, 20, 76

Cortisol, 34, 69, 76 Cortisone, 76, 77 Coumarin, 76 Coumestrol, 29, 76 Cranial, 74, 76, 85 Curative, 77, 97 Cyclophosphamide, 33, 77 Cytochrome, 34, 77 Cytotoxic, 77, 95 D De novo, 6, 9, 77 Decompensation, 57, 77 Degenerative, 77, 82 Depolarization, 77, 95 Dexamethasone, 9, 11, 12, 77 Diabetes Insipidus, 77, 91 Diabetes Mellitus, 32, 77, 81, 91 Diagnostic procedure, 44, 77 Diarrhea, 38, 77 Diastolic, 77, 83 Dietary Fats, 77, 86 Digestion, 72, 73, 77, 86, 96 Digestive system, 77, 80 Dihydrotestosterone, 77, 93 Dilation, 42, 78 Diploid, 78, 91 Direct, iii, 78, 93, 96 Disinfectant, 78, 79 Distal, 78, 81, 93 Drug Interactions, 78 Duct, 70, 78, 79 Duodenum, 72, 78, 82, 85, 89, 96 Dyspnea, 77, 78 E Eclampsia, 4, 17, 21, 23, 24, 78, 92 Edema, 77, 78, 92, 98 Effector, 75, 78 Efficacy, 9, 78 Electrocoagulation, 74, 78 Electrolyte, 76, 78, 87, 98 Electrons, 71, 72, 78, 89, 93 Embolus, 78, 84 Embryo, 8, 72, 73, 78, 92, 95 Embryo Transfer, 8, 78, 92 Emphysema, 42, 74, 78 Endotoxic, 78, 86 Endotoxin, 78, 79, 98 Environmental Health, 50, 52, 79 Enzymatic, 73, 75, 79 Epidermis, 79, 93 Epidural, 79, 85 Epigastric, 79, 89

103

Epinephrine, 69, 79, 88, 98 Epithelium, 72, 79 Erythrocytes, 79, 82, 93 Esophageal, 79, 81 Esophagitis, 79, 81 Esophagus, 77, 79, 80, 81, 86, 90, 93, 96 Estrogens, 79, 82 Ethanol, 32, 79 Evacuation, 76, 79 Exocrine, 79, 89 Extravasation, 79, 82 F Failure to Thrive, 42, 56, 79 Family Planning, 51, 79 Fat, 5, 6, 8, 33, 42, 69, 72, 76, 78, 79, 80, 86, 98 Fatigue, 5, 80 Fatty acids, 6, 7, 69, 80 Fatty Liver, 5, 8, 10, 19, 22, 38, 39, 80 Feces, 76, 80 Fertilization in Vitro, 80, 92 Fetus, 8, 74, 80, 92, 95, 96 Fibroblasts, 80, 85 Fibrosis, 5, 32, 80 Flatus, 80 Folate, 25, 80 Folic Acid, 80 Follicles, 80, 84 Forearm, 73, 80 Free Radicals, 71, 80 G Gallbladder, 26, 69, 72, 74, 77, 80, 82 Gamma-Glutamyltransferase, 3, 80 Gas, 6, 80, 83, 88, 98 Gastric, 13, 25, 71, 73, 80, 81 Gastric Bypass, 13, 25, 80 Gastroenterology, 10, 22, 23, 24, 37, 80 Gastroesophageal Reflux, 38, 81 Gastroesophageal Reflux Disease, 38, 81 Gastrointestinal, 38, 79, 81, 96 Gastrointestinal tract, 38, 79, 81 Gene, 8, 10, 32, 70, 72, 81 Gene Expression, 8, 81 Genotype, 8, 81, 90 Gestation, 16, 19, 22, 25, 81, 90, 92, 95 Gestational, 25, 81 Gland, 69, 76, 81, 89, 90, 94, 96, 97 Glomerular, 4, 81, 94 Glomerulus, 81 Glucocorticoid, 34, 77, 81 Glucose, 32, 71, 77, 81, 84 Glucose Intolerance, 77, 81

Glucose-6-Phosphatase, 32, 81 Gluten, 73, 81 Glycogen, 30, 81 Glycoprotein, 81, 85, 98 Gonadotropin, 19, 81 Governing Board, 82, 92 Granulocytes, 82, 95, 99 Granulosa Cells, 82, 84 H Haemolysis, 9, 12, 15, 16, 20, 21, 22, 24, 26, 82 Haploid, 82, 91 Hematoma, 38, 82 Hemochromatosis, 56, 82 Hemolysis, 4, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 38, 39, 82 Hemolytic, 12, 23, 24, 38, 82 Hemorrhage, 23, 78, 82, 93 Hepatic, 6, 7, 13, 15, 18, 23, 34, 38, 69, 73, 82 Hepatic Artery, 15, 82 Hepatitis, 7, 11, 24, 38, 42, 56, 57, 82, 99 Hepatitis A, 24, 82 Hepatocellular, 5, 42, 57, 82 Hepatocellular carcinoma, 42, 57, 82 Hepatocyte, 32, 74, 82 Hepatoma, 33, 82 Hepatotoxicity, 22, 82 Hepatovirus, 82 Heredity, 81, 82 Heterozygote, 8, 82 Homologous, 70, 82, 83, 96 Hormonal, 76, 83 Hormone, 76, 79, 83, 84, 94, 96, 97 Hybridomas, 83, 85 Hydrogen, 69, 72, 73, 83, 86, 88, 89, 99 Hydrogen Peroxide, 83, 86 Hydroxyproline, 30, 75, 83 Hyperbilirubinemia, 83, 85 Hypercholesterolemia, 31, 83 Hyperemesis, 38, 83 Hyperlipidemia, 6, 83 Hypersensitivity, 83, 94 Hypertension, 12, 22, 24, 26, 38, 83, 91, 92, 98 Hysterotomy, 74, 83 I Immersion, 30, 83 Immune Complex Diseases, 71, 83, 91 Immune response, 70, 71, 76, 83, 84, 96, 98, 99

104

Elevated Liver Enzymes

Immune system, 83, 84, 86, 98, 99 Immunity, 32, 69, 83, 86 Immunogenic, 83, 86 Immunologic, 74, 83, 86 Immunosuppressant, 5, 84 Immunosuppressive, 77, 81, 84 Implantation, 76, 84, 88 In vitro, 5, 78, 84 In vivo, 5, 6, 84 Incision, 23, 83, 84, 85 Incompetence, 81, 84 Infarction, 9, 84 Infection, 7, 71, 72, 74, 84, 86, 93, 94, 96, 99 Inflammation, 5, 7, 42, 69, 71, 73, 75, 79, 80, 82, 84, 89, 91, 96, 98 Inflammatory bowel disease, 38, 84 Infusion, 6, 84, 97 Inhibin, 19, 84 Initiation, 14, 84 Insulin, 5, 6, 84, 94 Insulin-dependent diabetes mellitus, 84 Interferon, 7, 57, 84, 85 Interferon-alpha, 84, 85 Interleukin-6, 19, 85 Internal Medicine, 5, 7, 19, 20, 80, 85 Interstitial, 85, 94 Intestinal, 73, 85, 87 Intestinal Mucosa, 73, 85 Intestines, 69, 77, 80, 81, 85 Intracellular, 84, 85, 94 Intracranial Hemorrhages, 13, 85 Intrahepatic, 20, 38, 85 Intravascular, 13, 85 Intravenous, 84, 85 Intrinsic, 72, 85 Intussusception, 10, 85 Invasive, 83, 85, 86 J Jaundice, 7, 42, 56, 83, 85 Jejunum, 80, 85 K Kava, 34, 85 Kb, 50, 85 L Labile, 75, 85 Laminin, 72, 85 Lamivudine, 57, 85 Lesion, 4, 86 Ligands, 28, 86 Lipase, 33, 86 Lipid, 6, 20, 84, 86, 89, 98 Lipid A, 6, 86

Lipid Peroxidation, 20, 86, 89 Lipopolysaccharide, 31, 86 Liver cancer, 38, 42, 57, 86 Liver Transplantation, 57, 86 Localized, 82, 84, 85, 86, 91 Locomotion, 86, 91 Loop, 80, 86 Lower Esophageal Sphincter, 81, 86 Lupus, 86, 96 Lymphatic, 84, 86 Lymphocytes, 70, 83, 86, 99 Lymphokines, 86 M Macrophage, 12, 86 Macrophage Activation, 12, 86 Magnetic Resonance Imaging, 15, 86 Malabsorption, 73, 87 Malaise, 16, 87 Malignant, 69, 71, 86, 87 MEDLINE, 51, 87 Melanin, 87, 90, 98 Membrane, 74, 75, 77, 82, 85, 87, 90, 94, 95 Mental, iv, 4, 50, 52, 80, 84, 87, 93, 98 Mesenteric, 87, 91 Metabolic disorder, 42, 56, 77, 87 Microbe, 87, 97 Microbiology, 71, 87 Microorganism, 87, 99 Microscopy, 72, 87 Microsomal, 30, 87 Migration, 86, 87 Milk Thistle, 87, 95 Mineralocorticoids, 69, 76, 87 Mitochondrial Swelling, 87, 88 Modification, 87, 93, 99 Modulator, 30, 87 Molecular, 8, 30, 33, 34, 51, 53, 72, 75, 87, 98 Molecule, 70, 72, 74, 75, 78, 87, 89, 93, 94, 97, 98 Monitor, 7, 88, 89 Monocytes, 85, 88 Mononuclear, 88, 98 Monotherapy, 7, 88 Morphological, 78, 88 Morphology, 86, 88 Motion Sickness, 88 Mutagen, 72, 88 Mydriatic, 78, 88 N Nausea, 38, 88, 98 Necrosis, 4, 13, 39, 84, 88

105

Neonatal, 21, 22, 88 Neoplasia, 38, 88 Neurotransmitter, 88, 94, 96 Neutropenia, 22, 88 Neutrophil, 12, 56, 88 Nidation, 78, 88 Nitrogen, 30, 70, 77, 88 Norepinephrine, 69, 88 Nuclear, 13, 23, 78, 88, 89 Nuclei, 78, 87, 89 Nucleic acid, 88, 89, 99 Nursing Care, 17, 89, 90 O Omentum, 82, 89 Ovum, 81, 89, 99 Oxidation, 7, 69, 71, 77, 86, 89 Oxidative Stress, 8, 32, 89 P Palliative, 89, 97 Pancreas, 38, 69, 77, 80, 82, 84, 86, 89, 95 Pancreatic, 81, 89 Pancreatic Juice, 81, 89 Pancreatitis, 38, 89 Panniculitis, 42, 89 Partial remission, 89, 94 Particle, 89, 97 Pathologic, 4, 72, 83, 89 Pathophysiology, 16, 38, 39, 89 Patient Care Management, 38, 89 Patient Education, 56, 62, 64, 67, 90 Peptide, 80, 90, 92, 93 Pericardium, 90, 96 Perinatal, 21, 90 Peritoneal, 38, 71, 90 Peritoneal Cavity, 71, 90 Peritoneum, 89, 90 Pharmacologic, 70, 90, 97 Pharynx, 81, 90 Phenotype, 8, 90 Phenylalanine, 90, 98 Phospholipases, 90, 95 Phospholipids, 79, 90 Phosphorylated, 74, 90 Photocoagulation, 74, 90 Physiologic, 38, 90, 93 Physiology, 80, 90 Pigment, 72, 90 Pituitary Gland, 76, 90 Plants, 32, 81, 88, 91, 97 Plaque, 71, 91 Plasma, 6, 17, 23, 69, 70, 74, 81, 87, 91, 99 Plasma Exchange, 23, 91

Plasma protein, 69, 91 Platelet Activation, 91, 95 Platelet Count, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 39, 91 Platelets, 4, 8, 9, 10, 11, 12, 13, 15, 16, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 38, 91, 97 Pneumonia, 76, 91 Poisoning, 88, 91 Polydipsia, 9, 91 Polyuria, 9, 91 Portal Hypertension, 38, 42, 57, 91 Portal Vein, 42, 57, 91 Post partum, 23, 91 Posterior, 74, 89, 91 Postsynaptic, 91, 95 Potentiation, 91, 95 Practice Guidelines, 52, 91 Precursor, 77, 78, 79, 88, 90, 92, 98 Preeclampsia, 4, 11, 12, 13, 15, 16, 17, 19, 20, 21, 22, 23, 24, 28, 38, 92 Pre-Eclampsia, 20, 23, 39, 92 Pre-eclamptic, 78, 92 Pregnancy Outcome, 24, 92 Prenatal, 78, 92 Prevalence, 5, 7, 24, 92 Primary Biliary Cirrhosis, 9, 92 Primary endpoint, 6, 92 Progeny, 34, 92 Progressive, 73, 74, 88, 91, 92, 94 Proline, 75, 83, 92 Promoter, 32, 92 Prophylaxis, 92, 98 Protein S, 72, 92 Proteins, 70, 74, 75, 88, 90, 91, 92, 93, 94, 97 Proteinuria, 4, 92 Proteoglycans, 72, 92 Proteolytic, 75, 92 Proximal, 78, 80, 93 Public Health, 52, 72, 93 Public Policy, 51, 93 Pulmonary, 73, 93 Pulmonary Artery, 73, 93 Pulse, 88, 93 Pupil, 78, 88, 93 Purpura, 12, 15, 27, 38, 93 Q Quality of Life, 42, 93, 96 R Radiation, 80, 93 Radioactive, 6, 83, 84, 89, 93

106

Elevated Liver Enzymes

Randomized, 9, 78, 93 Receptor, 10, 71, 93, 95 Rectum, 75, 77, 80, 84, 93 Recurrence, 27, 93 Red blood cells, 79, 82, 93 Reductase, 29, 93 Refer, 1, 75, 86, 93 Reflux, 81, 93 Refraction, 93, 95 Regimen, 78, 93 Regurgitation, 81, 93 Reinfection, 7, 93 Remission, 57, 93 Renal failure, 4, 24, 94, 98 Renovascular, 22, 94 Respiration, 88, 94 Retina, 76, 94 Rheumatoid, 4, 94 Rheumatoid arthritis, 4, 94 Rigidity, 91, 94 Risk factor, 6, 25, 33, 38, 42, 94 Rosiglitazone, 6, 94 S Saline, 91, 94 Screening, 42, 74, 94, 98 Secretion, 33, 76, 84, 87, 94 Sedative, 85, 94 Sediment, 94, 98 Seminiferous tubule, 84, 94 Sensibility, 70, 94 Sepsis, 31, 94 Serum, 14, 16, 17, 19, 25, 57, 69, 70, 75, 81, 83, 87, 94, 98 Side effect, 5, 69, 77, 94, 96, 97, 99 Signal Transduction, 32, 94 Signs and Symptoms, 93, 95, 98 Silymarin, 32, 87, 95 Social Environment, 93, 95 Solvent, 79, 95 Soybean Oil, 31, 95 Specialist, 58, 78, 95 Species, 79, 87, 95, 97, 99 Spectrum, 42, 56, 95 Spinal cord, 74, 79, 95 Splenic Vein, 91, 95 Spontaneous Abortion, 92, 95 Stabilization, 10, 95 Steatosis, 80, 95 Sterility, 77, 95 Steroid, 72, 76, 95 Stillbirth, 92, 96 Stimulus, 96, 97

Stomach, 69, 71, 77, 79, 80, 81, 82, 83, 85, 86, 88, 89, 90, 93, 95, 96 Stress, 30, 38, 76, 88, 89, 94, 96 Striate, 76, 96 Subacute, 84, 96 Subarachnoid, 85, 96 Subclinical, 84, 96 Subcutaneous, 42, 78, 89, 96, 99 Substance P, 94, 96 Sulfur, 85, 96 Supportive care, 4, 96 Suppression, 76, 96 Symptomatic, 89, 96 Synapse, 69, 96 Synaptic, 88, 95, 96 Systemic, 17, 73, 79, 83, 84, 96 Systemic lupus erythematosus, 17, 83, 96 Systolic, 83, 96 T Testosterone, 93, 96 Therapeutics, 97 Threonine, 34, 97 Threshold, 4, 83, 97 Thrombocytes, 91, 97 Thrombocytopenia, 11, 13, 24, 25, 97 Thyroid, 97, 98 Tissue, 6, 8, 30, 31, 32, 34, 69, 70, 71, 72, 74, 76, 78, 80, 81, 82, 83, 85, 86, 87, 89, 90, 91, 94, 96, 97, 98 Tomography, 6, 97 Tonicity, 82, 97 Topical, 79, 83, 97 Torsion, 84, 97 Toxaemia, 92, 97 Toxic, iv, 8, 83, 97, 99 Toxicity, 31, 33, 34, 78, 97 Toxicology, 32, 34, 35, 52, 97 Toxins, 70, 84, 97 Transcriptase, 85, 97, 99 Transduction, 33, 94, 97 Transfection, 72, 97 Transfusion, 97 Transplantation, 9, 57, 78, 97 Trauma, 79, 88, 89, 98 Triglyceride, 6, 98 Tumor Necrosis Factor, 19, 98 Tyrosine, 34, 98 U Uraemia, 89, 98 Uremia, 94, 98 Urinalysis, 4, 98 Urinary, 71, 91, 98

107

Urine, 71, 77, 91, 92, 98 V Vaccination, 57, 98 Vaccine, 7, 98 Vascular, 28, 84, 98 Vasculitis, 89, 98 Vector, 97, 98 Vein, 85, 89, 91, 95, 98 Venous, 77, 91, 92, 98 Venous blood, 91, 98 Vesicular, 82, 87, 98 Veterinary Medicine, 51, 98 Villous, 73, 98 Viraemia, 7, 99 Viral, 37, 38, 57, 97, 99

Viral Hepatitis, 38, 99 Virulence, 97, 99 Virus, 7, 24, 85, 91, 97, 99 Visceral, 6, 90, 99 Visceral fat, 6, 99 Vitro, 5, 33, 99 Vivo, 33, 99 W White blood cell, 56, 70, 86, 88, 99 Y Yeasts, 90, 99 Z Zalcitabine, 85, 99 Zygote, 76, 99

108

Elevated Liver Enzymes

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