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

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., 1960Liver 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: 0-597-84592-1 1. 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 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 LIVER ENZYMES ........................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Liver Enzymes............................................................................... 4 The National Library of Medicine: PubMed ................................................................................ 18 CHAPTER 2. ALTERNATIVE MEDICINE AND LIVER ENZYMES ........................................................ 55 Overview...................................................................................................................................... 55 National Center for Complementary and Alternative Medicine.................................................. 55 Additional Web Resources ........................................................................................................... 55 General References ....................................................................................................................... 57 CHAPTER 3. DISSERTATIONS ON LIVER ENZYMES .......................................................................... 59 Overview...................................................................................................................................... 59 Dissertations on Liver Enzymes .................................................................................................. 59 Keeping Current .......................................................................................................................... 59 CHAPTER 4. BOOKS ON LIVER ENZYMES ........................................................................................ 61 Overview...................................................................................................................................... 61 Book Summaries: Federal Agencies.............................................................................................. 61 Chapters on Liver Enzymes ......................................................................................................... 62 CHAPTER 5. MULTIMEDIA ON LIVER ENZYMES ............................................................................. 67 Overview...................................................................................................................................... 67 Video Recordings ......................................................................................................................... 67 CHAPTER 6. PERIODICALS AND NEWS ON LIVER ENZYMES........................................................... 69 Overview...................................................................................................................................... 69 News Services and Press Releases................................................................................................ 69 Academic Periodicals covering Liver Enzymes............................................................................ 71 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 75 Overview...................................................................................................................................... 75 NIH Guidelines............................................................................................................................ 75 NIH Databases............................................................................................................................. 77 Other Commercial Databases....................................................................................................... 79 APPENDIX B. PATIENT RESOURCES ................................................................................................. 81 Overview...................................................................................................................................... 81 Patient Guideline Sources............................................................................................................ 81 Finding Associations.................................................................................................................... 96 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 99 Overview...................................................................................................................................... 99 Preparation................................................................................................................................... 99 Finding a Local Medical Library.................................................................................................. 99 Medical Libraries in the U.S. and Canada ................................................................................... 99 ONLINE GLOSSARIES................................................................................................................ 105 Online Dictionary Directories ................................................................................................... 105 LIVER ENZYMES DICTIONARY .............................................................................................. 107 INDEX .............................................................................................................................................. 165

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with liver 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 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 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 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 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 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 LIVER ENZYMES Overview In this chapter, we will show you how to locate peer-reviewed references and studies on 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 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 “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: •

Abnormal Liver Enzyme Levels: The Spectrum of Causes Source: Postgraduate Medicine. 93(2): 113-116. February 1, 1993. Summary: Elevated levels of one or more liver enzymes are commonly found in asymptomatic patients. Such findings may be important, because minimal elevation may be the only manifestation of significant hepatobiliary disease. This article discusses the significance of liver enzyme abnormalities in asymptomatic patients and presents a rational approach to evaluation. Specific topics include aminotransferases; gammaglutamyl transpeptidase; and the clinical approach. 2 tables. 18 references. (AA-M).

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Mildly Elevated Liver Enzymes: Significance and Diagnostic Strategies. (editorial) Source: Liver Update: Function and Disease. 5(1): 1-2. Spring 1991.

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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. •

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.

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Abnormal Liver Enzyme Levels: Evaluation in Asymptomatic Patients Source: Postgraduate Medicine. 89(4): 137-141. March 1991. Summary: When serum levels of liver enzymes are found to be elevated and continue to be elevated on follow-up testing, significant disease may be present even if the patient has no symptoms. Physicians who are aware of possible causes of such elevations have the opportunity to identify certain disorders in the very early, presymptomatic stages. This article describes disorders of hepatic origin and some mimics that may cause abnormal enzyme levels and outlines the steps to narrow and confirm diagnosis. Patients with persistently abnormal alkaline phosphatase levels may have extrahepatic biliary tract disease or a chronic cholestatic disorder. The author recommends a careful history and thorough physical examination, appropriate timing of follow-up blood tests, and timely referral for percutaneous liver biopsy or endoscopic retrograde cholangiopancreatography. 2 tables. 17 references. (AA-M).

Federally Funded Research on Liver Enzymes The U.S. Government supports a variety of research studies relating to liver enzymes. These studies are tracked by the Office of Extramural Research at the National Institutes of

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Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to liver 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 liver enzymes. The following is typical of the type of information found when searching the CRISP database for liver enzymes: •

Project Title: ALCOHOL IN ISRAEL: GENETIC AND ENVIRONMENTAL EFFECTS Principal Investigator & Institution: Hasin, Deborah S.; Associate Professor; New York State Psychiatric Institute 1051 Riverside Dr New York, Ny 10032 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Alcohol dependence and heavy drinking are complex traits caused by genetic and environmental factors. A powerful design to study etiology would therefore address both types of factors jointly, but this has seldom been done. Polymorphisms in alcohol metabolizing genes encode liver enzymes that differ in their kinetic properties, including ADH2*2, which has a protective effect against heavy drinking and alcohol dependence. Elevated ADH2*2 prevalence in Jews facilitates its study in Jewish samples. Three large, distinct Jewish population groups in Israel offer the opportunity to study ADH2 and other alcohol metabolizing genes under different conditions. (1) Between late 1989 and 1994, many highly assimilated, urban Russian Ashkenazis migrated to Israel due to sharply increased Soviet anti-Semitism amid socially chaotic conditions. In Israel, they formed a consolidated ethnic group whose lifetime drinking histories reflect the high Russian per capita alcohol consumption. (2) Other Israeli Ashkenazis have much lower lifetime drinking histories, reflecting Israel's much lower per capita alcohol consumption. The lifetime histories of these two Ashkenazi groups allow study of ADH2*2 and other alcohol metabolizing genes under contrasting environmental conditions. (3) Israeli Sephardics offer a third important contrast. They differ from Ashkenazis in some social and genetic respects, and also have much lower lifetime drinking than the Russian immigrants. This is a unique research opportunity to study variation in gene-phenotype associations under different conditions. The relationship of ADH2 to lifetime peak alcohol consumption and lifetime DSM-IV alcohol dependence severity will be studied in 850 Russian immigrants arriving 1989-1994, 850 other Ashkenazis, and 850 Sephardics in Israel. The ADH2*2-alcohol phenotype associations are predicted to be weakest in the Russians due to Russian cultural influences promoting drinking even among those with the protective form of the gene. Gene effects are predicted to be intermediate in other Ashkenazis and strongest in Sephardics. ADH3 and promoters of ADH4 and ALDH2 will also be studied. Psychiatric comorbidity, religiosity and trauma will be assessed and controlled. Unrelated microsatellite markers will be tested for population stratification, which will be adjusted for if found. The sample will be drawn from the Israel Population Register.

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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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In-person interviews will include well-tested measures from U.S. and international studies. Genotyping will be done at Indiana and Columbia Universities. Preliminary studies support the hypotheses and feasibility of the methods. The larger significance of the study is to improve understanding of how genes relate to heavy drinking and alcohol dependence and how different environmental conditions may impact on these relationships Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ALCOHOL, INOS UPREGULATION, LEAKY GUT & LIVER DISEASE Principal Investigator & Institution: Keshavarzian, Ali; Professor of Pharmacology & Molecular Bi; Rush University Medical Center Chicago, Il 60612 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2008 Summary: (provided by applicant): Clinically significant alcoholic (A) liver damage (LD), secondary to a hepatic necroinflammatory cascade (HNIC), occurs only in a subset of alcoholics. Hence, factors other than ethanol (E) must be involved. Hypothesis: The key cofactor for ALD is a breakdown of gut barrier integrity ("leaky gut") due to chronic E use, which allows intestinal endotoxin to reach the liver & initiate a HNIC; this leakiness is due to cytoskeletal instability caused by oxidation of cytoskeletal proteins which is elicited by E-induced gut iNOS upregulation & nitric oxide (NO) overproduction. We found: 1} in man, gut leakiness in alcoholics with LD but not in those without LD or in nonalcoholics with LD; 2} in rats, E-induced leaky gut is associated with LD; reversal of gut leakiness attenuates LD; 3} in intestinal monolayers, E-induced iNOS upregulation causes cytoskeletal & barrier disruption. We will continue to use this successful translational approach (monolayers, rats & man) to test our current hypotheses. Aims: (1) To see if, in a larger sample, a leaky gut: a) occurs only in alcoholics with LD & precedes cirrhosis b) persists during abstinence & after liver transplant for ALD, c) correlates quantitatively with LD severity, d) is associated with NO overproduction & HNIC, e) is more pronounced in females. We predict that gut leakiness (excess urinary lactulose, mannitol & sucralose levels after oral sugar load): i) is seen only in alcoholics with LD, precedes cirrhosis; ii) correlates with severity of LD (clinical parameters, liver enzymes); iii) is associated with NO overproduction (gut mucosal NO), serum endotoxin & HNIC (high neopterin/cytokines). (2) To see if, in rats, prevention of E-induced leaky gut also prevents E-induced LD & if a hyperactive, NO pathway is involved. We predict that in E-fed rats with LD: i) leaky gut, endotoxemia, HNIC, upregulation of intestinal iNOS, NO overproduction & oxidation of actin & tubulin occurs; ii) preventing gut leakiness (by oats, iNOS inhibitors or Arginine) prevents LD. (3) To see, using monolayers of wild type ((inhibitors) & transfected cells, if E-induced iNOS upregulation & its consequences (assessed by cytoskeletal oxidation/disarray & barrier disruption) are mediated by NF-kappaB activation. We predict i) E activates NF-kappaB by degrading IkappaBalpha; ii) preventing NF-kappaB activation prevents E-induced iNOS upregulation & its consequences. Significance: Showing that ALD requires a leaky gut, & that NO & cytoskeletal pathways are involved, could 1) identify drinkers at risk for LD (sugar test); 2) lead to therapies to prevent LD in those drinkers unable to abstain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COMBINED TREATMENT FOR COCAINE-ALCOHOL DEPENDENCE Principal Investigator & Institution: Schmitz, Joy M.; Professor; Psychiatry and Behavioral Scis; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225

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Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2006 Summary: (provided by applicant): Treatment seeking patients who are cocaine and alcohol dependent have poor prognosis. While there are no uniquely effective medications, combined pharmaco- and psychotherapy may prove efficacious. Naltrexone (NTX), approved for alcohol dependence, may block cocaine-alcohol rewarding effects at higher doses (> 50 mg/d) but psychotherapeutic context is critical. Our preliminary work indicates potential utility of NTX when combined with Relapse Prevention (RP) therapy and Contingency Management Procedures (CMP). We propose a large, double-blind, placebo-controlled, full factorial study to examine the role of RP + CMP combined with NTX for treatment of cocaine-alcohol dependence. Cocaine-alcohol dependent outpatients (N = 140) will be randomly assigned to NTX 100 mg/d or placebo combined with one of two psychotherapy conditions (RP or RP + CMP). Standardized consent and intake procedures will be followed by a single-blind baseline placebo week and then a 12 week trial with twice weekly visits. Manual-guided RP therapy will be delivered weekly in 60-minute individual sessions. CMP will reinforce abstinence based on cocaine-negative urine screens and negative breath alcohol test results. Medication adherence will be monitored with riboflavin and pill counts. Followup assessments will be conducted at 3, 6, 9, and 12 months after treatment termination. Primary efficacy variables will be measures of substance use (i.e., urine screens, TimeLine Follow-Back methods, collateral informants, change in liver enzymes) and retention (i.e., number of sessions attended, time to dropout). Secondary variables will include addiction severity and adverse event measures. A third set of variables will be tested as possible predictors of therapeutic outcomes. These include measures of motivation, self-efficacy, medication compliance, serum 6-beta naltrexol levels, craving, family history of alcohol problems, and severity of dependence. Power is sufficient to test the main hypothesis that NTX 100 mg/d with RP + CMP will reduce cocaine and alcohol use. Secondarily we will: (1) examine outcome variability as a function of individual differences on a range of potential predictors; (2) evaluate relative reinforcement of cocaine and alcohol using an innovative multiple choice measurement strategy; and (3) examine the relationship between cocaine and alcohol use during treatment and follow-up. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIPHTHERIA FUSION PROTEIN THERAPY OF AML Principal Investigator & Institution: Frankel, Arthur E.; Professor of Medicine; Cancer Biology; Wake Forest University Health Sciences Winston-Salem, Nc 27157 Timing: Fiscal Year 2002; Project Start 12-DEC-1997; Project End 31-DEC-2006 Summary: Ten thousand people in the U.S. develop acute myeloid leukemia (AML) each year. While many patients achieve remissions with combination chemotherapy, most relapse and die with drug resistant disease. We have produced a diphtheria fusion protein (DT388GMCSF) consisting of the catalytic and translocation domains of diphtheria toxin fused to human granulocyte-macrophage colony- stimulating factor. We initiated a phase I single-arm, inter-patient dose escalation clinical trial of five daily intravenous infusions for patients with relapsed or refractory AML. To date, we have observed dose- related transient elevations in liver enzymes and circulating inflammatory cytokines. Half of the patients were found to have pre- treatment antibodies to DT388GMCSF >2mu g/mL associated with reductions in the peak blood concentrations of DT388GMCSF. Clinical remissions have been observed at the higher dose levels. In the next funding period, we propose to better define the potential role for DT388GMCSF in the care of AML patients. We will complete the on- going phase I

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study and expand the cohort of patients at the maximal tolerated dose to better estimate the preliminary response rate and side effects. Further, we propose three areas of laboratory studies to be carried out to facilitate our understanding of the molecular pharmacology of DT388GMCSF in these patients. In Specific Aim 1, the molecular mechanism for the liver damage and cytokine release will be investigated. The amount and types of cytokines released into the blood will be measured. Patient cytokine gene polymorphisms will be determined. A rat model will be used to determine whether the cytokines induce the liver injury. Methods of prevention of the cytokine release and liver injury in the rat will be tested. If successful, such measures may be tested in patients. In Specific Aim 2, anti- DT388GMCSF antibody formation and DT388GMCSF serum levels will continue to be measured and correlated with toxicity and response. In Specific Aim 3, pre-treatment blast proliferation sensitivity to DT388GMCSF will be measured and correlated with clinical response. These studies should lead to the design of pivotal phase II clinical trials to determine the role of this therapeutic in AML management. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FATTY LIVER DISEASE AND HEPATIC ENERGY HOMOSTATIS IN SH* Principal Investigator & Institution: Diehl, Anna M.; Professor; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 15-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): Obesity is associated with insulin resistance, diabetes mellitus, hypertension, and dyslipidemia; less well known is its association with non-alcoholic fatty liver disease (NAFLD). The prevalence of NAFLD is 14-21 percent in some populations, is more common in those who are diabetic or over age 45, and can lead to fibrosis and cirrhosis. Recent evidence indicates that NAFLD is a consequence of disordered hepatic energy homeostasis. Several emerging lines of evidence suggest the overall hypothesis that disordered hepatic energy homeostasis and subsequent NAFLD may play a central role in mediating the adverse metabolic effects of obesity and may influence the success of weight loss interventions. Unfortunately, prior clinical studies have been limited. We, therefore, have the following specific hypotheses: 1) NAFLD and disordered hepatic energy homeostasis will be common in SHOW participants; 2) NAFLD will be associated with disordered energy homeostasis, AfricanAmerican race and male gender; 3) disordered hepatic energy homeostasis will be associated with a proinflammatory state, and adaptive decreases in normal energy requirements; 4) those with disordered hepatic energy homeostasis will have a weaker response to the SHOW intervention compared to those with normal hepatic energy homeostasis; and 5) the SHOW intervention will improve NAFLD and hepatic energy homeostasis in those with little or no defect in hepatic energy homeostasis but worsen it in those with moderate to severe defects. To test these hypotheses we propose a single center ancillary study to the SHOW trial. The study sample for the ancillary study would be the 313 SHOW participants enrolled at Johns Hopkins. We will measure symptoms of hunger and fatigue (0, 6, 12 mo.) and collect additional data including liver enzymes (0, 6, 12 mo.), MRI Spectroscopy (0, 12 mo.), and ketone bodies, insulin levels, and proinflammatory cytokines (0, 12 mo.) The main outcomes will be the prevalence, correlation, and 1-year progression of NAFLD and disordered hepatic energy homeostasis. Our secondary outcomes will be weight change, physical activity, dietary intake, and symptoms of hunger and fatigue in those with and without NAFLD and disordered hepatic energy homeostasis. If our hypotheses are confirmed, this study

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will establish blood and other clinical markers of NAFLD and disordered hepatic energy homeostasis, which will facilitate population based research; advance our understanding of the pathophysiology of NAFLD; establish disordered hepatic energy homeostasis as a biologic modifier of behavioral approaches to weight loss; and determine whether weight loss improves NAFLD or poses unsuspected risks. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEPATITIS C INFECTION & DIABETES IN INJECTION DRUG USERS Principal Investigator & Institution: Mehta, Shruti H.; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-APR-2002 Summary: Proposed is a two-phase study to examine the association between hepatitis C virus (HCV) infection and subsequent development of type 2 diabetes mellitus. Recent evidence from the third National Health and Nutrition Examination Survey and other studies suggest such an association. Given the high prevalence of HCV infection (approximately 90 percent) in injection drug users (IDUs), this study has tremendous health implications for IDUs. Phase I involves a case-cohort study to determine whether there is an independent causal association between HCV infection and type 2 diabetes in a large cohort of community-based men and women. We will enroll 436 incident diabetes cases and 872 age- matched controls from the Atherosclerosis Risk in Communities (ARIC) study and will assess the presence of HCV antibody from frozen serum samples taken prior to the onset of diabetes. In Phase II, we will test a subset (n=210) of anti-HCV positive individuals from a large cohort of IDUs (AIDS Link to Intravenous Experiences) in Baltimore, Maryland for diabetes. Cases of type 2 diabetes will be compared to age-matched controls for differences in HCV viral characteristics such as HCV RNA, liver enzymes and HCV genotype in an attempt to elucidate the mechanism of this proposed association. The results of this study will drive future epidemiological and physiological research into the role of liver disease in the pathogenesis of diabetes as well as potential diabetes prevention programs in populations such as IDUS who bear most of the burden of the hepatitis C virus epidemic. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HIV, DRUG USE AND HEPATITIS C PATHOGENESIS Principal Investigator & Institution: Thomas, David L.; Associate Professor; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-JAN-1998; Project End 31-DEC-2002 Summary: (Applicant's Abstract) The purpose of this investigation is to evaluate the effect of HIV infection, drug use and other factors on the progression of hepatitis C. The observation of heterogenous outcomes after hepatitis C virus (HCV) infection suggests the hypothesis that viral, genetic, and environmental factors affect disease progression. To examine the relative importance of multiple factors, in a representative setting and with appropriate power, a series of integrated experiments have been designed for specimens from a large cohort (ALIVE) of injecting drug users (IDUs) who have been followed semiannually since 1988. The study population is 1,265 HCV-infected IDUs, including 378 coinfected with HIV at enrollment. By prospectively assessing liver enzymes and actively ascertaining clinical evidence of hepatic failure or death on all participants and evaluating liver biopsies randomly obtained from 210 individuals, an

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estimated 50 cases of progressive HCV infection will be identified. The effect of HIV infection, drug use, viral heterogeneity, and genetic factors on HCV natural history will be evaluated. Prospective and nested case control analysis will be used to compare the occurrence of putative cofactors among the 50 cases and controls, matched for confounders such as the duration of drug use. After 4 years of rigorous follow-up and reassessment with liver biopsy, the relationship of hepatic histology, liver enzymes, HCV viral load and the clinical expression of disease also will be evaluated. The investigators have experience with all research methods, including assessment of HCV viral load, genotype and quasispecies distribution; HLA haplotype and gene marker characterization; liver biopsy procurement and evaluation; and analytic techniques. Success at minimal expense is likely because the study will utilize a large HCV-infected cohort, an established research setting, eight years of existing data, experienced lab personnel, and superb collaborators. 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 63110 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 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

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Project Title: LIPID CONJUGATES OF XENOBIOTICS Principal Investigator & Institution: Ansari, Ghulam A.; Professor; Pathology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2002; Project Start 01-MAY-1988; Project End 31-MAY-2005 Summary: To understand the mechanism(s) responsible for toxicity of xenobiotics capable of forming fatty acid (FA) conjugates, the investigators characterized rat liver FA ethyl ester synthetase (FAEES) isozymes that conjugate xenobiotics to FAs. The studies indicate that pancreatic and plasma FAEES are structurally and functionally different from those they characterized in the liver. Therefore, in Aim 1, they will purify and characterize FAEES from pancreas and plasma and establish their interrelationships to each other and to the liver enzymes by comparing structural and functional properties. These relationships will be further characterized using inhibitors (e.g., tri-otolyphosphate) and inducers (e.g., phenobarbital) of FAESS. In Aim 2, the relative formation of FA conjugates will be examined in hepatoma cell lines expressing different levels of enzymes involved in the conventional oxidative metabolism of the model compounds methanol and aniline. In Aim 3, the formation, kinetics and enzymology of FA conjugation of biologically important functional compounds will be investigated in vivo and in vitro and in cell culture. Finally, in Aim 4, the mechanism of toxicity of FA conjugates of methanol (FA methyl esters) and aniline (fatty acid anilides) will be evaluated in vivo. The mechanism by which FA methyl esters inhibit Kupffer cell function (phagocytosis) will be thoroughly investigated by studying their metabolism and effect on energy production. Similarly, the pancreatic toxicity of FA methyl esters will be evaluated, along with the evaluation of FA anilides to induce autoimmunity, and associate mechanisms. The project may provide a clear understanding of the formation of FA conjugates of xenobiotics, the enzymes involved in this process and the mechanism(s) by which such conjugates exert their toxicity. This information may be important in devising approaches to prevent the toxicities mediated by FA conjugates. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

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Liver Enzymes

stable-isotope infusion of labeled FA and precursors of FA, preceding the scheduled biopsy. Liver biopsy tissue (100 mg) will be analyzed to determine its biochemical content (TG, cholesterol, phospholipid and FFA), the composition of FA within these fractions, and the enrichment of labeled FA in the tissue (the sources of these FA). Control subjects will be aged- and sex-matched individuals undergoing surgical treatment for obesity who will have an identical isotope infusion before surgery. These methods will be used to accomplish the specific aims: (1) to quantify the concentration of the various lipids in NASH liver samples and samples from obese control subjects; (2) to determine the sources of FA used for lipid synthesis, and the turnover of these lipids in NASH patients and controls; and (3) to determine whether there is a difference between NASH patients and controls with respect to the composition of FA within liver tissue. Liver samples will be graded histologically and the stage of NASH documented semi-quantitatively. Computer tomography will be used to quantify liver size and abdominal visceral fat; ultrasound will also be performed. The results of all of these measurements will be analyzed to determine their relationship with hepatic lipid content. NASH will become more clinically important in the future as the incidence of obesity and diabetes continue to rise in the United States. In combination with the clinical data obtained, an understanding of the contributions of FA sources to liver TG will aid in the development of future treatment strategies for this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LONG TERM ADMINISTRATION OF TESTOSTERONE IN ELDERLY MEN Principal Investigator & Institution: Urban, Randall J.; Professor; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: Elderly men have lower serum testosterone concentrations and less muscular strength than young men. In a short-term study (1 month), we administered testosterone to elderly men in doses designed to raise their testosterone concentrations to those found in young men. This treatment increased skeletal muscle strength and muscle protein synthesis. The goal of this project is to determine whether more prolonged testosterone administration (6 months) will show a continuation of an increase in muscle strength and net muscle protein synthesis. Moreover, it will assess the changes that occur in myofibrillar protein (actin and myosin) and muscle size. Elderly men (ages 60 and greater) will be recruited from 3 sources, the Geriatrics outpatient clinic, a registry of elderly volunteers maintained by the Geriatrics Division at the University of Texas Medical Branch, and the local population. They will be enrolled in a double-blinded, placebo controlled study in which testosterone enanthate is given by intramuscular injection every week for 1 month, then every 2 weeks for an additional 5 months. At baseline, 1 and 6 months, we will determine muscle strength, muscle protein synthesis and degradation, myofibrillar (actin and myosin) protein synthesis, amino acid transport and arterial-venous balance, mRNA concentrations of actin and myosin, and muscle strength. Muscle size will be determined by DEXA and MRI scan at baseline and 6 months. Careful assessment of the risks of testosterone administration in this age group will be done by measuring prostate size and urinary flow rates (baseline and 6 months), lipid concentrations, liver enzymes, CBC, blood pressure, and prostate specific antigen. This study will determine whether the long-term administration of testosterone in elderly men will increase muscle strength, net protein anabolism, and muscle size. If 6 month testosterone administration increases strength, then studies can be done to assess

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the functional implications of this therapy in reducing falls, increasing independence, and improving the quality of life in elderly men. 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

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alpha- subunit. Mutations in the alpha-subunit such as the prevalent G1528C mutation cause "isolated" LCHAD deficiency. Other mutations cause complete TFP deficiency (all 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 •

Project Title: NALTREXONE TREATMENT OF ALCOHOL DEPENDENCE Principal Investigator & Institution: Volpicelli, Joseph R.; Associate Professor; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-APR-1989; Project End 31-DEC-2002 Summary: APPLICANT'S ABSTRACT: The long range goal of this ongoing program of research is to find more effective treatments for alcohol dependence through combining medication with the appropriate psychosocial support. Naltrexone when used in conjunction with psychosocial therapy, reduces relapse to clinically significant drinking in compliant subjects. The present proposal extends our previous research by comparing the efficacy of naltrexone treatment administered in two types of primary care settings: one using simple medication management and a second using medication management with compliance enhancement techniques. In addition, we will compare these two conditions with cognitive behavioral therapy--a combination that has been successfully used to demonstrate naltrexone efficacy in prior research. This proposal has 3 specific aims: 1) To compare the effectiveness of naltrexone in 3 types of treatment settings; 2) Assess the effects of psychosocial support on medication compliance and treatment retention; and 3) To investigate the subject characteristics that may predict who is likely to benefit from additional psychosocial support versus simple medication management. To this end, 240 alcohol dependent outpatients who are, currently involved in outpatient

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alcohol rehabilitation at the University of Pennsylvania's Treatment Research Center will be randomly assigned to treatment with either naltrexone (100 mg per day) or placebo in double-blind fashion over a six-month period. Medication will be administered in three types of settings: 1) simple medication management by a research physician, 2) simple medication management plus Compliance Enhancement Techniques (CET) administered by a nurse practitioner, and 3) simple medication management plus Cognitive Behavioral Therapy (CBT) administered by a trained psychologist using the Project MATCH, CBT manual. The primary outcome measures are time to relapse to clinically significant drinking (5 or more in one day) and percent days of clinically significant drinking. Other alcohol use related measures include, alcohol craving, percent of abstinent days, and blood chemistries including liver enzymes. The outcome measures will be evaluated during the medication phase and at follow-up points 12 and 18 months after entrance into treatment. In addition, medication and treatment compliance will be evaluated during the trial. Medication compliance will be assessed by pill counts, urine screens for riboflavin and for those subjects on active medication by serum levels of naltrexone and beta-naltrexol. Treatment compliance will be evaluated by the percent of research visits attended. The results of this trial will provide important information on the clinical use of naltrexone in the treatment of alcohol dependence as alcohol dependence treatment moves into primary care settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NOVEL NON-PEPTIDE ANTAGONIST OF THE MCH RECEPTOR Principal Investigator & Institution: Schwarz, David A.; Neurocrine Biosciences, Inc. 10555 Science Center Dr San Diego, Ca 921211100 Timing: Fiscal Year 2003; Project Start 01-JAN-2001; Project End 30-APR-2005 Summary: (provided by applicant): Obesity is a rapidly advancing worldwide epidemic. Within the United States alone, 60% of the population is considered to be overweight. While new treatments for obesity have been introduced in the last decade, these drugs are only capable of reducing body weight by 10%, and patients typically gain back the lost weight following cessation of treatment. The potential for more effective therapeutics may be realized by targeting hormonal systems residing within the hypothalamus, a region of the brain critical for the appropriate regulation of food intake and energy utilization. Melanin concentrating hormone (MCH) is a prominent hormonal system originating within the lateral hypothalamus, which is responsible for initiating food intake. Genetically manipulating the expression of either the MCH ligand, or its receptor, inevitably results in alteration of body weight. Thus, mice overexpressing MCH ligand are obese, while mice lacking either the ligand or the receptor are lean. These data are consistent with the notion that blocking the interaction between MCH and its receptor will provide an effective means by which to reduce food intake in humans, and ultimately cause a loss of body weight. During the first phase of this project, we used high-throughput organic chemistry to develop multiple chemical series of potent MCH antagonists. We have also developed a number of critical in vitro and in vivo assays with which to monitor the bioavailability of these compounds, and their ability to inhibit acute food intake. In the second phase of this project, we propose to further refine these small molecules to improve their bioavailability. This will be accomplished by computer assisted drug design in conjunction with evaluation for a number of biological parameters including receptor affinity, hepatic stability, membrane permeability, and the potential for adverse reactions with liver enzymes necessary for proper drug metabolism. Compounds successfully emerging from this process will be

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Liver Enzymes

further evaluated in acute and chronic feeding paradigms in order to select candidates suitable for clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESISTANCE TO ANTIVIRAL THERAPY IN CHRONIC HEPATITIS C Principal Investigator & Institution: Terrault, Norah A.; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 30-JUN-2006 Summary: (provided by applicant): An estimated 600,000 African-Americans have chronic hepatitis C virus (HCV) infection, representing 22% of the total infected population in the U.S. Prior studies suggest African-Americans with chronic HCV infection have a lower rate of response to anti-viral therapy than non-Hispanic whites. The difference is, in part, related to the predominance of genotype 1 among AfricanAmericans. Response rates appear to higher with combination interferon plus ribavirin than with interferon monotherapy. However, the studies to date have included very low numbers of African-American subjects (<5%), limiting the interpretation of response rates. In the proposed study, the rate of sustained virological response (viral clearance) to pegylated interferon plus ribavirin will be compared in 200 African Americans and 200 non-Hispanic whites. The clinical, biochemical, or virological factors which predict sustained virological response to anti-viral therapy and reduced inflammatory activity on liver histology will be determined and early viral kinetics will be examined as a predictor of response or non-response. This collaborative study involving eight clinical centers will also provide the clinical data and biological specimens to coinvestigators focused on determining the virological, cellular, immunological and genetic factors that underlie the response to antiviral therapy in hepatitis C. Pegylated interferon plus interferon is chosen as the anti-viral intervention because combination therapy has been shown to be superior to interferon monotherapy and preliminary data indicate pegylated interferons are superior to standard interferons. Additionally, the convenience of once weekly dosing may improve compliance. Participants will undergo liver biopsy prior to study entry and at end of follow-up (96 wks). Virological analyses include HCV RNA quantitation (qualitative and quantitative) and HCV genotyping. Baseline assessments include demographic (using self-reporting of race/ethnicity) risk factor assessment, biochemistry and hematology, quality-of-life and fatigue assessments. Follow-up visits will include adverse events inquiry, assessment of compliance, collection of serum and peripheral blood mononuclear cells for virological analyses, and repeat liver biopys 48 weeks after completion of treatment. All study visits, including liver biopsies, will occur in the General Clinical Research Center. The primary treatment outcome is loss of HCV RNA at 96 weeks (48 weeks post-treatment). Secondary endpoints include loss of HCV RNA at 48 weeks; normalization of liver enzymes and improvement in histological inflammatory indices at 96 weeks; and tolerability (assessed by? adverse event inquiry and fatigue questionnaires). This study will accurately define the sustained response rates with optimal anti-viral therapy in African-Americans and provide important insights into the factors underlying differences in response compared to non-Hispanic whites. Moreover, the methodologies developed for patient outreach within the context of this collaborative study will serve as a model for enhancing participation of African Americans in clinical research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TESTOSTERONE MENOPAUSAL WOMENT

DOSE

RESPONSE

IN

17

SURGICALLY

Principal Investigator & Institution: Bhasin, Shalender; Professor and Chief; Charles R. Drew University of Med & Sci 1621 E 120Th St Los Angeles, Ca 90059 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2008 Summary: The clinical applications of testosterone in women are predicated upon the postulate that by appropriate selection of testosterone dose, clinically beneficial effects of testosterone on sexual, physical and neurocognitive functions can be dissociated from its virilizing side effects. However, we do not know whether the skin, hair, vocal cords, and clitoris differ in their testosterone sensitivity from sexual, cognitive, and physical functions. Therefore, the primary objective of this study is to establish testosterone doseresponse relationships in surgically menopausal women with low testosterone concentrations for a range of androgen-dependent outcomes, including sexual function, fat-free mass, thigh muscle strength and leg power, and several domains of neurocognitive function. The secondary objective is to determine the range of testosterone doses and concentrations that are associated with improvements in sexual, physical and neurocognitive functions and that can be safely administered to women without adverse effects on hair growth, voice, sebum production, clitoral size, and cardiovascular risk factors. In this randomized, double-blind, parallel-group study, surgically-menopausal women with low testosterone concentrations after a run-in period of transdermal estradiol for 3 months will be randomized to one of 4 groups to receive 0, 400, 1000, or 1600 uL testosterone gel daily for 6-months. These doses are expected to be associated with total testosterone concentrations of 20, 60, 120, and 180 ng/dL. The following outcomes will be assessed before and after 24-weeks of testosterone/placebo: sexual function, assessed by Brief Index of Sexual Functioning for Women, Derogatis Sexual Function Interview-Self Report, a sexual event log diary, and a Female Sexual Distress Scale; genital blood flow and sensation; mood by Psychological General Well Being Index; whole body and regional fat-free and fat mass by DEXA, deuterium water and sodium water dilution; and MRI scans of abdomen and thigh; leg press strength and leg power; physical function by Margaria power test, 400-m walk, and load carry test; and neurocognitive function by tests of spatial memory, spatial ability, logical memory, verbal (category and phonemic) fluency, immediate and delayed recall, digit and visual memory spans, spatial orientation, selective attention measure, and executive function. We will measure serum total and free testosterone, estradiol, DHT, SHBG, and FSH. For safety, we will evaluate hematocrit, liver enzymes, periodic breast and pelvic examination, hair growth by Ferriman and Galloway scale, sebuln production by Sebu-Tape, acne by Palatsi scale, clitoris size and index, changes in voice frequency, pitch range, and video images of vocal cords and digital speech records; plasma lipids, apolipoproteins and lipoprotein particles; inflammation sensitive markers; sleep apnea using Berlin's questionnaire; and insulin sensitivity by modified FSIVGT. These dose response data are crucial for the therapeutic applications of androgens in women, and will help determine whether by appropriate selection of testosterone dose, its beneficial effects can be dissociated from virilizing side effects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRANSCAPILLARY FLUID EXCHANGE Principal Investigator & Institution: Granger, D. Neil.; Boyd Professor and Head; Molecular and Cellular Physio; Louisiana State Univ Hsc Shreveport P. O. Box 33932 Shreveport, La 71103 Timing: Fiscal Year 2002; Project Start 01-DEC-1986; Project End 31-MAY-2004

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Summary: Hypercholesterolemia, an established risk factor for ischemic diseases of the heart, brain, liver and other tissues, appears to alter the function of both circulating blood cells and microvascular endothelial cells. Recent evidence in the literature and from our laboratory indicates that hypercholesterolemia profoundly exaggerates the microvascular dysfunction, inflammatory cell infiltration, and cellular necrosis associated with reperfusion of ischemic tissues. The work proposed in this application will extend our effort to define the mechanisms that underlie these exaggerated responses to ischemia/reperfusion (I/R) in hypercholesterolemic animals. We propose to assess the contributions of lymphocytes, platelets, and enhanced oxidant production to the leukocyte-endothelial cell adhesion, capillary malperfusion, tissue hypoxia, cytokine production, and cellular necrosis observed in an established model of I/R induced liver injury. Wild-type and LDL-receptor knockout mice with normal and elevated serum cholesterol levels will be studied. Intravital fluorescence microscopy will be used to monitor the number of perfused sinusoids and the accumulation of total leukocytes, lymphocytes, and platelets in liver sinusoids and hepatic venules after I/R. NADH autofluorescence will be monitored as an index of oxidative stress (tissue hypoxia) while the oxidation of dihyrorhodamine 123 will be used to monitor oxidant production. Plasma levels of liver enzymes will be used to assess hepatocellular injury, while a radiolabelled monoclonal antibody technique will be used to quantify the expression of P-selectin in the liver vasculature. One specific aim will focus on the influence of varying durations of ischemia, followed by reperfusion on the microvascular accumulation of total leukocytes, lymphocytes (T- and B-cells), and platelets in the postischemic liver of normal and hypercholesterolemic mice. A second specific aim will focus on the contributions of lymphocytes and platelets to the exaggerated responses of the liver microvasculature to I/R. SCID mice, reconstituted with specific lymphocyte populations from wild-type and mutant mice, will be used to address the role of lymphocytes in I/R-induced liver injury. Platelet-directed interventions (including neutralizing antibodies and mutant mice) will be used to assess the contribution of platelet accumulation. A third specific aim will determine whether the accumulation of these inflammatory cells and subsequent tissue injury is linked to an enhanced production of oxidants in hypercholesterolemic mice. Different mutant mice and oxidant-directed reagents will be used to assess the contribution and source of oxidants in normal and hypercholesterolemic mice. The results obtained from the proposed studies should lead to an improved understanding of the mechanisms by which hypercholesterolemia exacerbates ischemic tissue injury. 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

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

15-Month-old infant with failure to thrive, hepatomegaly, increased liver enzymes, hypoproteinemia, and seizures. Author(s): Barness LA, Patterson RF, Barness EG, Nora FE, Chamyan G, Lacson A, Pomerance HH. Source: American Journal of Medical Genetics. 2003 February 1; 116A(4): 391-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12522799

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64-year-old man with venous thrombosis and abnormal liver enzymes. Author(s): Harewood GC, Gupta D, Litin SC. Source: Mayo Clinic Proceedings. 1999 March; 74(3): 285-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10089999

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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 of postpartum hemolytic uremic syndrome with severe elevations of liver enzymes. Author(s): Sagawa N, Kariya M, Kanzaki H, Fujii S, Matsuura S, Mori T. Source: Obstetrics and Gynecology. 1985 May; 65(5): 761-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3920596

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A lipid lowering drug (bezafibrate) has a favorable effect on liver enzymes (Al-P and gamma-GTP). Author(s): Fukuo Y, Kitami T, Nomoto T, Terashi A. Source: Nippon Ika Daigaku Zasshi. 1996 October; 63(5): 424-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8937134

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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 study of hepatitis B virus serologic markers and liver enzymes. Author(s): McMahon BJ, Heyward WL, Bender TR, Murphy BL, Schreeder MT, Maynard JE. Source: The Journal of Infectious Diseases. 1980 November; 142(5): 772. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7462690

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A prospective, community-based evaluation of liver enzymes in individuals with hepatitis C after drug use. Author(s): Inglesby TV, Rai R, Astemborski J, Gruskin L, Nelson KE, Vlahov D, Thomas DL. Source: Hepatology (Baltimore, Md.). 1999 February; 29(2): 590-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9918940

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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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A young woman, 25 weeks pregnant, in labor with fever and abnormal serum liver enzymes. Author(s): Grier JF, Gholson CF, Fowler M, Abreo K. Source: J La State Med Soc. 1994 March; 146(3): 83-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7964115

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Abnormal liver enzymes and human chorionic gonadotropin elevation in abdominal testicular seminoma. Author(s): Hoard TD, Lewis EL. Source: Urology. 1976 May; 7(5): 512-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5796

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Abnormal liver enzymes and ketonuria in hyperemesis gravidarum. A retrospective review of 80 patients. Author(s): Morali GA, Braverman DZ. Source: Journal of Clinical Gastroenterology. 1990 June; 12(3): 303-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2362099

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Abnormal liver enzymes in outpatients with eating disorders. Author(s): Mickley D, Greenfeld D, Quinlan DM, Roloff P, Zwas F. Source: The International Journal of Eating Disorders. 1996 November; 20(3): 325-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8912046

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Abnormalities in liver enzymes during simultaneous therapy with itraconazole and amphotericin B in leukaemic patients. Author(s): Persat F, Schwartzbrod PE, Troncy J, Timour Q, Maul A, Piens MA, Picot S. Source: The Journal of Antimicrobial Chemotherapy. 2000 June; 45(6): 928-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10837458

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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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Activities of liver enzymes in serum after myocardial infarction. Author(s): Albertini A, Cavaliere G, Bonera E, Galante T. Source: Enzymologia. 1970 February 27; 38(2): 97-102. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5438787

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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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Liver Enzymes

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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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Aflatoxin, liver enzymes, and hepatitis B virus infection in Gambian children. Author(s): Wild CP, Fortuin M, Donato F, Whittle HC, Hall AJ, Wolf CR, Montesano R. Source: Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 1993 November-December; 2(6): 555-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8268773

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Alcohol abuse and liver enzymes (AALE): results of an intercompany study of mortality. Author(s): Titcomb C, Braun R, Roudebush B, Mast J, Woodman H; Mortality and Morbidity Liaison Committee of the Society of Actuaries, American Academy of Insurance Medicine, Academy of Life Underwriting. Source: J Insur Med. 2001; 33(3): 277-89. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11558411

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Alcohol and aldehyde dehydrogenases: structures of the human liver enzymes, functional properties and evolutionary aspects. Author(s): Jornvall H, Hempel J, von Bahr-Lindstrom H, Hoog JO, Vallee BL. Source: Alcohol and Alcoholism (Oxford, Oxfordshire). 1987; Suppl 1: 13-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3426669

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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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Androgenic-anabolic steroid effects on serum and skin surface lipids, on red cells, and on liver enzymes. Author(s): Kiraly CL. Source: International Journal of Sports Medicine. 1988 August; 9(4): 249-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2972634

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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

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Approach to the patient with abnormal liver enzymes. Author(s): Herlong HF. Source: Hosp Pract (Off Ed). 1994 November 15; 29(11): 32-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7962234

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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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Arterial blood gases, peak expiratory flow rate, serum electrolytes and liver enzymes in acute bronchial asthma. Author(s): Brundin A, Hedstrand U. Source: Acta Soc Med Ups. 1971; 76(5-6): 228-38. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5141079

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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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Liver Enzymes

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Assessment of anthropometric measurements, blood analytes and liver enzymes in Ghanaian alcoholics. Author(s): Quaye IK, Nyame PK, Dodoo DK, Gyan B, Adjei AA. Source: West Afr J Med. 1992 October-December; 11(4): 268-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1304790

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Association between serum concentrations of hexachlorobenzene and polychlorobiphenyls with thyroid hormone and liver enzymes in a sample of the general population. Author(s): Sala M, Sunyer J, Herrero C, To-Figueras J, Grimalt J. Source: Occupational and Environmental Medicine. 2001 March; 58(3): 172-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11171930

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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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Body fat distribution, relative weight, and liver enzyme levels: a population-based study. Author(s): Stranges S, Dorn JM, Muti P, Freudenheim JL, Farinaro E, Russell M, Nochajski TH, Trevisan M. Source: Hepatology (Baltimore, Md.). 2004 March; 39(3): 754-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14999694

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Caffeine as indicator of metabolic functions of microsomal liver enzymes. Author(s): Varagnolo M, Plebani M, Mussap M, Nemetz L, Paleari CD, Burlina A. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 1989 July 31; 183(1): 91-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2548774

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Car painters' exposure to a mixture of organic solvents. Serum activities of liver enzymes. Author(s): Kurppa K, Husman K. Source: Scand J Work Environ Health. 1982 June; 8(2): 137-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6127809

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Carcinogen activation by human liver enzymes in the Ames mutagenicity test. Author(s): Tang T, Friedman MA. Source: Mutation Research. 1977 December; 46(6): 387-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=339071

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Case of an adolescent girl with abnormal liver enzymes. Author(s): Noonan C, Ott MJ. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2000 January-February; 14(1): 37, 41-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11141827

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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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Changes in liver enzymes after clinical islet transplantation. Author(s): Rafael E, Ryan EA, Paty BW, Oberholzer J, Imes S, Senior P, McDonald C, Lakey JR, Shapiro AM. Source: Transplantation. 2003 November 15; 76(9): 1280-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14627903

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Changes in the level of serum liver enzymes after laparoscopic surgery. Author(s): Tan M, Xu FF, Peng JS, Li DM, Chen LH, Lv BJ, Zhao ZX, Huang C, Zheng CX. Source: World Journal of Gastroenterology : Wjg. 2003 February; 9(2): 364-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12532468

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Choledocholithiasis in patients with normal serum liver enzymes. Author(s): Goldman DE, Gholson CF. Source: Digestive Diseases and Sciences. 1995 May; 40(5): 1065-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7729265

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Chronic valproic acid and coantiepileptic drug therapy and incidence of increases in serum liver enzymes. Author(s): Haidukewych D, John G. Source: Therapeutic Drug Monitoring. 1986; 8(4): 407-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3103262

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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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Coffee, alcohol, and liver enzymes. Author(s): McLean AE. Source: Lancet. 1968 November 9; 2(7576): 1035. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4176362

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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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Cytochrome P-450-dependent monooxygenase activities in prenatal and postnatal human livers: comparison of human liver 7-alkoxycoumarin O-dealkylases with rat liver enzymes. Author(s): Matsubara T, Yamada N, Mitomi T, Yokoyama S, Fukiishi Y, Hasegawa Y, Nishimura H. Source: Japanese Journal of Pharmacology. 1986 March; 40(3): 389-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3486993

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Detection of liver metastases. A prospective study comparing liver enzymes, scintigraphy, ultrasonography and computed tomography. Author(s): Schreve RH, Terpstra OT, Ausema L, Lameris JS, van Seijen AJ, Jeekel J. Source: The British Journal of Surgery. 1984 December; 71(12): 947-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6388726

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Detoxification of the organophosphorus insecticide chlorfenvinphos by rat, rabbit and human liver enzymes. Author(s): Hutson DH, Logan CJ. Source: Xenobiotica; the Fate of Foreign Compounds in Biological Systems. 1986 January; 16(1): 87-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3946099

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Development of in vitro Vmax and Km values for the metabolism of isofenphos by P450 liver enzymes in animals and human. Author(s): Knaak JB, al-Bayati MA, Raabe OG, Blancato JN. Source: Toxicology and Applied Pharmacology. 1993 May; 120(1): 106-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8511771

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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

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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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Differences in the cytochrome P-450 isoenzymes involved in the 2-hydroxylation of oestradiol and 17 alpha-ethinyloestradiol. Relative activities of rat and human liver enzymes. Author(s): Ball SE, Forrester LM, Wolf CR, Back DJ. Source: The Biochemical Journal. 1990 April 1; 267(1): 221-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2327982

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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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Effect of Enovid on liver enzymes and accessory reproductive organs of male rat. Author(s): Adarkar MA, Sheth AR, Rao SS. Source: Indian J Biochem. 1967 December; 4(4): 204-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4298937

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Effect of hospitalisation on liver enzymes in healthy subjects. Author(s): Narjes H, Nehmiz G. Source: European Journal of Clinical Pharmacology. 2000 July; 56(4): 329-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10954348

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Effect of niclosamide on the marketable fish Liza ramada (Risso, 1826) concerning accumulation in muscles and activities of three metabolic liver enzymes. Author(s): Zinada OA. Source: J Egypt Soc Parasitol. 2000 December; 30(3): 791-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11198377

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Effect of oestrogen/gestagen replacement therapy on liver enzymes in patients with Ullrich-Turner syndrome. Author(s): Wemme H, Pohlenz J, Schonberger W. Source: European Journal of Pediatrics. 1995 October; 154(10): 807-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8529677

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Effect of type of alcoholic beverages on carbohydrate-deficient transferrin, sialic acid, and liver enzymes. Author(s): Sillanaukee P, van der Gaag MS, Sierksma A, Hendriks HF, Strid N, Ponnio M, Nikkari ST. Source: Alcoholism, Clinical and Experimental Research. 2003 January; 27(1): 57-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544006

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Effects of acute administration of naltrexone on cardiovascular function, body temperature, body weight and serum concentrations of liver enzymes in autistic children. Author(s): Herman BH, Hammock MK, Arthur-Smith A, Kuehl K, Appelgate K. Source: Dev Pharmacol Ther. 1989; 12(3): 118-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2721334

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Effects of age, sex and alcoholic habit of patients on liver enzymes during antituberculosis chemotherapy. Author(s): Aggarwal NP, Kallan BM, Aggarwal M, Joshi R. Source: J Indian Med Assoc. 1991 November; 89(11): 311-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1787318

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Effects of cafestol and kahweol from coffee grounds on serum lipids and serum liver enzymes in humans. Author(s): Urgert R, Schulz AG, Katan MB. Source: The American Journal of Clinical Nutrition. 1995 January; 61(1): 149-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7825527

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Effects of dioxins and furans on liver enzymes, lipid parameters, and thyroid hormones in former thermal metal recycling workers. Author(s): Triebig G, Werle E, Papke O, Heim G, Broding C, Ludwig H. Source: Environmental Health Perspectives. 1998 April; 106 Suppl 2: 697-700. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9599719

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Effects of moderate alcohol intake in fixed or variable amounts on concentration of serum lipids and liver enzymes in healthy young men. Author(s): Frimpong NA, Lapp JA. Source: The American Journal of Clinical Nutrition. 1989 November; 50(5): 987-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2573268

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Effects of preformed immune complexes on liver enzymes & their serum clearance in mice. Author(s): Kapoor RK, Tripathi AK, Chakrabarty AK, Sen P. Source: The Indian Journal of Medical Research. 1991 June; 94: 222-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1682248

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Effects of ursodeoxycholic acid and taurine on serum liver enzymes and bile acids in chronic hepatitis. Author(s): Podda M, Ghezzi C, Battezzati PM, Crosignani A, Zuin M, Roda A. Source: Gastroenterology. 1990 April; 98(4): 1044-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1968871

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Effects of ursodeoxycholic acid on serum liver enzymes and bile acid metabolism in chronic active hepatitis: a dose-response study. Author(s): Crosignani A, Battezzati PM, Setchell KD, Camisasca M, Bertolini E, Roda A, Zuin M, Podda M. Source: Hepatology (Baltimore, Md.). 1991 February; 13(2): 339-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1671665

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Effects of ursodeoxycholic acid on serum liver enzymes in patients with hepatitis C virus-related chronic liver disease. Author(s): Puoti C, Magrini A, Filippi T, Annovazzi G, Pannullo A. Source: European Journal of Gastroenterology & Hepatology. 1995 February; 7(2): 151-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7712308

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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): 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

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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

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Elevated serum liver enzymes in coke oven and by-product workers. Author(s): Wu MT, Kelsey KT, Mao IF, Wypij D, Liu HW, Christiani DC. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 1997 June; 39(6): 527-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9211210

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Elevated serum liver enzymes in obesity: a dilemma during clinical trials. Author(s): Golik A, Rubio A, Weintraub M, Byrne L. Source: Int J Obes. 1991 December; 15(12): 797-801. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1794921

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Elevation of liver enzymes in multiple dose trials during placebo treatment: are they predictable? Author(s): Merz M, Seiberling M, Hoxter G, Holting M, Wortha HP. Source: Journal of Clinical Pharmacology. 1997 September; 37(9): 791-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9549632

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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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Epigastric pain and spiking liver enzymes. Author(s): Jeffers L. Source: Hosp Pract (Off Ed). 1987 March 30; 22(3A): 113-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3102523

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Estimation of the fractional catabolic rate constants for the elimination of cytosolic liver enzymes from plasma. Author(s): Peltenburg HG, Hermens WT, Willems GM, Flendrig JG, Schmidt E. Source: Hepatology (Baltimore, Md.). 1989 November; 10(5): 833-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2807163

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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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First clinical trial of a novel caspase inhibitor: anti-apoptotic caspase inhibitor, IDN6556, improves liver enzymes. Author(s): Valentino KL, Gutierrez M, Sanchez R, Winship MJ, Shapiro DA. Source: Int J Clin Pharmacol Ther. 2003 October; 41(10): 441-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14703949

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Fluvoxamine and liver enzymes. Author(s): Bamrah JS, Benbow SM, McKenna J. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1990 February; 156: 286-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2107955

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Free and total serum valproate concentrations: their relationship to seizure control, liver enzymes and plasma ammonia in children. Author(s): Farrell K, Abbott FS, Orr JM, Applegarth DA, Jan JE, Wong PK. Source: The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques. 1986 August; 13(3): 252-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3091231

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Furosemide and increases in liver enzymes. Author(s): Lang I, Huber K, Capek J, Glogar DH, Probst P, Kaindl F. Source: Annals of Internal Medicine. 1988 November 15; 109(10): 845. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3190037

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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 gamma-glutamyltransferase activity in alcoholic fatty liver: comparison with other liver enzymes in man and rats. Author(s): Teschke R, Neuefeind M, Nishimura M, Strohmeyer G. Source: Gut. 1983 July; 24(7): 625-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6134656

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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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Hepatitis C viral quasispecies in hepatitis C virus carriers with normal liver enzymes and patients with type C chronic liver disease. Author(s): Naito M, Hayashi N, Moribe T, Hagiwara H, Mita E, Kanazawa Y, Kasahara A, Fusamoto H, Kamada T. Source: Hepatology (Baltimore, Md.). 1995 August; 22(2): 407-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7635407

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Hereditary variation of liver enzymes involved with detoxification and neurodegenerative disease. Author(s): Williams AC, Steventon GB, Sturman S, Waring RH. Source: Journal of Inherited Metabolic Disease. 1991; 14(4): 431-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1749211

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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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Hormonal regulation and liver enzymes. Author(s): Weber G. Source: Gastroenterology. 1967 December; 53(6): 984-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4863727

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Hypoxic hepatitis: a difficult diagnosis when the cardiomyopathy remains unrecognized and the course of liver enzymes follows an atypical pattern. A report of two cases. Author(s): Henrion J, De Maeght S, Schapira M, Ghilain JM, Maisin JM, Gerard R, Heller FR. Source: Acta Gastroenterol Belg. 1998 July-September; 61(3): 385-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9795478

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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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Identification of the human liver enzymes involved in the metabolism of the antimigraine agent almotriptan. Author(s): Salva M, Jansat JM, Martinez-Tobed A, Palacios JM. Source: Drug Metabolism and Disposition: the Biological Fate of Chemicals. 2003 April; 31(4): 404-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12642466

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Idraparinux and liver enzymes: observations from the PERSIST trial. Author(s): Reiter M, Bucek RA, Koca N, Heger J, Minar E; PERSIST. Source: Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis. 2003 January; 14(1): 61-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544730

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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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In vitro metabolism of the antimalarial agent primaquine by mouse liver enzymes and identification of a methemoglobin-forming metabolite. Author(s): Strother A, Allahyari R, Buchholz J, Fraser IM, Tilton BE. Source: Drug Metabolism and Disposition: the Biological Fate of Chemicals. 1984 January-February; 12(1): 35-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6141909

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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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Letter: Effects of salicylate on liver enzymes in normal young adults. Author(s): Furst DE, Kar NC, Sarkissian ES, Gupta N, Paulus HE. Source: Arthritis and Rheumatism. 1976 March-April; 19(2): 267-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=177026

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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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Lipid-lowering drugs and serum liver enzymes: the effects of body weight and baseline enzyme levels. Author(s): Kiortsis DN, Nikas S, Hatzidimou K, Tsianos E, Elisaf MS. Source: Fundamental & Clinical Pharmacology. 2003 August; 17(4): 491-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12914553

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Liver enzymes after retropubic prostatectomy in patients receiving continuous lumbar epidural analgesia or general anaesthesia. Author(s): Hendolin H, Penttila IM. Source: Ann Clin Res. 1982 February; 14(1): 1-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6182833

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Liver enzymes among microelectronics equipment maintenance technicians. Author(s): Upfal M. Source: J Occup Med. 1992 April; 34(4): 384-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1564576

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Liver enzymes and liver biopsy. Author(s): Whitney JP. Source: Annals of Internal Medicine. 1990 February 15; 112(4): 311. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2297213

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Liver enzymes and pathology in Hodgkin's disease. Author(s): Belliveau RE, Wiernik PH, Abt AB. Source: Cancer. 1974 August; 34(2): 300-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4152944

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Liver enzymes are commonly elevated following laparoscopic cholecystectomy: is elevated intra-abdominal pressure the cause? Author(s): Andrei VE, Schein M, Margolis M, Rucinski JC, Wise L. Source: Digestive Surgery. 1998; 15(3): 256-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9845595

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Liver enzymes as predictors of liver damage due to blunt abdominal trauma in children. Author(s): Puranik SR, Hayes JS, Long J, Mata M. Source: Southern Medical Journal. 2002 February; 95(2): 203-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11846245

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Liver enzymes as surrogate markers of hepatitis C histopathology--avoiding the liver biopsy needle? Author(s): Wong SG, Yoshida EM. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2001 September; 15(9): 629-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11573108

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Liver enzymes in alcohol-discordant twins. Author(s): Myrhed M, Bergstrom K. Source: Acta Med Scand. 1976; 200(1-2): 87-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8959

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Liver enzymes in hypertension. Author(s): Loyke HF. Source: The American Journal of Gastroenterology. 1970 April; 53(4): 339-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4314685

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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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Making sense of liver enzymes, liver function tests, and hepatobiliary disorders at the reference desk. Author(s): Fikar CR. Source: Medical Reference Services Quarterly. 2003 Fall; 22(3): 15-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14527136

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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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Marked increase in serum levels of liver enzymes in patients receiving chenic acid and phenobarbital for gallstone dissolution. Author(s): Menghini G, Pallotta B. Source: Digestion. 1976; 14(2): 163-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=950079

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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: 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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Metabolism of drugs and carcinogens by human liver enzymes. Author(s): Kuntzman R, Mark LC, Brand LC, Jacobson BM, Levin W, Conney AH. Source: The Journal of Pharmacology and Experimental Therapeutics. 1966 April; 152(1): 151-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4380008

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Methionine adenosyltransferase: kinetic properties of human and rat liver enzymes. Author(s): Tallan HH, Cohen PA. Source: Biochem Med. 1976 December; 16(3): 234-50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13790

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Mitochondrial liver enzymes and the ratio between mitochondrial and cytoplasmic enzymes in the differential diagnosis of acute rejection after liver transplantation. Author(s): Gozzo ML, Avolio AW, Colacicco L, Agnes S, Forni F, Barbaresi G, Castagneto M. Source: Transplantation Proceedings. 1993 April; 25(2): 1760-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8097065

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Modifications of liver enzymes during heparin therapy. Author(s): Lambert M, Laterre PF, Leroy C, Lavenne E, Coche E, Moriau M. Source: Acta Clin Belg. 1986; 41(5): 307-10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2881417

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Modified fasting in treatment of obesity. Effects on serum lipids, electrolytes, liver enzymes, and blood pressure. Author(s): Valenta LJ, Elias AN. Source: Postgraduate Medicine. 1986 March; 79(4): 263-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3952044

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Monitoring of liver enzymes in patients treated with traditional Chinese drugs. Author(s): Melchart D, Linde K, Hager S, Kaesmayr J, Shaw D, Bauer R, Weidenhammer W. Source: Complementary Therapies in Medicine. 1999 December; 7(4): 208-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10709303

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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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Normal serum activities of liver enzymes in Swedish paint industry workers with heavy exposure to organic solvents. Author(s): Lundberg I, Hakansson M. Source: Br J Ind Med. 1985 September; 42(9): 596-600. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2864077

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Normalization of liver enzymes in an HIV-hepatitis C virus-co-infected patient after potent antiretroviral therapy. Author(s): Diaz B, Martin-Carbonero L, Perez-Olmeda M, Soriano V. Source: Aids (London, England). 2002 May 24; 16(8): 1193. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12004283

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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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Outcomes of routine testing of liver enzymes in institutionalized geriatric patients. Author(s): Steinberg EN, Cho-Steinberg HM, Howden CW. Source: Am J Manag Care. 1997 February; 3(2): 267-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10169261

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Periportal tracking in pediatric blunt abdominal trauma. Correlation with liver enzymes and liver injury. Author(s): Vade A, Demos TC, Salvino C, Korach JL. Source: Clinical Imaging. 1994 July-September; 18(3): 189-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7922839

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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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Plasma electrolytes, total cholesterol, liver enzymes, and selected antioxidant status in protein energy malnutrition. Author(s): Etukudo MH, Agbedana EO, Akinyinka OO, Osifo BO. Source: Afr J Med Med Sci. 1999 March-June; 28(1-2): 81-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12953993

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Postoperative effect of halothane and electrocautery on liver enzymes. Author(s): Thompson DS, Thompson BW, Flacke JW. Source: Southern Medical Journal. 1974 November; 67(11): 1280-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4428209

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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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Progressive elevation of liver enzymes in a child treated with sulthiame. Author(s): Brockmann K, Hanefeld F. Source: Neuropediatrics. 2001 June; 32(3): 165-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11521216

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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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Raised liver enzymes in asymptomatic patients: investigation and outcome. Author(s): Goddard CJ, Warnes TW. Source: Digestive Diseases (Basel, Switzerland). 1992; 10(4): 218-26. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1521349

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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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Role of ERCP in asymptomatic orthotopic liver transplant patients with abnormal liver enzymes. Author(s): Eckhoff DE, Baron TH, Blackard WG, Morgan DE, Crowe R, Sellers M, McGuire B, Contreras JL, Bynon JS. Source: The American Journal of Gastroenterology. 2000 January; 95(1): 141-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10638573

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Saccharomyces cerevisiae: an alternative source for human microsomal liver enzymes and its use in drug interaction studies. Author(s): Eugster HP, Sengstag C. Source: Toxicology. 1993 October 5; 82(1-3): 61-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8236282

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Serum liver enzymes in Turner syndrome. Author(s): Larizza D, Locatelli M, Vitali L, Vigano C, Calcaterra V, Tinelli C, Sommaruga MG, Bozzini A, Campani R, Severi F. Source: European Journal of Pediatrics. 2000 March; 159(3): 143-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10664223

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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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Somatostatin and total intravenous anaesthesia. Assessment of analgesic requirements during surgery and the effects on liver enzymes. Author(s): Kanakoudis FS, Konstantinidou AS, Petrou A, Taliouridou EI, Papadopoulou-Bouti AL, Michaloudis DG. Source: Anaesthesia. 1995 July; 50(7): 594-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7653756

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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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S-oxygenation of an alkylmercaptotriazine herbicide by rat, rabbit and human liver enzymes. Author(s): Crawford MJ, Hutson DH. Source: Xenobiotica; the Fate of Foreign Compounds in Biological Systems. 1980 March; 10(3): 187-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7467402

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Sympathetic activation: a mechanism for morphine induced pain and rises in liver enzymes after cholecystectomy? Author(s): Roberts-Thomson IC, Jonsson JR, Frewin DB, Coates GC. Source: Gut. 1990 February; 31(2): 217-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2311982

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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 C677T mutation in the methylenetetrahydrofolate reductase gene: a genetic risk factor for methotrexate-related elevation of liver enzymes in rheumatoid arthritis patients. Author(s): van Ede AE, Laan RF, Blom HJ, Huizinga TW, Haagsma CJ, Giesendorf BA, de Boo TM, van de Putte LB. Source: Arthritis and Rheumatism. 2001 November; 44(11): 2525-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11710708

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The clinical importance of routine measurement of liver enzymes, total protein and albumin in a general medicine outpatient clinic: a prospective study. Author(s): Veldhuyzen van Zanten SJ, Depla AC, Dekker PC, Langius FA, Wesche MF, Sanders GT, Wieling W. Source: The Netherlands Journal of Medicine. 1992 February; 40(1-2): 53-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1579186

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The effect of methylprednisolone, naloxone, and spinal cord trauma on four liver enzymes: observations from NASCIS 2. National Acute Spinal Cord Injury Study. Author(s): Shepard MJ, Bracken MB. Source: Paraplegia. 1994 April; 32(4): 236-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8022633

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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 HELLP syndrome: a serious complication of pregnancy with hemolysis, elevated levels of liver enzymes, and low platelet count. Author(s): Baca L, Gibbons RB. Source: The American Journal of Medicine. 1988 October; 85(4): 590-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3177422

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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 prevalence of TT virus and GB virus C/hepatitis G virus infection in individuals with raised liver enzymes but without HBV or HCV infection in Taiwan. Author(s): Dai CY, Yu ML, Chang WY, Tseng CH, Hou C, Lin ZY, Chen SC, Hsieh MY, Wang LY, Tsai JF, Chuang WL. Source: Epidemiology and Infection. 2002 October; 129(2): 307-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12403107

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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 relationship between alcohol consumption, liver enzymes and high-density lipoprotein cholesterol. Author(s): LaPorte R, Valvo-Gerard L, Kuller L, Dai W, Bates M, Cresanta J, Williams K, Palkin D. Source: Circulation. 1981 September; 64(3 Pt 2): Iii 67-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7261299

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The role of serum liver enzymes in the diagnosis of choledocholithiasis. Author(s): Pereira-Lima JC, Jakobs R, Busnello JV, Benz C, Blaya C, Riemann JF. Source: Hepatogastroenterology. 2000 November-December; 47(36): 1522-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11148992

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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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Transient increase of liver enzymes induced by risperidone: two case reports. Author(s): Whitworth AB, Liensberger D, Fleischhacker WW. Source: Journal of Clinical Psychopharmacology. 1999 October; 19(5): 475-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10505592

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Transitional polytherapy, liver enzymes, and valproic acid hepatotoxicity. Author(s): Fidone GS, Jann MW, Rosenthal S. Source: Neurology. 1987 October; 37(10): 1692-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3116453

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Treatment of patients with chronic hepatitis C with normal liver enzymes. Author(s): Akbar HO. Source: Saudi Med J. 2002 March; 23(3): 301-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11938421

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Unexpected effects of coffee consumption on liver enzymes. Author(s): Casiglia E, Spolaore P, Ginocchio G, Ambrosio GB. Source: European Journal of Epidemiology. 1993 May; 9(3): 293-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8104822

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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 ENZYMES

2.

ALTERNATIVE

MEDICINE

AND

LIVER

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to 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 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 “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 liver enzymes: •

Effects of Nigella sativa L. and Urtica dioica L. on lipid peroxidation, antioxidant enzyme systems and some liver enzymes in CCl4-treated rats. Author(s): Kanter M, Meral I, Dede S, Gunduz H, Cemek M, Ozbek H, Uygan I. Source: Journal of Veterinary Medicine. A, Physiology, Pathology, Clinical Medicine. 2003 June; 50(5): 264-8. Erratum In: J Vet Med a Physiol Pathol Clin Med.

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/

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

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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/

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

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

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

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

The following is a specific Web list relating to 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 Hepatitis Source: Healthnotes, Inc.; www.healthnotes.com High Cholesterol Source: Prima Communications, Inc.www.personalhealthzone.com Systemic Lupus Erythematosus Source: Healthnotes, Inc.; www.healthnotes.com Viral Hepatitis Source: Prima Communications, Inc.www.personalhealthzone.com

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Herbs and Supplements Andrographis Alternative names: Andrographis paniculata Source: Healthnotes, Inc.; www.healthnotes.com Bupleurum Alternative names: Bupleurum chinense, Bupleurum falcatum Source: Healthnotes, Inc.; www.healthnotes.com Curcuma Alternative names: Turmeric; Curcuma longa L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

Alternative Medicine 57

Dehydroepiandrosterone (DHEA) Source: Healthnotes, Inc.; www.healthnotes.com Digoxin Source: Healthnotes, Inc.; www.healthnotes.com Green Tea Source: Prima Communications, Inc.www.personalhealthzone.com Mentha Alternative names: Pennyroyal; Mentha/Hedeoma pulegium Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Milk Thistle Source: Prima Communications, Inc.www.personalhealthzone.com Momordica Alternative names: Bitter Gourd, Karela; Momordica charantia Linn. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Red Yeast Rice Source: Prima Communications, Inc.www.personalhealthzone.com Silybum Alternative names: Milk Thistle; Silybum marianum (L.) Gaertn. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Tacrine Source: Healthnotes, Inc.; www.healthnotes.com Taurine Source: Prima Communications, Inc.www.personalhealthzone.com Theophylline/Aminophylline Source: Healthnotes, Inc.; www.healthnotes.com Tricyclic Antidepressants Source: Healthnotes, Inc.; www.healthnotes.com Warfarin Source: Healthnotes, Inc.; www.healthnotes.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.

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CHAPTER 3. DISSERTATIONS ON LIVER ENZYMES Overview In this chapter, we will give you a bibliography on recent dissertations relating to liver enzymes. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “liver enzymes” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on liver enzymes, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Liver Enzymes ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to liver enzymes. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Multiple Forms of the 3(17)alpha-hydroxysteroid Dehydrogenases of Rabbit Kidney Cytosol: Comparison with the Corresponding Liver Enzymes by Lau, Peter C. K.; PhD from University of Ottawa (Canada), 1980 http://wwwlib.umi.com/dissertations/fullcit/NK48567

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 4. BOOKS ON LIVER ENZYMES Overview This chapter provides bibliographic book references relating to liver enzymes. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on 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.

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

Hepatitis C: Diagnostic Techniques and Monitoring Strategies Source: Thousand Oaks, CA: Amgen, Inc. 1997. 32 p. Contact: Available from Amgen Professional Services. 1840 DeHavilland Drive, Thousand Oaks, CA 91320-1789. (800) 77-AMGEN. PRICE: Single copy free to health professionals. Summary: This document summarizes the present diagnostic techniques and monitoring strategies used as part of the management of hepatitis C virus (HCV). HCV infection results in a chronic disease state in 50 to 70 percent of cases and is now the most common cause of chronic liver disease in the United States. It is highly infectious; known routes of transmission include blood and blood products, injection drug use, and sexual contacts. The virus has been cloned and is now well characterized with respect to both structural and nonstructural proteins. Molecular cloning technology has resulted in the development of specific and sensitive screening, diagnostic, and monitoring assays

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for HCV. In addition, tests to determine the quantity of viral RNA in blood and to define areas of the viral genome have been developed. Both viral load and genome have been suggested to be predictive of patient response to therapy. The authors review HCV diagnostic and monitoring tests, including liver enzymes, serological assays, virological assays, genotyping and serotyping, and liver biopsy. The discovery of antibodies to HCV or elevated ALT in a patient with or without symptoms of liver disease frequently culminates in the diagnosis of hepatitis C. The sequence of tests used to confirm the diagnosis may depend on the patient's known risk factors and the type of test (ALT, anti-HCV, or both) that initially established the likelihood of infection. The authors conclude that once the diagnosis of HCV infection is confirmed, determination of the presence or absence of cirrhosis, HCV RNA concentration, and genotype or serotype are important predictive factors in determining which patients are most likely to respond to therapy. 8 figures. 8 tables. 66 references. (AA-M).

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

Autoimmune Hepatitis: Diagnosis and Treatment Source: in McDonald, J.W.D.; Burroughs, A.K.; Feagan, B.G., eds. Evidence Based Gastroenterology and Hepatology. London, UK: BMJ Publishing Group. 1999. p. 360371. Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. E-mail: [email protected]. Website: www.bmjbooks.com. PRICE: Contact publisher for price. Summary: Autoimmune hepatitis (AIH) is a self perpetuating, necroinflammatory disease of unknown etiology, which is characterized by a loss of tolerance towards the patient's own liver tissue. The disease may lead to liver cirrhosis (scarring) and liver failure. This chapter on the diagnosis and treatment of autoimmune hepatitis is from a book that emphasizes the approaches of evidence based medicine in gastroenterology (the study of the gastrointestinal tract and gastrointestinal diseases) and hepatology (the study of the liver and liver diseases). The authors note that AIH is a syndrome characterized by a set of epidemiological, laboratory, and clinical features: female predominance (female to male ratio is 4 to 1), overrepresentation of the HLA alleles DR3 and DR4, hypergammaglobulinemia, circulating autoantibodies, response to immunosuppressive therapy, and coexistence of extrahepatic (outside the liver) autoimmune diseases. In the majority of patients, the disease progresses without major symptoms, and the diagnosis is not made until symptoms of severe liver disease are present. Jaundice is present in a large proportion of patients at diagnosis. Patients' complaints include fatigue, anorexia, abdominal pain (10 to 20 percent of patients), and fever (20 percent of patients). Diagnosis requires the assessment of typical clinical and

Books

63

laboratory features; histology confirms disease activity and stage but by itself is not sufficient for diagnosis. Corticosteroids should be administered until remission, incomplete response, treatment failure, or unacceptable adverse effects occur. Remission is defined by the absence of symptoms, resolution of liver inflammation by liver histology, and a normalization of liver enzymes with the exception of AST, which may remain up to twice normal levels. Patients who fail to enter remission after 4 years of conventional treatment are regarded as potential candidates for liver transplantation. Liver transplantation has resulted in excellent long term survival rates that exceed 90 percent after 5 years. 3 figures. 4 tables. 46 references. •

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

•

When You Have Hepatitis C, Understanding the Diagnosis: Blood Tests and Biopsies Source: in Everson, G.T. and Weinberg, H. Living with Hepatitis C: A Survivor's Guide. New York, NY: Hatherleigh Press. 1999. p. 15-30. Contact: Available from Hatherleigh Company, Ltd. 1114 First Avenue, Suite 500, New York, NY 10021. (800) 367-2550 or (212) 832-1039. Website: hatherleigh.com. PRICE: $14.95 plus shipping and handling. ISBN: 1578260345. Summary: Hepatitis C is a viral infection that causes inflammation, injury, and ultimately scarring of the liver (cirrhosis). This chapter discussing the diagnosis of hepatitis C is from a book that offers information and guidance for people living with hepatitis C. The authors explain in nontechnical language some basic facts about the testing process for hepatitis C from diagnosis through the years of ongoing care. Diagnostic tests described include: ELISA I, ELISA II, and III; RIBA; HCV RNA assays; PCR quantitative assay; branched chain DNA assay; genotyping and quasispecies; radiologic imaging; ultrasound; CT scan; and liver biopsy. The authors also discuss testing limits, interpreting biopsy results, and monitoring tests, including liver enzymes, bilirubin, albumin, clotting factors, and complete blood count (CBC). The authors note that one predictor of response to therapy may be the number of quasispecies of hepatitis C circulating in the patient's blood. The virus mutates freely, so

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patients often have multiple copies of the hepatitis C virus that vary genetically; these are called quasispecies. In addition, the subtypes of hepatitis C respond differently to therapy, so it can be useful to have the subtype diagnosed. The authors recognize that many readers fear even the word 'biopsy,' but they stress that only a biopsy can give the doctor a true idea of the condition of the liver. They detail exactly what the patient can expect during and after the biopsy. The chapter includes lengthy quotes from patients with hepatitis, which offer the patients' perspectives, insights, and experiences to the reader. 2 figures. 1 table. •

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 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

Books

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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. •

Chapter 141: Porphyrias Source: in Berkow, R., ed. The Merck Manual of Medical Information: Home Edition (online version). Rahway, NJ: Merck and Company, Inc. 2000. 6 p. Contact: Available online from Merck and Company, Inc. (800) 819-9456. Website: www.merck.com/pubs/mmanual_home/contents.htm. Also available from your local book store. PRICE: $29.95 plus shipping. Summary: This chapter provides the general public and people who have porphyrias with information on the symptoms, diagnosis, and treatment of the three most common porphyrias: porphyria cutanea tarda, acute intermittent porphyria, and erythropoietic protoporphyria. Porphyrias are caused by deficiencies of enzymes involved in the synthesis of heme. Porphyria cutanea tarda, the most common porphyria, causes blistering, crusting, and scarring of skin exposed to sunlight. This hepatic porphyria is the only porphyria that is not hereditary. It occurs when one of the liver enzymes necessary for heme synthesis becomes inactivated. Diagnosis is based on tests of blood plasma, urine, and stool for porphyrins. This kind of porphyria can be treated with a procedure called a phlebotomy. Low doses of chloroquine or hydroxychloroquine are also effective. Acute intermittent porphyria, a hepatic porphyria, is the most common acute porphyria. It is caused by a deficiency of the enzyme porphobilinogen deaminase. Drugs, hormones, or diet are needed to activate the disorder and produce symptoms. Abdominal pain is the most common symptom. Others include nausea, vomiting, constipation, diarrhea, abdominal bloating, difficulty urinating, rapid heart rate, high blood pressure, sweating, and restlessness. All symptoms result from effects on the nervous system. Diagnosis is based on laboratory tests to measure the levels of two precursors of heme in the urine. Severe attacks are treated with intravenous heme. Intravenously administered glucose or a diet high in carbohydrates can also be helpful. Pain can be controlled with drugs until a person responds to heme or glucose. Attacks can be prevented by maintaining good nutrition and avoiding drugs that can induce them. Erythropoietic protoporphyria, a hereditary porphyria, causes photosensitivity of the skin as a result of protoporphyrin buildup in the bone marrow, red blood cells, and blood plasma. Symptoms, which usually begin in childhood, include pain and swelling after the skin is exposed to sunlight. Diagnosis is based on detection of increased levels of protoporphyrin in the plasma and red blood cells. The severity of the disease varies from person to person. Treatment involves avoiding sunlight and taking beta carotene to increase tolerance to sunlight.

•

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.

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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 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. •

Day 4: Finding Others Like You Source: in Green, W.F. First Year: Hepatitis B. New York, NY: Marlowe and Company. 2002. p. 35-47. Contact: Available from Marlowe and Company. 161 William Street, 16th Floor, New York, NY 10038. PRICE: $15.95 plus shipping and handling. ISBN: 1569245339. Summary: Viral hepatitis B (liver infection) is one of the most preventable medical conditions due to the availability of a hepatitis B vaccine, yet an estimated 100,000 people in the United States are infected each year, and 6,000 die from complications. When the author of this book was diagnosed in 1993, he decided to be proactive in his quest to understand and manage his illness. In this chapter, the author focuses on what readers can expect to experience on the fourth day after they receive their diagnosis of hepatitis B virus HBV) infection, discussing the issue of finding others. The chapter is in two parts: first, a focus on the psychosocial aspects that the reader might experience, followed by a section of instructional material. In nontechnical language, the author discusses the different types of support groups and resources that exist, Internet newsletters and magazines, Web resources, and a section on understanding lab tests, including liver function tests, liver enzymes, ALT, AST, alkaline phosphatase, bilirubin, GGT, serum albumin, prothrombin time, tests for other strains of hepatitis, HBV DNA PCR, ultrasound and CT scans.

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CHAPTER 5. MULTIMEDIA ON LIVER ENZYMES Overview In this chapter, we show you how to keep current on multimedia sources of information on 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 liver enzymes is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “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 “liver enzymes” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on 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 metabolic disorder that causes liver disease in infants and children; the disorder also

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

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

Liver enzyme implicated in artery disease Source: Reuters Health eLine Date: January 24, 2003

•

Leptin downregulates specific liver enzyme causing leanness, hypermetabolism Source: Reuters Medical News Date: July 12, 2002

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•

HCV-3 identified as risk factor for liver enzyme elevation after HAART Source: Reuters Medical News Date: May 21, 2002

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Liver enzymes linked to hepatic injury in children after abdominal trauma Source: Reuters Medical News Date: March 29, 2002 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “liver 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 “liver enzymes” (or synonyms). If you know the name of a company that is relevant to 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/.

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BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “liver enzymes” (or synonyms).

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

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

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute4: •

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

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

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

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

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

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

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

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

4

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The NLM 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 “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 186370 373 726 120 1507 189096

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 “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.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on liver 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 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 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 “liver enzymes”:

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Cirrhosis http://www.nlm.nih.gov/medlineplus/cirrhosis.html Genetic Brain Disorders http://www.nlm.nih.gov/medlineplus/geneticbraindisorders.html Hepatitis C http://www.nlm.nih.gov/medlineplus/hepatitisc.html Liver Diseases http://www.nlm.nih.gov/medlineplus/liverdiseases.html Metabolic Disorders http://www.nlm.nih.gov/medlineplus/metabolicdisorders.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on liver 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: •

Reye's Syndrome Source: Cedar Grove, NJ: American Liver Foundation. 1997. 2 p. Contact: Available from American Liver Foundation. Information and Distribution Center, 1425 Pompton Avenue, Suite 3, Cedar Grove, NJ 07009-1000. (800) GO-LIVER, ext. 234 or (888) HEP-ABC. Fax (973) 256-3214. E-mail: [email protected]. Website: www.liverfoundation.org. PRICE: $0.50 for single copy; bulk orders available; plus shipping and handling. Summary: A recently recognized childhood disease, Reye's syndrome is a rare complication of common respiratory infections, including chickenpox. This fact sheet from the American Liver Foundation (ALF) offers a brief overview of Reye's syndrome. Reye's syndrome should be suspected when vomiting begins 3 to 7 days after the onset of flu or chickenpox. Usually the vomiting becomes increasingly severe over a period of 8 to 12 hours. If the vomiting is associated with signs of disordered brain function, such as staring spells, stupor, delirium, or strange behavior, a medical examination. The fact sheet notes that Reye's syndrome can occur at any time, but it is most frequent during winter months, in association with influenza and similar respiratory infections. Diagnosis of Reye's syndrome is accomplished through the patient's recent history of flu like illness, persistent vomiting, elevation of certain liver enzymes (serum SGPT) with a

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normal bilirubin, and exclusion of meningitis and encephalitis. Almost all cases of Reye's syndrome have increased serum concentrations of certain liver enzymes, notably serum glutamic pyruvic transaminase (SGPT). The fact sheet notes that aspirin may contribute to the problem of Reye's syndrome; until conclusive evidence is obtained, doctors advise against the use of aspirin in chickenpox and during outbreaks of flu like illness. The fact sheet concludes with a list of medications that contain salicylates, including cold medications. Acetaminophen is the preferred antifever medicine during chickenpox and flu illnesses in children. The fact sheet offers the contact information for ALF (800-GO-LIVER, www.liverfoundation.org ). •

Guide to Diagnosis: Hemochromatosis Iron Overload Source: Greenville, SC: Iron Disorders Institute. 1999. [2 p.]. Contact: Available from Iron Disorders Institute. P.O. Box 2031, Greenville, SC 29602. (888) 565-IRON. Website: www.irondisorders.org. PRICE: Single copy free. Summary: Hemochromatosis (HHC) is a genetic metabolic disorder in which an individual absorbs and retains too much iron. Increased iron absorption in the gastrointestinal tract may cause lifelong excessive iron absorption and accumulation, and serious health effects, including arthritis, cirrhosis, diabetes, impotence, heart failure, and death can result. This brochure offers readers a guide to the diagnosis of HHC. Topics include symptoms, risk factors, candidacy for liver biopsy, tests for body iron status overload, DNA tests, indications for genetic testing, and the importance of working closely with one's physician. Chronic fatigue is generally the first and most common symptom associated with iron overload. Liver biopsy may be recommended if the patient's liver enzymes are elevated and ferritin is about 1,000 ng per milliliter. Liver biopsy is the only way to determine the extent of cirrhosis or fibrosis and formerly was the standard for diagnosing hemochromatosis. Trial phlebotomy (blood removal) is also a way to diagnose HHC. A patient who can tolerate several phlebotomies without developing anemia can be diagnosed with HHC. Genetic typing tests for HHC are available as well. Children do not need to be genetically tested. Once it is determined that parents are carriers or homozygous, offspring should be screened routinely using transferrin saturation percentage and ferritin test levels. The brochure notes that most patients with HHC can be diagnosed and treated by a family practice physician; however, specialists may also be necessary to treat chronic disease that may have developed as a result of iron overload. The brochure concludes with a brief description of the Iron Disorders Institute (IDI), founded to limit pain, suffering, and unnecessary death from common and often misdiagnosed disorders of iron, such as anemia of chronic disease, porphyria cutanea tarda, iron loading anemia, iron deficiency anemia, African siderosis, and HHC.

•

Role of Iron in Viral Hepatitis Source: idInsight. 2(2): 4. 1999. Contact: Available from Iron Disorders Institute. P.O. Box 2031, Greenville, SC 29602. (864) 241-0111. Fax (864) 244-2104. Website: www.irondisorders.org. Summary: More than 15 years ago, scientists began to notice elevated iron levels in those with chronic viral hepatitis. Some speculate that iron is released from liver cells injured by the presence of hepatitis virus. This brief newsletter article familiarizes patients and physicians with the role of iron in viral hepatitis. One of the researchers noted that patients on dialysis (whose serum ferritin, blood iron levels, were lower) cleared of infection sooner than those with elevated levels of ferritin. The levels of iron may also be

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correlated to which patients with hepatitis will respond to alpha interferon therapy; in one study, liver iron content in the 50 percent of patients who did not respond to treatment were twice as high as levels of iron in responders to interferon. In another study, it was noted that liver enzymes ALT were significantly reduced in response to interferon treatment when administered following a series of phlebotomies (removal of blood) to reduce ferritin. Patients with viral hepatitis are counseled to ask their attending physician to determine body iron status by measuring ferritine and transferrin iron saturation percentage. If elevated, reduction of ferritin levels may be considered for improved response to ongoing treatment. One chart summarizes the most common types of hepatitis, their transmission, risk factors, diagnostic tests, treatment, symptoms, anticipated recovery, and vaccination use. The article concludes with website addresses for readers wishing additional information; a suggested reading list for physicians is also provided. 1 table. 3 references. •

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 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.

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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

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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). •

What the Physician Can Do to Help the Child Who is a Hepatitis B Carrier Source: St. Paul, MN: Hepatitis B Coalition. 1994. 1 p. Contact: Available from Hepatitis B Coalition. 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 647-9009. PRICE: $1.00. Summary: This fact sheet, designed for physicians, reviews the recommended management of children who are hepatitis B carriers. Recommended actions include a yearly physical; hepatitis B testing every 3 years; liver enzymes, liver function tests, and a complete blood count; referral to a pediatric gastroenterologist; alpha-fetoprotein and ultrasound tests in patients with cirrhosis; testing and vaccination of household members; and hepatitis B education. Contact information for the author, a pediatric hepatitis B specialist at the University of Minnesota, is included.

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Leflunomide Source: Atlanta, GA: Arthritis Foundation. 1998. 6 p. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 300091616. (800) 207-8633. Fax (credit card orders only) (770) 442-9742. Website: www.arthritis.org. PRICE: Single copy free from local Arthritis Foundation chapter (call (800) 283-7800 for closest local chapter); bulk orders may be purchased from address above. Summary: This pamphlet uses a question and answer format to provide people who have arthritis with information on leflunomide. This disease modifying antirheumatic drug helps reduce the signs of inflammation and slow the rate of joint destruction in rheumatoid arthritis (RA). The drug is believed to work by affecting the function of certain immune cells involved in RA and the process of joint damage. Improvement from the drug may occur as soon as 4 weeks after beginning its use. Leflunomide, which is available only by prescription, comes in tablets of 10, 20, and 100 milligrams that are taken once per day. Side effects include skin rash, gastrointestinal symptoms, elevations of liver enzymes, and reversible hair loss. The drug should not be taken by people who have liver disease or known immune deficiency or women or men who are trying to conceive a child. The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site

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located at http://www.guideline.gov/ by using the keyword “liver enzymes” (or synonyms). The following was recently posted: •

(1) Best practice evidence-based guideline for the appropriate prescribing of hormone replacement therapy. (2) Guideline update: hormone replacement therapy Source: Effective Practice Institute, University of Auckland - Academic Institution; 2001 May (revised information released on 2002 September 30); 185 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3107&nbr=2333&a mp;string=liver+AND+enzyme

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(1) Prevention and control of influenza. (2) Update: influenza activity-United States, 2003--04 season Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1984 April (revised 2003 Apr; addendum released 2003 Dec); Original guideline: 36 pages; addendum: 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4428&nbr=3342&a mp;string=liver+AND+enzymes

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(1) Targeted tuberculin testing and treatment of latent tuberculosis infection Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2000 June 9 (addendum released 2003 August 8); 54 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4004&nbr=3134&a mp;string=liver+AND+enzymes

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2001 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1999 August (updated 2001 November 28); 64 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3080&nbr=2306&a mp;string=liver+AND+enzymes

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2002 national guideline on the management of sexually acquired reactive arthritis Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3045&nbr=2271&a mp;string=liver+AND+enzyme

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2002 national guideline on the management of the viral hepatitides A, B, and C Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3454&nbr=2680&a mp;string=liver+AND+enzyme

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2002 national guidelines on the management of early syphilis Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3036&nbr=2262&a mp;string=liver+AND+enzyme

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A guideline for the management of heart failure Source: National Heart Foundation of New Zealand - Disease Specific Society; 1996 (revised 2001 Dec); 30 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3309&nbr=2535&a mp;string=liver+AND+enzyme

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ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Source: American College of Cardiology Foundation - Medical Specialty Society; 2000 (revised online 2002 Mar); 95 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3190&nbr=2416&a mp;string=liver+AND+enzyme

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ACC/AHA guideline update on perioperative cardiovascular evaluation for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperati Source: American College of Cardiology Foundation - Medical Specialty Society; 1996 March 15 (revised 2002); 58 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3149&nbr=2375&a mp;string=liver+AND+enzyme

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ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evalua Source: American College of Cardiology Foundation - Medical Specialty Society; 1995 November 1 (revised 2001 Dec); 56 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3114&nbr=2340&a mp;string=liver+AND+enzymes

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Altered nutritional status Source: American Medical Directors Association - Professional Association; 2001; 32 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3304&nbr=2530&a mp;string=liver+AND+enzymes

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American Gastroenterological Association medical position statement: celiac sprue Source: American Gastroenterological Association - Medical Specialty Society; 2000 November 12 (reviewed 2001); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3058&nbr=2284&a mp;string=liver+AND+enzyme

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American Gastroenterological Association medical position statement: guidelines for the evaluation and management of chronic diarrhea Source: American Gastroenterological Association - Medical Specialty Society; 1998 November 8 (reviewed 2001); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3065&nbr=2291&a mp;string=liver+AND+enzyme

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American Gastroenterological Association medical position statement: nonalcoholic fatty liver disease Source: American Association for the Study of Liver Diseases - Private Nonprofit Research Organization; 2002 November; 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3491&nbr=2717&a mp;string=liver+AND+enzyme

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American Gastroenterological Association medical position statement: short bowel syndrome and intestinal transplantation Source: American Gastroenterological Association - Medical Specialty Society; 2003 April; 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3795&nbr=3021&a mp;string=liver+AND+enzyme

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Appropriate patient preparation for renal replacement therapy Source: Renal Physicians Association - Medical Specialty Society; 2002 October; 78 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3591&nbr=2817&a mp;string=liver+AND+enzyme

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Assessment and management of acute pain Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 2000 October (revised 2002 Oct); 74 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3500&nbr=2726&a mp;string=liver+AND+enzymes

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Chemotherapy and biotherapy: guidelines and recommendations for practice Source: Oncology Nursing Society - Professional Association; 2001; 226 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3209&nbr=2435&a mp;string=liver+AND+enzymes

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Chronic hepatitis B infection Source: Singapore Ministry of Health - National Government Agency [Non-U.S.]; 2003 March; 30 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3749&nbr=2975&a mp;string=liver+AND+enzyme

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Dehydration and fluid maintenance Source: American Medical Directors Association - Professional Association; 2001; 28 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3305&nbr=2531&a mp;string=liver+AND+enzyme

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Diagnosis and management of epilepsy in adults. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2003 April; 49 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3737&nbr=2963&a mp;string=liver+AND+enzymes

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Diagnosis and management of hemochromatosis Source: American Association for the Study of Liver Diseases - Private Nonprofit Research Organization; 2001 May; 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3448&nbr=2674&a mp;string=liver+AND+enzymes

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Diagnosis and treatment of adult degenerative joint disease (DJD) of the knee Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 June (revised 2002 May); 42 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3355&nbr=2581&a mp;string=liver+AND+enzymes

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Diseases characterized by urethritis and cervicitis. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 13 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3236&nbr=2462&a mp;string=liver+AND+enzyme

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Diseases characterized by vaginal discharge. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 7 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3237&nbr=2463&a mp;string=liver+AND+enzymes

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General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP) Source: American Academy of Family Physicians - Medical Specialty Society; 2002 February 8; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3180&nbr=2406&a mp;string=liver+AND+enzyme

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Global initiative for asthma. Global strategy for asthma management and prevention Source: National Heart, Lung, and Blood Institute (U.S.) - Federal Government Agency [U.S.]; 1995 January (revised 2002); 176 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3203&nbr=2429&a mp;string=liver+AND+enzymes

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Guidelines for Alzheimer's disease management. Source: Alzheimer's Association of Los Angeles, Riverside and San Bernardino Counties - Private Nonprofit Organization; 1999 January 8 (revised 2002 Jan 1); 52 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3157&nbr=2383&a mp;string=liver+AND+enzymes

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Guidelines for laboratory testing and result reporting of antibody to hepatitis C virus Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2003 February 7; 14 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3620&nbr=2846&a mp;string=liver+AND+enzyme

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Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients Source: American Society for Blood and Marrow Transplantation - Professional Association; 2000 October 20; 126 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2573&nbr=1799&a mp;string=liver+AND+enzyme

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Hemorrhagic fever viruses as biological weapons: medical and public health management Source: Center for Civilian Biodefense Strategies, School of Medicine, Johns Hopkins University - Academic Institution; 2002 May 8; 15 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3224&nbr=2450&a mp;string=liver+AND+enzyme

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Hepatitis C. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3243&nbr=2469&a mp;string=liver+AND+enzyme

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Hyperglycemic crises in diabetes Source: American Diabetes Association - Professional Association; 2000 October (revised 2001; republished 2004 Jan); 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4694&nbr=3428&a mp;string=liver+AND+enzymes

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Hypertension in older people. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2001 January; 49 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2915&nbr=2141&a mp;string=liver+AND+enzyme

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Laboratory guidelines for screening, diagnosis, and monitoring of hepatic injury Source: American Association for the Study of Liver Diseases - Private Nonprofit Research Organization; 2000; 42 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3520&nbr=2746&a mp;string=liver+AND+enzymes

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Lipids Source: National Committee on Cardiac Care (Singapore) - National Government Agency [Non-U.S.]; 2001 July; 52 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3075&nbr=2301&a mp;string=liver+AND+enzymes

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Liver transplantation Source: American Association for the Study of Liver Diseases - Private Nonprofit Research Organization; 2000 January; 14 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3449&nbr=2675&a mp;string=liver+AND+enzymes

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Management of chronic kidney disease and pre-ESRD in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 2000 November; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3099&nbr=2325&a mp;string=liver+AND+enzymes

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Management of hepatitis C: 2002 Source: National Institutes of Health (NIH) Consensus Development Panel on Management of Hepatitis C - Independent Expert Panel; 1997 March (revised 2002 August 26); 44 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3416&nbr=2642&a mp;string=liver+AND+enzyme

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Management of primary biliary cirrhosis Source: American Association for the Study of Liver Diseases - Private Nonprofit Research Organization; 2000 April; 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3445&nbr=2671&a mp;string=liver+AND+enzyme

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Management of type 2 diabetes mellitus Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 March (revised 2002 Sep); 77 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3499&nbr=2725&a mp;string=liver+AND+enzymes

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Massachusetts guidelines for adult diabetes care Source: Massachusetts Department of Public Health, Bureau of Family and Community Health, Diabetes Control Program - State/Local Government Agency [U.S.]; 1999 June (revised 2001 Jun); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3429&nbr=2655&a mp;string=liver+AND+enzyme

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National High Blood Pressure Education Program: Working Group report on high blood pressure in pregnancy Source: National Heart, Lung, and Blood Institute (U.S.) - Federal Government Agency [U.S.]; 1990 (revised 2000 Jul); 39 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1478&nbr=704&am p;string=liver+AND+enzymes

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Palliative treatment of cancer Source: Finnish Medical Society Duodecim - Professional Association; 2001 December 27 (revised 2003 May 30); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=4374&nbr=3296&a mp;string=liver+AND+enzyme

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Plague as a biological weapon. Medical and public health management Source: Center for Civilian Biodefense Strategies, School of Medicine, Johns Hopkins University - Academic Institution; 2000 October 4; 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2983&nbr=2209&a mp;string=liver+AND+enzyme

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Practice guideline for the treatment of patients with bipolar disorder (revision) Source: American Psychiatric Association - Medical Specialty Society; 1994 December (revised 2002 Apr); 50 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3302&nbr=2528&a mp;string=liver+AND+enzyme

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Practice guideline for the treatment of patients with delirium Source: American Psychiatric Association - Medical Specialty Society; 1999 May; 41 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2180&nbr=1406&a mp;string=liver+AND+enzyme

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Practice guidelines for the management of community-acquired pneumonia in adults Source: Infectious Diseases Society of America - Medical Specialty Society; 2000 February; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2665&nbr=1891&a mp;string=liver+AND+enzyme

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Practice guidelines for the management of infectious diarrhea Source: Infectious Diseases Society of America - Medical Specialty Society; 2001 February; 21 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2791&nbr=2017&a mp;string=liver+AND+enzyme

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Public Health Service Task Force recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1998 January 30 (revised 2003 November 26); 46 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4378&nbr=3300&a mp;string=liver+AND+enzyme

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Recommendations for preventing transmission of infections among chronic hemodialysis patients Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2001 April; 46 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2789&nbr=2015&a mp;string=liver+AND+enzyme

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Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update Source: American College of Rheumatology - Medical Specialty Society; 2000 September; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2935&nbr=2161&a mp;string=liver+AND+enzyme

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Screening for hepatitis C in adults: recommendation statement. Source: United States Preventive Services Task Force - Independent Expert Panel; 2004 March 16; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4581&nbr=3371&a mp;string=liver+AND+enzyme

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Sexual assault and STDs. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3246&nbr=2472&a mp;string=liver+AND+enzyme

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The diagnosis and management of urticaria: a practice parameter part I: acute urticaria/angioedema part II: chronic urticaria/angioedema Source: American Academy of Allergy, Asthma and Immunology - Medical Specialty Society; 2000 December; 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3622&nbr=2848&a mp;string=liver+AND+enzyme

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The diagnosis and treatment of adult asthma Source: New Zealand Guidelines Group - Private Nonprofit Organization; 2002 September; 101 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3462&nbr=2688&a mp;string=liver+AND+enzyme

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The management of diabetes mellitus in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 December; 147 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2583&nbr=1809&a mp;string=liver+AND+enzymes

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Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Source: National Cholesterol Education Program - Federal Government Agency [U.S.]; 1993 September (updated 2001); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2969&nbr=2195&a mp;string=liver+AND+enzymes

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Tularemia as a biological weapon. Medical and public health management Source: Center for Civilian Biodefense Strategies, School of Medicine, Johns Hopkins University - Academic Institution; 2001 June 6; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2981&nbr=2207&a mp;string=liver+AND+enzyme

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Venous thromboembolism Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1998 June (revised 2003 Apr); 93 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3757&nbr=2983&a mp;string=liver+AND+enzyme The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to liver 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

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

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

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

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

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

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to liver enzymes. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with 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 liver enzymes. For more information, see

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the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “liver 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 your search to “Organizations” and “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 “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 “liver enzymes” (or a synonym) into the search box, and click “Submit Query.”

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

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

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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/

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

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

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

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

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

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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

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

•

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

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

•

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/

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

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

•

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

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•

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

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

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

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

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

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

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

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

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

•

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

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

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

•

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

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

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

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

•

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/

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

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

•

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

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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

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

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

•

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

105

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

•

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

•

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

•

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

107

LIVER ENZYMES DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal fat: Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] 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] Acetone: A colorless liquid used as a solvent and an antiseptic. It is one of the ketone bodies produced during ketoacidosis. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Actin: Essential component of the cell skeleton. [NIH] Acute myelogenous leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myeloid leukemia or acute nonlymphocytic leukemia. [NIH] Acute myeloid leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myelogenous leukemia or acute nonlymphocytic leukemia. [NIH] Acute nonlymphocytic leukemia: A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myeloid leukemia or acute myelogenous leukemia. [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] 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,

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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] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, oxidative metabolism, or cell respiration. [NIH] Aerobic Respiration: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as oxidative metabolism, cell respiration, or aerobic metabolism. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [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] Aldehyde Dehydrogenase: An enzyme that oxidizes an aldehyde in the presence of NAD+ and water to an acid and NADH. EC 1.2.1.3. Before 1978, it was classified as EC 1.1.1.70. [NIH]

Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH]

Dictionary 109

Alkaline: Having the reactions of an alkali. [EU] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alpha-fetoprotein: AFP. A protein normally produced by a developing fetus. AFP levels are usually undetectable in the blood of healthy nonpregnant adults. An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] 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] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses.

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[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] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angioedema: A vascular reaction involving the deep dermis or subcutaneous or submucal tissues, representing localized edema caused by dilatation and increased permeability of the capillaries, and characterized by development of giant wheals. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anthropometric measurements: Measurements of human body height, weight, and size of component parts, including skinfold measurement. Used to study and compare the relative proportions under normal and abnormal conditions. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU]

Dictionary 111

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] 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] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antituberculosis: Refers to a drug used to treat tuberculosis. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apolipoproteins A: Lipoproteins found in human blood serum in the high-density and very-high-density lipoprotein fraction (HDL, VHDL). They consist of several different polypeptides, the most important of which are apolipoprotein A-I and A-II. They maintain the structural integrity of the HDL particles and are activators of lecithin:cholesterol acyltransferase (LCAT). Atherosclerotic patients show low apolipoprotein A levels and these

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apolipoproteins are either absent or present in extremely low plasma concentration in Tangier disease. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteritis: Inflammation of an artery. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Aspartate: A synthetic amino acid. [NIH] Aspergillosis: Infections with fungi of the genus Aspergillus. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH] Autoantigens: Endogenous tissue constituents that have the ability to interact with autoantibodies and cause an immune response. [NIH] 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] Autoimmune Hepatitis: A liver disease caused when the body's immune system destroys liver cells for no known reason. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Bacillus: A genus of Bacillaceae that are spore-forming, rod-shaped cells. Most species are saprophytic soil forms with only a few species being pathogenic. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls,

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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] 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] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Beta carotene: A vitamin A precursor. Beta carotene belongs to the family of fat-soluble vitamins called carotenoids. [NIH] Bezafibrate: Antilipemic agent that lowers cholesterol and triglycerides. It decreases low density lipoproteins and increases high density lipoproteins. [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] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving

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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] Biopterin: A natural product that has been considered as a growth factor for some insects. [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] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [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] Blastomycosis: A fungal infection that may appear in two forms: 1) a primary lesion characterized by the formation of a small cutaneous nodule and small nodules along the lymphatics that may heal within several months; and 2) chronic granulomatous lesions characterized by thick crusts, warty growths, and unusual vascularity and infection in the middle or upper lobes of the lung. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [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] 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] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH]

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Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [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] Butyric Acid: A four carbon acid, CH3CH2CH2COOH, with an unpleasant odor that occurs in butter and animal fat as the glycerol ester. [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] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH]

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Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carotenoids: Substance found in yellow and orange fruits and vegetables and in dark green, leafy vegetables. May reduce the risk of developing cancer. [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] Caspase: Enzyme released by the cell at a crucial stage in apoptosis in order to shred all cellular proteins. [NIH] Catalyse: To speed up a chemical reaction. [EU] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] 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 Adhesion: Adherence of cells to surfaces or to other cells. [NIH] 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 Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] 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] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [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

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infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chenodeoxycholic Acid: A bile acid, usually conjugated with either glycine or taurine. It acts as a detergent to solubilize fats for intestinal absorption and is reabsorbed by the small intestine. It is used as cholagogue, a choleretic laxative, and to prevent or dissolve gallstones. [NIH] Chickenpox: A mild, highly contagious virus characterized by itchy blisters all over the body. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorfenvinphos: An organophosphorus cholinesterase inhibitor that is used as an insecticide and an acaricide. [NIH] Chloroquine: The prototypical antimalarial agent with a mechanism that is not well understood. It has also been used to treat rheumatoid arthritis, systemic lupus erythematosus, and in the systemic therapy of amebic liver abscesses. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Choledocholithiasis: Gallstones in the bile ducts. [NIH] Choleretic: A choleretic agent. [EU] 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] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [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 Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [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] Clitoral: Pertaining to the clitoris. [EU] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a

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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] Coal: A natural fuel formed by partial decomposition of vegetable matter under certain environmental conditions. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] 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] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Coke: A residue of coal, left after dry (destructive) distillation, used as a fuel. [NIH] Colchicine: A major alkaloid from Colchicum autumnale L. and found also in other Colchicum species. Its primary therapeutic use is in the treatment of gout, but it has been used also in the therapy of familial Mediterranean fever (periodic disease). [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Combination chemotherapy: Treatment using more than one anticancer drug. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH]

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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] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH]

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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] Conjugation: 1. The act of joining together or the state of being conjugated. 2. A sexual process seen in bacteria, ciliate protozoa, and certain fungi in which nuclear material is exchanged during the temporary fusion of two cells (conjugants). In bacterial genetics a form of sexual reproduction in which a donor bacterium (male) contributes some, or all, of its DNA (in the form of a replicated set) to a recipient (female) which then incorporates differing genetic information into its own chromosome by recombination and passes the recombined set on to its progeny by replication. In ciliate protozoa, two conjugants of separate mating types exchange micronuclear material and then separate, each now being a fertilized cell. In certain fungi, the process involves fusion of two gametes, resulting in union of their nuclei and formation of a zygote. 3. In chemistry, the joining together of two compounds to produce another compound, such as the combination of a toxic product with some substance in the body to form a detoxified product, which is then eliminated. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [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] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Consumption: Pulmonary tuberculosis. [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] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [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] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a

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myocardial infarction. [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] Coumarins: Synthetic or naturally occurring substances related to coumarin, the deltalactone of coumarinic acid. Coumarin itself occurs in the tonka bean. The various coumarins have a wide range of proposed actions and uses including as anticoagulants, pharmaceutical aids, indicators and reagents, photoreactive substances, and antineoplastic agents. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] De novo: In cancer, the first occurrence of cancer in the body. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea,

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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] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] 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] Diabetic Ketoacidosis: Complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration. The metabolic acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids. Glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis). [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [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]

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Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Dioxins: Chlorinated hydrocarbons containing heteroatoms that are present as contaminants of herbicides. Dioxins are carcinogenic, teratogenic, and mutagenic. They have been banned from use by the FDA. [NIH] Diphtheria: A localized infection of mucous membranes or skin caused by toxigenic strains of Corynebacterium diphtheriae. It is characterized by the presence of a pseudomembrane at the site of infection. Diphtheria toxin, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. [NIH] Diphtheria Toxin: A 60 kD single chain protein elaborated by Corynebacterium diphtheriae that causes the sign and symptoms of diphtheria; it can be broken into two unequal fragments, the smaller (A fragment) inhibits protein synthesis and is the lethal moiety that needs the larger (B fragment) for entry into cells. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] 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] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU]

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Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Design: The molecular designing of drugs for specific purposes (such as DNAbinding, enzyme inhibition, anti-cancer efficacy, etc.) based on knowledge of molecular properties such as activity of functional groups, molecular geometry, and electronic structure, and also on information cataloged on analogous molecules. Drug design is generally computer-assisted molecular modeling and does not include pharmacokinetics, dosage analysis, or drug administration analysis. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [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] 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]

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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] Enanthate: An oily injectable contraceptive given every 8 weeks. [NIH] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalitis, Viral: Inflammation of brain parenchymal tissue as a result of viral infection. Encephalitis may occur as primary or secondary manifestation of Togaviridae infections; Herpesviridae infections; Adenoviridae infections; Flaviviridae infections; Bunyaviridae infections; Picornaviridae infections; Paramyxoviridae infections; Orthomyxoviridae infections; Retroviridae infections; and Arenaviridae infections. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopic retrograde cholangiopancreatography: ERCP. A procedure to x-ray the pancreatic duct, hepatic duct, common bile duct, duodenal papilla, and gallbladder. In this procedure, a thin, lighted tube (endoscope) is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and an x-ray is taken. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxemia: A condition characterized by the presence of endotoxins in the blood. If endotoxemia is the result of gram-negative rod-shaped bacteria, shock may occur. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] 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] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH]

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Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] 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] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] ERV: The expiratory reserve volume is the largest volume of gas that can be expired from the end-expiratory level. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [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] Ethionine: 2-Amino-4-(ethylthio)butyric acid. An antimetabolite and methionine antagonist that interferes with amino acid incorporation into proteins and with cellular ATP utilization. It also produces liver neoplasms. [NIH] Evacuation: An emptying, as of the bowels. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU]

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Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Expiratory Reserve Volume: The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common abbreviation is ERV. [NIH] Extracellular: Outside a cell or cells. [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] Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty 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] Febrile: Pertaining to or characterized by fever. [EU] 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] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetoprotein: Transabdominal aspiration of fluid from the amniotic sac with a view to detecting increases of alpha-fetoprotein in maternal blood during pregnancy, as this is an important indicator of open neural tube defects in the fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] 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] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH]

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Foetoplacental: Pertaining to the fetus and placenta. [EU] 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] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungicide: An agent that destroys fungi. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [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] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [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] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] 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]

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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] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] 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] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH]

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Gonadal: Pertaining to a gonad. [EU] 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 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] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Granulocyte: A type of white blood cell that fights bacterial infection. Neutrophils, eosinophils, and basophils are granulocytes. [NIH] Granulosa Cells: Cells of the membrana granulosa lining the vesicular ovarian follicle which become luteal cells after ovulation. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [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] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemochromatosis: A disease that occurs when the body absorbs too much iron. The body stores the excess iron in the liver, pancreas, and other organs. May cause cirrhosis of the liver. Also called iron overload disease. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid.

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The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [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] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatic Artery: A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum. [NIH] Hepatic Duct, Common: Predominantly extrahepatic bile duct which is formed by the junction of the right and left hepatic ducts, which are predominantly intrahepatic, and, in turn, joins the cystic duct to form the common bile duct. [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] Hepatology: The field of medicine concerned with the functions and disorders of the liver. [NIH]

Hepatoma: A liver tumor. [NIH] Hepatomegaly: Enlargement of the liver. [NIH] Hepatotoxicity: How much damage a medicine or other substance does to the liver. [NIH] Hepatovirus: A genus of Picornaviridae causing infectious hepatitis naturally in humans and experimentally in other primates. It is transmitted through fecal contamination of food or water. [NIH]

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Herbicide: A chemical that kills plants. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Heterogenic: Derived from a different source or species. Also called heterogenous. [NIH] Heterogenous: Derived from a different source or species. Also called heterogenic. [NIH] Heterozygote: An individual having different alleles at one or more loci in homologous chromosome segments. [NIH] Hexachlorobenzene: An agricultural fungicide and seed treatment agent. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] 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] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Host: Any animal that receives a transplanted graft. [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] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU] 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]

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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] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [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 Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [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

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH]

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Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [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]

Infectious Diarrhea: Diarrhea caused by infection from bacteria, viruses, or parasites. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [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]

Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH]

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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] Insecticides: Pesticides designed to control insects that are harmful to man. The insects may be directly harmful, as those acting as disease vectors, or indirectly harmful, as destroyers of crops, food products, or textile fabrics. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-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] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] 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] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] 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] Intramuscular: IM. Within or into muscle. [NIH] Intramuscular injection: IM. Injection into a muscle. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH]

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Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

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

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Islet: Cell producing insulin in pancreas. [NIH] Isoenzymes: One of various structurally related forms of an enzyme, each having the same mechanism but with differing chemical, physical, or immunological characteristics. [NIH] Isozymes: The multiple forms of a single enzyme. [NIH] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [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] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and lipid A. [NIH] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketonuria: Having ketone bodies in the urine; a warning sign of diabetic ketoacidosis (DKA). [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the

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cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactation: The period of the secretion of milk. [EU] Lactulose: A mild laxative. [NIH] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] 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] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Leflunomide: An anticancer drug that works by inhibiting a cancer cell growth factor. Also called SU101. [NIH] Lethal: Deadly, fatal. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [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] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU]

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Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [NIH]

Liver Cirrhosis: Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. [NIH] Liver metastases: Cancer that has spread from the original (primary) tumor to the liver. [NIH]

Liver Neoplasms: Tumors or cancer of the liver. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [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] 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] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [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]

Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [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] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphokines: Soluble protein factors generated by activated lymphocytes that affect other cells, primarily those involved in cellular immunity. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Macrophage Activation: The process of altering the morphology and functional activity of macrophages so that they become avidly phagocytic. It is initiated by lymphokines, such as the macrophage activation factor (MAF) and the macrophage migration-inhibitory factor

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(MMIF), immune complexes, C3b, and various peptides, polysaccharides, and immunologic adjuvants. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH] 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] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Manic: Affected with mania. [EU] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] 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] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Methanol: A colorless, flammable liquid used in the manufacture of formaldehyde and acetic acid, in chemical synthesis, antifreeze, and as a solvent. Ingestion of methanol is toxic and may cause blindness. [NIH]

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Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Methylprednisolone: (6 alpha,11 beta)-11,17,21-Trihydroxy-6-methylpregna-1,4-diene-3,2dione. A prednisolone derivative which has pharmacological actions similar to prednisolone. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] 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] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [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] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH]

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Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] 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] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Mutagenic: Inducing genetic mutation. [EU] Mutagenicity: Ability to damage DNA, the genetic material; the power to cause mutations. [NIH]

Myalgia: Pain in a muscle or muscles. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocarditis: Inflammation of the myocardium; inflammation of the muscular walls of the heart. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myoglobin: A conjugated protein which is the oxygen-transporting pigment of muscle. It is made up of one globin polypeptide chain and one heme group. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit.

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Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neopterin: A pteridine derivative present in body fluids; elevated levels result from immune system activation, malignant disease, allograft rejection, and viral infections. (From Stedman, 26th ed) Neopterin also serves as a precursor in the biosynthesis of biopterin. [NIH] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophil: A type of white blood cell. [NIH] Nidation: Implantation of the conceptus in the endometrium. [EU] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH]

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Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [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] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Oestradiol: Growth hormone. [NIH] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]

Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

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Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidants: Oxidizing agents or electron-accepting molecules in chemical reactions in which electrons are transferred from one molecule to another (oxidation-reduction). In vivo, it appears that phagocyte-generated oxidants function as tumor promoters or cocarcinogens rather than as complete carcinogens perhaps because of the high levels of endogenous antioxidant defenses. It is also thought that oxidative damage in joints may trigger the autoimmune response that characterizes the persistence of the rheumatoid disease process. [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]

Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] 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] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU]

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Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Ducts: Ducts that collect pancreatic juice from the pancreas and supply it to the duodenum. [NIH] 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] Papilla: A small nipple-shaped elevation. [NIH] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

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

Peak Expiratory Flow Rate: Measurement of the maximum rate of airflow attained during a forced vital capacity determination. Common abbreviations are PEFR and PFR. [NIH] Pediatric Gastroenterologist: A doctor who treats children with digestive diseases. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

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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] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] 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] Phagocyte: An immune system cell that can surround and kill microorganisms and remove dead cells. Phagocytes include macrophages. [NIH] Phagocytosis: The engulfing of microorganisms, other cells, and foreign particles by phagocytic cells. [NIH] Pharmacokinetics: Dynamic and kinetic mechanisms of exogenous chemical and drug absorption, biotransformation, distribution, release, transport, uptake, and elimination as a function of dosage, and extent and rate of metabolic processes. It includes toxicokinetics, the pharmacokinetic mechanism of the toxic effects of a substance. [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] Phlebotomy: The letting of blood from a vein. Although it is one of the techniques used in drawing blood to be used in diagnostic procedures, in modern medicine, it is used commonly in the treatment of erythrocytosis, hemochromocytosis, polycythemia vera, and porphyria cutanea tarda. Its historical counterpart is bloodletting. (From Cecil Textbook of Medicine, 19th ed & Wintrobe's Clinical Hematology, 9th ed) Venipuncture is not only for the letting of blood from a vein but also for the injecting of a drug into the vein for diagnostic analysis. [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] Photoallergy: Sensitization of the skin to light usually due to the action of certain substances or drugs, may occur shortly after exposure to a substance or after a latent period of from days to months. [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] Photosensitivity: An abnormal cutaneous response involving the interaction between

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photosensitizing substances and sunlight or filtered or artificial light at wavelengths of 280400 mm. There are two main types : photoallergy and photoxicity. [EU] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [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] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [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 Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [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] Polyneuritis: Inflammation of several peripheral nerves at the same time. [NIH]

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Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polytherapy: A therapy which uses more than one drug. [EU] Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Porphyria Cutanea Tarda: A form of hepatic porphyria (porphyria, hepatic) characterized by photosensitivity resulting in bullae that rupture easily to form shallow ulcers. This condition occurs in two forms: a sporadic, nonfamilial form that begins in middle age and has normal amounts of uroporphyrinogen decarboxylase with diminished activity in the liver; and a familial form in which there is an autosomal dominant inherited deficiency of uroporphyrinogen decarboxylase in the liver and red blood cells. [NIH] Porphyria, Hepatic: Porphyria in which the liver is the site where excess formation of porphyrin or its precursors is found. Acute intermittent porphyria and porphyria cutanea tarda are types of hepatic porphyria. [NIH] Porphyrins: A group of compounds containing the porphin structure, four pyrrole rings connected by methine bridges in a cyclic configuration to which a variety of side chains are attached. The nature of the side chain is indicated by a prefix, as uroporphyrin, hematoporphyrin, etc. The porphyrins, in combination with iron, form the heme component in biologically significant compounds such as hemoglobin and myoglobin. [NIH] Portal Hypertension: High blood pressure in the portal vein. This vein carries blood into the liver. Portal hypertension is caused by a blood clot. This is a common complication of cirrhosis. [NIH] 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] Postnatal: Occurring after birth, with reference to the newborn. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which

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another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predictive factor: A situation or condition that may increase a person's risk of developing a certain disease or disorder. [NIH] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] 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] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prophylaxis: An attempt to prevent disease. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH]

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Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein 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 promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Prothrombin Time: Measurement of clotting time of plasma recalcified in the presence of excess tissue thromboplastin. Factors measured are fibrinogen, prothrombin, and factors V, VII, and X. It is used for monitoring anticoagulant therapy with coumarins. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] 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]

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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] Pyridoxal: 3-Hydroxy-5-(hydroxymethyl)-2-methyl-4- pyridinecarboxaldehyde. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [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] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] 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] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] 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] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial

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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] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] 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] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [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] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribavirin: 1-beta-D-Ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the

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retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risperidone: A selective blocker of dopamine D2 and serotonin-5-HT-2 receptors that acts as an atypical antipsychotic agent. It has been shown to improve both positive and negative symptoms in the treatment of schizophrenia. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rosiglitazone: A drug taken to help reduce the amount of sugar in the blood. Rosiglitazone helps make insulin more effective and improves regulation of blood sugar. It belongs to the family of drugs called thiazolidinediones. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Sebum: The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. [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] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Sedimentation: The act of causing the deposit of sediment, especially by the use of a centrifugal machine. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH]

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Seminiferous tubule: Tube used to transport sperm made in the testes. [NIH] Seminoma: A type of cancer of the testicles. [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] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Short Bowel Syndrome: A malabsorption syndrome resulting from extensive operative resection of small bowel. [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] Siderosis: The deposition of iron in a tissue. In the eye, the iron may be deposited in the stroma adjacent to the Descemet's membrane. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin test: A test for an immune response to a compound by placing it on or under the skin. [NIH]

Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

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Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Channels: Cell membrane glycoproteins selective for sodium ions. Fast sodium current is associated with the action potential in neural membranes. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [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] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] 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] Sperm: The fecundating fluid of the male. [NIH] 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] Spirochete: Lyme disease. [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] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sprue: A non febrile tropical disease of uncertain origin. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Steatosis: Fatty degeneration. [EU]

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Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] 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] Stool: The waste matter discharged in a bowel movement; feces. [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] Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] 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] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [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] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Symphysis: A secondary cartilaginous joint. [NIH]

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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] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

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] Systemic therapy: Treatment that uses substances that travel through the bloodstream, reaching and affecting cells all over the body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH]

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Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thromboplastin: Constituent composed of protein and phospholipid that is widely distributed in many tissues. It serves as a cofactor with factor VIIa to activate factor X in the extrinsic pathway of blood coagulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroid Hormones: Hormones secreted by the thyroid gland. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tic: An involuntary compulsive, repetitive, stereotyped movement, resembling a purposeful movement because it is coordinated and involves muscles in their normal synergistic relationships; tics usually involve the face and shoulders. [EU] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] 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] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher

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plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transaminase: Aminotransferase (= a subclass of enzymes of the transferase class that catalyse the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally 2-keto acid). Most of these enzymes are pyridoxal-phosphate-proteins. [EU]

Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [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] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Failure: A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Tubercle: A rounded elevation on a bone or other structure. [NIH] Tuberculin: A sterile liquid containing the growth products of, or specific substances extracted from, the tubercle bacillus; used in various forms in the diagnosis of tuberculosis. [NIH]

Tuberculin Test: One of several skin tests to determine past or present tuberculosis

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infection. A purified protein derivative of the tubercle bacilli, called tuberculin, is introduced into the skin by scratch, puncture, or interdermal injection. [NIH] Tubulin: A microtubule subunit protein found in large quantities in mammalian brain. It has also been isolated from sperm flagella, cilia, and other sources. Structurally, the protein is a dimer with a molecular weight of approximately 120,000 and a sedimentation coefficient of 5.8S. It binds to colchicine, vincristine, and vinblastine. [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] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Ultrasound test: A test that bounces sound waves off tissues and internal organs and changes the echoes into pictures (sonograms). [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [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] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urethritis: Inflammation of the urethra. [EU] 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] Uroporphyrinogen Decarboxylase: One of the enzymes active in heme biosynthesis. It catalyzes the decarboxylation of uroporphyrinogen III to coproporphyrinogen III by the conversion of four acetic acid groups to four methyl groups. EC 4.1.1.37. [NIH] Ursodeoxycholic Acid: An epimer of chenodeoxycholic acid. It is a mammalian bile acid found first in the bear and is apparently either a precursor or a product of

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chenodeoxycholate. Its administration changes the composition of bile and may dissolve gallstones. It is used as a cholagogue and choleretic. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [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] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginal Discharge: A common gynecologic disorder characterized by an abnormal, nonbloody discharge from the genital tract. [NIH] Valproic Acid: A fatty acid with anticonvulsant properties used in the treatment of epilepsy. The mechanisms of its therapeutic actions are not well understood. It may act by increasing GABA levels in the brain or by altering the properties of voltage dependent sodium channels. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilators: Any nerve or agent which induces dilatation of the blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] 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] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [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] Vinblastine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. It is a mitotic inhibitor. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] 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]

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Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] 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] Vital Capacity: The volume of air that is exhaled by a maximal expiration following a maximal inspiration. [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] Vocal cord: The vocal folds of the larynx. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Weight Gain: Increase in body weight over existing weight. [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]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenobiotics: Chemical substances that are foreign to the biological system. They include naturally occurring compounds, drugs, environmental agents, carcinogens, insecticides, etc. [NIH]

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

Dictionary 163

165

INDEX A Abdomen, 17, 107, 114, 115, 126, 133, 135, 138, 143, 145, 146, 156, 157 Abdominal, 10, 12, 20, 40, 45, 62, 65, 70, 107, 116, 139, 145, 146, 152, 162 Abdominal fat, 107, 162 Abdominal Pain, 10, 62, 107, 139 Abortion, 107, 143, 149 Acceptor, 107, 137, 144, 159 Acetone, 107, 136 Acetylcholine, 107, 142 Acne, 17, 107 Actin, 6, 12, 107, 141 Acute myeloid leukemia, 7, 107 Acute renal, 21, 27, 107, 131 Adenocarcinoma, 107, 131 Adipose Tissue, 11, 107, 145 Adrenal Cortex, 107, 121, 126, 143, 149 Adrenergic, 22, 108, 111, 123, 126 Adverse Effect, 17, 63, 108, 154 Aerobic, 108, 144 Aerobic Metabolism, 108, 144 Aerobic Respiration, 108, 144 Affinity, 15, 108, 155 Age of Onset, 108, 160 Agonist, 108, 123, 141 Airway, 108, 154 Alanine, 4, 108 Albumin, 50, 63, 66, 108, 147 Aldehyde Dehydrogenase, 22, 108 Algorithms, 108, 114 Alkaline, 4, 66, 109, 115 Alkaline Phosphatase, 4, 66, 109 Alkaloid, 109, 118, 141 Alleles, 62, 109, 132 Allograft, 109, 142 Alpha-fetoprotein, 63, 85, 109, 127 Alternative medicine, 55, 57, 70, 109 Amino acid, 12, 108, 109, 110, 112, 126, 128, 129, 140, 145, 150, 154, 156, 158, 159, 160 Amino Acid Sequence, 109, 110 Ammonia, 33, 109 Amphetamines, 109, 118 Ampulla, 109, 117, 125 Anabolic, 23, 109, 123, 126 Anaesthesia, 40, 44, 49, 109, 134 Anal, 10, 109

Analgesic, 49, 109, 141, 143 Analog, 109, 137 Analogous, 109, 124, 159 Analytes, 24, 109 Anaphylatoxins, 110, 119 Anastomosis, 110, 128 Androgens, 17, 108, 110, 121 Anemia, 83, 110, 128, 130 Anesthesia, 41, 108, 110 Angina, 87, 110 Angioedema, 95, 110 Anions, 108, 110, 136, 154 Anorexia, 62, 109, 110, 160 Anthropometric measurements, 24, 110 Antibacterial, 110, 155 Antibiotic, 110, 155 Antibodies, 7, 18, 62, 63, 110, 112, 130, 131, 132, 133, 138, 147 Antibody, 8, 9, 13, 18, 36, 48, 90, 108, 110, 111, 119, 130, 132, 133, 134, 141, 155 Anticoagulant, 110, 150 Anticonvulsant, 110, 161 Antifungal, 110, 136 Antigen, 12, 108, 110, 111, 119, 132, 133, 134 Antigen-Antibody Complex, 111, 119 Anti-inflammatory, 111, 112, 121, 122, 129, 153 Anti-Inflammatory Agents, 111, 112, 121 Antimetabolite, 111, 126, 140, 152 Antineoplastic, 111, 121, 140 Antioxidant, 45, 55, 111, 144 Antipsychotic, 111, 153 Antituberculosis, 29, 111 Antiviral, 13, 16, 111, 135, 152 Anus, 109, 111, 115, 118 Apnea, 17, 111 Apolipoproteins, 17, 111, 137 Apolipoproteins A, 17, 111 Apoptosis, 112, 116 Arginine, 6, 110, 112, 142 Arterial, 12, 23, 112, 116, 117, 133, 150, 157 Arteries, 112, 114, 116, 120, 138, 140, 141 Arterioles, 112, 114, 115, 140 Arteritis, 31, 112 Artery, 52, 69, 112, 120, 124, 151, 152, 156 Articular, 112, 144 Aspartate, 4, 112

166

Liver enzymes

Aspergillosis, 112, 136 Aspiration, 112, 127 Aspirin, 83, 112 Assay, 63, 112 Asymptomatic, 3, 4, 13, 31, 33, 47, 48, 112, 145 Atypical, 22, 37, 46, 112, 153 Autoantibodies, 62, 112 Autoantigens, 112 Autodigestion, 112, 145 Autoimmune disease, 62, 112, 147 Autoimmune Hepatitis, 62, 112 Autoimmunity, 11, 112 B Bacillus, 112, 159 Bacteria, 110, 111, 112, 113, 120, 124, 125, 127, 130, 131, 134, 140, 155, 159, 161 Bactericidal, 113, 126 Bacterium, 113, 120, 131 Bacteriuria, 113, 160 Base, 113, 122, 136, 160 Basement Membrane, 4, 113, 137 Basophils, 113, 130, 137 Benign, 10, 113, 130, 142 Beta carotene, 65, 113 Bezafibrate, 19, 113 Bilateral, 66, 113 Bile, 23, 30, 113, 117, 125, 128, 131, 136, 138, 149, 156, 157, 160 Bile Acids, 30, 113, 128, 156, 157 Bile Acids and Salts, 113 Bile duct, 23, 113, 117, 125, 128, 131, 149 Bile Pigments, 113, 136 Biliary, 4, 64, 92, 113, 117, 145 Biliary Tract, 4, 113, 145 Bilirubin, 23, 24, 63, 66, 83, 108, 113, 128, 132 Bioavailability, 15, 113 Biochemical, 12, 13, 14, 16, 28, 109, 111, 113, 144, 154 Biological response modifier, 114, 135 Biopsy, 4, 10, 11, 16, 39, 40, 62, 63, 83, 85, 114, 145 Biopterin, 114, 142 Biotechnology, 18, 70, 77, 114 Bipolar Disorder, 93, 114 Bladder, 114, 119, 142, 149, 150, 152, 160 Blastocyst, 114, 120, 125, 147 Blastomycosis, 114, 136 Bloating, 65, 114, 139 Blood Cell Count, 114, 130 Blood Platelets, 114, 154, 158

Blood pressure, 4, 12, 43, 64, 65, 68, 84, 93, 114, 133, 140, 148, 155 Blood transfusion, 47, 114 Blood vessel, 114, 115, 116, 117, 125, 129, 131, 136, 138, 145, 146, 152, 154, 155, 158, 161 Body Fluids, 114, 124, 142, 155 Body Mass Index, 114, 144 Bone Marrow, 65, 107, 114, 133, 138, 141 Bone scan, 115, 153 Bowel, 65, 88, 109, 115, 122, 134, 135, 137, 142, 146, 154, 156 Bowel Movement, 115, 122, 156 Bradykinin, 115, 142, 147 Branch, 12, 103, 115, 131, 145, 150, 155, 156, 157 Breakdown, 6, 115, 122, 128 Bronchi, 115, 126, 159 Bronchial, 23, 68, 115 Bronchiectasis, 68, 115 Bronchitis, 68, 115, 117 Butyric Acid, 115, 126 C Calcium, 115, 119, 150 Capillary, 18, 115, 161 Carbohydrate, 14, 29, 115, 121, 148 Carcinogenic, 115, 123, 135, 156 Carcinogens, 42, 115, 144, 162 Carcinoma, 68, 84, 115 Cardiac, 92, 115, 121, 126, 141, 156 Cardiomyopathy, 37, 115 Cardiopulmonary, 23, 115 Cardiovascular, 17, 29, 87, 116, 154 Carotene, 65, 113, 116 Carotenoids, 113, 116 Case report, 30, 36, 39, 52, 66, 116 Caspase, 33, 116 Catalyse, 116, 159 Catheter, 116, 125 Caudal, 116, 122, 133, 148 Causal, 9, 116, 131 Celiac Artery, 116, 131 Celiac Disease, 22, 116 Cell, 11, 18, 35, 91, 107, 108, 109, 110, 112, 114, 116, 117, 119, 120, 121, 125, 127, 129, 130, 131, 132, 133, 135, 136, 137, 141, 142, 144, 146, 147, 151, 152, 155, 159, 160, 162 Cell Adhesion, 18, 116 Cell membrane, 116, 130, 146, 155 Cell Respiration, 108, 116, 144, 152

167

Central Nervous System, 107, 108, 109, 116, 118, 128, 130, 141, 154 Centrifugation, 116, 130, 140 Cerebellar, 19, 116 Cerebellum, 116 Cerebral, 116, 120, 121, 122, 126, 150, 156, 157 Cesarean Section, 45, 116 Character, 116, 122, 129 Chemotactic Factors, 116, 119 Chemotherapy, 7, 21, 29, 89, 117 Chenodeoxycholic Acid, 117, 160 Chickenpox, 82, 117 Chin, 117, 139 Chlorfenvinphos, 27, 117 Chloroquine, 65, 117 Cholecystectomy, 23, 40, 49, 117 Choledocholithiasis, 25, 51, 117 Choleretic, 117, 161 Cholestasis, 64, 68, 84, 117 Cholesterol, 12, 18, 45, 51, 56, 95, 111, 113, 117, 124, 128, 133, 137, 138, 156 Cholesterol Esters, 117, 137 Chromosome, 117, 120, 132 Chronic Disease, 61, 63, 83, 117 Chronic Obstructive Pulmonary Disease, 68, 117 Chylomicrons, 117, 137 Cirrhosis, 6, 8, 10, 62, 63, 68, 82, 83, 84, 85, 92, 117, 130, 148, 149 Clinical trial, 5, 7, 16, 32, 33, 77, 117, 120, 123, 124, 151 Clitoral, 17, 117 Cloning, 61, 114, 117 Coagulation, 26, 28, 38, 114, 115, 117, 147, 158 Coal, 118 Coca, 118 Cocaine, 7, 118 Coenzyme, 21, 118 Cofactor, 6, 118, 150, 158 Coke, 32, 118 Colchicine, 118, 160 Colitis, 118, 134 Collagen, 109, 113, 118, 127, 147 Collapse, 115, 118, 154 Colloidal, 108, 118, 154 Colon, 118, 134 Combination chemotherapy, 7, 118 Combination Therapy, 16, 118 Comorbidity, 5, 118

Complement, 26, 32, 110, 119, 129, 130, 147 Complementary and alternative medicine, 55, 57, 119 Complementary medicine, 55, 119 Complete remission, 119, 152 Compliance, 7, 14, 16, 119 Computational Biology, 77, 119 Computed tomography, 27, 63, 119, 153 Computerized tomography, 119 Conception, 64, 107, 120, 127, 149 Concomitant, 10, 120 Conjugated, 113, 117, 120, 121, 141 Conjugation, 11, 120 Conjunctiva, 120, 134 Connective Tissue, 114, 118, 120, 122, 127, 128, 152, 157 Consciousness, 109, 120, 122, 123 Constipation, 65, 111, 120 Constriction, 120, 136 Consumption, 5, 51, 52, 120, 143, 152 Contamination, 120, 131 Contraindications, ii, 120 Control group, 120, 149 Controlled study, 12, 120 Conventional therapy, 120 Conventional treatment, 63, 120 Convulsions, 110, 120, 124, 133, 149 Coronary, 120, 140, 141 Coronary Thrombosis, 120, 140, 141 Cortex, 121 Cortical, 35, 66, 121, 153 Cortical Blindness, 35, 121 Corticosteroid, 38, 41, 121, 149 Cortisol, 108, 121 Cortisone, 121, 122 Coumarins, 121, 150 Cranial, 116, 121, 130, 135 Curative, 121, 157 Cutaneous, 114, 121, 138, 146 Cyclic, 121, 130, 142, 148 Cytochrome, 27, 28, 121 Cytokine, 8, 18, 121 D De novo, 11, 20, 121 Decompensation, 85, 121 Degenerative, 89, 122, 131, 144 Delirium, 82, 93, 111, 122 Density, 51, 111, 113, 114, 116, 122, 124, 137, 143, 155 Dermis, 110, 122, 159 Detoxification, 27, 37, 122

168

Liver enzymes

Deuterium, 17, 122, 132 Dexamethasone, 20, 24, 27, 122 Diabetes Insipidus, 122, 147 Diabetes Mellitus, 8, 9, 92, 95, 122, 129, 131, 147 Diabetic Ketoacidosis, 122, 136 Diagnostic procedure, 70, 122, 146 Dialyzer, 122, 130 Diarrhea, 65, 88, 94, 122, 134, 139 Diastolic, 122, 133 Diencephalon, 122, 133, 157 Digestion, 41, 113, 115, 122, 135, 138, 156 Digestive system, 122, 128 Dihydrotestosterone, 123, 151 Dilatation, 107, 110, 115, 123, 161 Dilation, 68, 115, 123 Dilution, 17, 123 Dioxins, 29, 123 Diphtheria, 7, 123 Diphtheria Toxin, 7, 123 Direct, iii, 123, 151, 157 Disease Progression, 9, 123, 162 Disinfectant, 123, 126 Disorientation, 122, 123 Dissociation, 108, 123 Distal, 123, 128, 150 Dopamine, 111, 118, 123, 142, 153 Double-blind, 7, 12, 15, 17, 123, 124 Double-blinded, 12, 124 Drive, ii, vi, 9, 61, 64, 124, 137 Drug Design, 15, 124 Drug Tolerance, 124, 158 Duct, 109, 124, 125, 126, 131 Duodenum, 113, 124, 125, 131, 136, 145, 156 Dura mater, 124, 139, 144 Dyslipidemia, 8, 124 Dyspnea, 121, 124 E Eating Disorders, 21, 124 Eclampsia, 4, 35, 42, 46, 66, 124, 149 Edema, 110, 122, 124, 149, 160 Effector, 107, 119, 124 Efficacy, 7, 14, 20, 124, 159 Electrocoagulation, 118, 124 Electrolyte, 121, 122, 124, 140, 148, 155, 160 Embolus, 124, 134 Embryo, 14, 107, 114, 124, 125, 134, 143, 149, 155 Embryo Transfer, 14, 125, 149 Emphysema, 68, 117, 125

Enanthate, 12, 125 Encephalitis, 83, 125 Encephalitis, Viral, 125 Endogenous, 112, 123, 125, 144 Endoscope, 125 Endoscopic, 4, 125 Endoscopic retrograde cholangiopancreatography, 4, 125 Endothelial cell, 18, 125 Endothelium, 125, 142 Endothelium-derived, 125, 142 Endotoxemia, 6, 125 Endotoxic, 125, 137 Endotoxin, 6, 125, 160 Environmental Health, 29, 76, 78, 125 Enzymatic, 109, 115, 116, 119, 125 Eosinophils, 125, 130, 137 Epidemic, 9, 15, 126, 155 Epidemiological, 9, 62, 126 Epidermis, 122, 126, 136, 151 Epidural, 40, 126, 135 Epigastric, 32, 126, 145 Epinephrine, 108, 123, 126, 142, 143 Epithelial, 107, 126, 137 Epithelial Cells, 126, 137 Epithelium, 113, 125, 126 ERV, 78, 94, 126, 127 Erythema, 126, 161 Erythrocytes, 110, 114, 126, 131, 151 Escalation, 7, 126 Esophagus, 122, 126, 128, 138, 146, 151, 156 Estradiol, 17, 126 Estrogens, 126, 130 Ethanol, 6, 126 Ethionine, 126 Evacuation, 120, 126, 137 Exocrine, 126, 145 Exogenous, 125, 126, 146, 160 Expiratory, 126, 127 Expiratory Reserve Volume, 126, 127 Extracellular, 120, 127, 155 Extravasation, 127, 130 F Failure to Thrive, 19, 68, 84, 127 Family Planning, 77, 127 Family Practice, 83, 127 Fat, 10, 11, 14, 17, 24, 68, 107, 113, 114, 115, 116, 121, 124, 127, 136, 137, 144, 152, 153, 155, 159 Fatigue, 8, 10, 16, 62, 83, 127, 130 Fatty acids, 11, 13, 108, 122, 127

169

Fatty Liver, 8, 10, 14, 21, 36, 38, 44, 64, 66, 88, 127 Febrile, 127, 155 Feces, 120, 127, 156 Ferritin, 83, 127 Fertilization in Vitro, 127, 149 Fetoprotein, 63, 85, 127 Fetus, 14, 107, 109, 116, 127, 128, 147, 149, 155, 156 Fibrinogen, 127, 147, 150, 157 Fibroblasts, 127, 135 Fibrosis, 8, 10, 83, 127 Flatus, 127, 128 Fluorescence, 18, 127 Foetoplacental, 128, 143 Folate, 48, 128 Folic Acid, 128 Follicles, 122, 128, 135 Forearm, 114, 128 Free Radicals, 111, 123, 128 Fungi, 110, 112, 120, 128, 140, 162 Fungicide, 128, 132 G Gallbladder, 49, 107, 113, 117, 122, 125, 128, 131 Gallstones, 113, 117, 128, 161 Gamma-Glutamyltransferase, 4, 36, 128 Ganglia, 107, 111, 128, 142 Gas, 11, 109, 126, 127, 128, 132, 139, 142, 161 Gastric, 30, 47, 112, 116, 128 Gastric Bypass, 30, 47, 128 Gastrin, 128, 132 Gastroenterologist, 85, 128 Gastroenterology, 21, 25, 30, 37, 40, 41, 44, 45, 47, 48, 62, 64, 128 Gastroesophageal Reflux, 65, 128 Gastrointestinal, 62, 64, 83, 85, 115, 126, 129, 154, 156 Gastrointestinal tract, 62, 64, 83, 126, 129, 154 Gene, 5, 8, 10, 14, 22, 50, 109, 114, 129 Gene Expression, 14, 129 Genetic Engineering, 114, 117, 129 Genetic testing, 83, 129 Genetics, 19, 120, 129 Genital, 17, 129, 161 Genotype, 9, 10, 14, 16, 62, 129, 146 Gestation, 34, 37, 44, 47, 129, 146, 147, 149, 155 Gestational, 47, 129

Gland, 107, 121, 129, 145, 147, 149, 153, 156, 158 Glomerular, 4, 129, 152 Glomerulus, 129 Glucocorticoid, 122, 129, 149 Glucose, 65, 122, 129, 131, 133, 135, 153 Glucose Intolerance, 122, 129 Glucuronic Acid, 129, 131 Gluten, 116, 129 Glycine, 109, 113, 117, 129, 142 Glycoprotein, 127, 129, 137, 160 Gonadal, 130, 156 Gonadotropin, 20, 37, 130 Governing Board, 130, 148 Gram-negative, 125, 130 Granulocyte, 7, 130 Granulosa Cells, 130, 135 Growth, 17, 53, 68, 84, 110, 112, 114, 127, 130, 135, 137, 139, 142, 143, 147, 158, 159 Guanylate Cyclase, 130, 142 H Haemolysis, 26, 34, 41, 42, 43, 44, 47, 50, 130 Haptens, 108, 130 Headache, 130, 133, 134 Heart failure, 83, 87, 130 Hematocrit, 17, 114, 130 Hematology, 16, 130, 146 Hematoma, 64, 130 Heme, 65, 113, 121, 130, 141, 148, 160 Hemochromatosis, 83, 89, 130 Hemodialysis, 94, 122, 130 Hemoglobin, 110, 114, 126, 130, 131, 148 Hemoglobin A, 131, 148 Hemolysis, 4, 14, 64, 66 Hemolytic, 19, 27, 45, 46, 65, 66, 131 Hemorrhage, 46, 124, 130, 131, 151 Heparin, 43, 131 Hepatic, 4, 6, 8, 9, 11, 13, 15, 18, 64, 65, 70, 91 Hepatic Artery, 32, 131 Hepatic Duct, Common, 125, 131 Hepatitis, 9, 13, 16, 56, 61, 62, 63, 64, 66, 68, 82, 83, 84, 85, 89, 90, 91, 92, 94 Hepatitis A, 47, 84, 131 Hepatocellular, 10, 18, 68, 84, 131 Hepatocellular carcinoma, 68, 84, 131 Hepatocyte, 117, 131 Hepatology, 20, 24, 30, 31, 32, 37, 62, 131 Hepatoma, 11, 131 Hepatomegaly, 19, 131 Hepatotoxicity, 52, 131

170

Liver enzymes

Hepatovirus, 131 Herbicide, 49, 132 Hereditary, 37, 65, 132 Heredity, 129, 132 Heterogeneity, 10, 108, 132 Heterogenic, 132 Heterogenous, 9, 132 Heterozygote, 14, 132 Hexachlorobenzene, 24, 132 Histology, 10, 16, 63, 132 Homeostasis, 8, 132 Homologous, 109, 132 Hormonal, 15, 37, 121, 132 Hormone, 15, 24, 86, 121, 126, 128, 132, 135, 143, 149, 152, 157, 158 Hormone Replacement Therapy, 86, 132 Host, 132, 133, 161, 162 Hybridomas, 132, 135 Hydrogen, 107, 113, 115, 122, 132, 137, 140, 144, 162 Hydrogen Peroxide, 132, 137 Hydrophobic, 132, 137 Hydroxylation, 28, 132 Hydroxyproline, 109, 118, 132 Hyperbilirubinemia, 132, 136 Hypercholesterolemia, 18, 124, 133 Hyperemesis, 21, 64, 65, 133 Hyperlipidemia, 11, 124, 133 Hypersensitivity, 133, 152 Hypertension, 8, 27, 41, 44, 47, 49, 64, 65, 68, 84, 91, 130, 133, 148, 149, 160 Hypertriglyceridemia, 124, 133 Hypoglycaemia, 122, 133 Hypothalamus, 15, 122, 133, 147, 157 Hypoxia, 18, 122, 133 Hysterotomy, 116, 133 I Id, 55, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 102, 104, 133 Immune Complex Diseases, 111, 133, 147 Immune response, 111, 112, 121, 130, 133, 134, 154, 156, 161, 162 Immune Sera, 133 Immune system, 112, 133, 134, 138, 142, 146, 161, 162 Immunity, 108, 133, 138, 159 Immunization, 90, 133 Immunodeficiency, 86, 133 Immunogenic, 133, 137 Immunoglobulin, 110, 133, 141 Immunologic, 116, 133, 134, 139 Immunology, 95, 108, 134

Immunosuppressant, 134, 140 Immunosuppressive, 62, 129, 134 Immunosuppressive therapy, 62, 134 Impairment, 117, 122, 134, 139 Implantation, 120, 134, 142, 143 Impotence, 83, 134 In vitro, 11, 15, 27, 38, 125, 134 In vivo, 11, 15, 131, 134, 144 Incision, 45, 133, 134, 136, 150, 152 Incompetence, 128, 134 Induction, 110, 111, 134 Infarction, 19, 87, 134, 152 Infectious Diarrhea, 94, 134 Infiltration, 18, 134 Inflammatory bowel disease, 65, 134 Influenza, 82, 86, 134 Infusion, 12, 134, 159 Inhibin, 37, 135 Initiation, 31, 135 Insecticides, 135, 162 Insulin, 8, 10, 11, 17, 122, 135, 136, 153, 160 Insulin-dependent diabetes mellitus, 135 Interferon, 13, 16, 84, 85, 135 Interferon-alpha, 135 Interleukin-6, 39, 135 Intermittent, 65, 135, 148 Internal Medicine, 10, 13, 33, 38, 39, 40, 128, 130, 135 Interstitial, 135, 152 Intestinal, 6, 88, 116, 117, 135, 139 Intestinal Mucosa, 116, 135 Intestine, 113, 115, 135, 151, 154 Intoxication, 122, 135, 162 Intracellular, 134, 135, 142, 148 Intracranial Hemorrhages, 30, 135 Intrahepatic, 39, 64, 131, 135 Intramuscular, 12, 135 Intramuscular injection, 12, 135 Intravascular, 28, 135 Intravenous, 7, 9, 49, 65, 134, 135 Intrinsic, 108, 113, 136 Intussusception, 22, 136 Invasive, 133, 136, 139 Involuntary, 136, 141, 158 Ions, 113, 123, 124, 132, 136, 150, 155 Ischemia, 18, 136, 152 Islet, 25, 136 Isoenzymes, 28, 136 Isozymes, 11, 136 Itraconazole, 21, 136 J Jaundice, 13, 62, 68, 84, 132, 136

171

Jejunum, 128, 136 Joint, 85, 89, 112, 136, 144, 156, 157 K Kb, 76, 136 Keratin, 136, 153 Keto, 136, 159 Ketone Bodies, 8, 107, 122, 136 Ketonuria, 21, 136 Kidney Disease, 76, 92, 136 Kinetic, 5, 43, 137, 146 L Labile, 119, 137 Lactation, 137, 143 Lactulose, 6, 137 Laminin, 113, 137 Lamivudine, 85, 137 Larynx, 137, 159, 162 Latent, 86, 137, 146 Laxative, 117, 137 Leflunomide, 85, 137 Lethal, 113, 123, 137 Leukemia, 7, 107, 137 Leukocytes, 18, 113, 114, 116, 125, 135, 137, 141, 160 Libido, 110, 137 Library Services, 102, 137 Ligament, 137, 149 Ligands, 53, 137 Lipid, 11, 12, 19, 29, 39, 55, 111, 135, 136, 137, 144, 159 Lipid A, 11, 137 Lipid Peroxidation, 39, 55, 137, 144 Lipopolysaccharides, 137 Lipoprotein, 17, 51, 111, 124, 130, 137, 138 Liver cancer, 63, 65, 68, 84, 109, 138 Liver Cirrhosis, 62, 138 Liver metastases, 27, 138 Liver Neoplasms, 126, 138 Liver scan, 138, 153 Liver Transplantation, 43, 63, 84, 85, 138 Localized, 110, 123, 130, 134, 137, 138, 147, 161 Loop, 128, 138 Low-density lipoprotein, 124, 137, 138 Lower Esophageal Sphincter, 128, 138 Lumbar, 40, 138 Lupus, 56, 138, 157 Lymph, 125, 138 Lymphatic, 125, 134, 138, 158 Lymphocyte, 18, 111, 138 Lymphoid, 110, 138 Lymphokines, 138

Lytic, 138, 154 M Macrophage, 7, 26, 138 Macrophage Activation, 26, 138 Magnetic Resonance Imaging, 63, 139, 153 Malabsorption, 116, 139, 154 Malabsorption syndrome, 139, 154 Malaise, 34, 139 Malignant, 107, 111, 138, 139, 142 Malnutrition, 45, 108, 139 Manic, 111, 114, 139 Medical Staff, 124, 139 MEDLINE, 77, 139 Membrane, 15, 116, 119, 120, 122, 130, 137, 139, 141, 144, 146, 152, 154, 159 Memory, 17, 110, 122, 139 Meninges, 116, 124, 139 Meningitis, 83, 136, 139 Menopause, 139, 143 Menstrual Cycle, 139, 143, 149 Mental, iv, 5, 33, 76, 78, 117, 122, 123, 127, 134, 139, 150, 153, 160 Mental Disorders, 139, 150 Mental Health, iv, 5, 76, 78, 139, 150 Mesenteric, 139, 148 Metabolic disorder, 67, 83, 84, 122, 139 Metabolite, 38, 139 Methanol, 11, 139 Methionine, 43, 126, 140, 156 Methotrexate, 50, 140 Methylprednisolone, 50, 140 MI, 105, 140 Microbe, 140, 158 Microbiology, 112, 113, 140 Microcirculation, 138, 140 Microorganism, 118, 140, 162 Microscopy, 18, 113, 140 Microsomal, 24, 48, 140 Migration, 138, 140 Milliliter, 83, 140 Mineralocorticoids, 107, 121, 140 Modeling, 124, 140 Modification, 109, 129, 140, 151, 162 Molecular, 6, 8, 14, 17, 61, 77, 79, 114, 119, 124, 127, 131, 140, 159, 160 Molecule, 111, 113, 118, 119, 123, 124, 125, 140, 144, 151, 159 Monitor, 13, 15, 18, 140, 143 Monoclonal, 18, 132, 141 Monocytes, 135, 137, 141 Mononuclear, 16, 141, 160 Monotherapy, 13, 16, 141

172

Liver enzymes

Morphine, 49, 141, 143 Morphological, 124, 141 Morphology, 130, 138, 141 Motion Sickness, 141, 142 Muscle Fibers, 141 Mutagenic, 123, 141 Mutagenicity, 25, 141 Myalgia, 134, 141 Mydriatic, 123, 141 Myocardial infarction, 21, 87, 121, 140, 141 Myocarditis, 123, 141 Myocardium, 140, 141 Myoglobin, 141, 148 Myosin, 12, 141 N Naloxone, 50, 141 Naltrexone, 7, 14, 29, 141 Narcotic, 141 Nasal Mucosa, 134, 141 Nausea, 65, 111, 141, 160 Need, 3, 4, 61, 62, 63, 67, 83, 97, 108, 142, 158 Neonatal, 42, 43, 44, 142 Neoplasia, 65, 142 Neoplasms, 111, 115, 142 Neopterin, 6, 142 Nephropathy, 137, 142 Nerve, 108, 110, 117, 142, 144, 152, 156, 161 Nervous System, 65, 116, 142, 156 Neural, 127, 142, 155 Neural tube defects, 127, 142 Neurons, 118, 128, 142, 157 Neurotransmitter, 107, 109, 115, 123, 129, 142, 143, 156 Neutrophil, 26, 84, 142 Nidation, 125, 142 Nitric Oxide, 6, 142 Nitrogen, 109, 110, 142 Nonverbal Communication, 143, 150 Norepinephrine, 108, 123, 142, 143 Nuclear, 28, 46, 120, 143 Nuclei, 120, 129, 139, 143 Nucleic acid, 142, 143, 152, 162 Nucleus, 112, 113, 121, 122, 125, 141, 143 Nursing Care, 35, 143, 145 Nutritional Status, 88, 143 O Oestradiol, 28, 143 Oestrogen, 29, 143 Omentum, 131, 143 Opacity, 122, 143

Opiate, 141, 143 Opium, 141, 143 Opportunistic Infections, 86, 91, 143 Optic Chiasm, 133, 143 Osmotic, 108, 144, 154 Osteoarthritis, 94, 144 Osteoporosis, 143, 144 Outpatient, 12, 14, 50, 144 Ovary, 126, 143, 144 Overweight, 15, 144 Ovum, 129, 144, 149, 162 Oxidants, 18, 144 Oxidation, 6, 13, 18, 107, 111, 121, 122, 137, 144 Oxidation-Reduction, 144 Oxidative metabolism, 11, 108, 144 Oxidative Stress, 14, 18, 144 Oxygenation, 49, 144 P Pachymeningitis, 139, 144 Palliative, 93, 143, 144, 157 Pancreas, 11, 64, 107, 122, 128, 130, 131, 135, 136, 145, 155 Pancreatic, 11, 125, 128, 145 Pancreatic Ducts, 125, 145 Pancreatic Juice, 128, 145 Pancreatitis, 65, 145 Panniculitis, 68, 145 Papilla, 125, 145 Partial remission, 145, 152 Patch, 145, 159 Pathogenesis, 9, 10, 64, 145 Pathologic, 4, 112, 114, 120, 132, 133, 145 Pathophysiology, 9, 34, 64, 66, 145 Patient Care Management, 64, 145 Patient Education, 82, 100, 102, 105, 145 Peak Expiratory Flow Rate, 23, 145 Pediatric Gastroenterologist, 85, 145 Pelvic, 17, 145, 149 Pelvis, 107, 138, 145 Peptide, 109, 128, 136, 145, 150 Percutaneous, 4, 145 Perfusion, 133, 145 Pericardium, 145, 157 Perinatal, 42, 94, 146 Perioperative, 87, 146 Peripheral blood, 16, 135, 146 Peritoneal, 64, 146 Peritoneum, 143, 146 Phagocyte, 144, 146 Phagocytosis, 11, 146 Pharmacokinetics, 124, 146

173

Pharmacologic, 110, 146, 158 Pharynx, 128, 134, 146 Phenotype, 5, 14, 146 Phlebotomy, 65, 83, 146 Phospholipids, 127, 137, 146 Phosphorylated, 118, 146 Photoallergy, 146, 147 Photocoagulation, 118, 146 Photosensitivity, 65, 146, 148 Physical Examination, 4, 147 Physiologic, 64, 108, 139, 147, 151 Physiology, 55, 128, 130, 147 Pigments, 113, 116, 147 Pitch, 17, 147 Pituitary Gland, 121, 147 Placenta, 45, 126, 128, 147, 149 Plants, 109, 118, 129, 132, 141, 143, 147, 153, 159 Plasma, 11, 17, 18, 32, 33, 35, 45, 46, 65, 108, 110, 112, 116, 117, 127, 129, 131, 140, 147, 150, 153, 154, 161, 162 Plasma cells, 110, 147 Plasma Exchange, 46, 147 Plasma protein, 108, 147, 150, 154 Platelet Aggregation, 110, 142, 147 Platelet Count, 66 Platelets, 4, 14, 18, 64 Pneumonia, 94, 120, 147 Poisoning, 122, 135, 142, 147 Polydipsia, 20, 147 Polyneuritis, 123, 147 Polysaccharide, 111, 148, 150 Polytherapy, 52, 148 Polyuria, 20, 148 Porphyria, 65, 83, 146, 148 Porphyria Cutanea Tarda, 65, 83, 146, 148 Porphyria, Hepatic, 148 Porphyrins, 65, 148 Portal Hypertension, 65, 68, 84, 148 Portal Vein, 68, 84, 148 Post partum, 45, 148 Posterior, 109, 116, 145, 148 Postnatal, 27, 148 Potassium, 140, 148 Practicability, 148, 159 Practice Guidelines, 78, 85, 87, 148 Precursor, 113, 123, 124, 125, 142, 143, 148, 150, 160 Predictive factor, 62, 149 Prednisolone, 140, 149 Preeclampsia, 4, 24, 26, 27, 28, 32, 34, 35, 39, 41, 42, 44, 46, 53, 64, 149

Pre-Eclampsia, 41, 45, 66, 149 Pre-eclamptic, 124, 149 Pregnancy Outcome, 46, 149 Prenatal, 27, 124, 149 Prevalence, 5, 8, 9, 10, 13, 47, 51, 149 Primary Biliary Cirrhosis, 19, 92, 149 Primary endpoint, 10, 149 Progeny, 120, 149 Progesterone, 149, 156 Progression, 8, 9, 149 Progressive, 10, 47, 117, 124, 126, 130, 144, 149, 152 Prophylaxis, 149, 161 Prospective study, 20, 27, 50, 149 Prostate, 12, 143, 149, 150, 152 Prostatectomy, 150 Protease, 118, 150 Protein C, 108, 109, 111, 127, 136, 137, 150 Protein S, 12, 114, 123, 150 Proteins, 6, 61, 63, 109, 111, 116, 118, 119, 126, 136, 140, 142, 145, 147, 150, 154, 159 Proteinuria, 4, 149, 150 Proteoglycans, 113, 150 Proteolytic, 119, 127, 150 Prothrombin, 66, 150, 157 Prothrombin Time, 66, 150 Protozoa, 120, 140, 150 Proximal, 123, 128, 150 Psychiatry, 6, 14, 33, 150, 156 Psychic, 137, 139, 150, 153 Psychomotor, 122, 150 Psychotherapy, 7, 150 Public Health, 78, 91, 93, 94, 95, 150 Public Policy, 77, 150 Pulmonary, 68, 114, 120, 150 Pulmonary Artery, 114, 150 Pulse, 140, 151 Pupil, 123, 141, 151 Purpura, 27, 33, 52, 65, 66, 151 Pyridoxal, 151, 159 Q Quality of Life, 13, 68, 151, 156 R Race, 8, 16, 140, 151 Radiation, 127, 128, 151, 153, 162 Radioactive, 11, 115, 132, 134, 138, 143, 151, 153 Radiological, 145, 151 Randomized, 17, 20, 124, 151 Receptor, 15, 18, 22, 111, 123, 151, 154 Recombination, 120, 151

174

Liver enzymes

Rectum, 111, 115, 118, 122, 127, 128, 134, 149, 151 Recurrence, 51, 114, 151 Red blood cells, 65, 126, 131, 148, 151, 153 Reductase, 50, 140, 151 Refer, 1, 119, 128, 151, 158 Reflux, 65, 128, 151 Refraction, 151, 155 Refractory, 7, 124, 151 Regimen, 124, 151 Regurgitation, 128, 151 Reinfection, 13, 151 Relapse, 7, 14, 151 Remission, 63, 85, 114, 151 Renal failure, 4, 46, 122, 152, 160 Renovascular, 44, 152 Reperfusion, 18, 152 Reperfusion Injury, 152 Reproduction Techniques, 149, 152 Resection, 150, 152, 154 Respiration, 111, 140, 152 Response rate, 8, 16, 152 Retina, 121, 143, 152, 153 Retrograde, 4, 152 Retropubic, 40, 150, 152 Retropubic prostatectomy, 40, 152 Retrospective, 21, 152 Rheumatism, 39, 50, 152 Rheumatoid, 50, 85, 117, 144, 152 Rheumatoid arthritis, 50, 85, 117, 152 Ribavirin, 16, 152 Riboflavin, 7, 15, 152 Risk factor, 11, 16, 17, 18, 48, 50, 62, 64, 68, 70, 83, 84, 149, 153 Risperidone, 52, 153 Rod, 112, 113, 125, 153 Rosiglitazone, 10, 153 S Salicylate, 39, 153 Saponins, 153, 156 Scans, 17, 66, 153 Schizophrenia, 153, 162 Screening, 61, 68, 91, 94, 117, 153, 160 Sebaceous, 122, 153 Sebaceous gland, 122, 153 Sebum, 17, 153 Secretion, 121, 135, 137, 140, 153 Sediment, 153, 160 Sedimentation, 116, 153, 160 Seizures, 19, 122, 153 Semen, 149, 153 Seminiferous tubule, 135, 154

Seminoma, 20, 154 Sensibility, 109, 154 Serologic, 20, 154 Serotonin, 111, 142, 153, 154 Serum, 4, 6, 7, 8, 9, 12, 15, 16, 17, 18, 66, 82, 83, 85 Serum Albumin, 66, 154 Sex Characteristics, 110, 126, 143, 154, 157 Shock, 125, 154, 159 Short Bowel Syndrome, 88, 154 Side effect, 8, 17, 85, 108, 111, 154, 156, 158, 162 Siderosis, 83, 154 Signs and Symptoms, 151, 154, 160 Skeletal, 12, 110, 154 Skeleton, 107, 136, 154 Skin test, 154, 159 Sleep apnea, 17, 154 Small intestine, 117, 124, 125, 132, 135, 136, 154 Smooth muscle, 109, 110, 141, 154, 156 Social Environment, 151, 155 Sodium, 17, 140, 155, 161 Sodium Channels, 155, 161 Soft tissue, 114, 154, 155 Solvent, 107, 126, 139, 144, 155 Sound wave, 155, 160 Specialist, 85, 97, 123, 155 Species, 112, 118, 126, 132, 140, 141, 151, 155, 159, 162 Specificity, 108, 155 Spectrum, 3, 68, 84, 155 Sperm, 110, 117, 154, 155, 157, 160 Spinal cord, 50, 116, 117, 124, 126, 139, 142, 144, 155 Spirochete, 155, 157 Splenic Vein, 148, 155 Spontaneous Abortion, 149, 155 Sporadic, 148, 155 Sprue, 88, 155 Stabilization, 23, 155 Staging, 153, 155 Steatosis, 127, 155 Sterile, 156, 159 Steroid, 23, 113, 121, 143, 153, 156 Stillbirth, 149, 156 Stimulus, 124, 156, 157 Stomach, 107, 112, 122, 126, 128, 129, 131, 132, 138, 141, 143, 146, 151, 154, 155, 156 Stool, 65, 118, 156 Stress, 14, 18, 64, 66, 121, 142, 144, 152, 156, 161

175

Striate, 121, 156 Stroma, 154, 156 Stupor, 82, 141, 156 Subacute, 134, 156 Subarachnoid, 130, 135, 156 Subclinical, 134, 153, 156 Subcutaneous, 68, 110, 124, 145, 156, 162 Substance P, 139, 153, 156 Sulfur, 137, 140, 156 Support group, 66, 156 Supportive care, 4, 156 Suppression, 121, 156 Survival Rate, 63, 156 Symphysis, 117, 149, 156 Symptomatic, 145, 157 Synapse, 108, 157 Synergistic, 157, 158 Syphilis, 87, 157 Systemic, 35, 56, 114, 117, 122, 123, 126, 133, 134, 149, 157, 159 Systemic lupus erythematosus, 35, 117, 133, 157 Systemic therapy, 117, 157 Systolic, 133, 157 T Taurine, 30, 57, 113, 117, 157 Teratogenic, 123, 157 Testicles, 154, 157 Testicular, 20, 157 Testis, 126, 143, 157 Testosterone, 12, 17, 151, 157 Therapeutics, 15, 42, 157 Thermal, 29, 123, 157 Thigh, 17, 157 Third Ventricle, 133, 157 Thorax, 107, 138, 157 Threshold, 4, 133, 157 Thrombin, 127, 147, 150, 157 Thrombocytes, 147, 157 Thrombocytopenia, 24, 30, 46, 47, 158 Thromboembolism, 96, 158 Thromboplastin, 150, 158 Thrombosis, 38, 150, 158 Thrombus, 120, 134, 147, 158, 161 Thymus, 133, 138, 158 Thyroid, 24, 29, 158 Thyroid Gland, 158 Thyroid Hormones, 29, 158 Thyroxine, 108, 158 Tic, 10, 158 Tolerance, 62, 65, 129, 158 Tomography, 12, 63, 119, 153, 158

Tonicity, 131, 158 Topical, 126, 132, 158 Torsion, 134, 158 Toxaemia, 149, 158 Toxic, iv, 14, 120, 123, 133, 139, 146, 158, 159, 162 Toxicity, 8, 11, 158 Toxicology, 27, 48, 78, 158 Toxin, 7, 123, 125, 158 Trachea, 115, 137, 146, 158, 159 Transaminase, 83, 159 Transcriptase, 137, 159, 162 Transdermal, 17, 159 Transfection, 114, 159 Transfer Factor, 133, 159 Transfusion, 159 Translation, 109, 159 Translational, 6, 159 Translocation, 7, 159 Transplantation, 19, 20, 25, 43, 63, 84, 85, 88, 91, 92, 125, 133, 159 Trauma, 5, 40, 45, 50, 70, 122, 130, 145, 159 Treatment Failure, 63, 159 Treatment Outcome, 16, 159 Triglyceride, 11, 133, 159 Tubercle, 159, 160 Tuberculin, 86, 159 Tuberculin Test, 86, 159 Tubulin, 6, 160 Tumor Necrosis Factor, 39, 160 Type 2 diabetes, 9, 10, 92, 160 U Ultrasonography, 27, 160 Ultrasound test, 85, 160 Unconscious, 133, 160 Uraemia, 145, 160 Uremia, 152, 160 Urethra, 149, 160 Urethritis, 90, 160 Urinalysis, 4, 160 Urinary, 6, 12, 113, 148, 150, 152, 160 Urine, 7, 15, 65, 113, 114, 122, 136, 148, 150, 153, 160 Uroporphyrinogen Decarboxylase, 148, 160 Ursodeoxycholic Acid, 30, 160 Urticaria, 95, 161 V Vaccination, 84, 85, 161 Vaccine, 13, 66, 161 Vagina, 133, 161 Vaginal, 90, 161

176

Liver enzymes

Vaginal Discharge, 90, 161 Valproic Acid, 26, 52, 161 Vascular, 53, 110, 122, 125, 134, 138, 140, 142, 147, 158, 161 Vasculitis, 145, 161 Vasodilators, 142, 161 Vein, 68, 84, 135, 143, 146, 148, 155, 161 Venereal, 157, 161 Venous, 12, 19, 96, 114, 122, 147, 150, 161 Venous blood, 114, 147, 161 Venous Thrombosis, 19, 161 Venules, 18, 114, 115, 140, 161 Vertebrae, 155, 161 Vesicular, 130, 140, 161 Veterinary Medicine, 55, 77, 161 Villous, 116, 161 Vinblastine, 160, 161 Vincristine, 160, 161 Viraemia, 13, 161 Viral, 9, 16, 37, 56, 62, 63, 64, 66, 83, 85, 86, 125, 134, 142, 161, 162 Viral Hepatitis, 56, 64, 65, 83, 161 Viral Load, 10, 62, 162 Virulence, 158, 162

Virus, 9, 13, 16, 20, 22, 30, 37, 44, 47, 51, 61, 63, 66, 83, 86, 90, 117, 129, 135, 161, 162 Visceral, 12, 146, 162 Visceral fat, 12, 162 Vital Capacity, 145, 162 Vitro, 11, 15, 131, 162 Vivo, 11, 15, 162 Vocal cord, 17, 162 W Wakefulness, 122, 162 Weight Gain, 127, 162 White blood cell, 84, 110, 130, 137, 138, 142, 147, 162 Windpipe, 146, 158, 162 Withdrawal, 122, 162 X Xenobiotics, 11, 162 X-ray, 119, 125, 127, 143, 153, 162 Y Yeasts, 128, 146, 162 Z Zalcitabine, 137, 162 Zygote, 120, 162