Melissa Palmer, M.D.

A Phase 2, randomized, double-blind, placebo-controlled study of GS-9450 in subjects with nonalcoholic steatohepatitis
Ratziu V; Sheikh MY; Sanyal AJ; Lim JK; Conjeevaram H; Chalasani N; Abdelmalek M; Bakken A; Renou C; Palmer M; Levine RA; Bhandari BR; Cornpropst M; Liang W; King B; Mondou E; Rousseau FS; McHutchison J; Chojkier M
2011 Feb;55(2):419-28 L, Hepatology
In nonalcoholic steatohepatitis (NASH), extent of hepatocyte apoptosis correlates with disease severity. Reducing hepatocyte apoptosis with the selective caspase inhibitor GS-9450 has a potential for altering the course of the liver disease. In this phase 2, double-blind study, 124 subjects with biopsy-proven NASH were randomized to once-daily placebo or 1, 5, 10, or 40 mg GS-9450 for 4 weeks. Absolute and percent changes from baseline in ALT levels, AST levels, and caspase 3-cleaved cytokeratin (CK)-18 fragments at Week 4 were assessed by an analysis of covariance model with adjustment for baseline values. In the 40-mg group, mean (SD) ALT decreased by 47 (43) U/L from baseline to Week 4 (P < 0.0001 versus placebo), and the proportion of subjects with normal ALT increased from 0% to 35% at Week 4. In the 40-mg group, mean AST decreased by 13 U/L from baseline (not significant), and the proportion with normal AST increased from 20% at baseline to 48% at Week 4. By Week 4, mean CK-18 fragments decreased 393 (723) U/L in the GS-9450 10-mg group and 125 (212) U/L in the 40-mg group, but these reductions were not statistically significant. No serious adverse events were reported during treatment, and the percentage of subjects with at least one treatment-emergent Grade 3 or 4 laboratory abnormality ranged from 11.5% to 17% across the GS-9450 treatment groups versus 35% in the placebo group. Conclusions. GS-9450 treatment induced significant reductions in ALT levels in NASH patients. Reductions in CK-18 fragments also occurred, although they were not statistically significant. At appropriate therapeutic indices, selective caspase inhibitors may be a promising treatment option in patients with NASH. (HEPATOLOGY 2011.)
— id: 141651, year: 2011, vol: 55, page: 419, stat: Journal Article,

Change has arrived: Treating hepatitis C with protease inhibitors- The new standard of care
Thomas J.R.; Thomas S.; Nanda R.; Palmer M.
2011 ;35(6):13-27, Practical gastroenterology
Treating patients with the hepatitis C virus (HCV) is about to be changed forever. Over 170 million people are infected with HCV worldwide and this number grows as more and more patients are diagnosed with hepatitis C daily. Current standard of care (SoC) treatment for chronic hepatitis C consists of pegylated interferon (Peg IFN) and ribavirin (RBV). Success rates for viral eradication-sustained virological response (SVR), for patients infected with HCV genotype 1 (G1), the most common HCV genotype in the United States are less than 50%. New drugs, known as direct acting antivirals (DAAs), have been in development for over a decade, and the initial two of these, boceprevir and telaprevir, both protease inhibitors, have just been FDA approved (May 2011). Treating HCV with the addition of protease inhibitors to SoC is very promising with SVRs of approximately 70-75% in recent studies. This article, the first in this series, will review the burden of hepatitis C, the HCV lifecycle, and the studies behind the new therapies in an effort to preview how patients will likely be treated in the near future
— id: 141496, year: 2011, vol: 35, page: 13, stat: Journal Article,

Women's issues and HCV
Palmer, Melissa
2009 March;:?-?, Hepatitis magazine
— id: 100975, year: 2009, vol: , page: ?, stat: Journal Article,

Improvement in treatment adherence in patients with chronic hepatitis C
Palmer M.
2008 ;32(12):31-42, Practical gastroenterology
Background: Adherence to pegylated interferon (PIFN) plus ribavirin (RBV), especially in the first 12 weeks, affects sustained virologic response (SVR) in patients with chronic hepatitis C virus (HCV). RibaPak (RBP) requires fewer tablets than RBV. Aim: To determine if simplifying the dosing regimen of RBV impacts outcomes. Methods: Ninety-two patients on RBP >12 weeks were categorized as follows: Group A (n = 22): treatment experienced with IFN/PIFN and RBV, Group B (n = 49): treatment naive switched to RBP after >12 weeks RBV, Group C (n = 21): treatment naive on RBP. Outcomes were compared between RBP and RBV in Groups A and B. Group C was compared to Group D - a matched control group of RBV-treated patients. Results: Patients preferred RBP. RBP was associated with improved patient compliance, less side effects, improved quality of life and a trend toward improved SVR. Conclusions: RibaPak offers an attractive alternative to RBV
— id: 100793, year: 2008, vol: 32, page: 31, stat: Journal Article,

Gan yan he qi ta gan bing : xiu ding ban = Dr. Melissa Palmer's guide to hepititis & liver disease
Palmer, Melissa
Changchun : Jilin ren min chu ban she, 2008,
— id: 1844, year: 2008, vol: , page: , stat: ,

Hepatitis
Palmer, Melissa
Encyclopedia of pestilence, pandemics, and plagues Westport CT : Greenwood Press, 2008,
— id: 5092, year: 2008, vol: , page: ?, stat: Chapter,

Nutrition facts for liver disease
Palmer, Melissa
2008 May;:?-?, Hepatitis magazine
— id: 100974, year: 2008, vol: , page: ?, stat: Journal Article,

Preface
Palmer, Melissa
One of them : a first responder's story [New Bern NC] : Worldwide Association of Disable Veterans, 2008,
— id: 5093, year: 2008, vol: , page: ?, stat: Chapter,

The antibiotic rifaximin improves hepatic encephalopathy symptoms in patients with cirrhosis due to hepatitis C
Palmer M.
2007 ;31(2):72-76, Practical gastroenterology
Oral rifaximin is a nonabsorbed antibiotic with broad-spectrum antimicrobial activity. Rifaximin 400 mg 3 times daily for 14 days was prospectively investigated in an outpatient setting for the treatment of mild hepatic encephalopathy (HE) in patients with cirrhosis due to hepatitis C virus (HCV). Patients were assessed 24 hours before and 14 days posttreatment Thirty-seven consecutive patients were treated. Twenty-three patients were receiving pegylated interferon (IFN) plus ribavirin, and 12 patients had type 2 diabetes mellitus (DM). Overall, rifaximin improved HE symptoms and lowered serum ammonia to normal levels. Rifaximin was well tolerated, and no hypo/hyperglycemic episodes were reported. Because systemic antibiotics are associated with nephrotoxicity, and lactulose administration in DM patients is not ideal, rifaximin may be a more appropriate treatment for DM patients. Hepatic encephalopathy symptoms can be mistaken for pegylated IFN plus ribavirin adverse effects, and patients treated with these medications should be periodically evaluated for HE
— id: 100794, year: 2007, vol: 31, page: 72, stat: Journal Article,

Cirrhosis
Palmer, Melissa
McGraw-Hill encyclopedia of science & technology New York : McGraw-Hill, 2007,
— id: 5091, year: 2007, vol: , page: ?, stat: Chapter,

Esophageal varices during pregnancy
Palmer, Melissa
2007 Dec;:?-?, Hepatitis magazine
— id: 100973, year: 2007, vol: , page: ?, stat: Journal Article,

Hepatitis B -- new treatments
Palmer, Melissa
2007 June;:?-?, Hepatitis magazine
— id: 100971, year: 2007, vol: , page: ?, stat: Journal Article,

How to find a liver specialist
Palmer, Melissa
2007 April;:?-?, Hepatitis magazine
— id: 100970, year: 2007, vol: , page: ?, stat: Journal Article,

New tests for liver cancer
Palmer, Melissa
2007 Oct;:?-?, Hepatitis magazine
— id: 100972, year: 2007, vol: , page: ?, stat: Journal Article,

A study of low dose peginterferon alpha-2b with ribavirin for the initial treatment of chronic hepatitis C
Krawitt, Edward L; Gordon, Stuart R; Grace, Norman D; Ashikaga, Takamaru; Ray, Mary Ann; Palmer, Melissa; Yarze, Joseph C; Moskowitz, Sam
2006 Jun;101(6):1268-1273, American journal of gastroenterology
PURPOSE: A prospective randomized trial was undertaken to test the efficacy of low and standard doses of pegylated interferon alpha-2b in combination with ribavirin for the initial treatment of chronic hepatitis C. By nature of its design the study also provided data on response to therapy over a spectrum of doses of both pegylated interferon alpha-2b and ribavirin calculated on a body weight basis. SUBJECTS AND METHODS: Fifty micrograms of pegylated interferon alpha-2b or 100 microg for patients weighing<75 kg or 150 microg for patients>or=75 kg were administered weekly with 1000 mg ribavirin daily for 48 wk if serum hepatitis C virus (HCV) RNA was undetectable after the first 24 wk of therapy. RESULTS: Overall sustained viral response (SVR) was 45% for standard dose and 33% for low dose, p=0.02. For genotypes 2 and 3 SVR was 65% for standard dose, and 56% for low dose, p=0.51. For genotype 1 SVR was 38% for standard dose, and 24% for low dose, p=0.03. For genotype 1 patients whose doses exceeded the 1-2-5 threshold, that is >or=1.25 microg/kg body weight pegylated interferon alpha-2b weekly and >or=12.5 mg/kg body weight ribavirin daily, SVR was 51%. CONCLUSION: The results of this study underscore the importance of adequate dosing of ribavirin as well as pegylated interferons in achieving an SVR when treating genotype 1 chronic hepatitis C patients with combination therapy
— id: 100780, year: 2006, vol: 101, page: 1268, stat: Journal Article,

Hepatic encephalopathy
Palmer, Melissa
2006 Oct;:?-?, Hepatitis magazine
— id: 100969, year: 2006, vol: , page: ?, stat: Journal Article,

Hepatitis C and African Americans
Palmer, Melissa
2006 April;:?-?, Hepatitis magazine
— id: 100968, year: 2006, vol: , page: ?, stat: Journal Article,

RNA interference and ion channel physiology
Palmer, Melissa L; Fahrenkrug, Scott C; O'Grady, Scott M
2006 ;46(2):175-191, Cell biochemistry & biophysics
RNA interference (RNAi), through expression of small, double-stranded RNAs or short hairpin RNAs, produces sequence-specific mRNA degradation and decreased gene expression. Since its discovery in 1998 (Fire et al., 1998, Nature 391, 806-811), RNAi has rapidly become one of the most widely used technologies for exploring gene function in eukaryotic cells. Although the topic of RNAi has been the subject of a large number of excellent reviews, the focus of this article is on its application to the study of ion channel physiology in animal cells. In this regard, RNAi has provided definitive identification of ion channel subtypes responsible for both basal and stimulated ion conduction across the plasma membrane of several cell types. The approach has been particularly effective in identifying and establishing the contribution of auxiliary subunits and regulatory proteins to the overall function of ion channel complexes. Moreover, selective knockdown of ion channel expression has been a valuable means of demonstrating roles in the development of specific cell domains and in the normal growth of certain cell types. In this review, a brief description of the general mechanism of RNAi is presented, followed by a discussion of some important considerations for the in vitro application of this technology and in producing transgenic animals as models for human disease. We then describe several examples of where RNAi has been used to investigate the physiological role of ion channels in cells from model organisms (Caenorhabditis elegans and Drosophila melanogaster) and in mammalian cells
— id: 141654, year: 2006, vol: 46, page: 175, stat: Journal Article,

Stable knockdown of CFTR establishes a role for the channel in P2Y receptor-stimulated anion secretion
Palmer, Melissa L; Lee, So Yeong; Carlson, Dan; Fahrenkrug, Scott; O'Grady, Scott M
2006 Mar;206(3):759-770, Journal of cellular physiology
P2Y receptor regulation of anion secretion was investigated in porcine endometrial gland (PEG) epithelial cells. P2Y2, P2Y4, and P2Y6 receptors were detected in monolayers of PEG cells and immunocytochemistry indicated that P2Y4 receptors were located in the apical membrane. Apical membrane current measurements showed that Ca2+-dependent and PKC-dependent Cl- channels were activated following treatment with uridine triphosphate (UTP) (5 microM). Current-voltage relationships comparing calcium-dependent and PKC-dependent UTP responses under biionic conditions showed significant differences in selectivity between Cl-)and I- for the PKC-dependent conductance (P(I)/P(Cl) = 0.76), but not for Ca2+-dependent conductance (PI/P(Cl) = 1.02). The I-/Cl- permeability ratio for the PKC-dependent conductance was identical to that measured for 8-cpt cAMP. Furthermore, PKC stimulation using phorbol 12-myristate 13-acetate (PMA) activated an apical membrane Cl- conductance that was blocked by the CFTR selective inhibitor, CFTRinh-172. CFTR silencing, accomplished by stable expression of small hairpin RNAs (shRNA), blocked the PKC-activated conductance associated with UTP stimulation and provided definitive evidence of a role for CFTR in anion secretion. CFTR activation increased the initial magnitude of Cl- secretion, and provided a more sustained secretory response compared to conditions where only Ca2+-activated Cl- channels were activated by UTP. Measurements of [cAMP]i following UTP and PMA stimulation were not significantly different than untreated controls. Thus, these results demonstrate that UTP and PMA activation of CFTR occurs independently of increases in intracellular cAMP and extend the findings of earlier studies of CFTR regulation by PKC in Xenopus oocytes to a mammalian anion secreting epithelium
— id: 141653, year: 2006, vol: 206, page: 759, stat: Journal Article,

Protease-activated receptor regulation of Cl- secretion in Calu-3 cells requires prostaglandin release and CFTR activation
Palmer, Melissa L; Lee, So Yeong; Maniak, Peter J; Carlson, Dan; Fahrenkrug, Scott C; O'Grady, Scott M
2006 Apr;290(4):C1189-C1198, American journal of physiology. Cell physiology
Human lung epithelial (Calu-3) cells were used to investigate the effects of protease-activated receptor (PAR) stimulation on Cl(-) secretion. Quantitative RT-PCR (QRT-PCR) showed that Calu-3 cells express PAR-1, -2, and -3 receptor mRNAs, with PAR-2 mRNA in greatest abundance. Addition of either thrombin or the PAR-2 agonist peptide SLIGRL to the basolateral solution of monolayers mounted in Ussing chambers produced a rapid increase in short-circuit current (I(sc): thrombin, 21 +/- 2 microA; SLIGRL, 83 +/- 22 microA), which returned to baseline within 5 min after stimulation. Pretreatment of monolayers with the cell-permeant Ca(2+)-chelating agent BAPTA-AM (50 microM) abolished the increase in I(sc) produced by SLIGRL. When monolayers were treated with the cyclooxygenase inhibitor indomethacin (10 microM), nearly complete inhibition of both the thrombin- and SLIGRL-stimulated I(sc) was observed. In addition, basolateral treatment with the PGE(2) receptor antagonist AH-6809 (25 microM) significantly inhibited the effects of SLIGRL on I(sc). QRT-PCR revealed that Calu-3 cells express mRNAs for CFTR, the Ca(2+)-activated KCNN4 K(+) channel, and the KCNQ1 K(+) channel subunit, which, in association with KCNE3, is known to be regulated by cAMP. Stimulation with SLIGRL produced an increase in apical Cl(-) conductance that was blocked in cells expressing short hairpin RNAs designed to target CFTR. These results support the conclusion that PAR stimulation of Cl(-) secretion occurs by an indirect mechanism involving the synthesis and release of prostaglandins. In addition, PAR-stimulated Cl(-) secretion requires activation of CFTR and at least two distinct K(+) channels located in the basolateral membrane
— id: 141652, year: 2006, vol: 290, page: C1189, stat: Journal Article,

Rapid virologic response (RVR) is enhanced by higher drug exposure among patients receiving taribavirin in combination with pegylated interferon alfa-2b for the treatment of HCV infection
Shiffman, ML; Rodriguez-Torres, M; Gordon, S; Palmer, M; Pockros, P; Trepo, C; Kim, Y; Murphy, B
2006 OCT ;44(4):1146-1146, Hepatology
— id: 100979, year: 2006, vol: 44, page: 1146, stat: Journal Article,

Peginterferon alfa-2b and ribavirin for treatment-refractory chronic hepatitis C
Krawitt, Edward L; Ashikaga, Takamaru; Gordon, Stuart R; Ferrentino, Nicholas; Ray, Mary Ann; Lidofsky, Steven D
2005 Aug;43(2):243-249, Journal of hepatology
BACKGROUND/AIMS: Treatment regimens with pegylated interferons have yielded improved response rates, compared with conventional interferon-based regimens, for chronic hepatitis C. However, little is known about the utility of such regimens for individuals who failed to respond to prior conventional interferon-based treatment. METHODS: 182 patients who had previously failed to eliminate circulating hepatitis C virus 24 weeks after completion of a multi-week course of either interferon monotherapy or interferon in combination with ribavirin were treated with peginterferon alfa-2b weekly and ribavirin daily for 48 weeks. RESULTS: The sustained viral response, was 20% (23/116) in previous non-responders and 55% (36/66) in previous relapsers (P<0.001). In previous non-responders, the sustained viral response in those with viral genotype 1 was 17% (19/109) compared to 57% (4/7) in those with genotypes 2 and 3 (P=0.03). In previous relapsers, the sustained viral response in those with viral genotype 1 was 53% (26/49) compared to 59% (10/17) with genotypes 2 and 3 (P=0.78). CONCLUSIONS: The response to pegylated interferon and ribavirin in previous non-responders with genotypes 2 and 3 and in prior relapsers with chronic hepatitis C is comparable to overall sustained viral response rates seen in previously untreated patients
— id: 100792, year: 2005, vol: 43, page: 243, stat: Journal Article,

Infergen Hepatitis C Non-responders
Palmer, Melissa
2005 Jan;:?-?, Hepatitis magazine
— id: 100966, year: 2005, vol: , page: ?, stat: Journal Article,

Ursodiol for the treatment of liver disease
Palmer, Melissa
2005 April;:?-?, Hepatitis magazine
— id: 100967, year: 2005, vol: , page: ?, stat: Journal Article,

Dr. Melissa Palmer's guide to hepititis & liver disease
Palmer, Melissa
New York : Avery, 2004,
— id: 1842, year: 2004, vol: , page: , stat: ,

Women's issues of Hepatitis C. Pt.2
Palmer, Melissa
2004 June/July;:?-?, Hepatitis magazine
— id: 100965, year: 2004, vol: , page: ?, stat: Journal Article,

Women's issues with Hepatitis C. Pt 1
Palmer, Melissa
2004 April/May;:?-?, Hepatitis magazine
— id: 100964, year: 2004, vol: , page: ?, stat: Journal Article,

Comparison of low dose with standard dose PEG-interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C
Krawitt, EL; Grace, ND; Gordon, SR; Fromm, H; Palmer, M; Yarze, JC; Sheinbaum, A; Thomson, RD; Moskowitz, S; Schapira, L; Corsanti, JG; Polio, J; Smith, RE; Levine, RA; Bank, L; Kilby, AE; Fried, MB; Antignano, LV; Kohagen, KR; Ferrentino, N; Lidofsky, SD; LaBrecque, DR
2003 ;38(4):1202-1202, Hepatology
— id: 100787, year: 2003, vol: 38, page: 1202, stat: Journal Article,

Forward
Palmer, Melissa
Loving Joe Gallucci : love and life with hepatitis C Titusville, FL : Four Seasons Publishers, 2003,
— id: 5090, year: 2003, vol: , page: ?, stat: Chapter,

Efficacy of peginterferon-alfa-2b plus ribavirin in patients with chronic hepatitis C previously unresponsive to interferon-based therapy
Krawitt, EL; Lidofsky, SD; Ferrentino, N; Gordon, SR; Fromm, H; Palmer, M; LaBrecque, DR; Smith, RE; Levine, RA; Moskowitz, S; Schapira, T; Antignano, LV; Kilby, AE; Sheinbaum, A; Thomson, RD; Corsanti, JG; Polio, J; Bank, L; Yarze, JC; Molloy, PJ; Fried, MB; Grace, ND; Brass, CA
2002 ;36(4):786-786, Hepatology
— id: 100788, year: 2002, vol: 36, page: 786, stat: Journal Article,

Fatigue and the liver
Palmer, Melissa
2002 March/April;:?-?, Hepatitis magazine
— id: 100962, year: 2002, vol: , page: ?, stat: Journal Article,

Sex and the liver
Palmer, Melissa
2002 Jan/Feb;:?-?, Hepatitis magazine
— id: 100961, year: 2002, vol: , page: ?, stat: Journal Article,

Side-effects of interferon treatment
Palmer, Melissa
2002 Nov/Dec;:?-?, Hepatitis magazine
— id: 100963, year: 2002, vol: , page: ?, stat: Journal Article,

Gan bing quan shu : A, B, C, D shi da gan yan ji gan i = Dr. Melissa Palmer's guide to hepititis & liver disease
Palmer, Melissa
Taibei Shi : Yuan shui wen hua chu ban, 2001,
— id: 1843, year: 2001, vol: , page: , stat: ,

Aerobic exercise and the liver
Palmer, Melissa
2001 July/August;:?-?, Hepatitis magazine
— id: 100958, year: 2001, vol: , page: ?, stat: Journal Article,

Minerals and the liver
Palmer, Melissa
2001 May/June;:?-?, Hepatitis magazine
— id: 100957, year: 2001, vol: , page: ?, stat: Journal Article,

Painkillers and the liver
Palmer, Melissa
2001 Jan/Feb;:?-?, Hepatitis magazine
— id: 100955, year: 2001, vol: , page: ?, stat: Journal Article,

Vaccinations and the liver
Palmer, Melissa
2001 Nov/Dec;:?-?, Hepatitis magazine
— id: 100960, year: 2001, vol: , page: ?, stat: Journal Article,

Vitamins and the liver
Palmer, Melissa
2001 ;:?-?, Hepatitis magazine
— id: 100956, year: 2001, vol: , page: ?, stat: Journal Article,

Weight-bearing exercise and the liver
Palmer, Melissa
2001 Sept/Oct;:?-?, Hepatitis magazine
— id: 100959, year: 2001, vol: , page: ?, stat: Journal Article,

Dr. Melissa Palmer's guide to hepititis & liver disease : what you need to know
Palmer, Melissa
New York : Avery, 2000,
— id: 1841, year: 2000, vol: , page: , stat: ,

How to enjoy a liver friendly holiday
Palmer, Melissa
2000 Nov/Dec;:?-?, Hepatitis magazine
— id: 100954, year: 2000, vol: , page: ?, stat: Journal Article,

Improved work productivity, safety, and quality of life with pegylated (40KDA) interferon alfa-2a (Pegasys (TM)) therapy in the treatment of chronic hepatitis C
Perrillo, RP; Thuluvath, PJ; Rothstein, K; Alam, I; Palmer, M; Gordon, S; Pappas, SC; Wynohradnyk, L
2000 OCT ;32(4):809-809, Hepatology
— id: 100980, year: 2000, vol: 32, page: 809, stat: Journal Article,

Prediction of survival of patients with primary biliary cirrhosis. Examination of the Mayo Clinic model on a group of patients with known endpoint
Klion, F M; Fabry, T L; Palmer, M; Schaffner, F
1992 Jan;102(1):310-313, Gastroenterology
Increasing use of liver transplantation and new treatment regimens necessitate an accurate estimate of prognosis in primary biliary cirrhosis. To test the usefulness of the Mayo model for this purpose, the R value of the model was calculated for a group of 28 patients after each patient encounter and plotted against time. The data were best described by two linear regressions. For the period 10-2 years before death, the average increase in R value was 0.23 annually [R = 7.1-0.23 x time (in years)]. In the last 2 years of life, the average increase in R value was 1.4. This period could be fit by the expression R = 8.2-1.4 x time (in years). The increase in R value represents the natural progression of primary biliary cirrhosis and can be used for evaluating treatment of patients
— id: 100781, year: 1992, vol: 102, page: 310, stat: Journal Article,

Excessive weight gain after liver transplantation
Palmer, M; Schaffner, F; Thung, S N
1991 Apr;51(4):797-800, Transplantation
Twenty-eight patients (19 females, 9 males) were evaluated pre- and posttransplant to determine the frequency and find predictors of excessive weight gain after orthotopic liver transplant. Posttransplant, 21 patients gained and 7 patients lost weight as compared with their pretransplant dry weight. The majority of weight gain occurred between 2 and 16 months; 64.3% of patients (18/28 pts.) became overweight. All patients overweight prior to transplant (11 pts.) were more overweight posttransplant (P less than 0.005). Overweight and nonoverweight patients were similar in age, female predominance, etiology of liver disease, hypercholesterolemia, and hypertriglyceridemia pretransplant, as well as diabetes mellitus and medications including prednisone posttransplant. Overweight patients more commonly had a family history of diabetes mellitus, arteriosclerotic heart disease, and hypertension. They also had more hypertension, hypercholesterolemia, hypertriglyceridemia, abnormal physical findings related to the liver, and abnormal results of hepatic tests posttransplant. Mean rate of weight gain for overweight patients compared with nonoverweight ones during the first 16 months after transplant was 1.5 kg/month +/- 0.9 vs 0.4 kg/month +/- 0.4 for those not overweight. After 16 months mean rate of increase was slower for overweight patients (0.3 kg/month +/- 0.3), whereas weight appeared to stabilize in the nonoverweight ones. We conclude that excessive weight gain after liver transplant is common and occurs early. Since obesity may contribute to, as well as be a separate cause, of hepatic abnormalities, confusion may result when interpreting abnormal results of hepatic tests. Obesity prior to transplant predicts excessive weight gain posttransplant, although all patients may be at risk
— id: 100782, year: 1991, vol: 51, page: 797, stat: Journal Article,

PROGRESSION OF PRIMARY BILIARY CIRRHOSIS USING THE MAYO MODEL IN A GROUP OF PATIENTS WITH KNOWN END POINT
KLION F M; FABRY T; PALMER M; SCHAFFNER F
1990 ;98(5 PART 2):A597-A597, Gastroenterology
— id: 100789, year: 1990, vol: 98, page: A597, stat: Journal Article,

Effect of weight reduction on hepatic abnormalities in overweight patients
Palmer, M; Schaffner, F
1990 Nov;99(5):1408-1413, Gastroenterology
The effects of weight reduction on hepatic test results and physical findings related to the liver were retrospectively evaluated in 39 overweight patients screened to exclude other factors affecting the liver. An additional 11 overweight patients with primary liver disease were retrospectively evaluated to compare the effect of weight reduction in patients with liver disease with its effect in those without primary liver disease. This study showed that in overweight adults without primary liver disease, a weight reduction of greater than or equal to 10% corrected abnormal hepatic test results, decreased hepatosplenomegaly, and resolved some stigmata of liver disease. In similarly studied overweight patients with primary liver disease, some findings improved, but the changes did not correlate with a greater than or equal to 10% weight loss. Increased alanine aminotransferase activity was the most frequent hepatic enzyme abnormality in this population. For every 1% reduction in body weight, alanine aminotransferase activity improved by 8.1%. After other causes of liver disease are eliminated by clinical and biochemical parameters, weight reduction should be tried for overweight patients with abnormal hepatic test results in the absence of obvious primary liver disease as judged by clinical and biochemical parameters before extensive and expensive studies are undertaken
— id: 100783, year: 1990, vol: 99, page: 1408, stat: Journal Article,

EXCESSIVE WEIGHT-GAIN AFTER LIVER-TRANSPLANTATION
PALMER, M; SCHAFFNER, F
1989 ;10(4):665-665, Hepatology
— id: 100790, year: 1989, vol: 10, page: 665, stat: Journal Article,

PREGNANCY IN AUTOIMMUNE CHRONIC ACTIVE HEPATITIS
PALMER, M; SCHAFFNER, F
1989 ;10(4):684-684, Hepatology
— id: 100791, year: 1989, vol: 10, page: 684, stat: Journal Article,

Outcome of primary sclerosing cholangitis. Analysis of long-term observation of 38 patients
Lebovics, E; Palmer, M; Woo, J; Schaffner, F
1987 Apr;147(4):729-731, Archives of internal medicine
The natural history and prognostic factors of primary sclerosing cholangitis (PSC) are poorly defined. We reviewed our experience with PSC to determine its natural history and whether any factors on presentation or during follow-up were indicative of a favorable or unfavorable prognosis. Thirty-eight patients were followed up for 75.1 +/- 58.7 months; 17 (45%) had a poor outcome, defined as the occurrence of death (11 patients [29%]), variceal hemorrhage, hepatic encephalopathy, or hepatic transplantation. We found the following: the rate of progression of PSC is highly variable; an asymptomatic presentation may not indicate a more favorable outcome or prolonged survival; a serum bilirubin value of four times or more the upper limit of normal, particularly if sustained so as to exclude a reversible cause, is indicative of late-stage disease with a likelihood of subsequent poor outcome and death; and variceal hemorrhage may occur before the terminal stage of the disease
— id: 100785, year: 1987, vol: 147, page: 729, stat: Journal Article,

The liver in acquired immune deficiency disease
Palmer, M; Braly, L F; Schaffner, F
1987 Aug;7(3):192-202, Seminars in liver disease
— id: 100784, year: 1987, vol: 7, page: 192, stat: Journal Article,

Nephelometric determination of immunoglobulins in exocrine pancreatic secretion: studies on patients with and without pancreatic disease
Finkler, N J; Palmer, M; Gonda, M; Dreiling, D A
1979 May-Jun;46(3):339-340, Mount Sinai journal of medicine
— id: 100786, year: 1979, vol: 46, page: 339, stat: Journal Article,