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About Dr. John Hoefs
Dr. Hoefs has been actively involved in research as well as clinical care since 1979 when his first paper was published. These publications are listed in the enclosed CV and are referenced below. They include publications on ascites, hepatitis C (HCV), and scans to measure hepatic function.
Dr John Hoefs has been an important figure in the field of Hepatology since the description of hydraulic pressures between serum and ascites first published in 1983 when a series of publications (6, 8) led to an understanding that the serum to ascites albumin gradient (SAAG) is determined by portal pressure and ascites protein concentration by the combination of serum colloid osmotic pressure and portal pressure (13). There are many causes of ascites although chronic liver disease (CLD) is the most common. Prior to SAAG, the cause of ascites was thought to control the ascites protein concentration, but confusion occurred when this was strictly applied to assessment and management of the patient. The understanding of the importance of the portal pressure in formation of the SAAG led to the proposal to use the SAAG as the means to determine the cause of ascites (12). The SAAG was further enhanced by a better understanding of colloid osmotic pressure resulting in a globulin correction of the SAAG and a new method of estimating serum colloid osmotic pressure from serum proteins (44). Consolidation of the information on ascites was summarized in an editorial in 1990 (39) and a chapter in "Ascites and Renal Dysfunction" in 1999. Assessment of ascites using the SAAG is presently accepted world-wide as the most efficient method to determine the cause of ascites.
Additional studies of ascites showed the fluid to be active in production of CA125 (a tumor marker), immune complexes (3, 9), and fibrin degradation products (4). Furthermore, the fluid consumes coagulation proteins as fast as they enter the fluid (4). These studies show that ascites is an active fluid.
Infection in ascites is common as spontaneous bacterial peritonitis (SBP). This infection requires the presence of ascites, usually of a low protein concentration, and has a high mortality. A retrospective review early in Dr. Hoefs career (10) initiated a series of papers in collaboration with others that elucidated the cause of SBP (24), methods to differentiate the conditions from other causes of peritonitis in patients with ascites (15,16, 20, 21, 23), and the best method of diagnosis and treatment (30, 32, 37). An early summary in the Disease of the Month (31 (9):3-48), 1985and a later editorial summarized this material (41).
Dr Hoefs has investigated treatment of hepatitis C virus (HCV) since 1989 as a co-investigator on many of the seminal publications in this field including regular interferon, Rebetron, Consensus (Infergen), Pegintron plus ribavirin and Pegasys plus ribavirin (Copegasys) (48,52, 53-59,61-69, 74). His personal experience with all forms of interferon and combinations with ribavirin for the treatment of HCV are enormous within and outside of clinical trials. Eventually, he responded to an NIH RFA for UCI as a site for what eventually became known as the HALT-C trial; a 10 year prospective trial of HCV non-responders to routine therapy. This trial has investigated prospectively many of the major issues in chronic HCV infection and clinic outcomes of HCV including hepatocellular carcinoma (HCC). Dr Hoefs has been a co-author on many of the more than 40 publications from this study (75-77, 79-85). Dr. Hoefs is very experienced in treating chronic HCV.
John Hoefs, MD has investigated a number of methods to non-invasively evaluate patients with CLD. This has included the FM ultrasound (27, 28, 31, 35), magnetic resonance imaging (MRI) (42) and, finally, the quantitative liver spleen scan (QLSS) (19, 49-51, 60, 70, 73). The QLSS is a variant of the routine liver spleen scan (LSS) available at most institutions. The difference is in precise quantization of the parameters that allows measurement of the functional hepatic mass, liver and spleen volumes and the presence of cirrhosis with great reliability. No other technique can estimate both the amount of fibrosis and the amount of functioning tissue.
Dr. Hoefs has also published on hepatitis B (2, 22, 72), HCC (85), and hepatic hemodynamics and hepatic blood flow (33, 36, 38, 40, 77).